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BackgroundVirtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. ObjectiveThe objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. MethodsPeer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. ResultsIn total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. ConclusionsInterventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. Trial RegistrationPROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.earscirev.2005.10.003 Byline: Angela L. Lamb (a), Graham P. Wilson (b), Melanie J. Leng (a)(c) Keywords: organic material; carbon; nitrogen; isotope ratios; Holocene; coastal; decomposition Abstract: Holocene reconstructions of relative sea-level (RSL) and environmental change in the coastal zone have become progressively more numerous since the importance of assessing possible future sea-level rises has become apparent. Traditionally this has been achieved using a combination of biological and physical indicators (e.g. pollen, diatoms, foraminifera, grain size, etc.). In some circumstances, microfossils can be rare or absent from Holocene sediments and in these cases carbon isotope ratios ([delta].sup.13C) and organic carbon to total nitrogen ratios (C/N) can be used because they have the potential to provide information as to the origin of organic material preserved in coastal environments. The distinction in [delta].sup.13C and C/N of the various sources of carbon to estuarine sediments has led to its wide use as a tracer of carbon pathways and storage in estuaries. More recently these techniques have been applied to Holocene sediments to decipher changes in palaeocoastal environments and thus position relative to sea-level and/or palaeoriver discharge, which have direct relevance to palaeoclimate. This paper reviews the studies that have utilised this technique and explores examples from a wide range of coastal environments (saltmarshes, estuaries, lagoons, isolation basins and fjords). It also discusses the potential alteration of geochemical signatures as a result of decompositional processes. Organic matter decomposition has been shown to change sediment [delta].sup.13C and C/N values and thus an understanding of the processes involved is necessary in order to have confidence in the palaeoenvironmental interpretation of Holocene [delta].sup.13C and C/N. Decompositional shifts in C/N, and particularly [delta].sup.13C, can occur over a relatively short time-period, however it is the direction of change in [delta].sup.13C and C/N, rather than absolute values, that is key for interpreting changes in relative sea-level and thus such changes are commonly preserved. Author Affiliation: (a) NERC Isotope Geosciences Laboratory, British Geological Survey, Keyworth, Nottingham NG12 5GG, UK (b) Department of Geography, University of Hull, Hull HU6 7RX, UK (c) School of Geography, University of Nottingham, Nottingham NG7 2RD, UK Article History: Received 12 April 2005; Accepted 21 August 2005

Importance: Individuals with mental disorders are at an elevated risk of developing chronic age-related physical diseases. However, it is not clear whether psychopathology is also associated with processes of accelerated aging that precede the onset of age-related disease.Objective: To test the hypothesis that a history of psychopathology is associated with indicators of accelerated aging at midlife.Design, Setting, and Participants: This prospective cohort study was based on the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort of 1037 individuals born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand. Members were followed up to age 45 years (until April 2019). Data were analyzed from January 6 to December 7, 2020.Exposures: Mental disorders were assessed in 6 diagnostic assessments from ages 18 to 45 years and transformed through confirmatory factor analysis into continuous measures of general psychopathology (p-factor) and dimensions of internalizing, externalizing, and thought disorders (all standardized to a mean [SD] of 100 [15]).Main Outcomes and Measures: Signs of aging (biological pace of aging; declines in sensory, motor, and cognitive functioning; and facial age) were assessed up to age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports.Results: Of the original 1037 cohort participants, 997 were still alive at age 45 years, of whom 938 (94%) were assessed (474 men [50.5%]). Participants who had experienced more psychopathology exhibited a faster pace of biological aging (β, 0.27; 95% CI, 0.21-0.33; P < .01); experienced more difficulties with hearing (β, 0.18; 95% CI, 0.12-0.24; P < .01), vision (β, 0.08; 95% CI, 0.01-0.14; P < .05), balance (β, 0.20; 95% CI, 0.14-0.26; P < .01), and motor functioning (β, 0.19; 95% CI, 0.12-0.25; P < .01); experienced more cognitive difficulties (β, 0.24; 95% CI, 0.18-0.31; P < .01); and were rated as looking older (β, 0.20; 95% CI, 0.14-0.26; P < .01). Associations persisted after controlling for sex, childhood health indicators, maltreatment, and socioeconomic status and after taking into account being overweight, smoking, use of antipsychotic medication, and the presence of physical disease. Tests of diagnostic specificity revealed that associations were generalizable across externalizing, internalizing, and thought disorders.Conclusions and Relevance: In this cohort study, a history of psychopathology was associated with accelerated aging at midlife, years before the typical onset of age-related diseases. This link is not specific to any particular disorder family but generalizes across disorders. Prevention of psychopathology and monitoring of individuals with mental disorders for signs of accelerated aging may have the potential to reduce health inequalities and extend healthy lives. [ABSTRACT FROM AUTHOR]

