The challenge of patients’ unmet palliative care needs in the final stages of chronic illness.

Background: There is consensus in the literature that the end of life care for patients with chronic illness is suboptimal, but research on the specific needs of this population is limited. Aim: This study aimed to use a mixed methodology and case study approach to explore the palliative care needs of patients with a non-cancer diagnosis from the perspectives of the patient, their significant other and the clinical team responsible for their care. Patients (n 18) had a diagnosis of either end-stage heart failure, renal failure or respiratory disease. Methods: The Short Form 36 and Hospital and Anxiety and Depression Questionnaire were completed by all patients. Unstructured interviews were (n 35) were conducted separately with each patient and then their significant other. These were followed by a focus group discussion (n 18) with the multiprofessional clinical team. Quantitative data were analysed using simple descriptive statistics and simple descriptive statistics. All qualitative data were taped, transcribed and analysed using Colaizzi’s approach to qualitative analysis. Findings: Deteriorating health status was the central theme derived from this analysis. It led to decreased independence, social isolation and family burden. These problems were mitigated by the limited resources at the individual’s disposal and the availability of support from hospital and community services. Generally resources and support were perceived as lacking. All participants in this study expressed concerns regarding the patients’ future and some patients described feelings of depression or acceptance of the inevitability of imminent death. Conclusion: Patients dying from chronic illness in this study had many concerns and unmet clinical needs. Care teams were frustrated by the lack of resources available to them and admitted they were ill-equipped to provide for the individual’s holistic needs. Some clinicians described difficulty in talking openly with the patient and family regarding the palliative nature of their treatment. An earlier and more effective implementation of the palliative care approach is necessary if the needs of patients in the final stages of chronic illness are to be adequately addressed. Pa

Probabilistic program analysis for parallelizing compilers

Parallelizing compilers have difficulty analysing and optimising complex code. To address this, some analysis may be delayed until run-time, and techniques such as speculative execution used. Furthermore, to enhance performance, a feedback loop may be setup between the compile time and run-time analysis systems, as in iterative compilation. To extend this, it is proposed that the run-time analysis collects information about the values of variables not already determined, and estimates a probability measure for the sampled values. These measures may be used to guide optimisations in further analyses of the program. To address the problem of variables with measures as values, this paper also presents an outline of a novel combination of previous probabilistic denotational semantics models, applied to a simple imperative language.

Chemistry in the Circumstellar Medium: Unveiling the Dust Formation Zone

The growth of dust grains in the inner regions of late-type stars is shrouded in mystery due to the difficulty of understanding the growth of heterogeneous particles from simple atoms and molecules and the lack of observational data. This article reviews the molecular processes important in circumstellar envelopes and discusses how ALMA might be used to probe the dust formation zone either directly or indirectly.

Simulation or measurement: the effect of radio map creation on indoor WLAN-based localisation accuracy

Indoor wireless network based client localisation requires the use of a radio map to relate received signal strength to specific locations. However, signal strength measurements are time consuming, expensive and usually require unrestricted access to all parts of the building concerned. An obvious option for circumventing this difficulty is to estimate the radio map using a propagation model. This paper compares the effect of measured and simulated radio maps on the accuracy of two different methods of wireless network based localisation. The results presented indicate that, although the propagation model used underestimated the signal strength by up to 15 dB at certain locations, there was not a signigicant reduction in localisation performance. In general, the difference in performance between the simulated and measured radio maps was around a 30 % increase in rms error

Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial

Objective: To explore the difficulties experienced by lay-workers, women and health professionals involved in a peer-mentoring programme for first-time mothers living in socially disadvantaged areas. Design: Qualitative study; semi-structured interviews with lay-worker peer-mentoring programme participants at two separate stages of the programme (antenatal and postnatal). Setting: Community based. Participants: 11 women receiving peer-mentoring support (from first hospital antenatal visit to one year postnatal); 11 lay-workers; 2 research midwives. Results: Lay-workers had difficulty initiating contact with women and failure to establish contact affected their morale adversely. They felt that women understood their intended role poorly and attempted to develop relationships with them by sharing personal experiences and offering friendship; women who participated in the programme appreciated this. Developing a peer-mentor relationship was difficult if women lacked interest in the programme or in continuing contact. External influences on peer-mentoring uptake and delivery included family and friends who could prevent or encourage women’s participation and cause difficulties for the lay-worker both in delivering support and arranging follow-up. Lay-workers providing support to women from a different ethnic background experienced difficulties relating to both language and culture: these were perceived to affect peer-mentor relationships adversely. Major personal difficulties for lay-workers related to time constraints in reconciling mentoring requirements with demands of family and other work. Informing midwives of these difficulties helped identify solutions through training and ongoing professional support for the lay-workers. Conclusions: Lay-worker peer support is appreciated by first time mothers but difficulties in initiating contact, developing peer-mentor relationships and external influences such as family, ethnicity and time constraints are relevant to poor uptake and high staff turnover. In developing peer support programmes, awareness of potential difficulties and of how professional support can help resolve these should improve uptake and thus optimise the evaluations of their effectiveness.

