Healthcare professionals’ response to cachexia in advanced cancer: A qualitative study

Purpose/Objectives: To explore healthcare professionals' experience, understanding, and perception of the needs of patients with cachexia in advanced cancer.

Research Approach: A qualitative approach based on symbolic interactionism.

Setting: A regional cancer center in a large teaching hospital in the United Kingdom.

Participants: 34 healthcare professionals who had experience providing care to patients with cachexia in advanced cancer.

Methodologic Approach: Data collection consisted of two phases: focus group and semistructured interviews. Interviews were digitally recorded and transcribed verbatim for analysis. This article reports on findings from the second phase of data collection.

Findings: Analysis revealed that professional approaches to cachexia were influenced by three overarching and interthinking themes: knowledge, culture, and resources. Healthcare professionals commonly recognized the impact of the syndrome; however, for nonpalliative healthcare professionals, a culture of avoidance and an overreliance on the biomedical model of care had considerable influence on the management of cachexia in patients with advanced cancer.

Conclusions: Cachexia management in patients with advanced cancer can be difficult and is directed by a variable combination of the influence of knowledge, culture of the clinical area, and available resources. Distinct differences exist in the management of cachexia among palliative and nonpalliative care professionals.

Interpretation: This study presented a multiprofessional perspective on the management of cachexia in patients with advanced cancer and revealed that cachexia is a complex and challenging syndrome that needs to be addressed from a holistic model of care.

Knowledge Translation: Cachexia management in patients with advanced cancer is complex and challenging and is directed by a combination of variables. An overreliance on the biomedical model of health and illness occurs in the management of cachexia in patients with advanced cancer. Cachexia needs to be addressed from a holistic model of care to reflect the multidimensional needs of patients and their families.

Evidence for pain in decapod crustaceans

Vast numbers of decapods are used in human food and currently subject to extreme treatments and there is concern that they might experience pain. If pain is indicated then a positive change in the care afforded to this group has the potential to produce a major advance in animal welfare. However, it is difficult to determine pain in animals. The vast majority of animal phyla have a nociceptive ability that enables them to detect potential or actual tissue damage and move away by a reflex response. In these cases there is no need to assume an unpleasant feeling that we call pain. However, various criteria have been proposed that might indicate pain rather than simple nociception. Here, with respect to decapod crustaceans, four such criteria are discussed: avoidance learning, physiological responses, protective motor reactions and motivational trade-offs. The evidence from various experiments indicates that all four criteria are fulfilled and the data are thus consistent with the idea of pain. The responses cannot be explained by nociception alone but, it is still difficult to state categorically that pain is experienced by decapods. However, the evidence is as strong for this group as it is for fish but the idea that fish experience pain has broader acceptance than does the idea of decapod pain. A taxonomic bias is evident in the evaluation of experimental data. © 2012 Universities Federation for Animal Welfare.

Freshwater pearl mussels show plasticity of responses to different predation risks but also show consistent individual differences in responsiveness

Animals often show behavioural plasticity with respect to predation risk but also show behavioural syndromes in terms of consistency of responses to different stimuli. We examine these features in the freshwater pearl mussel. These bivalves often aggregate presumably to reduce predation risk to each individual. Predation risk, however, will be higher in the presence of predator cues. Here we use dimming light, vibration and touch as novel stimuli to examine the trade-off between motivation to feed and motivation to avoid predation. We present two experiments that each use three sequential novel stimuli to cause the mussels to close their valves and hence cease feeding. We find that mussels within a group showed shorter closure times than solitary mussels, consistent with decreased vulnerability to predation in group-living individuals. Mussels exposed to the odour of a predatory crayfish showed longer closures than control mussels, highlighting the predator assessment abilities of this species. However, individuals showed significant consistency in their closure responses across the trial series, in line with behavioural syndrome theory. Our results show that bivalves trade-off feeding and predator avoidance according to predation risk but the degree to which this is achieved is constrained by behavioural consistency. © 2011 Elsevier B.V.