Recent research that examines the relationship between physical activity and academic performance provides physical educators with multiple opportunities to engage others in recognizing the benefits of physical activity and high quality physical education programs. Local schools and community provide the greatest opportunity to educate and influence others about this important relationship. Success is related to thoughtful preparation and having just the right tools when one needs them. In this article, the author presents three easy and important steps for being prepared to maximize opportunities: (1) collect, consider, and create; (2) Be ready for the conversation; and (3) Identify opportunities and build a plan for this school year.

Bulk organic stable carbon isotope (δ 13 C) and element geochemistry (total organic carbon (TOC) and organic carbon to total nitrogen (C/N)) analysis is a developing technique in Holocene relative sea-level (RSL) research. The uptake of this technique in Northern Europe is limited compared to North America, where the common existence of coastal marshes with isotopically distinctive C 3 and C 4 vegetation associated with well-defined inundation tolerance permits the reconstruction of RSL in the sediment record. In Northern Europe, the reduced range in δ 13 C values between organic matter sources in C 3 estuaries can make the identification of elevation-dependent environments in the Holocene sediment record challenging and this is compounded by the potential for post-depositional alteration in bulk δ 13 C values. The use of contemporary regional δ 13 C, C/N and TOC datasets representing the range of physiographic conditions commonly encountered in coastal wetland sediment sequences opens up the potential of using absolute values of sediment geochemistry to infer depositional environments and associated reference water levels. In this paper, the application of contemporary bulk organic δ 13 C, C/N and TOC to reconstruct Holocene RSL is further explored. An extended contemporary regional geochemical dataset of published δ 13 C, C/N and TOC observations ( n = 142) from tidal-dominated C 3 wetland deposits (representing tidal flat, saltmarsh, reedswamp and fen carr environments) in temperate NW Europe is compiled, and procedures implemented to correct for the 13 C Suess effect on contemporary δ 13 C are detailed. Partitioning around medoids analysis identifies two distinctive geochemical groups in the NW European dataset, with tidal flat/saltmarsh and reedswamp/fen carr environments exhibiting characteristically different sediment δ 13 C, C/N and TOC values. A logistic regression model is developed from the NW European dataset in order to objectively identify in the sediment record geochemical groups and, more importantly, group transitions, thus allowing the altitude of reference water levels to be determined. The application of this method in RSL research is demonstrated using the Holocene sediments of the Mersey Estuary (UK), in which δ 13 C, C/N and TOC variability is typical of that encountered in Holocene sediments from C 3 coastal wetlands in NW Europe. Group membership was predicted with high probability in the depositional contexts studied and the accuracy of group prediction is verified by microfossil evidence. The method presented facilitates the application of δ 13 C, C/N and TOC analysis in RSL reconstruction studies in C 3 vegetated wetlands throughout temperate NW Europe. [ABSTRACT FROM AUTHOR]

