The barriers & solutions to providing good quality palliative care in dementia in the GP practice

BACKGROUND: Dementia is a significant worldwide health issue, however, it is often insidious in onset and difficult to diagnose, therefore GPs have expressed a limited confidence in their diagnostic skills, extending into their prognostication of the disease. As a result diagnosing the terminal phase of dementia has been identified as a significant challenge to delivering effective palliative care. Therefore, identifying the challenges faced by the GPs in this field will help to guide their training and support, and as a result could assist in the provision of sustained and effective palliative care for their dementia patients.

Experimental design and batch experiments for optimization of Cr(VI) removal from aqueous solutions by hydrous cerium oxide nanoparticles

Hydrous cerium oxide (HCO) was synthesized by intercalation of solutions of cerium(III) nitrate and sodium hydroxide and evaluated as an adsorbent for the removal of hexavalent chromium from aqueous solutions. Simple batch experiments and a 2⁵ factorial experimental design were employed to screen the variables affecting Cr(VI) removal efficiency. The effects of the process variables; solution pH, initial Cr(VI) concentration, temperature, adsorbent dose and ionic strength were examined. Using the experimental results, a linear mathematical model representing the influence of the different variables and their interactions was obtained. Analysis of variance (ANOVA) demonstrated that Cr(VI) adsorption significantly increases with decreased solution pH, initial concentration and amount of adsorbent used (dose), but slightly decreased with an increase in temperature and ionic strength. The optimization study indicates 99% as the maximum removal at pH 2, 20 °C, 1.923 mM of metal concentration and a sorbent dose of 4 g/dm³. At these optimal conditions, Langmuir, Freundlich and Redlich–Peterson isotherm models were obtained. The maximum adsorption capacity of Cr(VI) adsorbed by HCO was 0.828 mmol/g, calculated by the Langmuir isotherm model. Desorption of chromium indicated that the HCO adsorbent can be regenerated using NaOH solution 0.1 M (up to 85%). The adsorption interactions between the surface sites of HCO and the Cr(VI) ions were found to be a combined effect of both anion exchange and surface complexation with the formation of an inner-sphere complex.

A New Mechanism for Hydroxyl Radical Production in Irradiated Nanoparticle Solutions

The absolute yield of hydroxyl radicals per unit of deposited X-ray energy is determined for the first time for irradiated aqueous solutions containing metal nanoparticles based on a “reference” protocol. Measurements are made as a function of dose rate and nanoparticle concentration. Possible mechanisms for hydroxyl radical production are considered in turn: energy deposition in the nanoparticles followed by its transport into the surrounding environment is unable to account for observed yield whereas energy deposition in the water followed by a catalytic-like reaction at the water-nanoparticle interface can account for the total yield and its dependence on dose rate and nanoparticle concentration. This finding is important because current models used to account for nanoparticle enhancement to radiobiological damage only consider the primary interaction with the nanoparticle, not with the surrounding media. Nothing about the new mechanism appears to be specific to gold, the main requirements being the formation of a structured water layer in the vicinity of the nanoparticle possibly through the interaction of its charge and the water dipoles. The massive hydroxyl radical production is relevant to a number of application fields, particularly nanomedicine since the hydroxyl radical is responsible for the majority of radiation-induced DNA damage.

Symmetrical Solutions, Asymmetrical Realities: Beyond the Politics of Paralysis

The historic significance of the Good Friday Agreement and its role in ending organized political violence is acknowledged at the outset. The article then goes on to probe the roots of the political paralysis built into the architecture of the Agreement that are predicated on a misplaced political and cultural symmetry between the “two communities.” It is suggested that the institutionalized relationship between Northern Ireland and the rest of the U.K. facilitates a cross-party, populist, socio-economic consensus among the nationalist and unionist political parties on the welfare state, taxation and maintaining the massive British subvention to the region. This in turn allows them to concentrate on a divisive culturalist politics, i.e., on antagonistic forms of cultural and identity politics over such issues as flags, parades, and the legacy of the “Troubles” which spills over into gridlock into many areas of regional administration. The article argues for a much broader understanding of culture and identity rooted in the different, if overlapping and interdependent, material realities of both communities while challenging the idea of two cultures/identities as fixed, mutually exclusive, non-negotiable and mutually antagonistic. It then focuses on the importance of Belfast as a key arena which will determine the long-term prospects of an alternative and more constructive form of politics, and enable a fuller recognition of the fundamental asymmetries and inter-dependence between the “two communities.” In the long run, this involves re-defining and reconstructing what is meant by the “Union” and a “United Ireland.”

