bluuebunny/crossref_metadata_2025 huggingface dataset:
Practitioner Review: The victims and juvenile perpetrators of child sexual abuse – assessment and intervention
Authors: Vizard Eileen
Published: February 2013

Background:  The assessment of victims of child sexual abuse (CSA) is now a recognized aspect of clinical work for both CAMH and adult services. As juvenile perpetrators of CSA are responsible for a significant minority of the sexual assaults on other children, CAMH services are increasingly approached to assess these oversexualized younger children or sexually abusive adolescents. A developmental approach to assessment and treatment intervention is essential in all these cases.

Method:  This review examines research on the characteristics of child victims and perpetrators of CSA. It describes evidence‐based approaches to assessment and treatment of both groups of children. A selective review of MEDLINE, Psycinfo, Cochrane Library, and other databases was undertaken. Recommendations are made for clinical practice and future research.

Findings:  The characteristics of CSA victims are well known and those of juvenile perpetrators of sexual abuse are becoming recognized. Assessment approaches for both groups of children should be delivered within a safeguarding context where risk to victims is minimized. Risk assessment instruments should be used only as adjuncts to a full clinical assessment. Given high levels of psychiatric comorbidity, assessment, treatment, and other interventions should be undertaken by mental health trained staff.

Conclusions:  Victims and perpetrators of CSA present challenges and opportunities for professional intervention. Their complex presentations mean that their needs should be met by highly trained staff. However, their youth and developmental immaturity also give an opportunity to nip problem symptoms and behaviors in the bud. The key is in the earliest possible intervention with both groups. Future research should focus on long‐term adult outcomes for both child victims and children who perpetrate CSA. Adult outcomes of treated children could identify problems and/or strengths in parenting the next generation and also the persistence and/or desistence of sexualized or abusive behavior.
Perceived overqualification and withdrawal behaviours: Examining the roles of job attitudes and work values
Authors: Maynard Douglas C. , Parfyonova Natalya M.
Published: February 2013

The current study examined a moderated mediation model of perceived overqualification and job search, with job attitudes as mediators and the competence and growth work value as a moderator. We also hypothesized a positive relationship between overqualification and actual voluntary turnover behaviour. College graduates from diverse occupations completed two surveys spaced 6 months apart (n = 368). Results suggested that perceived overqualification at Time 1 led to active job search behaviour at Time 2, both directly and through job satisfaction. The direct link was moderated by work values, such that the overqualification–job search relationship was stronger for employees who highly valued work which offered skill utilization and growth. Perceived overqualification was also predictive of voluntary turnover behaviour; those at the high end of the overqualification scale were over four times more likely to have left their position than those at the low end of the scale. Finally, those who left their original positions reported less overqualification in their new positions. The current findings extend the limited existing literature by establishing relationships between overqualification and withdrawal behaviours 6 months later, and also providing evidence that individual differences may influence reactions to being overqualified.

Practitioner points

The current study found that employees who feel overqualified were more likely to be searching for a new job 6 months later, especially among those who strongly value work that utilizes their skills. Perceived overqualification was also linked to future actual turnover behaviour. Thus, organizations stand to potentially lose talented employees if they feel underutilized and underchallenged in their jobs.

These trends are particularly true of employees who strongly desire work that takes advantage of their talents, suggesting that the most ambitious employees are likely to seek alternate employment if they feel underutilized.

To retain these employees, supervisors first need to identify employees who might be feeling overqualified and underutilized, as these perceptions may or may not line up with ‘objective’ overqualification. The supervisor can then consider ways to empower the employee through increased involvement in decision‐making or offering more advanced job assignments.
Correlations between genetic and species diversity: effects of resource quantity and heterogeneity
Authors: Avolio Meghan L. , Smith Melinda D.
Published: February 2013

Questions

It is hypothesized that species and genetic diversity are correlated because niche differentiation among species and genotypes is either affected by the same processes (positive) or each level restricts the amount of diversity in the other (negative). Although many studies have observed both positive and negative relationships, others have found no correlation between the two diversity measures. Are measures of species (richness, diversity and evenness) and genetic diversity correlated, and how does resource (soil moisture, light, nitrogen and phosphorus) quantities and heterogeneity affect both levels of diversity?

Location

Intact tallgrass prairie atKonzaPrairieBiologicalStation, northeastKansas,US.

Methods

We investigate the correlation between plant species and genetic diversity in a long‐term precipitation manipulation experiment – theRainfallManipulationPlots (RaMPs) – located in intact tallgrass prairie as well as adjacent non‐manipulated prairie. TheRaMPs experiment has been imposing ambient and more variable precipitation regimes (a 50% increase in timing between rainfall events without changing total rainfall amount) during the growing season since 1998, resulting in reduced mean soil moisture and increased soil moisture variability. Thus, theRaMPs and non‐manipulated prairie plots capture a range of soil moisture amounts and variability. Genetic diversity (measured as genotype richness and genomic dissimilarity among individuals) was quantified for the dominant grass species,Andropogon gerardii, which has large impacts on plant community structure and ecosystem function.