As the average North American gets older, there is an increasing need to develop better rehabilitation and wellness software for the aging. Although the use of computerized entertainment is becoming more prevalent with older adults, knowledge of their preferences and usage habits is still limited. In order to understand how preferences might change over a lifespan, we conducted a survey of older and younger adults (N = 426). The goal of this analysis was to determine in what ways the electronic preferences and activities of older adults differed from younger cohorts. Our results showed that older adult respondents generally indicated a preference for games that were easy to learn and play, but also challenging, with puzzle & strategy games being the most popular. Older adults also indicated that they played games alone rather than with friends. Finally, although younger adults used a wider variety of electronic devices, most older adults reported regularly using at least one device capable of accessing video games such as a desktop computer. These results broaden our knowledge of older adults’ preferences and usage patterns for computerized entertainment, as compared to a younger cohort. These survey results can serve as a resource for game designers. [ABSTRACT FROM AUTHOR]

Purpose: Studies have shown that horizontal ridge augmentation with a nonresorbable membrane is subject to a relatively frequent occurrence of dehiscence and loss of the graft. This study was designed to compare the outcomes of a tunnel technique versus an open technique using a titanium-reinforced polytetrafluoroethylene (PTFE) membrane.Materials and Methods: A retrospective cohort study, in which the data were collected by chart review, was designed to compare patients who had undergone horizontal ridge augmentation with a 1:1 ratio of mineralized freeze-dried allograft and particulate bovine hydroxyapatite by the tunnel technique with patients who had undergone an open technique with a titanium-reinforced PTFE membrane. The incidence of wound dehiscence or membrane exposure, the number of postoperative visits required, and the number of systemic antibiotic courses needed, as well as the number of grafted sites that subsequently were amenable to routine implant placement after graft maturation, were compared between the 2 techniques. The differences in implants placed between the 2 methods were analyzed with the Fisher exact test. The secondary hypothesis (regarding wound dehiscence, number of postoperative visits, and number of systemic antibiotic courses) was analyzed by Poisson regression.Results: The chart review found 52 patients, with 21 treated by the tunnel technique and 31 treated with the open technique. Within 6 months after bone grafting, 18 patients (86%) treated with tunnel technique grafts received dental implants whereas 22 patients (71%) treated with the open technique received dental implants. Dehiscence developed in a greater proportion of ridge augmentations with the PTFE method (52% vs 19%). There was a trend toward an increased number of courses of antibiotics prescribed for this group (P = .11), as well as a significant increase in the number of postoperative visits required (P = .003).Conclusions: For horizontal defects amenable to either technique, the findings of this study show the tunnel technique is a more cost-effective option with similar success to the open technique. [ABSTRACT FROM AUTHOR]

Preservation or reconstruction of the soft tissues around dental implants is an essential component of implant dentistry. Increased width and thickness of the keratinized tissue surrounding dental implants has been recognized as an important factor associated with long-term implant success. When extractions and ridge reduction are performed concurrently with implant placement, maintaining vestibular depth also is of utmost importance. A previous report described a technique for applying bone-anchoring sutures to preserve keratinized tissue and vestibular depth around implants. The present report describes a variation of the procedure for the simultaneous correction of situations in which the existing keratinized tissue is thin and narrow and preserving and apically positioning it might not provide an appropriate gingival cuff. [ABSTRACT FROM AUTHOR]

Unlike the most recent deglaciation, the regional expression of climate changes during the penultimate deglaciation remains understudied, even though it led into a period of excess warmth with estimates of global average temperature 1-2 °C, and sea level ~6 m, above pre-industrial values. We present the first complete high-resolution southern European diatom record capturing the penultimate glacial-interglacial transition, from Lake Ioannina (northwest Greece). It forms part of a suite of proxies selected to assess the character and phase relationships of terrestrial and aquatic ecosystem response to rapid climate warming, and to resolve apparent conflicts in proxy evidence for regional paleohydrology. The diatom data suggest a complex penultimate deglaciation driven primarily by multiple oscillations in lake level, and provide firm evidence for the regional influence of abrupt changes in North Atlantic conditions. There is diachroneity in lake and terrestrial ecosystem response to warming at the onset of the last interglacial, with an abrupt increase in lake level occurring ~2.7 k.y. prior to sustained forest expansion with peak precipitation. We identify the potentially important role of direct input of snow melt and glacial meltwater transfer to the subterranean karst system in response to warming, which would cause rising regional groundwater levels. This explanation, and the greater sensitivity of diatoms to subtle changes in temperature, reconciles the divergent lacustrine and terrestrial proxy evidence and highlights the sensitivity of lakes situated in mountainous karstic environments to past climate warming. [ABSTRACT FROM AUTHOR]

