'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective

Background
Despite the recognized importance of end-of-life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking.

Objective
We sought to understand patient perspectives on physician behaviours during EOL communication.

Design
In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase. In the quantitative strand, we used the quality of communication tool (QOC) to measure physician behaviours that predict global rating of satisfaction in EOL communication skills, while in the qualitative strand we conducted semi-structured interviews. During the mixed methods analysis, we compared and contrasted qualitative and quantitative data.

Setting and Participants
Seriously ill inpatients at three tertiary care hospitals in Canada.

Results
We found convergence between qualitative and quantitative strands: patients desire candid information from their physician and a sense of familiarity. The quantitative results (n = 132) suggest a paucity of certain EOL communication behaviours in this seriously ill population with a limited prognosis. The qualitative findings (n = 16) suggest that at times, physicians did not engage in EOL communication despite patient readiness, while sometimes this may represent an appropriate deferral after assessment of a patient's lack of readiness.

Conclusions
Avoidance of certain EOL topics may not always be a failure if it is a result of an assessment of lack of patient readiness. This has implications for future tool development: a measure could be built in to assess whether physician behaviours align with patient readiness.

Arenedicarboximide Building Blocks for Fluorescent Photoinduced Electron Transfer pH Sensors Applicable with Different Media and Communication Wavelengths

N-(aminoalkyl)-4-chloronaphthalene-
1,8-dicarboximides 1, N-
(aminoalkyl)-4-acetamidonaphthalene-
1,8-dicarboximides 3 and N,N'-bis(aminoalkyl)-
perylene-3,4:9,10-tetracarboxydiimides
4 show good fluorescent off ±
on switching in aqueous alcoholic solution
with protons as required for fluorescent
PET sensor design. The excitation
wavelengths lie in the ultraviolet
(lmaxˆ345 and 351 nm) for 1 and 3 and
in the blue-green (lmaxˆ528, 492 and
461 nm) for 4; the emission wavelengths
lie in the violet (lmaxˆ408 nm) for 1, in
the blue (lmaxˆ474 nm) for 3 and in the
yellow-orange (lmaxˆ543 and 583 nm)
for 4. Compound 4b shows substantial
fluorescence enhancement with protons
when immobilized in a poly(vinylchloride)
matrix, provided that 2-nitrophenyloctyl
ether plasticizer and potassium
tetrakis(4-chlorophenyl)borate additive
are present to prevent dye crystallization
and to facilitate proton diffusion
into the membrane, respectively.

The 4Cs of Disaster Partnering: Communication, Coordination, Cooperation and Collaboration

Public, nonprofit and private organisations respond to large-scale disasters domestically and overseas. Critics of these assistance efforts, as well as those involved, often cite poor interorganisational partnering as an obstacle to successful disaster response. Observers frequently call for ‘more’ and ‘better’ partnering. We found important qualitative distinctions existed within partnering behaviours. We identified four different types of interorganisational partnering activities often referred to interchangeably: communication, cooperation, coordination and collaboration—the Four Cs. We derived definitions of the Four Cs from the partnering literature. We then tested them in a case study of the response to the 2010 Haiti earthquake. We suggest that the Four Cs are distinct activities, that organisations are typically strong or weak in one or more for various reasons, and that the four terms represent a continuum of increased interorganisational embeddedness in partnering activities.

IEEE C37.118-2 Synchrophasor Communication Framework

Synchrophasors have become an important part of the modern power system and numerous applications have been developed covering wide-area monitoring, protection and control. Most applications demand continuous transmission of synchrophasor data across large geographical areas and require an efficient communication framework. IEEE C37.118-2 evolved as one of the most successful synchrophasor communication standards and is widely adopted. However, it lacks a predefined security mechanism and is highly vulnerable to cyber attacks. This paper analyzes different types of cyber attacks on IEEE C37.118-2 communication system and evaluates their possible impact on any developed synchrophasor application. Further, the paper also recommends an efficent security mechanism that can provide strong protection against cyber attacks. Although, IEEE C37.118-2 has been widely adopted, there is no clear understanding of the requirements and limitations. To this aim, the paper also presents detailed performance evaluation of IEEE C37.118-2 implementations which could help determine required resources and network characteristics before designing any synchrophasor application.

