Family Caregivers and Palliative Care: Current Status and Agenda for the Future

The quality of life of the person confronting the end stages of their life may be severely compromised without the support of family caregivers. Indeed, most people requiring palliative care would not be able to fulfill their preferences, such as care at home, without significant family caregiver input. As a consequence, health services are mandated to support the family alongside the person diagnosed with a life-threatening illness. In short, palliative care is supposed to be family centred. However, the quality and type of support made available to family caregivers has been questioned. The purpose of this review is to outline a succinct and empirically informed account of family caregiving within the context of palliative care and to propose an agenda for the future. The appraisal is underpinned by several systematic reviews, and other seminal publications from the last decade.

PROBLEM-SOLVING IN SCHIZOPHRENIA - A SPECIFIC DEFICIT IN PLANNING ABILITY

The study investigated problem solving ability in schizophrenia. Thirty DSM-IIIR schizophrenic patients and 27 matched normal controls were tested on the Three-Dimensional Computerised Tower of London Test (3-D CTL Test) (Morris et al., 1993). The patients took significantly more moves to solve a series of problems and solved significantly fewer problems in the predetermined minimum number of moves. The patients response times, as measured using a control version of the task (the 3-D CTL Control), were longer than those of the controls. However, when latencies were adjusted to take into account the slower responses overall, the patients planning times were not significantly increased. Inaccurate planning, as defined by taking more moves, did not correlate with either positive or negative symptoms, but the response times tended to be longer in patients who had more negative symptoms. The findings suggest that there is a deficit in problem solving activity in schizophrenia that may be associated with translating 'willed intentions' into action, independent of slower motor speed.

Male Perpetrators of Domestic Violence: How should we hold them to account?

Domestic violence is now widely acknowledged as being a significant social, health and legal issue. At both a national and transnational level governments have sought to develop strategies built upon prevention, support for victims and holding perpetrators to account through criminal justice sanctions. However, the current paradigm that informs the policy response to most perpetrators of domestic violence has failed to deliver the outcomes required, in terms of a reduction in levels of recidivism or the improved safety of women and children. It is argued that holding men to account through external controls has failed and that interventions should support men to take responsibility for their own behaviour.

Current understanding of learning psychomotor skills and the impact on teaching laparoscopic surgical skills

Key content
- Trainees face many challenges in learning the skill set required to perform laparoscopic surgery.
- The time spent in the operating room has been detrimentally impacted upon since the implementation of the European Working Time Directive. In order to address the deficit, surgical educators have looked to the benefits enjoyed in the aviation and sports industries in using simulation training.

Learning objectives
- To summarise the current understanding of the neuropsychological basis of learning a psychomotor skill.
- To clarify factors that influence the acquisition of these skills.
- To summarise how this information can be used in teaching and assessment of laparoscopic skills.

Ethical issues
- The use of virtual reality simulators may be able to form a part of the aptitude assessment in the selection process, in order to identify trainees with the desired attributes to progress into the training programmes. However, as skill improves with practice, is it ethical to exclude novices with poor initial performance assessment before allowing them the opportunities to improve?

Toxic substances in blood: an analysis of current recommendations under a Bayesian (decision) approach

This article extends existing discussion in literature on probabilistic inference and decision making with respect to continuous hypotheses that are prevalent in forensic toxicology. As a main aim, this research investigates the properties of a widely followed approach for quantifying the level of toxic substances in blood samples, and to compare this procedure with a Bayesian probabilistic approach. As an example, attention is confined to the presence of toxic substances, such as THC, in blood from car drivers. In this context, the interpretation of results from laboratory analyses needs to take into account legal requirements for establishing the 'presence' of target substances in blood. In a first part, the performance of the proposed Bayesian model for the estimation of an unknown parameter (here, the amount of a toxic substance) is illustrated and compared with the currently used method. The model is then used in a second part to approach-in a rational way-the decision component of the problem, that is judicial questions of the kind 'Is the quantity of THC measured in the blood over the legal threshold of 1.5 μg/l?'. This is pointed out through a practical example.

