Written survey on recently deceased patients in germany and switzerland: how do general practitioners see their role?

BACKGROUND General practitioners (GPs) play an important role in end-of-life care due to their proximity to the patient's dwelling-place and their contact to relatives and other care providers. METHODS In order to get a better understanding of the role which the GP sees him- or herself as playing in end-of-life care and which care their dying patients get, we conducted this written survey. It asked questions about the most recently deceased patient of each physician. The questionnaire was sent to 1,201 GPs in southern North Rhine-Westphalia (Germany) and the Canton of Bern (Switzerland). RESULTS Response rate was 27.5 % (n = 330). The average age of responding physicians was 54.5 years (range: 34-76; standard derivation: 7.4), 68 % of them were male and 45 % worked alone in their practice. Primary outcome measures of this observational study are the characteristics of recently deceased patients as well as their care and the involvement of other professional caregivers. Almost half of the most recently deceased patients had cancer. Only 3 to 16 % of all deceased suffered from severe levels of pain, nausea, dyspnea or emesis. More than 80 % of the doctors considered themselves to be an indispensable part of their patient's end-of-life care. Almost 90 % of the doctors were in contact with the patient's family and 50 % with the responsible nursing service. The majority of the GPs had taken over the coordination of care and cooperation with other attending physicians. CONCLUSION The study confirms the relevance of caring for dying patients in GPs work and provides an important insight into their perception of their own role.

The role of the experience and expression of anger in future cardiovascular profiles in young adolescents

Cardiovascular disease (CVD) is this nation's leading source of morbidity and mortality, with health disparities evident. Despite inconsistencies in the literature, there is a growing body of evidence that links anger and CV reactivity (CVR) to future CVD. Because CVD is a life-long process with beginnings in childhood, and because adolescents experience and express anger frequently, the need to understand the role that anger has in future CV profiles is important. If identifiable patterns are found, nursing interventions can be implemented at the most beneficial point in the lifespan. This study examined data collected as part of The Heartfelt Study (N = 374), which investigated anger in relation to 24-hour ambulatory blood pressure (BP) and CVR in a multi-ethnic (African, Hispanic, and European American) sample of adolescents (Time 1). This investigator conducted a follow-up for all The Heartfelt Study participants, 11 to 13 years old at the beginning of study, still in attendance at the middle school (N = 44) one year later (Time 2) to determine: (1) changes in anger over time were associated with changes in ambulatory CV profiles: systolic (SBP), diastolic (DBP), heart rate (HR), and pulse pressure (PP) over time; and (2) the extent to which CVR, initiated by talking about a recent anger-producing event, related to future ambulatory CV profiles. A mixed-effects regression for repeated measures was used to analyze the data and found that SBP reactivity at Time 1 was significantly (β = 0.2341, t = 5.91, p < 0.0001) associated with ambulatory SBP at Time 2 and PP reactivity at Time 1 was significantly (β = 0.1530, t = 5.70, p < 0.0001) associated with ambulatory PP at Time 2. Changes in anger over time were not associated with changes in ambulatory BP measures over time. Further research on anger and CVR among adolescents over longer periods of time is recommended. ^

The experience and meaning of injury among migrant farmworkers from Starr County, Texas

Occupational injuries suffered by migrant farmworkers in the United States continue to be a significant byproduct of the hazards of the agricultural work sector. Although the fields of study involving occupational health and safety have helped to further an understanding of the importance of injury prevention in the workplace, farmworkers have typically not been the beneficiaries of significant improvement in working conditions; similarly, public health policies have generally not been successful in significantly improving their protection. The primary objective of this research was to examine more closely, through in-depth interviews, the underlying reasons attributed by migrant farmworkers to their having suffered occupational injuries. By re-contacting and re-interviewing migrant farmworkers who had reported injuries in a study entitled A Cohort Study of Injuries in Migrant Farmworker Families in South Texas, the current research study employed qualitative research methods and determined several reasons that may help to explain why this specific group has suffered injuries and may not have reported such injuries, as well as to consider what their experiences may say about injury prevention within the context of public health.^

Prospective gated 64 slice computed tomography in assessment of coronary artery disease: A single center experience and relationship of body mass index to outcomes