Purpose To characterize nonrespiratory stomach motion in the fasting state and postprandial. Methods and materials Ten healthy volunteers underwent 2-dimensional Fiesta cine magnetic resonance imaging studies in 30-second voluntary breath hold, in axial, coronal, and 2 oblique planes while fasting, and 5, 15, 30, 45, and 60 minutes postmeal. Each stomach contour was delineated and sampled with 200 points. Matching points were found for all contours in the same 30-second acquisition. Using deformable parametric analysis (Matlab, version 7.1), mean magnitude, and standard deviation of displacement of each point were determined for each patient. Maximal, minimal, and median population values in 6 cardinal, and in any direction, were calculated. Results The median of mean displacements for the baseline position of each point was small and rarely exceeded 1.1 mm; greatest value was 1.6 mm superior-inferior. Median displacement (pooled across time) in the right-left, superior-inferior, and anterior-posterior directions was 0.3 (range, - 0.7 to 1.3), 0.8 (- 0.4 to 2.4), and 0.3 (- 1.1 to 1.6) mm, respectively. Fasting and postprandial standard deviation did not differ. Conclusions Nonrespiratory stomach displacement is small and stomach position is stable after a small, standard meal. Radiation therapy may be delivered at any time within the first hour after eating without significant compromise of planned planning target volumes. Sources of support: Funding for this study was provided by the Radiation Medicine Program at the Princess Margaret Cancer Centre. Conflicts of interest: Dr Brock reports grants and personal fees from RaySearch Laboratories, grants from Philips Medical Systems, and personal fees from IMPAC Advisory Board; Dr Dawson reports grants and nonfinancial support from Bayer, other from RaySearch Laboratories; and Ms Moseley reports personal fees from RaySearch Laboratories. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the prevalence of caries experience and periodontal pathology on asymptomatic third molars in young adults. Subjects and Methods: Healthy subjects with 4 asymptomatic third molars were enrolled in an institutional review board-approved study during a 5-year period. Full mouth periodontal probing, 6 sites per tooth, was the measure of clinical periodontal status. The presence or absence of occlusal caries experience (carious lesions or restorations, including sealants) on third molars and on any surface of the first and second molars were assessed using a visual-tactile examination and panoramic radiographs. The primary outcome measures were at least 1 periodontal probing depth of at least 4 mm versus none and caries experience versus no caries experience. Results: The data were analyzed from 409 subjects, who averaged 25 years old. More subjects were female (53%) and white (76%). More subjects had at least 1 periodontal probing depth of 4 mm or deeper on a third molar (55%) than on the distal of a second molar (46%). These findings were more likely to be detected around a third molar in subjects with all third molars at the occlusal plane (72%) than in subjects with at least one third molar below (33%). Overall, fewer subjects were affected by third molar caries experience than first or second molars (24% vs 73%, respectively). Of the subset of subjects with all four third molars at the occlusal plane, 26% were affected by both third molar periodontal pathology and caries experience and 16% were caries and periodontal pathology free. Conclusions: In these cross-sectional analyses, periodontal pathology was detected more frequently on third molars than on first and second molars and caries experience was detected more frequently on first and second molars than on third molars. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence of periodontal pathology and caries experience in visible third molars, as well as the relationship of these findings to periodontal pathology and caries experience in teeth more anterior in the mouth. Patients and Methods: Data were from 6,793 Dental Atherosclerosis Risk in Communities participants who underwent a clinical examination for periodontal disease and coronal caries experience and who retained at least 1 visible third molar. Outcome variables were the detection of periodontal pathology or coronal caries experience on visible third molars and on teeth more anterior in the mouth (non–third molars). Periodontal probing depths at least 4 mm (PD4+) and clinical attachment levels at least 3 mm (CAL3+) were indicator variables for periodontal pathology. At least 1 carious/decayed coronal surface or filled coronal surface was an indicator variable for caries experience. Outcomes for third molar and non–third molar teeth were compared by descriptive statistics and χ2 tests with statistical significance set at P < .05. Results: A third of the 6,793 Dental Atherosclerosis Risk in Communities subjects, who averaged 62 years of age, had at least 1 visible third molar. Subjects were more likely to have at least 1 third molar CAL3+ as compared with at least 1 third molar PD4+: 78% versus 61%. PD4+ and CAL3+ were significantly more prevalent among non–third molars as compared with third molars (P < .01). Most subjects, 73%, had restorations on visible third molars and non–third molars, and over two-thirds of subjects had a visible third molar with caries experience and periodontal pathology. Fewer than 2% of subjects had third molars free of caries experience or periodontal pathology. Conclusions: Most subjects had clinical evidence of caries experience or periodontal pathology on visible third molars; few subjects had visible third molars that were disease free. Subjects with periodontal pathology or caries experience on third molars were significantly more likely to have these findings detected on teeth more anterior in the mouth. [Copyright &y& Elsevier]