Key Account Management in Paper and Board Industry- Identification of Key Accounts for Stora Enso Graphical Boards

Tutkimuksen tarkoituksena oli tunnistaa nykyiset sekä potentiaaliset avainasiakkaat case yritykselle. Avainasiakkaat tunnistettiin Chevertonin tunnistamis- ja valintamatriisin avulla, jossa asiakkaan sijoittumista matriisiin arvioidaan asiakkaan houkuttelevuuden sekä toimittajan suhteellisten vahvuuksien avulla. Kriteereiksi avainasiakkaiden tunnistamiseen valittiin asiakkaan vuotuinen ostovolyymi, asiakkaan business-potentiaali sekä case-yrityksen toimittajaosuus. Asiakkaat luokiteltiin avainasiakkaisiin, kehitettäviin avainasiakkaisiin, ylläpidettäviin asiakkaisiin sekä satunnaisiin asiakkaisiin. Tutkimus tarjosi lähtökohdan case-yrityksen uusille avainasiakaspäälliköille sekä osoitti suunnan tulevaisuuden tutkimustarpeille. Aktiivisen tiedonvaihdannan kautta eri myyntikonttoreiden johtohenkilöstön sekä myös yrityksen eri funktionaalisten divisioonien välillä voidaan saavuttaa kilpailuetua kun lähestytään asiakasta toimintojaan järkiperäisesti koordinoineena toimittajana samalla kun asiakkaat keskittävät ostojaan. Jotta yrityksen tavoitteet, markkinamahdollisuudet sekä resurssit olisivat hyvin tasapainossa, tulisi myös asiakaskannattavuutta sekä asiakkaiden strategista merkittävyyttä arvioida ja mitata säännöllisesti tässä tutkimuksessa käytettyjen tunnistuskriteereiden lisäksi.

Avian mortalities due to transmission line collisions: a review of current estimates and field methods with an emphasis on applications to the Canadian electric network

Birds are vulnerable to collisions with human-made fixed structures. Despite ongoing development and increases in infrastructure, we have few estimates of the magnitude of collision mortality. We reviewed the existing literature on avian mortality associated with transmission lines and derived an initial estimate for Canada. Estimating mortality from collisions with power lines is challenging due to the lack of studies, especially from sites within Canada, and due to uncertainty about the magnitude of detection biases. Detection of bird collisions with transmission lines varies due to habitat type, species size, and scavenging rates. In addition, birds can be crippled by the impact and subsequently die, although crippling rates are poorly known and rarely incorporated into estimates. We used existing data to derive a range of estimates of avian mortality associated with collisions with transmission lines in Canada by incorporating detection, scavenging, and crippling biases. There are 231,966 km of transmission lines across Canada, mostly in the boreal forest. Mortality estimates ranged from 1 million to 229.5 million birds per year, depending on the bias corrections applied. We consider our most realistic estimate, taking into account variation in risk across Canada, to range from 2.5 million to 25.6 million birds killed per year. Data from multiple studies across Canada and the northern U.S. indicate that the most vulnerable bird groups are (1) waterfowl, (2) grebes, (3) shorebirds, and (4) cranes, which is consistent with other studies. Populations of several groups that are vulnerable to collisions are increasing across Canada (e.g., waterfowl, raptors), which suggests that collision mortality, at current levels, is not limiting population growth. However, there may be impacts on other declining species, such as shorebirds and some species at risk, including Alberta’s Trumpeter Swans (Cygnus buccinator) and western Canada’s endangered Whooping Cranes (Grus americana). Collisions may be more common during migration, which underscores the need to understand impacts across the annual cycle. We emphasize that these estimates are preliminary, especially considering the absence of Canadian studies.

Where do winds drive the Antarctic Circumpolar Current?