Results

We found species and genetic diversity were not significantly correlated. Genotypic richness was negatively related to soil moisture variability, but measures of species diversity were not. In the non‐manipulated plots only, we found generally negative relationships between resource quantity (light and nitrogen) and community diversity, and positive relationships between resource heterogeneity (CVof light) and community diversity.

Conclusions

Our results suggest that a lack of a positive or negative relationship between species and genetic diversity could be due to these two levels of diversity responding differently to the identity, quantity and heterogeneity of resources.
Shakespeare and Popular Politics
Authors: Doty Jeffrey S
Published: February 2013

This article defines popular politics as the tactics – ranging from grumbling to rioting – used by common people to articulate and redress economic and social injustice. Early modern popular politics were not, however, exclusively radical and were rarely antimonarchical. A study of popular politics thus pressures the conservative versus progressive binary through which most critics discuss Shakespeare’s politics. Furthermore, this article contests the widely held assumption that Shakespeare was hostile in his representations of ‘the people’ and toward his audience. An understanding of popular politics equips one to read Shakespeare’s crowds not as irrational lovers of violence but rather as stewards of the commonwealth or conscious agents of their own material interests. This article poses the theater itself as a space of popular politics, insofar as it was a space where popular politics were depicted onstage and where common people were invited to think through political issues.
Hayabusa‐returned sample curation in the Planetary Material Sample Curation Facility of JAXA
Authors: YADA Toru , FUJIMURA Akio , ABE Masanao , NAKAMURA Tomoki , NOGUCHI Takaaki , OKAZAKI Ryuji , NAGAO Keisuke , ISHIBASHI Yukihiro , SHIRAI Kei , ZOLENSKY Michael E. , SANDFORD Scott , OKADA Tatsuaki , UESUGI Masayuki , KAROUJI Yuzuru , OGAWA Maho , YAKAME Shogo , UENO Munetaka , MUKAI Toshifumi , YOSHIKAWA Makoto , KAWAGUCHI Junichiro
Published: February 2013

Abstract–  The Planetary Material Sample Curation Facility of JAXA (PMSCF/JAXA) was established in Sagamihara, Kanagawa, Japan, to curate planetary material samples returned from space in conditions of minimum terrestrial contaminants. The performances for the curation of Hayabusa‐returned samples had been checked with a series of comprehensive tests and rehearsals. After the Hayabusa spacecraft had accomplished a round‐trip flight to asteroid 25143 Itokawa and returned its reentry capsule to the Earth in June 2010, the reentry capsule was brought back to the PMSCF/JAXA and was put to a series of processes to extract recovered samples from Itokawa. The particles recovered from the sample catcher were analyzed by electron microscope, given their ID, grouped into four categories, and preserved in dimples on quartz slide glasses. Some fraction of them has been distributed for initial analyses at NASA, and will be distributed for international announcement of opportunity (AO), but a certain fraction of them will be preserved in vacuum for future analyses.
Early modification stage (preresurge) sediment mobilization in the Lockne concentric, marine‐target crater, Sweden
Authors: Sturkell Erik , Ormö Jens , Lepinette Alain
Published: February 2013

Lockne is a concentric impact structure due to a layered target where weak sediments and seawater covered a crystalline basement. A matrix‐supported, sedimentary breccia is interlayered between the crystalline breccia lens and the resurge deposits in the crater infill. As the breccia is significantly different from the direct impact breccia and the resurge deposit, we propose a separate unit name, Tramsta Breccia, based on the type locality (i.e., the LOC02 drilling at Tramsta). We use granulometry and a novel matrix line‐log method to characterize the sedimentology of the Tramsta Breccia. The obliquity of impact combined with the layered target caused an asymmetric, concentric transient crater, which upon its collapse controlled the deposition of the breccia. On the wide‐brimmed downrange side of the crater where the sedimentary target succession was removed during crater excavation, wide, overturned basement crater ejecta flaps prevented any slumping of exterior sediments. Instead, the sediments most likely originated from the uprange side where the brim was narrow and the basement crater rim was poorly developed, sediment‐rich, and relatively unstable. Here, the water cavity wall remained in closer proximity to the basement crater and, aided by the pressure of the collapsing water wall, unconsolidated black mud would flow back into the crater. The absence of interlayered resurge deposits in the Tramsta Breccia and the evidence for reworking at the contact between the overlying resurge deposits and the Tramsta Breccia indicate that the slumping was a rapid process (<75 s) terminating well before the resurge entered the crater.
Postglacial recolonization history of the European crabapple (Malus sylvestris Mill.), a wild contributor to the domesticated apple
Authors: Cornille A. , Giraud T. , Bellard C. , Tellier A. , Le Cam B. , Smulders M. J. M. , Kleinschmit J. , Roldan‐Ruiz I. , Gladieux P.
Published: February 2013

