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.

A comparative study of Type II-P and II-L supernova rise times as exemplified by the case of LSQ13cuw

We report on our findings based on the analysis of observations of the Type II-L supernova LSQ13cuw within the framework of currently accepted physical predictions of core-collapse supernova explosions. LSQ13cuw was discovered within a day of explosion, hitherto unprecedented for Type II-L supernovae. This motivated a comparative study of Type II-P and II-L supernovae with relatively well-constrained explosion epochs and rise times to maximum (optical) light. From our sample of twenty such events, we find evidence of a positive correlation between the duration of the rise and the peak brightness. On average, SNe II-L tend to have brighter peak magnitudes and longer rise times than SNe II-P. However, this difference is clearest only at the extreme ends of the rise time versus peak brightness relation. Using two different analytical models, we performed a parameter study to investigate the physical parameters that control the rise time behaviour. In general, the models qualitatively reproduce aspects of the observed trends. We find that the brightness of the optical peak increases for larger progenitor radii and explosion energies, and decreases for larger masses. The dependence of the rise time on mass and explosion energy is smaller than the dependence on the progenitor radius. We find no evidence that the progenitors of SNe II-L have significantly smaller radii than those of SNe II-P.

ARE OECD MACROECONOMIC VARIABLES TREND STATIONARY? EVIDENCE FROM PANEL STATIONARITY TESTS ALLOWING FOR A STRUCTURAL BREAK AND CROSS-SECTIONAL DEPENDENCE

This article applies the panel stationarity test with a break proposed by Hadri and Rao (2008) to examine whether 14 macroeconomic variables of OECD countries can be best represented as random walk or stationary fluctuations around a deterministic trend. In contrast to previous studies, based essentially on visual inspection of the break type or just applying the most general break model, we use a model selection procedure based on BIC. We do this for each time series so that heterogeneous break models are allowed for in the panel. Our results suggest, overwhelmingly, that if we account for a structural break, cross-sectional dependence and choose the break models to be congruent with the data, then the null of stationarity cannot be rejected for all the 14 macroeconomic variables examined in this article. This is in sharp contrast with the results obtained by Hurlin (2004), using the same data but a different methodology.

Beyond the ideal free distribution: More general models of predator distribution

The ideal free distribution model which relates the spatial distribution of mobile consumers to that of their resource is shown to be a limiting case of a more general model which we develop using simple concepts of diffusion. We show how the ideal free distribution model can be derived from a more general model and extended by incorporating simple models of social influences on predator spacing. First, a free distribution model based on patch switching rules, with a power-law interference term, which represents instantaneous biased diffusion is derived. A social bias term is then introduced to represent the effect of predator aggregation on predator fitness, separate from any effects which act through intake rate. The social bias term is expanded to express an optimum spacing for predators and example solutions of the resulting biased diffusion models are shown. The model demonstrates how an empirical interference coefficient, derived from measurements of predator and prey densities, may include factors expressing the impact of social spacing behaviour on fitness. We conclude that empirical values of log predator/log prey ratio may contain information about more than the relationship between consumer and resource densities. Unlike many previous models, the model shown here applies to conditions without continual input. (C) 1997 Academic Press Limited.</p>

Parallel Programming of General-Purpose Programs Using Task-Based Programming Models

The prevalence of multicore processors is bound to drive most kinds of software development towards parallel programming. To limit the difficulty and overhead of parallel software design and maintenance, it is crucial that parallel programming models allow an easy-to-understand, concise and dense representation of parallelism. Parallel programming models such as Cilk++ and Intel TBBs attempt to offer a better, higher-level abstraction for parallel programming than threads and locking synchronization. It is not straightforward, however, to express all patterns of parallelism in these models. Pipelines are an important parallel construct, although difficult to express in Cilk and TBBs in a straightfor- ward way, not without a verbose restructuring of the code. In this paper we demonstrate that pipeline parallelism can be easily and concisely expressed in a Cilk-like language, which we extend with input, output and input/output dependency types on procedure arguments, enforced at runtime by the scheduler. We evaluate our implementation on real applications and show that our Cilk-like scheduler, extended to track and enforce these dependencies has performance comparable to Cilk++.

