Health care professionals’ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic.

Background: Cachexia has been defined as an on-going loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. It can be found in up to 80% of patients with advanced cancer and has profound psycho-social consequences for patients and their families. There is a paucity of studies examining the role and experience of healthcare professionals in relation to cachexia and existing studies suggest that professional staff have limited understanding and do not intervene effectively.
Aim: To identify barriers and facilitators to good practice in cachexia care in order to inform future developments in service provision.
Design: An exploratory qualitative study was conducted employing semi-structured interviews with a range of healthcare professionals recruited purposefully from an Australian hospital. Interviews were conducted in private rooms within the hospital.
Setting/participants: A range of healthcare professionals responsible for cancer care were recruited from a large Australian teaching hospital.
Results: Interviews were conducted with 8 healthcare professionals responsible for delivering cancer care. Four themes were identified: formal and informal education, knowledge and understanding, truth telling in cachexia and palliative care, and, a multi-disciplinary approach. Findings show how improved knowledge and understanding across a staff body can lead to improved staff confidence and a willingness to address cancer cachexia and its consequences with patients and their families.
Conclusion: Comparison with previous studies illustrates the importance of improving knowledge and understanding about cachexia and how this can contribute to staff having the skills and experience necessary to address cachexia and provide an improved care experience for patients and carers.

Health and Social Care Workers Perceptions of Novel Psychoactive substances in Northern Ireland

Background: The EU Early Warning System currently monitors more than 450 new psychoactive substances (EMCDDA, 2015), far outweighing the total number of illicit drugs under international control (UNODC, 2013). Due to the recent emergence of NPS and rapidly changing nature of the market, evidence about the way in which the emerging drugs are managed in health and social care settings is limited. Methods: The study adopted a mixed methods design, utilising a cross sectional survey and follow up telephone interviews to capture data from staff working in drug and alcohol related services in statutory and voluntary sectors, across the five Health and Social Care (HSC) Trust areas in Northern Ireland. 196 staff participated in the survey and 13 took part in follow up telephone interviews. Results: Study respondents reported that addressing NPS related issues with service users was a key aspect of their daily role and function. Levels of injecting behaviours were also viewed as relatively high by the study participants. Almost all workers used harm reduction as their primary approach when working with service users and the majority of respondents called for additional practical training in relation to addressing drug interactions and intervening with NPS related issues.

A Central Role for Monocyte-Platelet Interactions in Heart Failure

Heart failure (HF) is an increasingly prevalent and costly multifactorial syndrome with high morbidity and mortality rates. The exact pathophysiological mechanisms leading to the development of HF are not completely understood. Several emerging paradigms implicate cardiometabolic risk factors, inflammation, endothelial dysfunction, myocardial fibrosis, and myocyte dysfunction as key factors in the gradual progression from a healthy state to HF. Inflammation is now a recognized factor in disease progression in HF and a therapeutic target. Furthermore, the monocyte-platelet interaction has been highlighted as an important pathophysiological link between inflammation, thrombosis, endothelial activation, and myocardial malfunction. The contribution of monocytes and platelets to acute cardiovascular injury and acute HF is well established. However, their role and interaction in the pathogenesis of chronic HF are not well understood. In particular, the cross talk between monocytes and platelets in the peripheral circulation and in the vicinity of the vascular wall in the form of monocyte-platelet complexes (MPCs) may be a crucial element, which influences the pathophysiology and progression of chronic heart disease and HF. In this review, we discuss the role of monocytes and platelets as key mediators of cardiovascular inflammation in HF, the mechanisms of cell activation, and the importance of monocyte-platelet interaction and complexes in HF pathogenesis. Finally, we summarize recent information on pharmacological inhibition of inflammation and studies of antithrombotic strategies in the setting of HF that can inform opportunities for future work. We discuss recent data on monocyte-platelet interactions and the potential benefits of therapy directed at MPCs, particularly in the setting of HF with preserved ejection fraction.

