The Effect of Community-Based Specialist Palliative Care Teams on Place of Care

BACKGROUND: Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death.

OBJECTIVE: The study objective was to examine the place of care in the last 30 days of life.

METHODS: In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort.

RESULTS: After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care.

CONCLUSION: Examining place of care in the last month can effectively illustrate the service use trajectory over time.

Spatial Allocation of Material Flow Analysis: A Geographic Information System Application of Material Flow Analysis in Ireland

This study concerns the spatial allocation of material flows, with emphasis on construction material in the Irish housing sector. It addresses some of the key issues concerning anthropogenic impact on the environment through spatial temporal visualisation of the flow of materials, wastes and emissions at different spatial levels. This is presented in the form of a spatial model, Spatial Allocation of Material Flow Analysis (SAMFA), which enables the simulation of construction material flows and associated energy use. SAMFA parallels the Island Limits project (EPA funded under 2004-SD-MS-22-M2), which aimed to create a material flow analysis of the Irish economy classified by industrial sector. SAMFA further develops this by attempting to establish the material flows at the subnational geographical scale that could be used in the development of local authority (LA) sustainability strategies and spatial planning frameworks by highlighting the cumulative environmental impacts of the development of the built environment. By drawing on the idea of planning support systems, SAMFA also aims to provide a cross-disciplinary, integrative medium for involving stakeholders in strategies for a sustainable built environment and, as such, would help illustrate the sustainability consequences of alternative The pilot run of the model in Kildare has shown that the model can be successfully calibrated and applied to develop alternative material flows and energy-use scenarios at the ED level. This has been demonstrated through the development of an integrated and a business-as-usual scenario, with the former integrating a range of potential material efficiency and energysaving policy options and the latter replicating conditions that best describe the current trend. Their comparison shows that the former is better than the latter in terms of both material and energy use. This report also identifies a number of potential areas of future research and areas of broader application. This includes improving the accuracy of the SAMFA model (e.g. by establishing actual life expectancy of buildings in the Irish context through field surveys) and the extension of the model to other Irish counties. This would establish SAMFA as a valuable predicting and monitoring tool that is capable of integrating national and local spatial planning objectives with actual environmental impacts. Furthermore, should the model prove successful at this level, it then has the potential to transfer the modelling approach to other areas of the built environment, such as commercial development and other key contributors of greenhouse emissions. The ultimate aim is to develop a meta-model for predicting the consequences of consumption patterns at the local scale. This therefore offers the possibility of creating critical links between socio technical systems with the most important challenge of all the limitations of the biophysical environment.

Blue luminous stars in nearby galaxies: Quantitative spectral analysis of M33 B-type supergiant stars

We present the detailed spectral analysis of a sample of M33 B-type supergiant stars, aimed at the determination of their fundamental parameters and chemical composition. The analysis is based on a grid of non-LTE metal line-blanketed model atmospheres including the effects of stellar winds and spherical extension computed with the code FASTWIND. Surface abundance ratios of C, N, and O are used to discuss the chemical evolutionary status of each individual star. The comparison of observed stellar properties with theoretical predictions of massive star evolutionary models shows good agreement within the uncertainties of the analysis. The spatial distribution of the sample allows us to investigate the existence of radial abundance gradients in the disk of M33. The comparison of stellar and H II region O abundances ( based on direct determinations of the electron temperature of the nebulae) shows good agreement. Using a simple linear radial representation, the stellar oxygen abundances result in a gradient of -0.0145 +/- 0.005 dex arcmin(-1) (or -0.06 +/- 0.02 dex kpc(-1)) up to a distance equal to similar to 1.1 times the isophotal radius of the galaxy. A more complex representation cannot be completely discarded by our stellar sample. The stellar Mg and Si abundances follow the trend displayed by O abundances, although with shallower gradients. These differences in gradient slope cannot be explained at this point. The derived abundances of the three alpha-elements yield solar metallicity in the central regions of the disk of M33. A comparison with recent planetary nebula data from Magrini and coworkers indicates that the disk of M33 has not suffered from a significant O enrichment in the last 3 Gyr.