Behavioural and physiological responses of heifer calves to acute stressors: long-term consistency and relationship with adult reactivity to milking

The present study investigated the long-term consistency of individual differences in dairy cattles’ responses in tests of behavioural and hypothalamo–pituitary–adrenocortical (HPA) axis reactivity, as well as the relationship between responsiveness in behavioural tests and the reaction to first milking. Two cohorts of heifer calves, Cohorts 1 (N = 25) and 2 (N = 16), respectively, were examined longitudinally from the rearing period until adulthood. Cohort 1 heifers were subjected to open field (OF), novel object (NO), restraint, and response to a human tests at 7 months of age, and were again observed in an OF test during first pregnancy between 22 and 24 months of age. Subsequently, inhibition of milk ejection and stepping and kicking behaviours were recorded in Cohort 1 heifers during their first machine milking. Cohort 2 heifers were individually subjected to OF and NO tests as well as two HPA axis reactivity tests (determining ACTH and/or cortisol response profiles after administration of exogenous CRH and ACTH, respectively) at 6 months of age and during first lactation at approximately 29 months of age. Principal component analysis (PCA) was used to condense correlated response measures (to behavioural tests and to milking) within ages into independent dimensions underlying heifers’ reactivity. Heifers demonstrated consistent individual differences in locomotion and vocalisation during an OF test from rearing to first pregnancy (Cohort 1) or first lactation (Cohort 2). Individual differences in struggling in a restraint test at 7 months of age reliably predicted those in OF locomotion during first pregnancy in Cohort 1 heifers. Cohort 2 animals with high cortisol responses to OF and NO tests and high avoidance of the novel object at 6 months of age also exhibited enhanced cortisol responses to OF and NO tests at 29 months of age. Measures of HPA axis reactivity, locomotion, vocalisation and adrenocortical and behavioural responses to novelty were largely uncorrelated, supporting the idea that stress responsiveness in dairy cows is mediated by multiple independent underlying traits. Inhibition of milk ejection and stepping and kicking behaviours during first machine milking were not related to earlier struggling during restraint, locomotor responses to OF and NO tests, or the behavioural interaction with a novel object. Heifers with high rates of OF and NO vocalisation and short latencies to first contact with the human at 7 months of age exhibited better milk ejection during first machine milking. This suggests that low underlying sociality might be implicated in the inhibition of milk ejection at the beginning of lactation in heifers.

The size and shape of shells used by hermit crabs: A multivariate analysis of Clibanarius erythropus

Shell attributes Such as weight and shape affect the reproduction, growth, predator avoidance and behaviour of several hermit crab species. Although the importance of these attributes has been extensively investigated, it is still difficult to assess the relative role of size and shape. Multivariate techniques allow concise and efficient quantitative analysis of these multidimensional properties, and this paper aims to understand their role in determining patterns of hermit crab shell use. To this end, a multivariate approach based on a combination of size-unconstrained (shape) PCA and RDA ordination was used to model the biometrics of southern Mediterranean Clibanarius erythropus Populations and their shells. Patterns of shell utilization and morphological gradients demonstrate that size is more important than shape, probably due to the limited availability of empty shells in the environment. The shape (e.g. the degree of shell elongation) and weight of inhabited shells vary considerably in both female and male crabs. However, these variations are clearly accounted for by crab biometrics in males only. Oil the basis of statistical evidence and findings from past studies. it is hypothesized that larger males of adequate size and strength have access to the larger, heavier and relatively more available shells of the globose Osilinus turbinatus, which cannot be used by average-sized males or by females investing energy in egg production. This greater availability allows larger males to select more Suitable Shapes. (C) 2009 Elsevier Masson SAS. All rights reserved.

A Comparative Look on Foreign State Compulsion as a Defence in Antitrust Litigation

This paper presents and investigates the foreign state compulsion as a defence in transnational antitrust cases. It takes a comparative approach by looking at the doctrine and its developments in the United States and in the European Union. To illustrate the relevance of the defence and the difficulties of its applicability, this paper analyses the new antitrust case law emerging in the US involving Chinese export cartels. It is argued that at present the standard required to prove compulsion is too high to serve its function.