Understanding the way in which the climatic oscillations of the Quaternary Period have shaped the distribution and genetic structure of extant tree species provides insight into the processes driving species diversification, distribution and survival. Deciphering the genetic consequences of past climatic change is also critical for the conservation and sustainable management of forest and tree genetic resources, a timely endeavour as the Earth heads into a period of fast climate change. We used a combination of genetic data and ecological niche models to investigate the historical patterns of biogeographic range expansion of a wild fruit tree, the European crabapple (Malus sylvestris), a wild contributor to the domesticated apple. Both climatic predictions for the last glacial maximum and analyses of microsatellite variation indicated that M. sylvestris experienced range contraction and fragmentation. Bayesian clustering analyses revealed a clear pattern of genetic structure, with one genetic cluster spanning a large area in Western Europe and two other genetic clusters with a more limited distribution range in Eastern Europe, one around the Carpathian Mountains and the other restricted to the Balkan Peninsula. Approximate Bayesian computation appeared to be a powerful technique for inferring the history of these clusters, supporting a scenario of simultaneous differentiation of three separate glacial refugia. Admixture between these three populations was found in their suture zones. A weak isolation by distance pattern was detected within each population, indicating a high extent of historical gene flow for the European crabapple.
The life of regulatory T cells
Authors: Gratz Iris K. , Rosenblum Michael D. , Abbas Abul K.
Published: February 2013

Foxp3+ regulatory T (Treg) cells are essential for maintaining self‐tolerance and preventing autoimmune reactions. Treg cells arise as a consequence of self‐antigen recognition during the maturation of cells in the thymus, and also following self‐antigen recognition in the periphery. Both thymic and peripherally generated Treg cells respond to antigen recognition by expanding in number, increasing their suppressive activity, and accumulating in the tissue where the antigen is located. A fraction of these activated “effector” Treg cells survive even in the absence of antigen expression and continue to control inflammatory reaction in the tissues, thus functioning as a population of “memory” Treg cells. Antigen exposure and the presence of IL‐2 are key determinants in the generation of memory Treg cells. These results provide a foundation for studying the role of memory Treg cells in controlling and treating autoimmune disorders and for testing the hypothesis that defects in the generation and maintenance of these cells underlie chronic, relapsing inflammatory diseases.
The Epistemology of Religious Diversity in Contemporary Philosophy of Religion
Authors: Dastmalchian Amir
Published: February 2013

Religious diversity is a key topic in contemporary philosophy of religion. One way religious diversity has been of interest to philosophers is in the epistemological questions it gives rise to. In other words, religious diversity has been seen to pose a challenge for religious belief. In this study four approaches to dealing with this challenge are discussed. These approaches correspond to four well‐known philosophers of religion, namely, Richard Swinburne, Alvin Plantinga, William Alston, and John Hick. The study is concluded by suggesting four factors which shape one’s response to the challenge religious diversity poses to religious belief.
Varieties of Reasons/Motives Internalism
Authors: Arkonovich Steven
Published: February 2013

Under what conditions do you have a reason to perform some action? Do you only have reason to do what you want to do? Reasons‐motives internalism is the appealingly simple view that unless an agent is, or could be, motivated to act in a certain way, he has no normative reason to act in that way. Thus, according to reasons‐motives internalism, facts about an individual’s motivational psychology constrain what is rational for that agent to do. This article canvasses several ways of formulating the view and considers some advantages and disadvantages of each.
Philosophical Reflection on Petitionary Prayer
Authors: Smith Nicholas D.
Published: February 2013

If God actually answers prayers that petition him for something, then it seems he is willing to withhold some good(s) from the world unless and until someone prays for those goods. But how is this compatible with His benevolence? On the other hand, if God is dedicated to providing every good to us that we may need, it would seem that He would provide these to us even if we did not pray for them. But if so, it would appear that petitionary prayer is pointless. This discussion reviews the various contributions (especially the most recent ones) made by philosophers in trying to answer these questions, and in criticizing these answers.
Law and Coercion
Authors: Hughes Robert C
Published: February 2013

Though political philosophers often presuppose that coercive enforcement is fundamental to law, many legal philosophers have doubted this. This article explores doubts of two types. Some legal philosophers argue that given an adequate account of coercion and coerciveness, the enforcement of law in actual legal systems will generally not count as coercive. Others accept that actual legal systems enforce many laws coercively, but they deny that law has a necessary connection with coercion. There can be individual laws that lack coercive sanctions, and it is at least conceptually possible for there to be a legal system that lacks coercive enforcement altogether. This article then examines why most political philosophers and some legal philosophers have been reluctant to treat the conceptual possibility of non‐coercive law as significant.
Artistry as Methodology: Aesthetic Experience and Chinese Philosophy1
Authors: Mattice Sarah
Published: February 2013

Although aesthetics has been to some extent marginalized in western philosophy, within the Chinese philosophical tradition aesthetics plays a key role. This article explores Chinese aesthetics as a site of valuable resources for rethinking the ways in which we conceptualize philosophical activity. After introducing a few distinct features of the Chinese aesthetic tradition, the article examines aesthetic distance in terms of guan, he, and ying, Chinese conceptions of artists and participants, and aesthetic suggestiveness or the inexhaustibility of a work of art, in order to suggest that the Chinese philosophical tradition might contribute its sense of connection between style or method of doing philosophy and aesthetics to a contemporary metaphor of philosophy as aesthetic experience.
Game Theoretic Pragmatics
Authors: Franke Michael
Published: February 2013