Abductive reasoning is the central form of explanation in environmental reconstruction. This paper outlines the nature of the abductive method restating it in Bayesian terms, ie, in terms of a priori belief based on context and the relations between multiple proxies. A key role within this working method is played by evidence and, in particular, proxies of the past in the explanatory framework. Proxies, whether singularly or as groups, are interpreted within the context of the event, and the derived hypothesis, for which they have evidential claim. They are not considered as independent entities but rather as inter-related pieces of information concerning the likelihood of specific events. The degree of belief in an individual proxy is based on the interplay between the belief in the hypothesis before the proxy is considered and the relations and belief in the cluster of proxies of which the individual proxy is usually a part. [ABSTRACT FROM AUTHOR]

Background: Digital technologies are creating unprecedented opportunities to improve and increase support to older people with cognitive and mental health problems, and to their family and carers. However, barriers that preclude the implementation of technology driven programs for the assessment and intervention of adults at risk of cognitive decline need to be better understood. This study investigated these outstanding issues, as well as considering the impact that the COVID‐19 Pandemic has had on such barriers. Methods: A sample of 105 participants completed an online survey. Their ages ranged from 18 to 92 years. Of these, 72% were female, 83% had higher education and beyond, 42% were working, 42% were retired, and 14% were unemployed. The questionnaires assessed IT experience alongside awareness, attitudes, and stigmas regarding the use of technologies, particularly those used to support cognitive and mental health. Questionnaires also explored the impact of the COVID‐19 pandemic on these technology‐related factors. We compared these across groups of young (n=45), middle age (n=12) and older adults (n=48). Results: Relative to younger participants, older participants were less aware of, and held stronger stigmas against healthcare technologies, even though they reported more IT experience. IT awareness was associated to more positive (r=0.619, p<0.001) and less negative IT Attitudes (r=‐0.271, p=0.015), more acceptability (r=‐0.374, p=0.001) and receptiveness towards technologies (r=‐0.610, p<0.001). Male participants appeared to be more aware of such technologies than female participants. However, relative to men, women had increased the number of ways and frequency with which they used technologies since the COVID‐19 pandemic started, and older people in general felt more inclined to endorse the need to learn more about healthcare technologies. Conclusions: Having more accumulated IT experience throughout our lives may not necessarily lead to better acceptance of healthcare technologies. More awareness about such specific technologies will help overcome stigmas, and challenging environments such as those imposed by the COVID‐19 pandemic may lead to positive changes in perception and acceptance of such technologies. These are necessary steps towards the personalisation of healthcare technologies to support vulnerable adults at risk of dementia. [ABSTRACT FROM AUTHOR]