The importance of validating the diagnosis of coronary heart disease when measuring secondary prevention:a cross-sectional study in general practice

To compare levels of recorded risk factors and drug treatment between patients with validated and non-validated diagnoses of coronary heart disease (CHD) in Northern Ireland.

Are food-related perceptions associated with meal portion size decisions? A cross-sectional study

The purpose of this study was to test a comprehensive model of meal portion size determinants consisting of sociodemographic, psychological and food-related variables, whilst controlling for hunger and thirst.
Using cross-sectional nationally representative data collected in 2075 participants from the Island of Ireland (IoI) and Denmark (DK), eight separate hierarchical multiple regression analyses were conducted to examine the association between food-related variables and meal portion size (i.e. pizza, vegetable soup, chicken salad and a pork meal) within each country. Stepwise regressions were run with physiological control measures (hunger and thirst) entered in the first step, sociodemographic variables (sex, age, body mass index (BMI)) in the second step; psychological variables (cognitive restraint, uncontrolled eating, emotional eating, general health interest (GHI)) in the third step and food-related variables (expected fillingness, liking, expected healthfulness, food familiarity) in the fourth step.
Sociodemographic variables accounted for 2-19% of the variance in meal portion sizes; psychological variables explained an additional 3-8%; and food-related variables explained an additional 2-12%. When all four variable groups were included in the regression models, liking and sometimes expected healthfulness was positively associated with meal portion size. The strongest association was for liking, which was statistically significant in both countries for all meal types. Whilst expected healthfulness was not associated with pizza portion size in either country, it was positively associated with meals that have a healthier image (vegetable soup; chicken salad and in IoI, the pork meal).
In conclusion, after considering sociodemographic and psychological variables, and the food-related variables of liking and expected healthfulness, there may be little merit in manipulating the satiating power, at least of these type of meals, to maintain or promote weight loss.
Keywords: Meal portion size; psychological variables; expected fillingness; expected healthfulness; food liking; food familiarity.

Self-reported quality of life of 8-12 year old children with cerebral palsy: a cross-sectional European Study

Background

Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that influence it, and how it compares with QoL of the general population.

Methods

1174 children aged 8–12 years were randomly selected from eight population-based registers of children with cerebral palsy in six European countries and 743 (63%) agreed to participate; one further region recruited 75 children from multiple sources. Researchers visited these 818 children. 318 (39%) with severe intellectual impairment could not self-report; 500 (61%) reported their QoL using KIDSCREEN, an instrument with scores in ten domains, each with SD=10. Multivariable regression was used to relate QoL to impairments, pain, and sociodemographic characteristics. Comparisons were made with QoL data from the general population.

Findings

Impairments were not significantly associated with six KIDSCREEN domains. Comparison of least and most able groups showed that severely limited self-mobility was significantly associated with reduced mean score for physical wellbeing (7·6, 95% CI 2·7–12·4); intellectual impairment with reduced mean for moods and emotions (3·7, 1·5–5·9) and autonomy (3·3, 0·9–5·7); and speech difficulties with reduced mean for relationships with parents (4·5, 1·9–7·1). Pain was common and associated with lower QoL on all domains. Impairments and pain explained up to 3% and 7%, respectively, of variation in QoL. Children with cerebral palsy had similar QoL to children in the general population in all domains except schooling, in which evidence was equivocal, and physical wellbeing, in which comparison was not possible.

Interpretation

Parents can be reassured that most children aged 8–12 years with cerebral palsy will have similar QoL to other children. This finding should guide social and educational policy to ensure that disabled children participate fully in society. Because of its association with QoL, children's pain should be carefully assessed.

Frequency of participation of 8-12 year old children with cerebral palsy: a multi-centre cross sectional European study

Participation in home, school and community is important for all children; and little is known about the frequency of participation of disabled children. Frequency of participation is a valuable outcome measure for evaluating habilitation programmes for disabled children and for planning social and health services.