Neurophobia among general practice trainees: The evidence, perceived causes and solutions

Introduction

As general practice (GP) is the main source of referrals to neurologists, neurology education for GP trainees is important. We investigated the existence of neurophobia, contributing factors and potential prevention strategies among GP trainees.

In a questionnaire survey interest, knowledge, confidence and perceived difficulty in neurology were compared with different medical specialties. Reasons for difficulty with neurology, postgraduate neurology education experience, learning methods and suggested teaching improvements were examined.

Of 205 GP trainees, 118 (58%) completed the questionnaire. Threshold analyses justified categorical intervals for the Likert responses. Trainees recorded poorer knowledge (p < 0.001), less confidence (p < 0.001) and more perceived difficulty (p < 0.001) with neurology than with any other medical specialty. GP trainees had less interest in neurology than any other medical specialty (Duncan test, p < 0.001). There was a similar gradation in difficulty and confidence perception across medical specialties. Hospital and community-based neurology teaching was graded as “poor” or “very poor” by over 60% of GP trainees. There were multiple perceived causes of neurophobia, including neuroanatomy and poor quality teaching. More organised clinical teaching and referral guidance were suggested to address GP neurophobia.

Neurophobia is common among GP trainees in Northern Ireland. GP trainees have clear and largely uniform ideas on improving their neurology education. GP training posts should reflect the importance of neurology within the GP curriculum.

General practitioners’ perceptions of the barriers and solutions to good quality palliative care in dementia

The general practitioner (GP) is in a pivotal position to initiate and adapt care for their patients living with dementia. This study aimed to elicit GPs' perceptions of the potential barriers and solutions to the provision of good-quality palliative care in dementia in their practices. A postal survey of GPs across Northern Ireland was conducted with open-ended items soliciting for barriers in their practices and possible solutions; 40.6% (138/340) were returned completed. Barriers to palliative care in dementia were perceived to be a dementia knowledge deficit for healthcare staff and the public, a resource shortfall within the GP practice and community, poor team coordination alongside inappropriate dementia care provision, and disagreements from and within families. These findings have significant implications for educators and clinicians as enhanced dementia education and training were highlighted as a strong agenda for GPs with the suggestions of dementia awareness programmes for the public.

CO2 Capture in Wet and Dry Superbase Ionic Liquids

The solubility of carbon dioxide in five tetraalkylphosphonium superbase ionic liquids, namely the trihexyltetradecylphoshonium phenoxide, trihexyltetradecylphoshonium benzotriazolide, trihexyltetradecylphoshonium benzimidazolide, trihexyltetradecylphoshonium 1,2,3-triazolide, and trihexyltetradecylphoshonium 1,2,4-triazolide was studied experimentally under dry and wet conditions at 22 A degrees C and at atmospheric pressure, using a gravimetric saturation technique. The effects of anion structure and of the presence or absence of water in the solution on the carbon dioxide solubility were then deduced from the data. H-1 and C-13-NMR spectroscopy and ab initio calculations were also conducted to probe the interactions in these solutions, as carbon dioxide and water can compete in the ionic liquid structure during the absorption process. Additionally, the viscosity of selected superbase ionic liquids was measured under dry and wet conditions, in the presence or absence of CO2, to evaluate their practical application in carbon dioxide capture processes. Finally, the recyclability of the trihexyltetradecylphoshonium 1,2,4-triazolide under dry and wet conditions was determined to probe the ability of selected solvents to solubilize chemically a high concentration of carbon dioxide and then release it in a low energy demand process.

Dust-acoustic shocks in strongly coupled dusty plasmas

Electrostatic dust-acoustic shock waves are investigated in a viscous, complex plasma consisting of dust particles, electrons, and ions. The system is modelled using the generalized hydrodynamic equations, with strong coupling between the dust particles being accounted for by employing the effective electrostatic temperature approach. Using a reductive perturbation method, it is demonstrated that this model predicts the existence of weakly nonlinear dust-acoustic shock waves, arising as solutions to Burgers's equation, in which the nonlinear forces are balanced by dissipative forces, in this case, associated with viscosity. The evolution and stability of dust-acoustic shocks is investigated via a series of numerical simulations, which confirms our analytical predictions on the shock characteristics.