Game theoretic pragmatics is a small but growing part of formal pragmatics, the linguistic subfield studying language use. The general logic of a game theoretic explanation of a pragmatic phenomenon is this: (i) the conversational context is modelled as a game between speaker and hearer; (ii) an adequate solution concept then selects the to‐be‐explained behavior in the game model. For such an explanation to be convincing, both components, game model and solution concept, should be formulated and scrutinized as explicitly as possible. The article demonstrates this by a concise overview of both evolutionary and non‐evolutionary approaches to game theoretic pragmatics, arguing for the use of agent‐based micro‐dynamics within evolutionary, and for the use of epistemic game theory within non‐evolutionary approaches.
Territorial Rights and Exclusion
Authors: Ypi Lea
Published: February 2013

Is it possible to justify territorial rights? Provided a justification for territorial rights can be found, does it ground claims toparticularterritories? And provided a claim to particular territories can be justified, what kind of claim is it? Is it a claim to jurisdiction? A claim to control resources? A claim to control the movement of people across borders? In this paper I review some prominent accounts seeking to answer these questions. After outlining their main features, I focus on some difficulties they encounter, in particular with regard to the justification of exclusion.
Selective mitochondrial Ca2+ uptake deficit in disease endstage vulnerable motoneurons of the SOD1G93A mouse model of amyotrophic lateral sclerosis
Authors: Fuchs Andrea , Kutterer Sylvie , Mühling Tobias , Duda Johanna , Schütz Burkhard , Liss Birgit , Keller Bernhard U. , Roeper Jochen
Published: February 2013

Key points

So far, increased excitability and calcium handling problems have been discussed as causes for motoneuron death in amyotrophic lateral sclerosis (ALS) mainly on the basis of studies in juvenile presymptomatic mice.

We developed a brainstem preparation to analyse excitability and calcium handling during disease progression up to disease endstage of motoneurons in an ALS mouse model.

Increased excitability of motoneurons is not seen at disease endstage, challenging this factor as a direct cause for motoneuron death in ALS.

We show that calcium handling is remodelled during disease progression from mitochondrial uptake to mitochondrial uptake failure and increased plasma membrane extrusion, providing a compensatory mechanism that fails at disease endstage and might lead to a toxic calcium overload of the cells.

Supporting this newly described compensatory endeavour of the motoneurons might be a promising therapeutic strategy.

Abstract  Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that targets some somatic motoneuron populations, while others, e.g. those of the oculomotor system, are spared. The pathophysiological basis of this pattern of differential vulnerability, which is preserved in a transgenic mouse model of amyotrophic lateral sclerosis (SOD1G93A), and the mechanism of neurodegeneration in general are unknown. Hyperexcitability and calcium dysregulation have been proposed by others on the basis of data from juvenile mice that are, however, asymptomatic. No studies have been done with symptomatic mice following disease progression to the disease endstage. Here, we developed a new brainstem slice preparation for whole‐cell patch‐clamp recordings and single cell fura‐2 calcium imaging to study motoneurons in adult wild‐type and SOD1G93A mice up to disease endstage. We analysed disease‐stage‐dependent electrophysiological properties and intracellular Ca2+ handling of vulnerable hypoglossal motoneurons in comparison to resistant oculomotor neurons. Thereby, we identified a transient hyperexcitability in presymptomatic but not in endstage vulnerable motoneurons. Additionally, we revealed a remodelling of intracellular Ca2+ clearance within vulnerable but not resistant motoneurons at disease endstage characterised by a reduction of uniporter‐dependent mitochondrial Ca2+ uptake and enhanced Ca2+ extrusion across the plasma membrane. Our study challenged the notion that hyperexcitability is a direct cause of neurodegeneration in SOD1G93A mice, but molecularly identified a Ca2+ clearance deficit in motoneurons and an adaptive Ca2+ handling strategy that might be targeted by future therapeutic strategies.
Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs
Authors: Bhatt Sasmira , Alison Beth J. , Wallace Euan M. , Crossley Kelly J. , Gill Andrew W. , Kluckow Martin , te Pas Arjan B. , Morley Colin J. , Polglase Graeme R. , Hooper Stuart B.
Published: February 2013

Key points

Delayed cord clamping improves circulatory stability in preterm infants at birth, but the underlying reason is not known.

In a new preterm lamb study we investigated whether delayed cord clamping until ventilation had been initiated improved pulmonary, cardiovascular and cerebral haemodynamic stability.

We demonstrated that ventilation prior to cord clamping markedly improves cardiovascular function by increasing pulmonary blood flow before the cord is clamped, thus further stabilising the cerebral haemodynamic transition.

These results show that delaying cord clamping until after ventilation onset leads to a smoother transition to newborn life, and probably underlies previously demonstrated benefits of delayed cord clamping.

