“There’s a Catch-22”. The complexities of pain management for people with advanced dementia nearing the end of life: a qualitative exploration of physicians’ perspectives

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring: barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Settings/Participants: Twenty-three physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care (n=9), psychiatry (n=7) and hospice care (n=7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side-effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialties. Cross-specialty mentoring, and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusions: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

Spectral Signature Secured Retrodirective Array

A novel retrodirective array (RDA) architecture is proposed which utilises a special case spectral signature embedded within the data payload as pilot signals. With the help of a pair of phase-locked-loop (PLL) based phase conjugators (PCs) the RDA’s response to other unwanted and/or unfriendly interrogating signals can be disabled, leading to enhanced secrecy performance directly in the wireless physical layer. The effectiveness of the proposed RDA system is experimentally demonstrated.

Applied web traffic analysis for numerical encoding of SQL Injection attack features.

SQL Injection Attack (SQLIA) remains a technique used by a computer network intruder to pilfer an organisation’s confidential data. This is done by an intruder re-crafting web form’s input and query strings used in web requests with malicious intent to compromise the security of an organisation’s confidential data stored at the back-end database. The database is the most valuable data source, and thus, intruders are unrelenting in constantly evolving new techniques to bypass the signature’s solutions currently provided in Web Application Firewalls (WAF) to mitigate SQLIA. There is therefore a need for an automated scalable methodology in the pre-processing of SQLIA features fit for a supervised learning model. However, obtaining a ready-made scalable dataset that is feature engineered with numerical attributes dataset items to train Artificial Neural Network (ANN) and Machine Leaning (ML) models is a known issue in applying artificial intelligence to effectively address ever evolving novel SQLIA signatures. This proposed approach applies numerical attributes encoding ontology to encode features (both legitimate web requests and SQLIA) to numerical data items as to extract scalable dataset for input to a supervised learning model in moving towards a ML SQLIA detection and prevention model. In numerical attributes encoding of features, the proposed model explores a hybrid of static and dynamic pattern matching by implementing a Non-Deterministic Finite Automaton (NFA). This combined with proxy and SQL parser Application Programming Interface (API) to intercept and parse web requests in transition to the back-end database. In developing a solution to address SQLIA, this model allows processed web requests at the proxy deemed to contain injected query string to be excluded from reaching the target back-end database. This paper is intended for evaluating the performance metrics of a dataset obtained by numerical encoding of features ontology in Microsoft Azure Machine Learning (MAML) studio using Two-Class Support Vector Machines (TCSVM) binary classifier. This methodology then forms the subject of the empirical evaluation.

Bitcoin mining is about to become a lot less profitable.

Imagine being told that your wage was going to be cut in half. Well, that’s what’s soon going to happen to those who make money from Bitcoin mining, the process of earning the online currency Bitcoin. The current expected date for this change is 11 July 2016. Many see this as the day when Bitcoin prices will rocket and when Bitcoin owners could make a great deal of money. Others see it as the start of a Bitcoin crash. At present no one quite knows which way it will go. Bitcoin was created in 2009 by someone known as Satoshi Nakamoto, borrowing from a whole lot of research methods. It is a cryptocurrency, meaning it uses digital encryption techniques to create bitcoins and secure financial transactions. It doesn’t need a central government or organisation to regulate it, nor a broker to manage payments. Conventional currencies usually have a central bank that creates money and controls its supply. Bitcoin is instead created when individuals “mine” for it by using their computers to perform complex calculations through special software. The algorithm behind Bitcoin is designed to limit the number of bitcoins that can ever be created. All Bitcoin transactions are recorded on a public database known as a blockchain. Every time someone mines for Bitcoin, it is recorded with a new block that is transmitted to every Bitcoin app across the network, like a bank updating its online records.