Secure D2D Communication in Large-Scale Cognitive Cellular Networks: A Wireless Power Transfer Model

In this paper, we investigate secure device-to-device (D2D) communication in energy harvesting large-scale cognitive cellular networks. The energy constrained D2D transmitter harvests energy from multiantenna equipped power beacons (PBs), and communicates with the corresponding receiver using the spectrum of the primary base stations (BSs). We introduce a power transfer model and an information signal model to enable wireless energy harvesting and secure information transmission. In the power transfer model, three wireless power transfer (WPT) policies are proposed: 1) co-operative power beacons (CPB) power transfer, 2) best power beacon (BPB) power transfer, and 3) nearest power beacon (NPB) power transfer. To characterize the power transfer reliability of the proposed three policies, we derive new expressions for the exact power outage probability. Moreover, the analysis of the power outage probability is extended to the case when PBs are equipped with large antenna arrays. In the information signal model, we present a new comparative framework with two receiver selection schemes: 1) best receiver selection (BRS), where the receiver with the strongest channel is selected; and 2) nearest receiver selection (NRS), where the nearest receiver is selected. To assess the secrecy performance, we derive new analytical expressions for the secrecy outage probability and the secrecy throughput considering the two receiver selection schemes using the proposed WPT policies. We presented Monte carlo simulation results to corroborate our analysis and show: 1) secrecy performance improves with increasing densities of PBs and D2D receivers due to larger multiuser diversity gain; 2) CPB achieves better secrecy performance than BPB and NPB but consumes more power; and 3) BRS achieves better secrecy performance than NRS but demands more instantaneous feedback and overhead. A pivotal conclusion- is reached that with increasing number of antennas at PBs, NPB offers a comparable secrecy performance to that of BPB but with a lower complexity.

Communication Nonlinearities Techniques for Analysis of Passive Intermodulation

The X-parameter based nonlinear modelling tools have been adopted as the foundation for the advanced methodology
of experimental characterisation and design of passive nonlinear devices. Based upon the formalism of the Xparameters,
it provides a unified framework for co-design of antenna beamforming networks, filters, phase shifters and
other passive and active devices of RF front-end, taking into account the effect of their nonlinearities. The equivalent
circuits of the canonical elements are readily incorporated in the models, thus enabling evaluation of PIM effect on the
performance of individual devices and their assemblies. An important advantage of the presented methodology is its
compatibility with the industry-standard established commercial RF circuit simulator Agilent ADS.
The major challenge in practical implementation of the proposed approach is concerned with experimental retrieval of the X-parameters for canonical passive circuit elements. To our best knowledge commercial PIM testers and practical laboratory test instruments are inherently narrowband and do not allow for simultaneous vector measurements at the PIM and harmonic frequencies. Alternatively, existing nonlinear vector analysers (NVNA) support X-parameter measurements in a broad frequency bands with a range of stimuli, but their dynamic range is insufficient for the PIM characterisation in practical circuits. Further opportunities for adaptation of the X-parameters methodology to the PIM
characterisation of passive devices using the existing test instruments are explored.

Public health risk communication by text message in response to a cluster of invasive meningococcal infection in a primary school

Public health risk communication during emergencies should be rapid and accurate in order to allow the audience to take steps to prevent adverse outcomes. Delays to official communications may cause unnecessary anxiety due to uncertainty or inaccurate information circulating within the at-risk group. Modern electronic communications present opportunities for rapid, targeted public health risk communication. We present a case report of a cluster of invasive meningococcal disease in a primary school in which we used the school's mass short message service (SMS) text message system to inform parents and guardians of pupils about the incident, to tell them that chemoprophylaxis would be offered to all pupils and staff, and to advise them when to attend the school to obtain further information and antibiotics. Following notification to public health on a Saturday, an incident team met on Sunday, sent the SMS messages that afternoon, and administered chemoprophyaxis to 93% of 404 pupils on Monday. The use of mass SMS messages enabled rapid communication from an official source and greatly aided the public health response to the cluster.