Healthful grocery shopping. Perceptions and barriers

While there is evidence of the factors influencing the healthfulness of consumers' food choice, little is known about how consumers perceive the healthfulness of their shopping. This study aimed to explore consumers' perceptions of, and identify barriers to, conducting a healthful shop. Using a qualitative approach, consisting of an accompanied shop and post-shop telephone interview, 50 grocery shoppers were recruited. Results showed that consumers used three criteria to identify a healthful shop: (1) inclusion of healthful foods; (2) avoidance or restriction of particular foods; and (3) achieving a balance between healthful and unhealthful foods. Those who take a balanced approach employ a more holistic approach to their diet while those who avoid or include specific foods may be setting criteria to purchase only certain types of food. The effectiveness of any of these strategies in improving healthfulness is still unclear and requires further investigation. Two barriers to healthful shopping were: (i) lack of self-efficacy in choosing, preparing and cooking healthful foods and (ii) conflicting needs when satisfying self and others. This highlights the need for interventions targeted at building key food skills and for manufacturers to make healthful choices more appealing. (C) 2013 Elsevier Ltd. All rights reserved.

Trends in skin cancer knowledge, sun protection practices and behaviours in the Northern Ireland population

Background: Sun exposure increases risk of skin cancer, especially melanoma, incidence of which continues to rise. Reported skin cancer knowledge and trends in sun care behaviours are documented in a UK region where there has been 20 years of sun-related health promotion campaigns. Methods: In 2000, 2004 and 2008, a 'care in the sun' module was included in the Northern Ireland (NI) Omnibus survey. Randomly selected subjects were asked to complete a sun-related questionnaire and proportions of respondents analysed by demographic and socio-economic factors, with differences tested using z-tests and the chi-squared test. Results: Around 3623 persons responded. Skin cancer knowledge was high (97). Sun avoidance decreased with time and was lowest among younger age groups and males. Sunscreen use was high (70), unchanged over 8 years, and more likely among younger age groups, females, those in paid employment, and those with tertiary level education. Use of sunscreen with minimum Sun Protection Factor (SPF) 15 (a campaign message) increased from 45 to 70 (P

Newly Acquired Fear of Falling Leads to Altered Eye Movement Patterns and Reduced Stepping Safety: A Case Study

This opportune case study describes visual and stepping behaviours of an 87 year old female (P8), both prior to, and following two falls. Before falling, when asked to walk along a path containing two stepping guides positioned before and after an obstacle, P8 generally visually fixated the first stepping guide until after foot contact inside it. However, after falling P8 consistently looked away from the stepping guide before completing the step into it in order to fixate the upcoming obstacle in her path. The timing of gaze redirection away from the target (in relation to foot contact inside it) correlated with absolute stepping error. No differences in eyesight, cognitive function, or balance were found between pre- and post-fall recordings. However, P8 did report large increases in fall-related anxiety and reduced balance confidence, supporting previously suggested links between anxiety/increased fear or falling and maladaptive visual/stepping behaviours. The results represent a novel insight into how psychological and related behavioural factors can change in older adults following a fall, and provide a possible partial rationalisation for why recent fallers are more likely to fall again in the following 12 months. These findings highlight novel possibilities for falls prevention and rehabilitation.

How to classify the Oldest Old according to Health Status: A study of 1160 subjects belonging to 552 90+ Italian sibships characterised by familial longevity recruited within the GeHA EU project