Petr Eben's oratorio Apologia Sokratus (1967) and ballet Curses and Blessings (1983): An interpretative analysis of the symbolism behind the text settings and musical style

The Czech composer Petr Eben (1927-2007) has written music in all genres except symphony, but he is highly recognized for his organ and choral compositions, which are his preferred genres. His vocal works include choral songs and vocal-instrumental works at a wide range of difficulty levels, from simple pedagogical songs to very advanced and technically challenging compositions. This study examines two of Eben‘s vocal-instrumental compositions. The oratorio Apologia Sokratus (1967) is a three-movement work; its libretto is based on Plato‘s Apology of Socrates. The ballet Curses and Blessings (1983) has a libretto compiled from numerous texts from the thirteenth to the twentieth centuries. The formal design of the ballet is unusual—a three-movement composition where the first is choral, the second is orchestral, and the third combines the previous two played simultaneously. Eben assembled the libretti for both compositions and they both address the contrasting sides of the human soul, evil and good, and the everlasting fight between them. This unity and contrast is the philosophical foundation for both compositions. The dissertation discusses the multileveled meanings behind the text settings and musical style of the oratorio and ballet in analyses focusing on the text, melodic and harmonic construction, and symbolism. Additional brief analyses of other vocal and vocal-instrumental compositions by Eben establish the ground for the examination of the oratorio and ballet and for understanding features of the composer‘s musical style. While the oratorio Apologia Sokratus was discussed in short articles in the 1970s, the ballet Curses and Blessings has never previously been addressed within Eben scholarship. The dissertation examines the significant features of Eben‘s music. His melodic style incorporates influences as diverse as Gregorian chant and folk tunes on the one hand, and modern vocal techniques such as Sprechgesang and vocal aleatoricism on the other. His harmonic language includes bitonality and polytonality, used to augment the tonal legacy of earlier times, together with elements of pitch collections and limited serial procedures as well as various secundal and quartal harmonic sonorities derived from them. His music features the vibrant rhythms of folk music, and incorporates other folk devices like ostinato, repetitive patterns, and improvisation.

Numerical encoding to tame SQL injection attacks.

Recent years have seen an astronomical rise in SQL Injection Attacks (SQLIAs) used to compromise the confidentiality, authentication and integrity of organisations’ databases. Intruders becoming smarter in obfuscating web requests to evade detection combined with increasing volumes of web traffic from the Internet of Things (IoT), cloud-hosted and on-premise business applications have made it evident that the existing approaches of mostly static signature lack the ability to cope with novel signatures. A SQLIA detection and prevention solution can be achieved through exploring an alternative bio-inspired supervised learning approach that uses input of labelled dataset of numerical attributes in classifying true positives and negatives. We present in this paper a Numerical Encoding to Tame SQLIA (NETSQLIA) that implements a proof of concept for scalable numerical encoding of features to a dataset attributes with labelled class obtained from deep web traffic analysis. In the numerical attributes encoding: the model leverages proxy in the interception and decryption of web traffic. The intercepted web requests are then assembled for front-end SQL parsing and pattern matching by applying traditional Non-Deterministic Finite Automaton (NFA). This paper is intended for a technique of numerical attributes extraction of any size primed as an input dataset to an Artificial Neural Network (ANN) and statistical Machine Learning (ML) algorithms implemented using Two-Class Averaged Perceptron (TCAP) and Two-Class Logistic Regression (TCLR) respectively. This methodology then forms the subject of the empirical evaluation of the suitability of this model in the accurate classification of both legitimate web requests and SQLIA payloads.

Nietzsche's orphans: music and the search for unity in revolutionary Russia, 1905-1921