Prediction- and simulation-error based perceptron training: Solution space analysis and a novel combined training scheme

Previous papers have noted the difficulty in obtaining neural models which are stable under simulation when trained using prediction-error-based methods. Here the differences between series-parallel and parallel identification structures for training neural models are investigated. The effect of the error surface shape on training convergence and simulation performance is analysed using a standard algorithm operating in both training modes. A combined series-parallel/parallel training scheme is proposed, aiming to provide a more effective means of obtaining accurate neural simulation models. Simulation examples show the combined scheme is advantageous in circumstances where the solution space is known or suspected to be complex. (c) 2006 Elsevier B.V. All rights reserved.

Robust fuzzy Gustafson-Kessel clustering for nonlinear system identification

This paper deals with Takagi-Sugeno (TS) fuzzy model identification of nonlinear systems using fuzzy clustering. In particular, an extended fuzzy Gustafson-Kessel (EGK) clustering algorithm, using robust competitive agglomeration (RCA), is developed for automatically constructing a TS fuzzy model from system input-output data. The EGK algorithm can automatically determine the 'optimal' number of clusters from the training data set. It is shown that the EGK approach is relatively insensitive to initialization and is less susceptible to local minima, a benefit derived from its agglomerate property. This issue is often overlooked in the current literature on nonlinear identification using conventional fuzzy clustering. Furthermore, the robust statistical concepts underlying the EGK algorithm help to alleviate the difficulty of cluster identification in the construction of a TS fuzzy model from noisy training data. A new hybrid identification strategy is then formulated, which combines the EGK algorithm with a locally weighted, least-squares method for the estimation of local sub-model parameters. The efficacy of this new approach is demonstrated through function approximation examples and also by application to the identification of an automatic voltage regulation (AVR) loop for a simulated 3 kVA laboratory micro-machine system.

Cryptic species diversity in a widespread bumble bee complex revealed using mitochondrial DNA RFLPs

Cryptic species diversity is thought to be common within the class Insecta, posing problems for basic ecological and population genetic studies and conservation management. Within the temperate bumble bee (Bombus spp.) fauna, members of the subgenus Bombus sensu stricto are amongst the most abundant and widespread. However, their species diversity is controversial due to the extreme difficulty or inability morphologically to identify the majority of individuals to species. Our character-based phylogenetic analyses of partial CO1 (700 bp) from 39 individuals spread across their sympatric European ranges provided unequivocal support for five taxa (3-22 diagnostic DNA base pair sites per species). Inclusion of 20 Irish specimens to the dataset revealed >= 2.3% sequence divergence between taxa and 200 m) whilst B. cryptarum was relatively more abundant at higher altitudes. Bombus magnus was rarely encountered at urban sites. Both B. lucorum and B. terrestris are nowadays reared commercially for pollination and transported globally. Our RFLP approach to identify native fauna can underpin ecological studies of these important cryptic species as well as the impact of commercial bumble bees on them.

Hydrogenation/hydrogenolysis of disulfides using sulfided Ni/Mo catalysts

The mechanism of the hydrogenation/hydrogenolysis of dinitrodiphenyldisulfides using sulfided NiMo/ gamma Al2O3 catalysts has been examined in detail. Although two routes are possible, the major pathway involves an initial S-S bond cleavage followed by reduction of the nitro group. Importantly, the disulfide hydrogenolysis occurs in the absence of the catalyst with the role of the catalyst thought to be to activate the hydrogen and trap the cleaved intermediate as well as facilitate the reduction of the nitro group. Monitoring the mass balance throughout the reaction demonstrates the difficulty in measuring intrinsic kinetics for gas-liquid-solid reactions. Although the mass balance is restored at the end of the reaction, up to 45% of the substrate/products is found to be adsorbed on the catalyst during the reaction. (c) 2008 Elsevier B.V. All rights reserved.

Activation of waste MDF sawdust charcoal and its reactive dye adsorption characteristics

This paper reports an experimental investigation of converting waste medium density fibreboard (MDF) sawdust into chars and activated carbon using chemical activation and thermal carbonisation processes. The MDF sawdust generated during the production of architectural mouldings was characterised and found to have unique properties in terms of fine particle size and high particle density. It also has a high content of urea formaldehyde resin used as a binder in the manufacturing of MDF board. Direct thermal carbonisation and chemical activation of the sawdust by metal impregnation and acid (phosphoric acid) treatment prior to pyrolysis treatment were carried out. The surface morphology of the raw dust, its chars and activated carbon were examined using scanning electron microscopy (SEM). Adsorptive properties and total pore volume of the materials were also analysed using the BET nitrogen adsorption method. Liquid adsorption of a reactive dye (Levafix Brilliant red E-4BA) by the derived sawdust carbon was investigated in batch isothermal adsorption process and the results compared to adsorption on to a commercial activated carbon (Filtrasorb F400). The MDF sawdust carbon exhibited in general a very low adsorption capacity towards the reactive dye, and physical characterisation of the carbon revealed that the conventional chemical activation and thermal carbonisation process were ineffective in developing a microporous structure in the dust particles. The small size of the powdery dust, the high particle density, and the presence of the urea formaldehyde resin all contributed to the difficulty of developing a proper porous structure during the thermal and chemical activation process. Finally, activation of the dust material in a consolidated form (cylindrical pellet) only achieved very limited improvement in the dye adsorption capacity. This original study, reporting some unexpected outcomes, may serve as a stepping-stone for future investigations of recycle and reuse of the waste MDF sawdust which is becoming an increasing environmental and cost liability. (C) 2004 Elsevier Ltd. All rights reserved.