The health status of the oldest old, the fastest increasing population segment worldwide, progressively becomes more heterogeneous, and this peculiarity represents a major obstacle to their classification. We compared the effectiveness of four previously proposed criteria (Franceschi et al., 2000; Evert et al., 2003; Gondo et al., 2006; Andersen-Ranberg et al., 2001) in 1160 phenotypically fully characterized Italian siblings of 90 years of age and older (90+, mean age: 93 years; age range: 90–106 years) belonging to 552 sib-ships, recruited in Northern, Central and Southern Italy within the EU-funded project GEHA, followed for a six-year-survival. Main findings were: (i) ‘‘healthy’’ subjects varied within a large range, i.e. 5.2% (Gondo), 8.7% (Evert), 17.7% (Franceschi), and 28.5% (Andersen-Ranberg); (ii) Central Italy subjects showed better health than those from Northern and Southern Italy; (iii) mortality risk was correlated with health status independently of geographical areas; and (iv) 90+ males, although fewer in number, were healthier than females, but with no survival advantage. In conclusion, we identified a modified version of Andersen-Ranberg criteria, based on the concomitant assessment of two basic domains (cognitive, SMMSE; physical, ADL), called ‘‘Simple Model of Functional Status’’ (SMFS), as the most effective proxy to distinguish healthy from not-healthy subjects. This model showed that health status was correlated within sib-ships, suggesting a familial/genetic component.

Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning

Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study's aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8Gy vs 35.5 ± 4.2Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4Gy vs 35.5 ± 4.2Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to deliverable apertures, particularly for plans that emphasize avoidance of critical structures. Minimizing these differences would result in better quality treatments for patients with prostate cancer who were treated with radiotherapy using MCO plans.

Replacing the ASBO with the injunction to prevent nuisance and annoyance: a plea for legislative scrutiny and amendment

In May 2013, the Coalition Government introduced a Bill which if passed will streamline the tools available to tackle anti-social behaviour. One of their proposals is to replace the controversial anti-social behaviour order (ASBO) with what is termed an Injunction to Prevent Nuisance and Annoyance (IPNA). Although designed to tackle criminal and sub-criminal behaviour, this new intervention will be a purely civil order replacing the civil-criminal hybrid ASBO. This article explores some of the more troubling aspects of this part of the Bill including its expansive definition of anti-social behaviour, the avoidance of due process protections, the extensive restrictions that respondents may face and the likely impact of its use on young people. With legislation presently under Parliamentary scrutiny, this article calls for amendments to avoid the most problematic aspects of the ASBO being not just replicated but amplified.

Uniformity and diversity in religious education in Northern Ireland

This paper considers the tension that can exist in the aims of religious education between the desire to encourage open-minded, critical thinking through exposure to diverse traditions, ideas and cultures and the encouragement, overt or otherwise, into uniformity whereby learners take on the values of a particular tradition, culture or ideology (say of a religion, family or school). The particular situation of teaching religious education to post-primary school pupils in Northern Ireland is considered, and evidence cited to suggest that the Northern Ireland Core Syllabus in Religious Education has tried to impose a particular non-denominational Christian uniformity on pupils and teachers through its use of religious language. This has contributed to a culture of 'avoidance' in relation to the teaching of broad Christian diversity. The article concludes that there is a need for an ongoing and meaningful dialogue to discover what kind of balance between uniformity and diversity is best in teaching religious education in Northern Ireland, and notes that this also requires the reassessment of fundamental issues such as the aims of education and the relationship between secular and religious values in publicly funded schools. © 2004 Christian Education.

One-pot two-step mechanochemical synthesis: ligand and complex preparation without isolating intermediates

