Reducing the psychological distress of family caregivers of home based palliative care patients: Longer term effects from a randomised controlled trial.

Background: Palliative care incorporates comprehensive support of family caregivers because many of them experience burden and distress. However, evidence-based support initiatives are few.

Purpose: We evaluated a one-to-one psychoeducational intervention aimed at mitigating the distress of caregivers of patients with advanced cancer receiving home-based palliative care. We hypothesised that caregivers would report decreased distress as assessed by the General Health Questionnaire (GHQ).

Method: A randomised controlled trial comparing two versions of the delivery of the intervention (one face-to-face home visit plus telephone calls versus two visits) plus standard care to a control group (standard care only) across four sites in Australia.

Results: Recruitment to the one visit condition was 57, the two visit condition 93, and the control 148. We previously reported non-significant changes in distress between times 1 (baseline) and 2 (1-week post-intervention) but significant gains in competence and preparedness. We report here changes in distress between times 1 and 3 (8-week post-death). There was significantly less worsening in distress between times 1 and 3 in the one visit intervention group than in the control group; however, no significant difference was found between the two visit intervention and the control group.

Conclusions: These results are consistent with the aim of the intervention, and they support existing evidence demonstrating that relatively short psychoeducational interventions can help family caregivers who are supporting a dying relative. The sustained benefit during the bereavement period may also have positive resource implications, which should be the subject of future inquiry. © 2014 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Measurement-based Policy-driven QoS Management in Converged Next Generation Networks

Policy-based management is considered an effective approach to address the challenges of resource management in large complex networks. Within the IU-ATC QoS Frameworks project, a policy-based network management framework, CNQF (Converged Networks QoS Framework) is being developed aimed at providing context-aware, end-to-end QoS control and resource management in converged next generation networks. CNQF is designed to provide homogeneous, transparent QoS control over heterogeneous access technologies by means of distributed functional entities that co-ordinate the resources of the transport network through policy-driven decisions. In this paper, we present a measurement-based evaluation of policy-driven QoS management based on CNQF architecture, with real traffic flows on an experimental testbed. A Java based implementation of the CNQF Resource Management Subsystem is deployed on the testbed and results of the experiments validate the framework operation for policy-based QoS management of real traffic flows.

Synthesis and characterization of amphiphilic star copolymers of 2-(dimethylamino) ethyl methacrylate and methyl methacrylate: Effects of architecture and composition

Six amphiphilic star copolymers comprising hydrophilic units of 2-(dimethylamino)ethyl methacrylate (DMAEMA) and hydrophobic units of methyl methacrylate (MMA) were prepared by the sequential group transfer polymerization (GTP) of the two comonomers and ethylene glycol dimethacrylate (EGDMA) cross-linker. Four star-block copolymers of different compositions, one miktoarm star, and one statistical copolymer star were synthesized. The molecular weights (MWs) and MW distributions of all the star copolymers and their linear homopolymer and copolymer precursors were characterized by gel permeation chromatography (GPC), while the compositions of the stars were determined by proton nuclear magnetic resonance (H-1 NMR) spectroscopy. Tetrahydrofuran (THF) solutions of all the star copolymers were characterized by static light scattering to determine the absolute weight-average MW ((M) over bar (w)) and the number of arms of the stars. The R, of the stars ranged between 359,000 and 565,000 g mol(-1), while their number of arms ranged between 39 and 120. The star copolymers were soluble in acidic water at pH 4 giving transparent or slightly opaque solutions, with the exception of the very hydrophobic DMAEMA(10)-b-MMA(30)-star, which gave a very opaque solution. Only the random copolymer star was completely dispersed in neutral water, giving a very opaque solution. The effective pKs of the copolymer stars were determined by hydrogen ion titration and were found to be in the range 6.5-7.6. The pHs of precipitation of the star copolymer solutions/dispersions were found to be between 8.8-10.1, except for the most hydrophobic DMA-EMA(10)-b-MMA(30)-Star, which gave a very opaque solution over the whole pH range. (c) 2006 Elsevier Ltd. All rights reserved.