Abstract  Delayed cord clamping improves circulatory stability in preterm infants at birth, but the underlying physiology is unclear. We investigated the effects of umbilical cord clamping, before and after ventilation onset, on cardiovascular function at birth. Prenatal surgery was performed on lambs (123 days) to implant catheters into the pulmonary and carotid arteries and probes to measure pulmonary (PBF), carotid (CaBF) and ductus arteriosus blood flows. Lambs were delivered at 126 ± 1 days and: (1) the umbilical cord was clamped at delivery and ventilation was delayed for about 2 min (Clamp 1st; n = 6), and (2) umbilical cord clamping was delayed for 3–4 min, until after ventilation was established (Vent 1st; n = 6). All lambs were subsequently ventilated for 30 min. In Clamp 1st lambs, cord clamping rapidly (within four heartbeats), but transiently, increased pulmonary and carotid arterial pressures (by ∼30%) and CaBF (from 30.2 ± 5.6 to 40.1 ± 4.6 ml min−1 kg−1), which then decreased again within 30–60 s. Following ventilation onset, these parameters rapidly increased again. In Clamp 1st lambs, cord clamping reduced heart rate (by ∼40%) and right ventricular output (RVO; from 114.6 ± 14.4 to 38.8 ± 9.7 ml min−1 kg−1), which were restored by ventilation. In Vent 1st lambs, cord clamping reduced RVO from 153.5 ± 3.8 to 119.2 ± 10.6 ml min−1 kg−1, did not affect heart rates and resulted in stable blood flows and pressures during transition. Delaying cord clamping for 3–4 min until after ventilation is established improves cardiovascular function by increasing pulmonary blood flow before the cord is clamped. As a result, cardiac output remains stable, leading to a smoother cardiovascular transition throughout the early newborn period.
PET/CT imaging evidence of FUS‐mediated (18)F‐FDG uptake changes in rat brain
Authors: Kim Hyungmin , Park Mi‐Ae , Wang Shuyan , Chiu Alan , Fischer Krisztina , Yoo Seung‐Schik
Published: February 2013

Purpose:

Transcranial focused ultrasound (FUS) delivers highly focused acoustic energy to a small region of the brain in a noninvasive manner. Recent studies have revealed that FUS, which is administered either in pulsed or continuous waves, can elicit or suppress neural tissue excitability. This neuromodulatory property of FUS has been demonstratedvia direct motion detection, electrophysiological recordings, functional magnetic resonance imaging (fMRI), confocal imaging, and microdialysis sampling of neurotransmitters. This study presents new evidence of local increase in glucose metabolism induced by FUS to the rat brain using FDG (18‐fludeoxyglucose) positron emission tomography (PET).

Methods:

Sprague–Dawley rats underwent sonication to a unilateral hemispheric area of the brain prior to PET scan. The pulsed sonication (350 kHz, tone burst duration of 0.5 ms, pulse repetition frequency of 1 kHz, and duration of 300 ms) was applied in 2 s intervals for 40 min immediately after the FDG injectionvia tail vein. Subsequently, the PET was acquired in dynamic list‐mode to image FDG activity for an hour, and reconstructed into a single volume representing standardized uptake value (SUV). The raw SUV as well as its asymmetry index (AI) were measured from five different volume‐of‐interests (VOIs) of the brain for both hemispheres, and compared between sonicated and unsonicated groups.

Results:

Statistically significant hemispheric changes in SUV were observed only at the center of sonication focus within the FUS group [pairedt‐test; t(7) = 3.57, p < 0.05]. There were no significant hemispheric differences in SUV within the control group in any of the VOIs. A statistically significant elevation in AI (t‐test; t(7) = 3.40, p < 0.05) was observed at the center of sonication focus (7.9 ± 2.5%, the deviations are in standard error) among the FUS group when compared to the control group (−0.8 ± 1.2%).

Conclusions:

Spatially distinct increases in the glucose metabolic activity in the rat brain is present only at the center of sonication focus, suggesting localized functional neuromodulation mediated by the sonication.
The effect of flattening filter free delivery on endothelial dose enhancement with gold nanoparticles
Authors: Detappe Alexandre , Tsiamas Panagiotis , Ngwa Wilfred , Zygmanski Piotr , Makrigiorgos Mike , Berbeco Ross
Published: February 2013

Purpose:

The aim of this study is to quantify and to compare the dose enhancement factor from gold nanoparticles (AuNP) to tumor endothelial cells for different concentrations of AuNP, and clinical MV beam configurations.

Methods:

Tumor endothelial cells are modeled as slabs measuring 10 × 10 × 2μm. A spherical AuNP is simulated on the surface of the endothelial cell, within the blood vessel. 6 MV photon beams with and without the flattening filter are investigated for different field sizes, depths in material and beam modulation. The incident photon energy spectra for each configuration is generated using EGSnrc. The dose enhancement in the tumor endothelial cell is found using an analytical calculation. The endothelial dose enhancement factor is defined to be the ratio of the dose deposited with and without AuNPs.

Results:

It is found that clinical beam parameters may be chosen to maximize the effect of gold nanoparticles during radiotherapy. This effect is further amplified ∼20% by the removal of the flattening filter. Modulation of the clinical beam with the multileaf collimator tends to decrease the proportion of low energy photons, therefore providing less enhancement than the corresponding open field.