The strength of the Antarctic Circumpolar Current (ACC) is believed to depend on the westerly wind stress blowing over the Southern Ocean, although the exact relationship between winds and circumpolar transport is yet to be determined. Here we show, based on theoretical arguments and a hierarchy of numerical modeling experiments, that the global pycnocline depth and the baroclinic ACC transport are set by an integral measure of the wind stress over the path of the ACC, taking into account its northward deflection. Our results assume that the mesoscale eddy diffusivity is independent of the mean flow; while the relationship between wind stress and ACC transport will be more complicated in an eddy-saturated regime, our conclusion that the ACC is driven by winds over the circumpolar streamlines is likely to be robust.

Intestinal microflora of human infants and current trends for its nutritional modulation

Diet, among other environmental and genetic factors, is currently recognised to have an important role in health and disease. There is increasing evidence that the human colonic microbiota can contribute positively towards host nutrition and health. As such, dietary modulation has been proposed as important for improved gut health, especially during the highly sensitive stage of infancy. Differences in gut microflora composition and incidence of infection occur between breast- and formula-fed infants. Human milk components that cannot be duplicated in infant formulae could possibly account for these differences. However, various functional food ingredients such as oligosaccharides, prebiotics, proteins and probiotics could effect a beneficial modification in the composition and activities of gut microflora of infants. The aim of the present review is to describe existing knowledge on the composition and metabolic activities of the gastrointestinal microflora of human infants and discuss various possibilities and opportunities for its nutritional modulation.

Dementia and cancer: a review of the literature and current practice

Age is a risk factor for dementia, and also for most cancers. Surprisingly, rates of cancer appear to be lower in individuals with dementia and vice versa. Genetic mechanisms could underpin this inverse relationship and are outlined, but underdiagnosis must also be taken into account. Individuals with cancer and dementia pose unique challenges to healthcare professionals owing to the potential for impaired decision-making capacity, poor communication and difficulties following medication regimes. Mild cognitive impairment and ‘chemo brain’ should be differentiated from progressive neurodegeneration.

Sensory and consumer science methods used with older adults: a review of current methods and recommendations for the future

Capturing the sensory perception and preferences of older adults, whether healthy or with particular disease states, poses major methodological challenges for the sensory community. Currently a vastly under researched area, it is at the same time a vital area of research as alterations in sensory perception can affect daily dietary food choices, intake, health and wellbeing. Tailored sensory methods are needed that take into account the challenges of working with such populations including poor access leading to low patient numbers (study power), cognitive abilities, use of medications, clinical treatments and context (hospitals and care homes). The objective of this paper was to review current analytical and affective sensory methodologies used with different cohorts of healthy and frail older adults, with focus on food preference and liking. We particularly drew attention to studies concerning general ageing as well as to those considering age-related diseases that have an emphasis on malnutrition and weight loss. Pubmed and Web of Science databases were searched to 2014 for relevant articles in English. From this search 75 papers concerning sensory acuity, 41 regarding perceived intensity and 73 relating to hedonic measures were reviewed. Simpler testing methods, such as directional forced choice tests and paired preference tests need to be further explored to determine whether they lead to more reliable results and better inter-cohort comparisons. Finally, sensory quality and related quality of life for older adults suffering from dementia must be included and not ignored in our future actions.

Chinese Basic Pension Substitution Rate: A Monte Carlo Demonstration of the Individual Account Model

At the end of 2005, the State Council of China passed ”The Decision on adjusting the Individual Account of Basic Pension System”, which adjusted the individual account in the 1997 basic pension system. In this essay, we will analyze the adjustment above, and use Life Annuity Actuarial Theory to establish the basic pension substitution rate model. Monte Carlo simulation is also used to prove the rationality of the model. Some suggestions are put forward associated with the substitution rate according to the current policy.

Is the meander growth in the Brazil Current system off Southeast Brazil due to baroclinic instability?