Physical and numerical constraints in source modeling for finite difference simulation of room acoustics

In finite difference time domain simulation of room acoustics, source functions are subject to various constraints. These depend on the way sources are injected into the grid and on the chosen parameters of the numerical scheme being used. This paper addresses the issue of selecting and designing sources for finite difference simulation, by first reviewing associated aims and constraints, and evaluating existing source models against these criteria. The process of exciting a model is generalized by introducing a system of three cascaded filters, respectively, characterizing the driving pulse, the source mechanics, and the injection of the resulting source function into the grid. It is shown that hard, soft, and transparent sources can be seen as special cases within this unified approach. Starting from the mechanics of a small pulsating sphere, a parametric source model is formulated by specifying suitable filters. This physically constrained source model is numerically consistent, does not scatter incoming waves, and is free from zero- and low-frequency artifacts. Simulation results are employed for comparison with existing source formulations in terms of meeting the spectral and temporal requirements on the outward propagating wave.

Network Usage Determination for Transmission Cost Allocation using a Transformer Analogy

This study presents a new method for determining the transmission network usage by loads and generators, which can then be used for transmission cost/loss allocation in an explainable and justifiable manner. The proposed method is based on solid physical grounds and circuit theory. It relies on dividing the currents through the network into two components; the first one is attributed to power flows from generators to loads, whereas the second one is because of the generators only. Unlike almost all the available methods, the proposed method is assumption free and hence it is more accurate than similar methods even those having some physical basis. The proposed method is validated through a transformer analogy, and theoretical derivations. The method is verified through application to the IEEE 30 bus system and the IEEE 118 test system. The results obtained verified many desirable features of the proposed method. Being more accurate in determining the network usage, in an explainable transparent manner, and in giving accurate cost signals, indicating the best locations to add loads and generation, are among the many desirable features.

Factors influencing European consumer uptake of personalised nutrition. Results of a qualitative analysis.

The aim of this research was to explore consumer perceptions of personalised nutrition and to compare these across three different levels of "medicalization": lifestyle assessment (no blood sampling); phenotypic assessment (blood sampling); genomic assessment (blood and buccal sampling). The protocol was developed from two pilot focus groups conducted in the UK. Two focus groups (one comprising only "older" individuals between 30 and 60 years old, the other of adults 18-65 yrs of age) were run in the UK, Spain, the Netherlands, Poland, Portugal, Ireland, Greece and Germany (N = 16). The analysis (guided using grounded theory) suggested that personalised nutrition was perceived in terms of benefit to health and fitness and that convenience was an important driver of uptake. Negative attitudes were associated with internet delivery but not with personalised nutrition per se. Barriers to uptake were linked to broader technological issues associated with data protection, trust in regulator and service providers. Services that required a fee were expected to be of better quality and more secure. An efficacious, transparent and trustworthy regulatory framework for personalised nutrition is required to alleviate consumer concern. In addition, developing trust in service providers is important if such services to be successful. (C) 2013 Elsevier Ltd. All rights reserved.

Do mirrors reflect reality in agonistic encounters? A test of mutual cooperation in displays

Animals frequently engage in mutual displays that may allow or at least help decisions about the outcome of agonistic encounters with mutual benefit to the opponents. In fish these often involve lateral displays, with previous studies finding evidence of population-level lateralization with a marked preference for showing the right side and using the right eye. Because both opponents tend to show this preference a head to tail configuration is formed and is used extensively during the display phase. Here we tested the significance of these lateral displays by comparing displays to a mirror with those to a real opponent behind a transparent barrier. The frequency of displays was lower to a mirror but the individual displays were of greater duration indicating a slower pace of the interaction with a mirror. This suggests that fish respond to initiatives of real opponents but as mirror images do not initiate moves the focal fish only moves when it is ready to change position. However, lateralization was still found with mirrors, indicating that the right-side bias is a feature of the individual and not of the interaction between opponents. We discuss implications for ideas about the evolution of mutual cooperation and information exchange in contests, as well as the utility of the use of mirrors in the study of aggression in fish.