At the dawn of the twentieth century, Imperial Russia was in the throes of immense social, political and cultural upheaval. The effects of rapid industrialization, rising capitalism and urbanization, as well as the trauma wrought by revolution and war, reverberated through all levels of society and every cultural sphere. In the aftermath of the 1905 revolution, amid a growing sense of panic over the chaos and divisions emerging in modern life, a portion of Russian educated society (obshchestvennost’) looked to the transformative and unifying power of music as a means of salvation from the personal, social and intellectual divisions of the contemporary world. Transcending professional divisions, these “orphans of Nietzsche” comprised a distinct aesthetic group within educated Russian society. While lacking a common political, religious or national outlook, these philosophers, poets, musicians and other educated members of the upper and middle strata were bound together by their shared image of music’s unifying power, itself built upon a synthesis of Russian and European ideas. They yearned for a “musical Orpheus,” a composer capable of restoring wholeness to society through his music. My dissertation is a study in what I call “musical metaphysics,” an examination of the creation, development, crisis and ultimate failure of this Orphic worldview. To begin, I examine the institutional foundations of musical life in late Imperial Russia, as well as the explosion of cultural life in the aftermath of the 1905 Revolution, a vibrant social context which nourished the formation of musical metaphysics. From here, I assess the intellectual basis upon which musical metaphysics rested: central concepts (music, life-transformation, theurgy, unity, genius, nation), as well as the philosophical heritage of Nietzsche and the Christian thinkers Vladimir Solov’ev, Aleksei Khomiakov, Ivan Kireevskii and Lev Tolstoi. Nietzsche’s orphans’ struggle to reconcile an amoral view of reality with a deeply felt sense of religious purpose gave rise to neo-Slavophile interpretations of history, in which the Russian nation (narod) was singled out as the savior of humanity from the materialism of modern life. This nationalizing tendency existed uneasily within the framework of the multi-ethnic empire. From broad social and cultural trends, I turn to detailed analysis of three of Moscow’s most admired contemporary composers, whose individual creative voices intersected with broader social concerns. The music of Aleksandr Scriabin (1871-1915) was associated with images of universal historical progress. Nikolai Medtner (1879-1951) embodied an “Imperial” worldview, in which musical style was imbued with an eternal significance which transcended the divisions of nation. The compositions of Sergei Rachmaninoff (1873-1943) were seen as the expression of a Russian “national” voice. Heightened nationalist sentiment and the impact of the Great War spelled the doom of this musical worldview. Music became an increasingly nationalized sphere within which earlier, Imperial definitions of belonging grew ever more problematic. As the Germanic heritage upon which their vision was partially based came under attack, Nietzsche’s orphans found themselves ever more divided and alienated from society as a whole. Music’s inability to physically transform the world ultimately came to symbolize the failure of Russia’s educated strata to effectively deal with the pressures of a modernizing society. In the aftermath of the 1917 revolutions, music was transformed from a symbol of active, unifying power into a space of memory, a means of commemorating, reinterpreting, and idealizing the lost world of Imperial Russia itself.

Accessing dental anxiety online support groups: An exploratory qualitative study of motives and experiences

Objectives: In recent years, Internet access has grown markedly providing individuals with new opportunities for online information retrieval, psychological advice and support. The objectives of the present study were to explore the context through which dentally anxious individuals access an online support group and the nature of their online experiences. Methods: An online questionnaire was completed by 143 individuals who accessed the Dental Fear Central online support group bulletin board. Qualitative analysis was conducted on the responses. Results: Analysis revealed three emergent themes which reflected the motives and experiences of individuals: ‘Searching for help’, ‘Sharing fears’ and ‘I feel empowered’. Conclusion: This exploratory study suggests that for most individuals accessing this online support group was a positive and beneficial experience. Practice Implications: Online support groups may represent a convenient and beneficial tool that may assist certain individuals to confront their debilitating anxiety/phobia and successfully receive dental care.

Social support in cyberspace: A content analysis of communication within a Huntington’s Disease online support group

Objective: Huntington’s Disease (HD) is an inherited disorder, characterised by a progressive degeneration of the brain. Due to the nature of the symptoms, the genetic element of the disease and the fact that there is no cure, HD patients and those in their support network often experience considerable stress and anxiety. With an expansion in Internet access, individuals affected by HD have new opportunities for information retrieval and social support. The aim of this study is to examine the provision of social support in messages posted to a HD online support group bulletin board. Methods: In total, 1313 messages were content analysed using a modified version of the Social Support Behaviour Code developed by Cutrona & Suhr (1992). Results: The analysis indicates that group members most frequently offered informational (56.2%) and emotional support (51.9%) followed by network support (48.4%) with esteem support (21.7%) and tangible assistance (9.8%) least frequently offered. Conclusion: This study suggests that exchanging informational and emotional support represents a key function of this online group. Practice implications: Online support groups provide a unique opportunity for health professionals to learn about the experiences and views of individuals affected by HD and explore where and why gaps may exist between evidence-based medicine and consumer behaviour and expectations.