Bimanual aiming and overt attention: one law for two hands

Reaching to interact with an object requires a compromise between the speed of the limb movement and the required end-point accuracy. The time it takes one hand to move to a target in a simple aiming task can be predicted reliably from Fitts' law, which states that movement time is a function of a combined measure of amplitude and accuracy constraints (the index of difficulty, ID). It has been assumed previously that Fitts' law is violated in bimanual aiming movements to targets of unequal ID. We present data from two experiments to show that this assumption is incorrect: if the attention demands of a bimanual aiming task are constant then the movements are well described by a Fitts' law relationship. Movement time therefore depends not only on ID but on other task conditions, which is a basic feature of Fitts' law. In a third experiment we show that eye movements are an important determinant of the attention demands in a bimanual aiming task. The results from the third experiment extend the findings of the first two experiments and show that bimanual aiming often relies on the strategic co-ordination of separate actions into a seamless behaviour. A number of the task specific strategies employed by the adult human nervous system were elucidated in the third experiment. The general strategic pattern observed in the hand trajectories was reflected by the pattern of eye movements recorded during the experiment. The results from all three experiments demonstrate that eye movements must be considered as an important constraint in bimanual aiming tasks.

A Brown Dwarf Mass Donor in an Accreting Binary

A long-standing and unverified prediction of binary star evolution theory is the existence of a population of white dwarfs accreting from substellar donor stars. Such systems ought to be common, but the difficulty of finding them, combined with the challenge of detecting the donor against the light from accretion, means that no donor star to date has a measured mass below the hydrogen burning limit. We applied a technique that allowed us to reliably measure the mass of the unseen donor star in eclipsing systems. We were able to identify a brown dwarf donor star, with a mass of 0.052 ± 0.002 solar mass. The relatively high mass of the donor star for its orbital period suggests that current evolutionary models may underestimate the radii of brown dwarfs.

Decision making by senior social workers at point of first referral

In the United Kingdom there has been difficulty in implementing the family support provisions contained in the 1989 Children Act, largely because of continued emphasis on child protection activity by local authorities. There is an observable international tendency for child-care referrals to receive investigative response, resulting in families being traumatized and children's needs left unmet. There has been a lack of research into how child-care referrals are initially categorized by senior social workers. This paper reports on research undertaken in two Health and Social Services Trusts within Northern Ireland to ascertain if it might be possible to treat more initial referrals as 'child-care problem enquiries' as opposed to 'child protection investigations'. Results demonstrate that, while such potential may exist, a preoccupation with the management of risk could lead to the development of child-care problems receiving quasi-child protection responses. Consequently, changes in initial decision making may not have the full intended effects in terms of the organizational release of resources for family support or a lessening of the traumatic impact upon families.

Individual differences in trajectories of arithmetical development in typically achieving 5-to 7-year-olds

The arithmetical performance of typically achieving 5- to 7-year-olds (N = 29) was measured at four 6-month intervals. The same seven tasks were used at each time point: exact calculation, story problems, approximate arithmetic, place value, calculation principles, forced retrieval, and written problems. Although group analysis showed mostly linear growth over the 18-month period, analysis of individual differences revealed a much more complex picture. Some children exhibited marked variation in performance across the seven tasks, including evidence of difficulty in some cases. Individual growth patterns also showed differences in developmental trajectories between children on each task and within children across tasks. The findings support the idea of the componential nature of arithmetical ability and underscore the need for further longitudinal research on typically achieving children and of careful consideration of individual differences. (C) 2009 Elsevier Inc. All rights reserved.

‘‘An old quarrel between us that will never be at an end": Middleton’s Women Beware Women and Late Jacobean Religious Politics

In this article, I examine Thomas Middleton's Women Beware Women as a response to the particular religio-political context in the years surrounding 1621. The onset of the Thirty Years War in 1618 and the subsequent humiliation of James' son-in-law Frederick, Elector of Palatine, the vexed question of a possible Catholic marriage for Charles, Prince of Wales, the ever present difficulty of Anglo-Catholic relations, particularly with Spain, as well as growing religious factionalism within the Church of England between Calvinists and Arminians: all contributed towards a culturally febrile atmosphere, one to which, as I will argue, Middleton was well placed to respond. Given Middleton's Calvinistic beliefs, I suggest that Women Beware Women offers an acerbic examination of contemporary debates concerning human will, especially women's will, as well as promoting a sceptically apocalyptic anti-Catholic agenda throughout. I also examine the religious language and imagery used to construct Bianca as the whore of Babylon, and argue that her emergence and fall offer a political commentary on the precarious position of the English Church around 1621.