Self-perceptions of the role of the planner

The role of the planning practitioner has received considerable attention in a diverse range of theoretical and empirical debates within the broad spectrum of planning scholarship from normative debates surrounding the planner's role in society, to more empirical investigations into the skills, attributes, and evolving nature of planning practitioners. Fundamental questions surrounding the role and purpose of planners have also entered into more mainstream discussions as the democratic nature of the planning system has been consistently undermined by allegations of misconduct, corruption, and incompetence. Despite the broad range of literature and debate which centres on the role of the planner, relatively few studies have explored the views of planning practitioners themselves, making it difficult to judge whether the ideas of planning academics are actually shared by those in the field. In this paper we seek to address this particular gap and argue that such insights are critical in determining the extent to which planning practitioners serve to challenge, maintain, or reinforce existing power imbalances in the planning system. The methodology consists of a series of qualitative interviews with twenty local authority planners working throughout the Greater Dublin Area, Ireland. The results suggest that planners' self-perceptions of their role tend to reflect traditional pluralist and managerialist perspectives. More broadly, the results suggest that the role orientations of contemporary planners are being shaped by dominant discourses in current planning ideology — namely, collaborative and participatory approaches

Informal caregiving and mental ill health – differential relationships by workload, gender, age and area-remoteness in a UK region

Informal caregiving can be a demanding role which has been shown to impact on physical, psychological and social wellbeing. Methodological weaknesses including small sample sizes and subjective measures of mental health have led to inconclusive evidence about the relationship between informal caregiving and mental health. This paper reports on a study carried out in a UK region which investigated the relationship between informal caregiving and mental ill health. The analysis was conducted by linking three datasets, the Northern Ireland Longitudinal Study, the Northern Ireland Enhanced Prescribing Database and the Proximity to Service Index from the Northern Ireland Statistics and Research Agency. Our analysis used both a subjective measure of mental ill health, i.e. a question asked in the 2011 Census, and an objective measure, whether the respondents had been prescribed antidepressants by a General Practitioner between 2010 and 2012. We applied binary logistic multilevel modelling to these two responses to test whether, and for what sub-groups of the population, informal caregiving was related to mental ill health. The results showed that informal caregiving per se was not related to mental ill health although there was a strong relationship between the intensity of the caregiving role and mental ill health. Females under 50, who provided over 19 hours of care, were not employed or worked part-time and who provided care in both 2001 and 2011 were at a statistically significantly elevated risk of mental ill health. Caregivers in remote areas with limited access to shops and services were also at a significantly increased risk as evidenced by prescription rates for antidepressants. With community care policies aimed at supporting people to remain at home, the paper highlights the need for further research in order to target resources appropriately.

Nursing and medical students as agents of change in health care: impact of schools core values and culture-a discussion paper

Within the UK the quality of care delivered in some hospitals, nursing homes and caring facilities has been the subject of significant enquiry, challenge and concern in recent years. There was need for a change in the culture of patient and client care. Traditionally a change in culture is seen as moving from an organisational head through to the organisation and in this case through to front-line care. This hasn’t necessarily achieved the desired effect and impact in terms of quality of care within the UK. Historically, certainly nurses have acted more as recipients of change, rather than agents of change
This paper suggests that schools of nursing and medicine with robust core values and a more consistently enacted culture of care, are better able and more likely to transfer this to nursing and medical students within their professional socialisation. In addition, and rather than the newly qualified nurse or doctor being absorbed into existing cultures of care delivery (which are not necessarily always reflecting high qualities of care), schools of nursing and medicine could better facilitate the development of more `agency’ within students and better equipping the students on qualification and stepping into practice, with a role and function as potential agents of change. Effective leadership within schools of nursing and medicine can both translate to quality and consistency, and enactment of organisational core values and working culture. The working culture of schools is intrinsic to developing students as agents of change

The quality of parenting of individuals who had failed to thrive as children

Parenting behaviour is determined by a range of factors including personality, psychopathology, values, social support, child characteristics and socio-cultural influences. It has also been suggested that an individual's style of child-rearing is influenced by the style of parenting that they experienced as children. The relationships between children who fail-to-thrive and their parents are often characterized by interactional difficulties. Previous research using retrospective accounts suggested that mothers of children who fail-to-thrive for non-organic reasons themselves showed high levels of abuse, neglect, and deprivation during their childhoods. However, to date no one has investigated prospectively what kinds of parents failure-to-thrive individuals become. This paper examines the parenting experiences of individuals who had received psychosocial intervention for their non-organic failure-to-thrive as children over 20 years ago. Results suggest that where initial intervention failed to bring about long-term changes in family interactional patterns, there was a greater incidence of failure-to-thrive in the next generation. These families were characterized by dissatisfaction with the child, high levels of stress associated with the parenting role, and low levels of social support. However, where the family environment in the original study had changed substantially, the former clients' outcomes were more positive with their own children. These parents tended to find interaction with their children more rewarding, had good support networks and low levels of stress. The characteristics of particular cases are discussed in detail to illustrate differences between these two groups of individuals.