We investigated how frequency of participation varied between children with cerebral palsy and the general population; and examined variation across countries to understand better how the environmental factors such as legislation, public attitudes and regulation in different countries might influence participation.

We undertook a multi-centre, population-based study in children with and without cerebral palsy. Working from the Life-H instrument, we developed a questionnaire to capture frequency of participation in 8–12-year-old children. In nine regions of seven European countries, parents of 813 children with cerebral palsy and 2939 children from the general populations completed the questionnaire.

Frequency of participation for each question was dichotomised about the median; multivariable logistic regressions were carried out.

In the general population, frequency of participation varied between countries. Children with cerebral palsy participated less frequently in many but not all areas of everyday life, compared with children from the general population. There was regional variation in the domains with reduced participation and in the magnitude of the differences. We discuss how this regional variation might be explained by the different environments in which children live. Attending a special school or class was not associated with further reduction in participation in most areas of everyday life.

Psychological processes underlying nurses' handwashing behaviour

Aim/Background Psychological models of behaviour change have been found to be useful in predicting health-related behaviour in patients but have rarely been used in relation to the health behaviour of staff. This study explored the association between a range of psychological variables and self-reported handwashing in a sample of nurses who work in a large general hospital. Method A questionnaire-based cross-sectional, correlational study was used. Questionnaires examining demographics, self-efficacy, perceived importance of handwashing, perception of risk, occupational stress and training related to handwashing were administered to an opportunity sample (n = 76) of nurses drawn from an acute hospital. ANOVAs, correlation and regression analyses were performed to determine significant covariates of handwashing behaviour. Findings There was a weak relationship between demographic variables and self-reported handwashing. The degree to which employees perceived their workplace to assist handwashing and perceived importance of handwashing were related to self-reported handwashing. Accordingly further covariates of these variables were sought. Training received and occupational stress both covaried with nurses’ perceptions of the degree to which their workplace assisted handwashing. Nurses’ beliefs regarding the transmission of infections covaried with perceived importance of handwashing. Conclusion Occupational stress was observed to reduce the perception of having a supportive employer: organisations need to facilitate handwashing and protect staff from factors that have a detrimental impact, such as work-related stress. Nurses’ perceived importance of the potential for poor handwashing practice to contribute to the transmission of infections should be highlighted in interventions.

Radiotherapy in the presence of contrast agents: a general figure of merit and its application to gold nanoparticles

Delivering sufficient dose to tumours while sparing surrounding tissue is one of the primary challenges of radiotherapy, and in common practice this is typically achieved by using highly penetrating MV photon beams and spatially shaping dose. However, there has been a recent increase in interest in the possibility of using contrast agents with high atomic number to enhance the dose deposited in tumours when used in conjunction with kV x-rays, which see a significant increase in absorption due to the heavy element's high-photoelectric cross-section at such energies. Unfortunately, the introduction of such contrast agents significantly complicates the comparison of different source types for treatment efficacy, as the dose deposited now depends very strongly on the exact composition of the spectrum, making traditional metrics such as beam quality less valuable. To address this, a 'figure of merit' is proposed, which yields a value which enables the direct comparison of different source types for tumours at different depths inside a patient. This figure of merit is evaluated for a 15 MV LINAC source and two 150 kVp sources (both of which make use of a tungsten target, one with conventional aluminium filtration, while the other uses a more aggressive thorium filter) through analytical methods as well as numerical models, considering tissue treated with a realistic concentration and uptake ratio of gold nanoparticle contrast agents (10 mg ml(-1) concentration in 'tumour' volume, 10: 1 uptake ratio). Finally, a test case of human neck phantom is considered with a similar contrast agent to compare the abstract figure to a more realistic treatment situation. Good agreement was found both between the different approaches to calculate the figure of merit, and between the figure of merit and the effectiveness in a more realistic patient scenario. Together, these observations suggest that there is the potential for contrast-enhanced kilovoltage radiation to be a useful therapeutic tool for a number of classes of tumour on dosimetric considerations alone, and they point to the need for further research in this area.