Although the use of ball milling to induce reactions between solids (mechanochemical synthesis) can provide lower-waste routes to chemical products by avoiding solvent during the reaction, there are further potential advantages in using one-pot multistep syntheses to avoid the use of bulk solvents for the purification of intermediates. We report here two-step syntheses involving formation of salen-type ligands from diamines and hydroxyaldehydes followed directly by reactions with metal salts to provide the corresponding metal complexes. Five salen-type ligands 2,2'-[1,2-ethanediylbis[(E)-nitrilomethylidyne]] bisphenol, ` salenH2', 1; 2,2'-[(+/-)-1,2-cyclohexanediylbis-[(E)-nitrilomethylidyne]] bis-phenol, 2; 2,2'-[1,2-phenylenebis( nitrilomethylidyne)]-bis-phenol, ` salphenH2' 3; 2-[[(2-aminophenyl) imino] methyl]-phenol, 4; 2,2'-[(+/-)-1,2-cyclohexanediylbis[(E)-nitrilomethylidyne]]-bis[4,6-bis(1,1-dimethylethyl)]-phenol, ` Jacobsen ligand', 5) were found to form readily in a shaker-type ball mill at 0.5 to 3 g scale from their corresponding diamine and aldehyde precursors. Although in some cases both starting materials were liquids, ball milling was still necessary to drive those reactions to completion because precipitation of the product and or intermediates rapidly gave in thick pastes which could not be stirred conventionally. The only ligand which required the addition of solvent was the Jacobsen ligand 5 which required 1.75 mol equivalents of methanol to go to completion. Ligands 1-5 were thus obtained directly in 30-60 minutes in their hydrated forms, due to the presence of water by-product, as free-flowing yellow powders which could be dried by heating to give analytically pure products. The one-armed salphen ligand 4 could also be obtained selectively by changing the reaction stoichiometry to 1 : 1. SalenH(2) 1 was explored for the onepot two-step synthesis of metal complexes. In particular, after in situ formation of the ligand by ball milling, metal salts (ZnO, Ni(OAc)2 center dot 4H(2)O or Cu(OAc)(2)center dot H2O) were added directly to the jar and milling continued for a further 30 minutes. Small amounts of methanol (0.4-1.1 mol equivalents) were needed for these reactions to run to completion. The corresponding metal complexes [M(salen)] (M = Zn, 6; Ni, 7; or Cu, 8) were thus obtained quantitatively after 30 minutes in hydrated form, and could be heated briefly to give analytically pure dehydrated products. The all-at-once ` tandem' synthesis of [Zn(salen)] 6 was also explored by milling ZnO, ethylene diamine and salicylaldehyde together in the appropriate mole ratio for 60 minutes. This approach also gave the target complex selectively with no solvent needing to be added. Overall, these syntheses were found to be highly efficient in terms of time and the in avoidance of bulk solvent both during the reaction and for the isolation of intermediates. The work demonstrates the applicability of mechanochemical synthesis to one-pot multi-step strategies.

Trajectories of Learning Dispositions and Attitudes in Upper Primary Schools in Northern Ireland: What exactly is going on?

There is increasing research and policy interest in the importance of attitudes to learning, learning orientations and learning dispositions (however they are labelled), not only because they influence traditional measures of school achievement but also because they facilitate how well children function at school, with implications for their future learning. This paper reports the findings on pupils’ learning dispositions and attitudes from two separate cohorts of pupils as they progress through upper primary school (Key Stage 2) in 50 schools in Northern Ireland. (These data are drawn from two different longitudinal studies and the data collection period predates the introduction of the new Northern Ireland Curriculum.) Approximately 1200 pupils completed seven scales from the Assessment of Learner-Centred Practices, ALCPs (McCombs and Lauer, 1997) at three time points, at the end of P5 (9 year olds), at the end of P6 (10 years olds) and at the end of P7 (11 year olds). ALCPs draws on an extensive research base that has identified cognitive and motivational dispositions and attitudes that are associated with a positive orientation to learning, and ultimately with positive progress in school (Alexander and Murphy, 1998). Although each scale can be considered separately, the seven scales cluster into two groups: self-efficacy, mastery orientation, active learning strategies and curiosity are all predicted to be pro-learning; and challenge avoidance, work avoidance, and – to a lesser extent – performance orientation, are predicted to be negatively associated with learning. The general trajectory in the children’s self-evaluations shows that they are becoming less pro-learning over time, with significant decreases in their self-ratings of active learning, curiosity, mastery orientation and self-efficacy. At the same time, there is some evidence that they work harder and put more effort into their work but this is not accompanied by maintaining their previous pro-learning motivations and strategies. The pattern is consistently more negative for boys than for girls. There are very few differences between the two cohorts indicating that the pattern is not confined to a specific cohort. These findings are challenging and will be interrogated with regard to two questions – are the changes related to the influence of the children’s school experiences per se or are they more related to developmental differences as children adopt more critical appraisals of their personal attributes and efforts as they get older? Whatever the reason, these learning dispositions and attitudes are important as they contribute significantly to school achievement even when the more traditional predictors like gender and ability are taken into account.