Abstract: Background: A national initiative in Ireland in 2000 defined 13 designated Units to provide care for symptomatic breast cancer, and resources, including an ability to develop audit programmes, were provided. In the absence of a national audit of breast cancer outcomes, the aim of this study is to provide a detailed report of one Unit''s subsequent experience, in particular comparing process and outcome data with international norms and benchmarks, and to infer on the likely impact of the national initiative. Methods: A 5-year prospective audit of patients presenting to the Symptomatic Breast Clinic from 2001 to 2005 was conducted. All cancer diagnoses were discussed at the Breast Multidisciplinary Conference, and all clincopathological treatment details and follow-up information were entered by a full-time data manager. Overall survival was calculated using the Kaplan–Meier method. Results: Eight hundred and thirty-nine patients were diagnosed through the clinic, 18 (2%) Stage 0, 169 (20%) Stage I, 380 (45%) Stage II, 142 (17%) Stage III, and 123 (15%) Stage IV. At a median follow-up of 35 months the overall 5-year survival was 71%, with 100%, 91%, 83%, 72%, and 11% survival for Stages 0–IV, respectively, and disease-specific survival of 82%. Conclusions: The process and outcome data are consistent with international benchmarks. These data from one designated centre support the national initiatives in Ireland to restructure breast services. [Copyright &y& Elsevier]

Abstract: Holocene reconstructions of relative sea-level (RSL) and environmental change in the coastal zone have become progressively more numerous since the importance of assessing possible future sea-level rises has become apparent. Traditionally this has been achieved using a combination of biological and physical indicators (e.g. pollen, diatoms, foraminifera, grain size, etc.). In some circumstances, microfossils can be rare or absent from Holocene sediments and in these cases carbon isotope ratios (δ 13C) and organic carbon to total nitrogen ratios (C/N) can be used because they have the potential to provide information as to the origin of organic material preserved in coastal environments. The distinction in δ 13C and C/N of the various sources of carbon to estuarine sediments has led to its wide use as a tracer of carbon pathways and storage in estuaries. More recently these techniques have been applied to Holocene sediments to decipher changes in palaeocoastal environments and thus position relative to sea-level and/or palaeoriver discharge, which have direct relevance to palaeoclimate. This paper reviews the studies that have utilised this technique and explores examples from a wide range of coastal environments (saltmarshes, estuaries, lagoons, isolation basins and fjords). It also discusses the potential alteration of geochemical signatures as a result of decompositional processes. Organic matter decomposition has been shown to change sediment δ 13C and C/N values and thus an understanding of the processes involved is necessary in order to have confidence in the palaeoenvironmental interpretation of Holocene δ 13C and C/N. Decompositional shifts in C/N, and particularly δ 13C, can occur over a relatively short time-period, however it is the direction of change in δ 13C and C/N, rather than absolute values, that is key for interpreting changes in relative sea-level and thus such changes are commonly preserved. [Copyright &y& Elsevier]

Abstract: The reconstruction of former environments, and ultimately relative sea-level changes, in coastal and estuarine environments normally utilises a range of microfossil proxies, such as diatoms, foraminifera and pollen. As microfossils are sometimes poorly preserved, sparse or absent from coastal sediments, this study assesses the potential of using 13C and C/N analysis of sedimentary organic matter as an alternative. Contemporary high inter-tidal and sub-tidal surface saltmarsh sediments of the Mersey Estuary, UK, reveal distinctly different 13C and C/N values, reflecting the contrasting sources of organic matter in relation to ground elevation within the tidal frame. Despite decomposition effects, the relationship between ground elevation, 13C and C/N, is preserved in the sediment record, with a gradual increase in 13C and decrease in C/N from supra-tidal, through to inter-tidal and to sub-tidal environments. Holocene variations in 13C and C/N are compared with stratigraphical palaeoenvironmental changes inferred from diatom and pollen evidence and show a good correspondence. Although 13C and C/N are not as accurate as microfossil analysis in terms of coastal palaeoenvironmental reconstruction, they may be applied successfully in the field of relative sea-level reconstruction by helping to verify sea-level index points when microfossils are absent. [Copyright &y& Elsevier]