Acoustic and Volumetric Properties of Diluted Solutions of Water in Ionic Liquids

Herein, we report the densities and speeds of sound in binary mixtures of three hydrophobic and one hydrophilic ionic liquids: 1-butyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide, [C4mim][NTf2], 1-butyl-1-methylpyrrolidinium bis[(trifluoromethyl)sulfonyl]imide, [C4mpyr][NTf2], 1-propyl-3-methylimidazolium bis[(trifluoromethyl)sulfonyl]imide, [C3mim][NTf2] and 1-ethyl-3-methylimidazolium thiocyanate, [C2mim][SCN], with water at 298.15 K and 0.1 MPa. The concentration range of water, which encompassed relatively small values well below the saturation point, is often regarded as an impurity for hydrophobic ionic liquids. On the basis of experimental results the molar volume, adiabatic molar compressibility, partial molar volume and apparent molar volume, as well as, partial molar and apparent molar isentropic compressibility properties were then calculated. Interesting results are obtained using the solutions based on the hydrophilic [C2mim][SCN], since these mixtures are characterized by relatively low density and high values of speed of sound. Furthermore, the partial molar volumes and partial molar adiabatic compressibilities of water in solution with [C2mim][SCN] are the lowest among the investigated in mixtures with ionic liquids. However, in the case of the hydrophobic ionic liquid solutions, only small differences are observed for molar adiabatic compressibilities with the change of the cation structure, i.e. for water + [C4mim][NTf2] or + [C4mpyr][NTf2]. A more pronounced difference has been observed for the partial molar compressibility of water in solutions with these two ionic liquids.

A Soft Sensor for Viscosity Control of Polymer Extrusion

Viscosity represents a key indicator of product quality in polymer extrusion but has traditionally been difficult to measure in-process in real-time. An innovative, yet simple, solution to this problem is proposed by a Prediction-Feedback observer mechanism. A `Prediction' model based on the operating conditions generates an open-loop estimate of the melt viscosity; this estimate is used as an input to a second, `Feedback' model to predict the pressure of the system. The pressure value is compared to the actual measured melt pressure and the error used to correct the viscosity estimate. The Prediction model captures the relationship between the operating conditions and the resulting melt viscosity and as such describes the specific material behavior. The Feedback model on the other hand describes the fundamental physical relationship between viscosity and extruder pressure and is a function of the machine geometry. The resulting system yields viscosity estimates within 1% error, shows excellent disturbance rejection properties and can be directly applied to model-based control. This is of major significance to achieving higher quality and reducing waste and set-up times in the polymer extrusion industry.

Oxygen vacancy formation in CeO2 and Ce1-xZrxO2 solid solutions:electron localization, electrostatic potential and structural relaxation

Ceria (CeO2) and ceria-based composite materials, especially Ce1-xZrxO2 solid solutions, possess a wide range of applications in many important catalytic processes, such as three-way catalysts, owing to their excellent oxygen storage capacity (OSC) through the oxygen vacancy formation and refilling. Much of this activity has focused on the understanding of the electronic and structural properties of defective CeO2 with and without doping, and comprehending the determining factor for oxygen vacancy formation and the rule to tune the formation energy by doping has constituted a central issue in material chemistry related to ceria. However, the calculation on electronic structures and the corresponding relaxation patterns in defective CeO2-x oxides remains at present a challenge in the DFT framework. A pragmatic approach based on density functional theory with the inclusion of on-site Coulomb correction, i.e. the so-called DFT + U technique, has been extensively applied in the majority of recent theoretical investigations. Firstly, we review briefly the latest electronic structure calculations of defective CeO2(111), focusing on the phenomenon of multiple configurations of the localized 4f electrons, as well as the discussions of its formation mechanism and the catalytic role in activating the O-2 molecule. Secondly, aiming at shedding light on the doping effect on tuning the oxygen vacancy formation in ceria-based solid solutions, we summarize the recent theoretical results of Ce1-xZrxO2 solid solutions in terms of the effect of dopant concentrations and crystal phases. A general model on O vacancy formation is also discussed; it consists of electrostatic and structural relaxation terms, and the vital role of the later is emphasized. Particularly, we discuss the crucial role of the localized structural relaxation patterns in determining the superb oxygen storage capacity in kappa-phase Ce1-xZr1-xO2. Thirdly, we briefly discuss some interesting findings for the oxygen vacancy formation in pure ceria nanoparticles (NPs) uncovered by DFT calculations and compare those with the bulk or extended surfaces of ceria as well as different particle sizes, emphasizing the role of the electrostatic field in determining the O vacancy formation.