Conclusions:

The results of this work predict a dose enhancement to tumor blood vessel endothelial cells using conventional therapeutic (MV) x‐rays and quantify the relative change in enhancement with treatment depth and field size.
Of Proneurotrophins and Their Antineurotrophic Effects
Authors: Kotlyanskaya Lucy , McLinden Kristina A. , Giniger Edward
Published: February 2013

The precursor forms of neurotrophins are functional and mediate opposite signals from the mature forms.
A population-level prediction tool for the incidence of first-episode psychosis: translational epidemiology based on cross-sectional data
Authors: Kirkbride James B , Jackson Daniel , Perez Jesus , Fowler David , Winton Francis , Coid Jeremy W , Murray Robin M , Jones Peter B
Published: February 2013

Objectives

Specialist early intervention services (EIS) for people aged 14–35 years with first episodes of psychosis (FEP) have been commissioned throughout England since 2001. A single estimate of population need was used everywhere, but true incidence varies enormously according to sociodemographic factors. We sought to develop a realistically complex, population-based prediction tool for FEP, based on precise estimates of epidemiological risk.

Design and participants

Data from 1037 participants in two cross-sectional population-based FEP studies were fitted to several negative binomial regression models to estimate risk coefficients across combinations of different sociodemographic and socioenvironmental factors. We applied these coefficients to the population at-risk of a third, socioeconomically different region to predict expected caseload over 2.5 years, where the observed rates of ICD-10 F10-39 FEP had been concurrently ascertained via EIS.

Setting

Empirical population-based epidemiological data from London, Nottingham and Bristol predicted counts in the population at-risk in the East Anglia region of England.

Main outcome measures

Observed counts were compared with predicted counts (with 95% prediction intervals (PI)) at EIS and local authority district (LAD) levels in East Anglia to establish the predictive validity of each model.

Results

A model with age, sex, ethnicity and population density performed most strongly, predicting 508 FEP participants in EIS in East Anglia (95% PI 459, 559), compared with 522 observed participants. This model predicted correctly in 5/6 EIS and 19/21 LADs. All models performed better than the current gold standard for EIS commissioning in England (716 cases; 95% PI 664–769).

Conclusions

We have developed a prediction tool for the incidence of psychotic disorders in England and Wales, made freely available online (http://www.psymaptic.org), to provide healthcare commissioners with accurate forecasts of FEP based on robust epidemiology and anticipated local population need. The initial assessment of some people who do not require subsequent EIS care means additional service resources, not addressed here, will be required.
LIVING AND DYING WITH LIVER FAILURE: A SERIAL INTERVIEW STUDY
Authors: Kimbell B , Kendall M , Boyd K , Murray S A
Published: February 2013

Introduction

In the UK, the incidence of liver disease is increasing dramatically and by 2030 is predicted to kill more people than heart disease. In order to effectively treat this growing patient population we need to understand their experiences. However, research in this area is still underdeveloped.

Aims and Methods

To better understand the experiences, goals and support needs of patients with chronic liver failure, and to what extent existing services are perceived to meet these. We recruited 15 patients with advanced liver disease with a range of aetiologies. Up to three in-depth interviews are undertaken with patients and their informal carers over the course of 1 year. One-off interviews are also undertaken with their professional carers. The data are analysed thematically using Grounded Theory and NVivo 9.

Results

Initial results indicate a high level of unmet physical needs and comorbidities. Considerable uncertainty, anxiety and confusion exist amongst patients regarding their disease and its likely progression. Interprofessional and doctor-patient communication is challenging, and advance care planning largely absent.

Conclusions

This study is the first serial interview study of people with advanced progressive liver disease. They have a high and prolonged burden of physical, social and psychological unmet needs, and like heart failure and COPD patients receive much less support and palliative care than cancer sufferers.
THE BEHAVIOUR AND PAIN (BEPAID) STUDY: DEMENTIA PATIENTS WHO DIE IN THE ACUTE HOSPITAL
Authors: Lord K , White N , Scott S , Sampson E L
Published: February 2013

Introduction

People with dementia admitted to acute hospitals often receive poor care, many of whom die in this setting. The BePaid study (Behaviour and Pain in Dementia) is funded jointly by Alzheimer's Society and the BUPA Foundation.

Aims and Methods

A longitudinal cohort study in two London hospitals providing evidence about mortality rates, pain and carer satisfaction using the following tools: Pain Assessment in Advanced Dementia (PAINAD), medical notes review and carer questionnaire.

Results

230 patients were recruited, with a mortality rate of 13%. 70% of deaths were documented as expected, with 77% of those individuals being put on the Liverpool Care Pathway. Only 17% of patients that subsequently died were referred to the palliative care team during their admission and 27% died with a pressure sore (grades 1–4). 50% of patients were noted by clinicians to be in pain in the last 48 h of life. Mean pain score throughout admission for these that died was 2.69 on the PAINAD, in comparison to 1.49 for those who were discharged. Of those that died, 45% of carers were a little dissatisfied/ dissatisfied with the overall quality of care provided on the ward.