Anna Magdalena as Bach's Copyist

Among the wives of eighteenth-century composers, no one is perhaps more favourably and affectionately described than Bach's second wife, Anna Magdalena (1701-1760). She has been commonly pictured as her husband's trusted assistant, copying his works in handwriting which closely resembled her husband's beautiful calligraphy. No one appreciates her contributions more than today's musicologists, for her copies are usually 'neat and accurate', and are often among the most important primary sources when Bach's autographs do not survive. Occasionally, however, it is difficult to accommodate this patronising view of her role and its significance. It is well known, for instance, that her copy of Bach's Cello Suites (BWV 1007-1012) contains an unusually large number of inaccuracies and copying errors. One must ask how many of these blunders should be ascribed to her. How would a 'neat and accurate' copyist produce such an error-ridden manuscript if she had made it from a fair copy? In this paper, I shall first discuss Anna's copies of Bach's works, and see if any particular patterns or tendencies in her copying activities emerge when these are placed in this broader chronological context. In an attempt to evaluate her performance as a copyist, I shall look at typical situations in which she worked, while at the same time seeking to discover what additional values her copies may bring to our studies of Bach's life and works.

Interstitial cells of blood vessels

Blood vessels are made up of several distinct cell types. Although it was originally thought that the tunica media of blood vessels was composed of a homogeneous population of fully differentiated smooth muscle cells, more recent data suggest the existence of multiple smooth muscle cell subpopulations in the vascular wall. One of the cell types contributing to this heterogeneity is the novel, irregularly shaped, noncontractile cell with thin processes, termed interstitial cell, found in the tunica media of both veins and arteries. While the principal role of interstitial cells in veins seems to be pacemaking, the role of arterial interstitial cells is less clear. This review summarises the knowledge of the functional and structural properties of vascular interstitial cells accumulated so far, offers hypotheses on their physiological role, and proposes directions for future research.

An exploratory study of Principal Investigator roles in UK University Proof-of-Concept processes: an Absorptive capacity perspective

The increasing emphasis on academic entrepreneurship, technology transfer and research commercialisation within UK universities is predicated on basic research being developed by academics into commercial entities such as university spin-off companies or licensing arrangements. However, this process is fraught with challenges and risks, given the degree of uncertainty regarding future returns. In an attempt to minimise such risks, the Proof-of-Concept (PoC) process has been developed within University Science Park Incubators (USIs) to test the technological, business and market potential of embryonic technology. The key or the pivotal stakeholder within the PoC is the Principal Investigator (PI), who is usually the lead academic responsible for the embryonic technology. Within the current literature, there appears to be a lack of research pertaining to the role of the PI in the PoC process. Moreover, Absorptive Capacity (ACAP) has emerged within the literature as a theoretical framework or lens for exploring the development and application of new knowledge and technology, where the USI is the organisation considered in the current study. Therefore, the aim of this paper is to explore the role and influence of the PI in the PoC process within a USI setting using an ACAP perspective. The research involved a multiple case analysis of PoC applications within a UK university USI. The results demonstrate the role of the PI in developing practices and routines within the PoC process. These practices and processes were initially tacit and informal in nature but became more explicit and formal over time so that knowledge was retained within the USI after the PIs had completed the PoC process. © 2010 The Authors. R&D Management © 2010 Blackwell Publishing Ltd.

Whole-Life Costing for Capability

In recent years, there has been growing emphasis on the need to provide transparency in the costs of engineering programmes, leading to growing emphasis on Whole Life Cost (WLC) modelling techniques. This has arisen largely due to the increased interested in longer timescale projects and programmes, combined with the emergence of system-of-systems and network enabled capability concepts. This change in the implementation and management of large scale projects has necessitated the development of alternative methods of evaluating performance. This work seeks to address the shortfalls in current costing methodologies when applied to these highly flexible environments, and to propose a conceptual model for dealing with the encountered complexities. The approach has a fundamental role and potential significance in the future of whole life costing for Network Enabled Capability (NEC) but can also offer a potential paradigm shift for costing in traditional engineering environments.