Abstract: Microfossil analysis (e.g. diatoms, foraminifera and pollen) represents the cornerstone of Holocene relative sea-level (RSL) reconstruction because their distribution in the contemporary inter-tidal zone is principally controlled by ground elevation within the tidal frame. A combination of poor microfossil preservation and a limited range in the sediment record may severely restrict the accuracy of resulting RSL reconstructions. Organic δ 13C and C/N analysis of inter-tidal sediments have shown some potential as coastal palaeoenvironmental proxies. Here we assess their viability for reconstructing RSL change by examining patterns of organic δ 13C and C/N values in a modern estuarine environment. δ 13C and C/N analysis of bulk organic inter-tidal sediments and vegetation, as well as suspended and bedload organic sediments of the Mersey Estuary, U.K., demonstrate that the two main sources of organic carbon to surface saltmarsh sediments (terrestrial vegetation and tidal-derived particulate organic matter) have distinctive δ 13C and C/N signatures. The resulting relationship between ground elevation within the tidal frame and surface sediment δ 13C and C/N is unaffected by decompositional changes. The potential of this technique for RSL reconstruction is demonstrated by the analysis of part of an early Holocene sediment core from the Mersey Estuary. Organic δ 13C and C/N analysis is less time consuming than microfossil analysis and is likely to provide continuous records of RSL change. [Copyright &y& Elsevier]

Coronary artery aneurysm is a rare entity and has been described in association with by-pass graft procedure , percutaneous transluminal angioplasty , atherosclerosis and Kawasaki''s disease . We present a case of a giant aneurysm of a coronary artery by-pass graft, according to our literature search is the largest aneurysm documented in relation to the coronary arteries. [Copyright &y& Elsevier]

Abstract: Preoperative assessment clinics are more common now that increasing numbers of children are admitted on the day of surgery. Such clinics often use protocols and are ‘nurse-led’, which may restrict their relevance to the anaesthetist. Routine screening before admission should reduce the rate of cancellation (by promptly identifying medical or social problems) and speed up the admission process. Children and their parents (or carers) can be provided with information about the admission procedures. Information about the anaesthetic can be gained from a range of sources (Figure 1), which can lead to confusion when conflicting opinions are presented. [Copyright &y& Elsevier]

The article focuses on engaging others in recognizing the benefits of physical activity. This advocacy seeks to enlighten everyone to understand the relationship between physical activity and performance. It states that success in this endeavor is guaranteed by planning, a knowledge of the benefits and the readiness to communicate. Communication tips such as conversation inserts and presentation paraphernalia are suggested.

Abstract: Organic δ 13C and C/N analyses of estuarine deposits provide proxies for changes in the source of organic matter, which can be driven by fluctuations in relative sea level, river discharge, and catchment disturbance. Here we present the results of a comprehensive vegetation and sediment δ 13C and C/N survey of Welwich Marsh (outer Humber Estuary, UK), together with high-resolution δ 13C and C/N analyses of Holocene cores collected nine years previously from the Humber Estuary and the Lincolnshire Marshes, Eastern England, UK. The contemporary intertidal δ 13C and C/N dataset shows a gradual increase in surface sediment δ 13C with decreasing marsh height and suggests that δ 13C is controlled by the degree of tidal inundation and thus reflects organic matter source. However, sediment C/N ratios are less sensitive to tidal changes and the recent introduction of C4 salt-marsh species complicates the contemporary analogue. The Holocene δ 13C and C/N records are in general agreement with existing microfossil data and provide additional palaeoenvironmental information. This includes support for an estuary-wide expansion of marine conditions from c. 3.3 ka cal. yr BP, followed by a contraction of marine conditions after c. 2.7 ka cal. yr BP, and evidence for an increase in delivery of terrigenous organic matter to the inner estuary in the late Holocene. Bulk organic δ 13C and C/N analysis is shown to be a reliable and independent indicator of coastal environmental change and is therefore a complementary technique to the more commonly used microfossil approach. However, this study also shows that in some circumstances the technique may be compromised when applied to sediments from cores that have been stored for a period of time. [Copyright &y& Elsevier]