Conclusions

Recognising and planning for dying in the acute setting is challenging for clinicians. Palliative Care Teams are not being regularly involved in this process. The data highlights the importance of assessing and managing pain until the end of life. Hospitals need to focus on working with relatives to improve satisfaction with overall quality of care for those whose relatives are dying.
MORECARE CAPACITY: MENTAL CAPACITY AND PROCESSES OF CONSENT FOR RESEARCH ON END-OF-LIFE CARE
Authors: Stone K , Hotopf M , Koffman J , Lewis P , Wee B , Bernal W , Higginson IJ , Evans C J
Published: February 2013

Introduction

A major barrier to improving end-of-life care (EoLC) is the inclusion of those near to death in research studies. The Mental Capacity Act 2005 clarified concepts on involving adults lacking capacity in research and there are examples of innovative approaches but uncertainty surrounds best research practice. This paper systematically appraises the evidence on the challenges and solutions for adults lacking capacity to participate in research on EoLC.

Aims and Methods

A meta-synthesis of the literature on capacity and consent in research on palliative and EoLC to examine the challenges and solutions and identify best practice. A systematic literature appraisal searching five electronic databases and grey literature email survey. Search terms included consent and capacity (and synonyms) within three patient groups: palliative care, mental health and accident and emergency. Selection criteria: primary research concerning adults with compromised capacity and processes of consent in research. A short-semi structured email survey to leading national and international researchers (n=317) to capture ‘out of view’ best practice.

Results

9916 references were identified, 107 included for full paper review in the palliative care group. Four main themes were identified: (1) timing, (2) proxies and supportive decision making, (3) research resource and expertise, and (4) ethical consideration. 63% of survey respondents had undertaken research involving adults with compromised capacity with assent being the most common approach used.

Conclusions

The meta-synthesis provides guidance on key challenges and solutions to involving those at the end-of-life in research including timing, proxies and supportive decision making, resources for research and ethical considerations.
HANDLE WITH CARE: ADVANCE CARE PLANNING FOR CHILDREN AND YOUNG PEOPLE WITH PALLIATIVE CARE NEEDS
Authors: Mitchell S , Dale J
Published: February 2013

Introduction

ACP for children with life-limiting illnesses presents one of the most complex and ethically challenging scenarios in medicine. Currently most children who die, do so in hospital and most commonly on PICU, despite growing evidence that family preferences are for end-of-life care at home.

Aims and Methods

To investigate current practice related to ACP on PICU, and how this might be improved. A qualitative study was carried out in a PICU setting. Semi-structured interviews were conducted and thematic content analysis carried out on transcriptions.

Results

Eight consultants and six senior nurses. Themes emerged around ‘the significance of the death of a child’. ACP is a dynamic, MDT process which is essential to improve care for children with life-limiting conditions. It is currently lacking. As a result, children endure intensive care which is ultimately futile. The GP has an increasingly important role.

Conclusions

ACP is needed for paediatric patients with life-limiting conditions to improve care, avoid potentially harmful interventions and deliver choice to families. The palliative care population in paediatrics represent a complex group with a diverse range of diagnoses, family situation and multicultural differences. The numbers of children and young people with palliative care needs is rising, and with advances in paediatric medicine the mortality rate is falling. Some are outliving their own life expectancies and transitioning in to adult services, presenting a new challenge for adult palliative care services. There is opportunity for knowledge to be shared between adult and paediatric practitioners in this increasingly relevant area.
REMOTE AND RURAL: THE FORGOTTEN INEQUITY
Authors: Layden J , Bunch H , Hekerem D , Millar L , Maxwell V
Published: February 2013

Introduction

Remote rural Scotland is 18% of the population and 94% of the land mass. With a lower demand for specialist healthcare, patients are at significant risk of being hidden and forgotten. Barriers to equitable access in remote rural communities includes: poor transport infrastructure, lack of OOH cover and recruitment from a limited pool.

Aims and Methods

Innovative service models have been developed in partnership with NHS Boards to address the palliative care needs of Scotland's remote and rural communities. Service models deliver improvements to the quality of end of life care, increase the number of patients dying in their preferred place and reduce unplanned hospital admissions. Two examples are presented.

Results

Optimal Utilisation of remote rural Resources (Argyll and Bute) involves a bank of Marie Curie nurses working to a more flexible contract, complementing existing staff to enable a fast, local and consistent response to palliative care needs. Staff receive some online training which overcomes the difficulties in arranging training within remote rural services. Blended Multi-visit model (Deeside)—a shared community nursing and Marie Curie role, with the flexibility for staff to split their time between a generalist and specialist palliative care role. This enables the service to meet patient needs whilst minimising staff travelling time.

Conclusions

The service models focus on integration and partnership, which takes account of a less predictable demand, the geography and capitalising on the limited local resources. A complete understanding of remote rural communities is essential to develop innovative palliative care services that respond to patient needs.
‘NEW’ POPULATION, NEW CHALLENGES: YOUNG ADULTS IN PALLIATIVE CARE
Authors: Sivell S , Lidstone V , Taubert M , Thompson C , Nelson A
Published: February 2013

Introduction

The prognosis of life-limiting conditions of childhood has improved in recent years with an increase in the number of young people accessing adult specialist palliative care (SPC) services. However, little is known about the learning needs and requirements of SPC teams to help provide them with the knowledge and skills to provide care to young people.

