A shared care model pilot for palliative home care in a rural area:Impact on symptoms, distress, and place of death

Context: Shared care models integrating family physician services with interdisciplinary palliative care specialist teams are critical to improve access to quality palliative home care and address multiple domains of end-of-life issues and needs. Objectives: To examine the impact of a shared care pilot program on the primary outcomes of symptom severity and emotional distress (patient and family separately) over time and, secondarily, the concordance between patient preferences and place of death. Methods: An inception cohort of patients (n = 95) with advanced, progressive disease, expected to die within six months, were recruited from three rural family physician group practices (21 physicians) and followed prospectively until death or pilot end. Serial measurement of symptoms, emotional distress (patient and family), and preferences for place of death was performed, with analysis of changes in distress outcomes assessed using t-tests and general linear models. Results: Symptoms trended toward improvement, with a significant reduction in anxiety from baseline to 14 days noted. Symptom and emotional distress were maintained below high severity (7-10), and a high rate of home death compared with population norms was observed. Conclusion: Future controlled studies are needed to examine outcomes for shared care models with comparison groups. Shared care models build on family physician capacity and as such are promising in the development of palliative home care programs to improve access to quality palliative home care and foster health system integration. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Vegetation changes and human settlement of Easter Island during the last millennia: a multiproxy study of the Lake Raraku sediments

Earlier palynological studies of lake sediments from Easter Island suggest that the island underwent a recent and abrupt replacement of palm-dominated forests by grasslands, interpreted as a deforestation by indigenous people. However, the available evidence is inconclusive due to the existence of extended hiatuses and ambiguous chronological frameworks in most of the sedimentary sequences studied. This has given rise to an ongoing debate about the timing and causes of the assumed ecological degradation and cultural breakdown. Our multiproxy study of a core recovered from Lake Raraku highlights the vegetation dynamics and environmental shifts in the catchment and its surroundings during the late Holocene. The sequence contains shorter hiatuses than in previously recovered cores and provides a more continuous history of environmental changes. The results show a long, gradual and stepped landscape shift from palm-dominated forests to grasslands. This change started c. 450 BC and lasted about two thousand years. The presence of Verbena litoralis, a common weed, which is associated with human activities in the pollen record, the significant correlation between shifts in charcoal influx, and the dominant pollen types suggest human disturbance of the vegetation. Therefore, human settlement on the island occurred c. 450 BC, some 1500 years earlier than is assumed. Climate variability also exerted a major influence on environmental changes. Two sedimentary gaps in the record are interpreted as periods of droughts that could have prevented peat growth and favoured its erosion during the Medieval Climate Anomaly and the Little Ice Age, respectively. At c. AD 1200, the water table rose and the former Raraku mire turned into a shallow lake, suggesting higher precipitation/evaporation rates coeval with a cooler and wetter Pan-Pacific AD 1300 event. Pollen and diatom records show large vegetation changes due to human activities c. AD 1200. Other recent vegetation changes also due to human activities entail the introduction of taxa (e.g. Psidium guajava, Eucalyptus sp.) and the disappearance of indigenous plants such as Sophora toromiro during the two last centuries. Although the evidence is not conclusive, the American origin of V. litoralis re-opens the debate about the possible role of Amerindians in the human colonisation of Easter Island.

Dangerously empty? Hegemony and the construction of the Irish entrepreneur

In this article we build on Jones and Spicer's (2009) conceptualization of the entrepreneur as an empty signifier. We explore the function of the signifier 'entrepreneurship' within a social context marked by crisis: Ireland 2007-2010. In doing so, we show how its articulation by government acted to legitimize the continuation of market logics and, relatedly, the existing political status quo. Theoretically, we demonstrate the usefulness of Laclau and Mouffe's conception of hegemony, which shares a Lacanian legacy with Jones and Spicer. This helps us to understand the contradictory nature of the signifier of the entrepreneur in Irish political and social discourse, along with its relationship to the reproduction of political hegemony.

A preliminary survey of micro-organisms in the gut and pellets of a tropical millipede Doratogonus uncinatus Attems (Diplopoda, Spirostreptida, Spirostreptidae).

Millipede gut microbiology and decomposition of faecal pellets over a period of eight weeks were studied in the laboratory. Bacterial numbers, carbon and nitrogen content, pH and weight loss were monitored. Heterotrophic bacteria were the most abundant and reached a peak in the first two weeks of decomposition. The amount of carbon was constant while ammonium nitrogen decreased from 1.51 % to 0.03 % after eight weeksThe pH of the pellets was slightly acidic and did not change much during the course of decomposition. A succession of micro-organisms was observed on decomposing pellets. Zygomycetes were replaced by Ascomycetes after 20 days of decomposition. Decomposition was significantly affected by temperature. The rate of decomposition was highest at 35[degree]C .