Viscosity Control for Extrusion Processes Using Recycled Polymers

The aim of this paper is to develop a new extruder control system for recycled materials which has ability to automatically maintain constant a polymer melt viscosity of mixed recycled polymers during extrusion, regardless of variations in the Melt Flow Index (MFI) of recycled mixed grade high density polyethylene (HDPE) feedstock. A closed-loop controller is developed to automatically regulate screw speed and barrel temperature profile to achieve constant viscosity and enable consistent processing of variable grade recycled HDPE materials. The experimental results of real time viscosity measurement and control using a 38mm single screw extruder with different recycled HDPEs with widely different MFIs are reported in this work

Assessment of Atomic Data: Problems and Solutions

For the reliable analysis and modeling of astrophysical, laser-produced, and fusion plasmas, atomic data are required for a number of parameters, including energy levels, radiative rates, and electron impact excitation rates. Such data are desired for a range of elements (H to W) and their many ions. However, measurements of atomic data, mainly for radiative and excitation rates, are not feasible for many species, and therefore, calculations are needed. For some ions (such as of C, Fe, and Kr), there is a variety of calculations available in the literature, but often, they differ significantly from one another. Therefore, there is a great demand from the user community to have data "assessed" for accuracy so that they can be confidently applied to the modeling of plasmas. In this paper we highlight the difficulties in assessing atomic data and offer some solutions for improving the accuracy of calculated results.

A comparative study on the thermophysical properties for two bis[(trifluoromethyl)sulfonyl]imide-based ionic liquids containing the trimethyl-sulfonium or the trimethyl-ammonium cation in molecular solvents

Herein, we present a comparative study of the thermophysical properties of two homologous ionic liquids, namely, trimethyl-sulfonium bis[(trifluoromethyl) sulfonyl]imide, [S₁₁₁][TFSI], and trimethyl-ammonium bis[(trifluoromethyl)sulfonyl]imide, [HN₁₁₁][TFSI], and their mixtures with propylene carbonate, acetonitrile, or gamma butyrolactone as a function of temperature and composition. The influence of solvent addition on the viscosity, conductivity, and thermal properties of IL solutions was studied as a function of the solvent mole fraction from the maximum solubility of IL, x_s, in each solvent to the pure solvent. In this case, x_s is the composition corresponding to the maximum salt solubility in each liquid solvent at a given temperature from 258.15 to 353.15 K. The effect of temperature on the transport properties of each binary mixture was then investigated by fitting the experimental data using Arrhenius' law and the Vogel-Tamman-Fulcher (VTF) equation. The experimental data shows that the residual conductivity at low temperature, e.g., 263.15 K, of each binary mixture is exceptionally high. For example, conductivity values up to 35 and 42 mS·cm^-1 were observed in the case of the [S ₁₁₁][TFSI] + ACN and [HN₁₁₁][TFSI] + ACN binary mixtures, respectively. Subsequently, a theoretical approach based on the conductivity and on the viscosity of electrolytes was formulated by treating the migration of ions as a dynamical process governed by ion-ion and solvent-ion interactions. Within this model, viscosity data sets were first analyzed using the Jones-Dole equation. Using this theoretical approach, excellent agreement was obtained between the experimental and calculated conductivities for the binary mixtures investigated at 298.15 K as a function of the composition up to the maximum solubility of the IL. Finally, the thermal characterization of the IL solutions, using DSC measurements, showed a number of features corresponding to different solid-solid phase transitions, T_S-S, with extremely low melting entropies, indicating a strong organizational structure by easy rotation of methyl group. These ILs can be classified as plastic crystal materials and are promising as ambient-temperature solid electrolytes. © 2013 American Chemical Society.