Temporally-growing frontal meandering and occasional eddy-shedding is observed in the Brazil Current (BC) as it flows adjacent to the Brazilian Coast. No study of the dynamics of this phenomenon has been conducted to date in the region between 22 degrees S and 25 degrees S. Within this latitude range, the flow over the intermediate continental slope is marked by a current inversion at a depth that is associated with the Intermediate Western Boundary Current (IWBC). A time series analysis of 10-current-meter mooring data was used to describe a mean vertical profile for the BC-IWBC jet and a typical meander vertical structure. The latter was obtained by an empirical orthogonal function (EOF) analysis that showed a single mode explaining 82% of the total variance. This mode structure decayed sharply with depth, revealing that the meandering is much more vigorous within the BC domain than it is in the IWBC region. As the spectral analysis of the mode amplitude time series revealed no significant periods, we searched for dominant wavelengths. This search was done via a spatial EOF analysis on 51 thermal front patterns derived from digitized AVHRR images. Four modes were statistically significant at the 95% confidence level. Modes 3 and 4, which together explained 18% of the total variance, are associated with 266 and 338-km vorticity waves, respectively. With this new information derived from the data, the [Johns, W.E., 1988. One-dimensional baroclinically unstable waves on the Gulf Stream potential vorticity gradient near Cape Hatteras. Dyn. Atmos. Oceans 11, 323-350] one-dimensional quasi-geostrophic model was applied to the interpolated mean BC-IWBC jet. The results indicated that the BC system is indeed baroclinically unstable and that the wavelengths depicted in the thermal front analysis are associated with the most unstable waves produced by the model. Growth rates were about 0.06 (0.05) days(-1) for the 266-km (338-km) wave. Moreover, phase speeds for these waves were low compared to the surface BC velocity and may account for remarks in the literature about growing standing or stationary meanders off southeast Brazil. The theoretical vertical structure modes associated with these waves resembled very closely to the one obtained for the current-meter mooring EOF analysis. We interpret this agreement as a confirmation that baroclinic instability is an important mechanism in meander growth in the BC system. (C) 2008 Elsevier B.V. All rights reserved.

A Model for Bundled Conductors considering a Non-Homogeneous Distribution of the Current through Subconductors

This paper describes an alternative procedure to obtain an equivalent conductor from a bundled conductor, taking into account the distribution of the current in subcondutors of the bundle. Firstly, it is introduced a brief background about the concept of Geometric Mean Radius (GMR) and how this methodology is applied to define an equivalent conductor and its electric parameters. Emphasizing that the classical procedure, using GMR, is limited to premise which the current is equally distributed through subconductors. Afterwards, it is described the development of proposed method and applications for an equivalent conductor obtained from a conventional transmission line bundled conductor and from an equivalent conductor based on a bundle with compressed SF(6) insulation system, where the current is unequally distributed through subconductors.

Toward a hierarchical concept of plant stress

A number of attempts have been made to obtain a clear definition of biological stress. However, in spite of the efforts, some controversies on the concept of plant stress remain. The current versions are centered either on the cause (stress factor) or on the effect (stress response) of environmental stress. The objective of this study was to contribute to the definition of stress, using a hierarchical approach. Thus, we have performed an analysis of the most usual stress concepts and tested the relevance of considering different observation scales in a study on plant response to water deficit. Seedlings of Eucalyptus grandis were grown in vitro at water potentials ranging from -0.16 to -0.6 MPa, and evaluated according to growth and biochemical parameters. Data were analyzed through principal component analysis (PCA), which pointed to a hierarchical organization in plant responses to environmental disturbances. Growth parameters (height and dry weight) are more sensitive to water deficit than biochemical ones (sugars, proline, and protein), suggesting that higher hierarchical levels were more sensitive to environmental constraints than lower hierarchical ones. We suggest that before considering an environmental fluctuation as stressful, it is necessary to take into account different levels of plant response, and that the evaluation of the effects of environmental disturbances on an organism depends on the observation scale being used. Hence, a more appropriate stress concept should consider the hierarchical organization of the biological systems, not only for a more adequate theoretical approach, but also for the improvement of practical studies on plants under stress.