Reconfigurable frequency selective surfaces with interleaved spiral slots

A new type of active frequency selective surface (AFSS) is proposed to realise a voltage controlled bi-state (transparent and reflecting) response at the specified frequencies. The bi-state switching is achieved by combining a passive array of interleaved spiral slots in conducting screens and active dipole arrays with integrated pin diodes at the opposite sides of a thin dielectric substrate. Simulation results show that such active surfaces have high isolation between the transparency and reflection states, while retaining the merits of substantially sub-wavelength response of the unit cell and large fractional bandwidths (FBWs) inherent to the original passive interwoven spiral arrays. Potential applications include reconfigurable and controllable electromagnetic architecture of buildings.

Active singly and dual polarised interwoven spiral frequency selective surfaces

Reconfigurable bi-state interwoven spiral FSSs are explored in this work. Their switching capability is realized by pin diodes that enable the change of the electromagnetic response between transparent and reflecting modes at the specified frequencies in both singly and dual polarised unit cell configurations. The proposed topologies are single layer FSS with their elements acting also as dc current carrying conductors supplying the bias signal for switching pin diodes between the on and off states, thus avoiding the need of external bias lines that can cause parasitic resonances and affect the response at oblique incidence. The presented simulation results show that such active FSSs have potentially good isolation between the transmission and reflection states, while retaining the substantially subwavelength response of the unit cell with large fractional bandwidths (FBWs) inherent to the original passive FSSs.

Pulse mixing by Fibonacci and Thue-Morse ordered semiconductor layers

The properties of combinatorial frequency generation by two-tone Gaussian pulses incident at oblique angles on quasiperiodic (Fibonacci and Thue-Morse) stacks of binary semiconductor layers are discussed. The analysis has been performed using the self-consistent model taking into account the nonlinear dynamics of mobile charges in the layers. The effects of the stack arrangements and constituent layer parameters on the combinatorial frequency waveforms are presented for the specific structures of both types

Ultra-broadband Polarisers Based on Metastable Free-Standing Aligned Carbon Nanotube Membranes

A carbon nanotube free-standing linearly dichroic polariser is developed using solid-state extrusion. Membrane cohesion is experimentally and numerically demonstrated to derive from inter-tube van der Waals interactions in this family of planar metastable morphologies, controlled by the chemical vapour deposition conditions. Ultra-broadband polarisation (400 nm – 2.5 mm) is shown and corroborated by effective medium and full numerical simulations.

Beam profiles of proton and carbon ions in the relativistic transparency regime

Ion acceleration from relativistic laser solid interactions has been of particular interest over the last decade. While beam profiles have been studied for target normal sheath acceleration (TNSA), such profiles have yet to be described for other mechanisms. Here, experimental data is presented, investigating ion beam profiles from acceleration governed by relativistic transparent laser plasma interaction. The beam shape of carbon C6+ ions and protons has been measured simultaneously with a wide angle spectrometer. It was found that ion beams deviate from the typical Gaussian-like shape found with TNSA and that the profile is governed by electron dynamics in the volumetric laser-plasma interaction with a relativistically transparent plasma; due to the ponderomotive force electrons are depleted from the center of the laser axis and form lobes affecting the ion beam structure. The results are in good agreement with high resolution three-dimensional-VPIC simulations and can be used as a new tool to experimentally distinguish between different acceleration mechanisms.

Methodologies for the Development of the Management of Cough: CHEST Guideline and Expert Panel Report

BACKGROUND: This series of guidance documents on cough, which will be published over time, is a hybrid of two processes: (1) evidence-based guidelines and (2) trustworthy consensus statements based on a robust and transparent process.