Power and the Construction of Independence in ICTD Organizations

How do powerful vested interests continue to influence ICT for development (ICTD) projects? In this paper, instead of adopting a macro-level analysis, I take an in-depth, ethnographic approach to focus on work practices at one NGO involved in producing information and communication technologies for use in developing countries. Staff decisions at this NGO were influenced by particular powerful organizations, and I draw on theoretical insights from organization studies in order to understand this. The approach yields surprising results. Staff members appeared able to "stand back" from the pressures coming from donors and other influential parties, and to critically reflect upon these. Paradoxically, rather than fueling resistance, this sense of independence appeared to reinforce dependency on these powerful organizations. Moreover, the fact that this NGO was engaged in ICTD work further heightened these effects. This study extends existing understandings of how power operates within ICTD organizations, by highlighting the ways in which a sense of independence can paradoxically exacerbate donor influence over work activities.

Consideration of future consequences and alcohol use among Northern Irish adolescents

This study investigated the relationship between consideration of future consequences and alcohol use among adolescents. A cross-sectional design was used and a large sample of 12-to 16-year-old schoolchildren (n = 806) in Northern Ireland were recruited for this study. Alcohol use was assessed using a composite measure of drinking behaviour, the Adolescent Alcohol Involvement Scale. Time perspective was measured using the Consideration of Future Consequences Scale (CFCS). Data were also gathered on self-esteem, three domains of self-efficacy and aggression, all of which have been found to be related to both drinking behaviour and time perspective. Factor analysis of the CFCS revealed support for a two-factor solution, with CFC-I representing present orientation and CFC-F representing future orientation. After controlling for year in school (proxy for age) and gender and for clustering at school level, scores on both subscales were significantly associated with alcohol use. Only CFC-F score remained significant with the addition of psychosocial variables. These results support recent findings of a significant relationship between CFCS score and alcohol use in UK adolescents and University undergraduates, and suggest that in more fully controlled analyses, future orientation, rather than present, is related to adolescent drinking. Results are discussed in relation to health promotion. © 2013 Informa UK Ltd.

Staffing, status and subject knowledge: what does the construction of citizenship as a new curriculum subject in England tell us about the nature of school subjects?

Almost a decade ago, the new subject of citizenship was created in the English National Curriculum and several universities were funded to train teachers in this new subject. This presented a rare challenge, namely how to train people to teach a subject that did not exist in schools, and in which they were unlikely to have a specialist degree. In this article we have taken the opportunity afforded by the
tenth birthday of the report in which Crick recommended this curriculum reform to reflect on that experience from the perspective of teacher educators. Through reflecting on the case study of citizenship education in England we highlight several themes that are of more general interest to teacher educators. The key issues that have emerged in this case study relate to the general problems of translating central policy into classroom practice; the nature and aims of subjects in the curriculum; and the identities of teachers in secondary schools. The article illustrates how teacher educators responded to the formidable challenge of creating (or at least contributing to) a new subject and a subject community.

Changes in management and outcome of patients with rectal cancer in northern ireland:1996-2006

Aim This study aimed to document developments in rectal cancer services in a UK population and evaluate changes in outcome over a 10-year period.

Method Patients diagnosed with primary rectal carcinoma in 1996, 2001 and 2006 were identified by the Northern Ireland Cancer Registry. Data were retrospectively collected on presentation, investigation, treatment and staging. Differences over the period were analysed using the chi-squared test; Kaplan–Meier and Cox regression tests were used for survival analysis.

Results After exclusions there were 636 patients, including 187 presenting in 1996, 203 in 2001 and 246 in 2006. The use of preoperative MRI of the rectum, endorectal ultrasound and abdominal CT increased during the study period. For patients treated by surgery, total mesorectal excision (TME) increased from 19% in 1996 to 64% in 2006 (P < 0.001). The use of radiotherapy (27% in 1996, 47% in 2006) and chemotherapy (21% in 1996, 32% in 2006) increased. The overall 5-year survival improved significantly between 1996 and 2006 from 34% in 1996 to 45% in 2006 (P = 0.02). Among patients having surgery, 5-year survival increased from 43% in 1996 to 63% in 2006 (P < 0.001). Multivariate analysis showed that the improvement in survival was associated with TME and chemotherapy, while radiotherapy was not.

Conclusion Survival of patients with rectal cancer in Northern Ireland has improved significantly over the last decade, probably due to the increased use of TME and chemotherapy.

Keywords Surgery, rectum, oncology

What does this paper add to the literature?
This population-based study demonstrates a significant improvement in survival over recent years of rectal cancer patients in Northern Ireland. It concludes that surgical resection with TME and chemotherapy have had a significant impact on survival and that the improvement was not due to a stage-migration effect.