Notating the Unpredictable

Notation can be seen to sit comfortably between theory and practice as it symbolizes practice, generates and implements theory, and produces practice. Historically, its presence changes in significance across the development of activities such as music or architecture. From design tool to canonic text, notational artefacts both solidify and formalize practice, as will be expanded below. How, then, does the role and function of notation change with specific contemporary practices, which are by definition ill-defined and feed off fluidity and change? What is the nature of notation in distributed and collaborative practices such as improvised music or network music performance?

The emerging relevance of the cysteine protease Cathepsin S in disease

Cathepsin S is a lysosomal cysteine protease that has been shown to play a key role in MHC class II antigen presentation. Consequently, it has been extensively evaluated as a therapeutic target in autoimmune diseases, such as rheumatoid arthritis and psoriasis. Additionally, clinical and mechanistic evidence is emerging, revealing its inappropriate expression and secretion in a wide range of disease states including atherosclerosis and tumourigenesis. This review covers the known role and consequences of cathepsin S activity in these pathological disorders, highlighting various studies that have demonstrated its utility as a therapeutic target. This review also examines challenges that exist towards the development of agents that specifically target this protease and discusses the studies to date that have applied cathepsin S inhibitors in disease models.

Unheard Voices: Stories from the Troubles

Produced in association with WAVE Trauma Centre, this short film records the experiences of six victims and survivors of the Northern Irish Troubles. Filmed and edited collaboratively, UV addresses issues of trauma, loss, justice and recovery. The story-tellers range from a police widow, to the brother of a sectarian victim, to a youth worker who lost is legs in an explosion. This film has been screened, with public discussions, between 2010 and 2012 by the Good Relations Departments of the following Borough and City Councils - Belfast, Derry/Londonderry, Lisburn, Ballymena, Coleraine, Moyle and Newtownabbey. It has also been screened at the Hallwells Contemporary Arts Centre, Buffalo, and at St Bonaventure University, NY (2012)

http://www.wavetraumacentre.org.uk/about-us/wave-projects/unheard-voices

Further Information:

This 30 minute documentary film was produced in collaboration with WAVE Trauma Centre, Belfast. Working closely with six survivors of the Troubles violence in Northern Ireland through all stages of production and exhibition, the film contributes to on-going discussions about dealing with the conflicted past in a contested present. The role of storytelling, identified by two government reports – the Bloomfield Report and the Eames-Bradley Report - as an important method of addressing the violent past, is one of the key research questions involved in the research. Public screenings and discussions have been organised by the Good Relations Departments of seven borough councils (Belfast, Lisburn, Derry, Ballymena, Newtownabbey, Coleraine and Moyle). The film has also been screened in New York State and London. One of the recurring themes brought up in these public discussions in the role and limits of storytelling alongside the legal issues of justice, prosecutions and reparations. An accompanying co-written article with PhD student, Jolene Mairs, 'Unheard Voices' in Mc Keogh, C. and O'Connel, D. (eds) (2012) Documentary in a Changing State,Cork University Press, is part of the portfolio presented for REF.

Exploring consumer's preferences for farmed sea bream

Sea bream (Sparus aurata) production plays a significant part in Italian aquaculture, contributing to almost 18% of national pisciculture sales revenue. In recent years, Italian firms faced higher competition from countries with lower production costs. This prompted responses toward both cost reduction and product differentiation. The objective of this study was to investigate the preferences of Italian consumers for sea bream from fish farms, with a focus on aspects of product differentiation as gleaned from the analysis of the market situation: price, product origin, type and place of fish farming, and, in particular, type of feed. Data were collected with a consumers’ survey using personal interviews conducted on a questionnaire that included a choice experiment. Consumer preferences were analyzed with choice models based on stated preference data. The models made it possible to evaluate the potential of products with different combinations of attributes for which there is currently no market information available. In particular, the country of origin emerged as an important element of consumer choice, and to a lesser degree, organic certification and fish farming in marine cages also play a relevant role and may command a price premium.