Aims and Methods

To identify the training needs of SPC teams and inform the development of an education package for SPC teams.Online Delphi Process:Collated expert opinion on the format, delivery and content of the education package.Round 1: content analysis of free text responses. Rounds 2 and 3: median and mean scores calculated to score the relevance/importance of each item. IQR scores assessed the extent of agreement about the scored relevance of each items. Items where no agreement was reached in Round 2 were put forward to Round 3 for re-rating.Focus groups:Focus groups were held with young people (pre- and post-transition), parents/carers of young people post-transition and staff from a local adult hospice and analysed using thematic analysis.

Results

Delphi:Consensus was reached on the frequency of delivery, who could deliver the training, format of the package and content.Focus Groups:Discussions centred around: challenges of caring for young people; barriers to transition; education and training of staff; facilitating transition.

Conclusions

Recommendations include a continuous/rolling programme of education, tailored for content and mode of delivery and incorporated into working practice. A template to guide handover and a single point of contact would facilitate the transition process.
Cyclic tests on high-quality undisturbed block samples of soft marine Norwegian clay
Authors: Wichtmann T. , Andersen K.H. , Sjursen M.A. , Berre T.
Published: February 2013

The results of a study with undrained cyclic triaxial and direct simple shear (DSS) tests on high-quality undisturbed samples obtained from large blocks of a soft marine Norwegian clay are presented. Several tests with different average shear stresses, shear stress amplitudes, loading frequencies, and sample geometries have been performed on block samples taken from different depths. In tests with small average shear stresses, failure occurred due to large shear strain amplitudes, while large permanent shear strains were observed in tests with higher average shear stresses. Diagrams quantifying the undrained cyclic strength, permanent shear strain, shear strain amplitude, and permanent pore-water pressure dependent on average shear stress, shear stress amplitude, and number of cycles have been developed based on the test results. The undrained cyclic strength was found strongly dependent on loading frequency. Block samples from shallower depth showed a somewhat higher undrained cyclic strength. No influence of the height-to-diameter ratio of the samples (h/d = 1 and 2 were compared) could be found. A qualitative comparison of the test results with data for standard tube samples is provided.
Predicting climate change effects on subarctic–Arctic populations of Atlantic salmon (Salmo salar)
Authors: Hedger Richard D. , Sundt-Hansen Line E. , Forseth Torbjørn , Ugedal Ola , Diserud Ola H. , Kvambekk Ånund S. , Finstad Anders G.
Published: February 2013

We predict an increase in parr recruitment and smolt production of Atlantic salmon (Salmo salar) populations along a climate gradient from the subarctic to the Arctic in western and northern Norway in response to future climate change. Firstly, we predicted local stream temperature and discharge from downscaled data obtained from Global Climate Models. Then, we developed a spatially explicit individual-based model (IBM) parameterized for the freshwater stage, with combinations of three different postsmolt survival probabilities reflecting different marine survival regimes. The IBM was run for three locations: southern Norway (∼59°N), western Norway (∼62°N), and northern Norway (∼70°N). Increased temperatures under the future climate regimes resulted in faster parr growth, earlier smolting, and elevated smolt production in the western and northern locations, in turn leading to increased egg deposition and elevated recruitment into parr. In the southern location, density-dependent mortality of parr resulting from low summer wetted-areas reduced predicted future smolt production in comparison to the other locations. It can be inferred, therefore, that climate change may have both positive and negative effects on anadromous fish abundance within the subarctic–Arctic according to geographical region.
Hatchery tank enrichment affects cortisol levels and shelter-seeking in Atlantic salmon (Salmo salar)
Authors: Näslund Joacim , Rosengren Malin , Del Villar Diego , Gansel Lars , Norrgård Johnny R. , Persson Lo , Winkowski John James , Kvingedal Eli
Published: February 2013

Stocking programs using hatchery-reared salmon are often implemented for augmenting natural populations. However, survival of these fish is often low compared with wild conspecifics, possibly because of genetic, physiological, and behavioural deficiencies. Here, we compared presmolt Atlantic salmon (Salmo salar) from three different environmental treatments (barren environment, plastic tube enrichment, and plastic shredding enrichment) with regard to plasma cortisol levels, shelter-seeking behaviour, and fin deterioration. Basal plasma cortisol levels were higher in barren-reared fish, indicating higher stress levels, while no differences were found in acute cortisol response after a 30 min confinement test. Shelter-seeking was higher in salmon reared in enriched tanks when tested alone, but not when tested in small groups. Barren-reared fish had higher levels of fin deterioration over winter, potentially owing to higher aggression levels. These results suggest that enrichment can reduce the impact of stressors experienced in the hatchery and thus increase fish welfare. Tank enrichment may also be used to produce salmon better adapted for the more complex environment encountered after release.