End-of-Life care and people with intellectual disabilities: A multi-media educational resource

Aim This study aimed to develop and evaluate a multi-media educational resource in palliative and end-of-life care for specialist palliative care and intellectual disability services which promoted collaborative working. Methods: A mixed methods design involving three phases was used. Qualitative data were obtained from semi-structured interviews with a purposive sample of professionals (n=30) and family carers (n=5) and from two focus groups with people with intellectual disabilities (n=17). Data were content analysed as outlined y Newell and Burnard (2006). This identified training needs and issues, in end-of-life care for this population which were confirmed through quantitative data from services in a regional scoping study analysed using descriptive statistics. A DVD and manual were developed and evaluated with twelve professionals. Data were collected using a solicited diary, the Readiness for Inter-professional Learning Scale, Likert Scales and an evaluation questionnaire. Thematic analysis and descriptive statistics appropriate to data were used.Results: Findings suggest that this resource demonstrates the need for and benefits of partnership working and transferability of this learning to practice could address issues at end-of-life for people with intellectual disabilities. Conclusions: Findings of this study have importance for partnership working and service provision in end-of-life care for this population.

A cosmic ray current-driven instability in partially ionised media

Context. We investigate the growth of hydromagnetic waves driven by streaming cosmic rays in the precursor environment of a supernova remnant shock.

Aims. It is known that transverse waves propagating parallel to the mean magnetic field are unstable to anisotropies in the cosmic ray distribution, and may provide a mechanism to substantially amplify the ambient magnetic field. We quantify the extent to which temperature and ionisation fractions modify this picture.

Methods. Using a kinetic description of the plasma we derive the dispersion relation for a collisionless thermal plasma with a streaming cosmic ray current. Fluid equations are then used to discuss the effects of neutral-ion collisions.

Results. We calculate the extent to which the environment into which the cosmic rays propagate influences the growth of the magnetic field, and determines the range of possible growth rates.

Conclusions. If the cosmic ray acceleration is efficient, we find that very large neutral fractions are required to stabilise the growth of the non-resonant mode. For typical supernova parameters in our Galaxy, thermal effects do not significantly alter the growth rates. For weakly driven modes, ion-neutral damping can dominate over the instability at more modest ionisation fractions. In the case of a supernova shock interacting with a molecular clouds, such as in RX J1713.7-3946, with high density and low ionisation, the modes can be rapidly damped.

Nuclear magnetic resonance-determined lipoprotein subclass profile in the DCCT/EDIC cohort:associations with carotid intima-media thickness

To relate nuclear magnetic resonance lipoprotein subclass profiles (NMR-LSP) and other lipoprotein-related factors with carotid intima-media thickness (IMT) in Type 1 diabetes.

Immune complexes containing modified lipoproteins are related to the progression of internal carotid intima-media thickness in patients with type 1 diabetes

Modified lipoproteins induce autoimmune responses including the synthesis of autoantibodies with pro-inflammatory characteristics. Circulating modified lipoprotein autoantibodies combine with circulating antigens and form immune complexes (IC). We now report the results of a study investigating the role of circulating IC containing modified lipoproteins in the progression of carotid intima-media thickness (IMT) in patients enrolled in the Epidemiology of Diabetes Interventions and Complications (EDIC) Trial, a follow-up study of the Diabetes Control and Complications Trial (DCCT). This cohort includes 1229 patients with type 1 diabetes in whom B-mode ultrasonography of internal and common carotid arteries was performed in 1994-1996 and in 1998-2000. Conventional CHD risk factors, antibodies against modified forms of LDL and modified lipoprotein IC were determined in 1050 of these patients from blood collected in 1996-1998. Cholesterol and apolipoprotein B content of IC (surrogate markers of modified ApoB-rich lipoproteins) were significantly higher in patients who showed progression of the internal carotid IMT than in those showing no progression, regression or mild progression. Multivariate linear and logistic regression modeling using conventional and non-conventional risk factors showed that the cholesterol content of IC was a significant positive predictor of internal carotid IMT progression. In conclusion these data demonstrate that increased levels of modified ApoB-rich IC are associated with increased progression of internal carotid IMT in the DCCT/EDIC cohort of type 1 diabetes.

Hagar Qim and Mnajdra Visitor Centre, Ggantija Visitor Centre:Prehistoric World Heritage Sites visitor centre media and academic content

2010-12 Expert Assistance with research material, digital illustration and text for Visitor Centres in Malta and Gozo (Heritage Malta) and National Museum