METHODS: The CHEST Guidelines Oversight Committee selected a nonconflicted Panel Chair and jointly assembled an international panel of experts in each clinical area with few, if any, conflicts of interest. PICO (population, intervention, comparator, outcome)-based key questions and parameters of eligibility were developed for each clinical topic to inform the comprehensive literature search. Existing guidelines, systematic reviews, and primary studies were assessed for relevance and quality. Data elements were extracted into evidence tables and synthesized to provide summary statistics. These, in turn, are presented to support the evidence-based graded recommendations. A highly structured consensus-based Delphi approach was used to provide expert advice on all guidance statements. Transparency of process was documented.

RESULTS: Evidence-based guideline recommendations and consensus-based suggestions were carefully crafted to provide direction to health-care providers and investigators who treat and/or study patients with cough. Manuscripts and tables summarize the evidence in each clinical area supporting the recommendations and suggestions.

CONCLUSIONS: The resulting guidance statements are based on a rigorous methodology and transparency of process. Unless otherwise stated, the recommendations and suggestions meet the guidelines for trustworthiness developed by the Institute of Medicine and can be applied with confidence by physicians, nurses, other health-care providers, investigators, and patients.

Price Discovery in the Dual-Platform US Treasury Market

Inter-dealer trading in US Treasury securities is almost equally divided between two electronic trading platforms that have only slight differences in terms of their relative liquidity and transparency. BrokerTec is more active in the trading of 2-, 5-, and 10-year T-notes while eSpeed has more active trading in the 30-year bond. Over the period studied, eSpeed provides a more pre-trade transparent platform than BrokerTec. We examine the contribution to ‘price discovery’ of activity in the two platforms using high frequency data. We find that price discovery does not derive equally from the two platforms and that the shares vary across term to maturity. This can be traced to differential trading activities and transparency of the two platforms.

Systemic oxidative-nitrosative-inflammatory stress during acute exercise in hypoxia; implications for microvascular oxygenation and aerobic capacity

New Findings

What is the central question of this study?Exercise performance is limited during hypoxia by a critical reduction in cerebral and skeletal tissue oxygenation. To what extent an elevation in systemic free radical accumulation contributes to microvascular deoxygenation and the corresponding reduction in maximal aerobic capacity remains unknown.What is the main finding and its importance?We show that altered free radical metabolism is not a limiting factor for exercise performance in hypoxia, providing important insight into the fundamental mechanisms involved in the control of vascular oxygen transport.

Exercise performance in hypoxia may be limited by a critical reduction in cerebral and skeletal tissue oxygenation, although the underlying mechanisms remain unclear. We examined whether increased systemic free radical accumulation during hypoxia would be associated with elevated microvascular deoxygenation and reduced maximal aerobic capacity (). Eleven healthy men were randomly assigned single-blind to an incremental semi-recumbent cycling test to determine  in both normoxia (21% O_{2) and hypoxia (12% O2) separated by a week. Continuous-wave near-infrared spectroscopy was employed to monitor concentration changes in oxy- and deoxyhaemoglobin in the left vastus lateralis muscle and frontal cerebral cortex. Antecubital venous blood samples were obtained at rest and at  to determine oxidative (ascorbate radical by electron paramagnetic resonance spectroscopy), nitrosative (nitric oxide metabolites by ozone-based chemiluminescence and 3-nitrotyrosine by enzyme-linked immunosorbent assay) and inflammatory stress biomarkers (soluble intercellular/vascular cell adhesion 1 molecules by enzyme-linked immunosorbent assay). Hypoxia was associated with increased cerebral and muscle tissue deoxygenation and lower  (P < 0.05 versus normoxia). Despite an exercise-induced increase in oxidative–nitrosative–inflammatory stress, hypoxia per se did not have an additive effect (P > 0.05 versus normoxia). Consequently, we failed to observe correlations between any metabolic, haemodynamic and cardiorespiratory parameters (P > 0.05). Collectively, these findings suggest that altered free radical metabolism cannot explain the elevated microvascular deoxygenation and corresponding lower  in hypoxia. Further research is required to determine whether free radicals when present in excess do indeed contribute to the premature termination of exercise in hypoxia.}