ATTACHMENT, GROWTH AND PERSISTENCE OF CRONOBACTER ON GRANULAR ACTIVATED CARBON FILTERS

Several Cronobacter outbreaks have implicated contaminated drinking water. This study assessed the impact of granular activated carbon (GAC) on the microbial quality of the water produced. A simulated water filter system was installed by filling plastic columns with sterile GAC, followed by sterile water with a dilute nutrient flowing through the column at a steady rate. Carbon columns were inoculated with Cronobacter on the surface, and the effluent monitored for Cronobacter levels. During a second phase, commercial faucet filters were distributed to households for 4-month use. Used filters were backwashed with sterile peptone water, and analyzed for Cronobacter, total aerobic plate count, coliform bacteria and Enterobacteriaceae. Cronobacter colonized the simulated GAC and grew when provided minimal levels of nutrients. Backwashed used filters used in home settings yielded presumptive Escherichia coli, Pseudomonas and other waterborne bacteria. Presumptive Cronobacter strains were identified as negative through biochemical and genetic test.

ENHANCEMENT OF THERMAL INACTIVATION OF CRONOBACTER SAKAZAKII WITH INCLUSION OF PARABENS

Parabens are a family of p-hydroxybenzoic acid esters, which have antimicrobial activity over a broad pH range (4-8). This study was designed to evaluate the enhanced thermal inactivation of Cronobacter sakazakii by the inclusion of “parabens” and to ultimately develop mathematical models to describe this effect. A heat-resistant strain, Cronobacter sakazakii 607, was heated at three mild heating temperatures in combination with treatments with five parabens in various concentrations. Results showed the presence of parabens significantly enhanced thermal inactivation in a concentration-dependent manner, and the effect increased with increasing alkyl chain length. The concentration of parabens, alkyl side chain length, and heating temperature acted synergistically, causing bacterial inactivation even at low temperatures that were not effective in killing C. sakazakii. The survival data were used to develop primary and secondary mathematical models that accurately describe how this synergistic activity can be applied in the food industry.

The reality of cross-disciplinary energy research in the United Kingdom:a social science perspective

Cross-disciplinary research is essential in understanding and reducing energy usage, however the reality of this collaboration comes with many challenges. This paper provides an insight into the integration of social science in energy research, drawing on the expertise and first hand experiences of a range of social science researchers (predominantly Early Career Researchers (ECRs)) working on UK cross-disciplinary projects in energy demand. These researchers, participants in a workshop dedicated to understanding the integration of social science in energy research, identified four groups of challenges to successful integration: Differing expectations of the role of social scientists; Working within academia; Feeling like a valued member of the team; and Communicating and comprehension between disciplines. Suggestions of how to negotiate those challenges included: Management and planning; Increasing contact; Sharing experience; and Understanding team roles. The paper offers a definition of ‘success’ in cross-disciplinary energy research from the perspective of social science ECRs, comprising external, internal and personal components. Using the logics of interdisciplinarity, this paper suggests that integration of the social sciences in the projects discussed may be partial at best and highlights a need to recognise the challenges ECRs face, in order to achieve full integration and equality of disciplines.

The Proceedings of the South Carolina Historical Association

Annually, the association publishes a journal, The Proceedings, which consists of papers presented at the annual meeting. William Gilmore Simms— Almost a Historian by Hampton M. Jarrell United States Aggrandizement, 1850-1860— the Walker Expeditions as an Illustrative Case by William H. Patterson Xenophobia in the South by G. A. Buchanan, Jr.