Coronary artery disease (CAD) is the most common cause of morbidity and mortality in the United States. While Coronary Angiography (CA) is the gold standard test to investigate coronary artery disease, Prospective gated-64 Slice Computed Tomography (Prosp-64CT) is a new non-invasive technology that uses the 64Slice computed tomography (64CT) with electrocardiographic gating to investigate coronary artery disease. The aim of the current study was to investigate the role of Body Mass Index (BMI) as a factor affecting occurrence of CA after a Prosp-64CT, as well as the quality of the Prosp-64CT. Demographic and clinical characteristics of the study population were described. A secondary analysis of data on patients who underwent a Prosp-64CT for evaluation of coronary artery disease was performed. Seventy seven patients who underwent Prosp-64CT for evaluation for coronary artery disease were included. Fifteen patients were excluded because they had missing data regarding BMI, quality of the Prosp-64CT or CA. Thus, a total of 62 patients were included in the final analysis. The mean age was 56.2 years. The mean BMI was 31.3 kg/m 2. Eight (13%) patients underwent a CA within one month of Prosp-64CT. Eight (13%) patients had a poor quality Prosp-64CT. There was significant association of higher BMI as a factor for occurrence of CA post Prosp-64CT (P<0.05). There was a trend, but no statistical significance was observed for the association of being obese and occurrence of CA (P=0.06). BMI, as well as obesity, were not found to be significantly associated with poor quality of Prosp-64CT (P=0.19 and P=0.76, respectively). In conclusion, BMI was significantly associated with occurrence of CA within one month of Prosp-64CT. Thus, in patients with a higher BMI, diagnostic investigation with both tests could be avoided; rather, only a CA could be performed. However, the relationship of BMI to quality of Prosp-64CT needs to be further investigated since the sample size of the current study was small.^

Quality of life, symptom experience, and use of complementary and alternative medicine among women with ovarian cancer

The objectives of this dissertation were to determine the quality of life in women with ovarian cancer and the association of their physical and emotional well-being with the number of symptoms, duration of symptoms, and the scores of common symptoms of ovarian cancer; to study the prevalence of complementary and alternative medicine techniques for symptom relief and its association with the number of symptoms, age, education, insurance, comorbidity, and satisfaction with medical care they received, and their pre-diagnostic experience of symptoms.^ This study was based on a secondary data analysis of a study of early detection of ovarian cancer. A sample of 139 women with ovarian cancer was recruited and was administered a questionnaire comprised of questions on their quality of life, their symptoms and what they did about the symptoms, whether they used any complementary and alternative medicine techniques, and other medical conditions they had. Out of this sample, 53 patients underwent in-depth interviews relating to their symptoms before the diagnosis and their experiences with the health care system leading to the ovarian cancer diagnosis. ^ In article #1, ovarian cancer patients were observed to have significantly poorer quality of life on all subscales and summary scores except pain, compared to that of the general population of US women. Physical well-being scores were negatively associated with the number of symptoms before diagnosis and a significant negative association of comorbidity index was observed with physical well-being. Higher education and increase in time since diagnosis was found to have better physical scores. Emotional well-being scores showed marginally significant associations with number of symptoms and bloating. ^ In article #2, a thematic content analysis of the ovarian cancer patients’ interviews revealed that on recognition of their symptoms women first assumed their symptoms to be a normal transient occurrence due to a pre-existing disease condition, or due to some other disease. A series of misattributions of their symptoms on their and their doctors’ part impacted their health care seeking.In article #3, a significantly greater likelihood of CAM use with an increase in the number of symptoms was observed.^ Based on the foregoing results, it is important to educate women on possible signs of ovarian cancer and also to educate doctors about the results of current research regarding ovarian cancer diagnosis. This will help to avoid a delay in getting a diagnosis and improve women’s quality of life. It emphasizes the diagnosis of ovarian cancer in earlier stages by more sensitive screening techniques. This study emphasizes the importance of consideration of comorbidity in any quality of life research. Additionally, educating women in the safe use of CAM techniques carries immense significance because the efficacy and safety of many of the currently advertized CAM products has not been scientifically validated. Further research is needed to confirm the findings of this study. ^

Myanmar and Japan: How Close Friends Become Estranged

Independent Myanmar and Japan had long held the strongest ties among Asian countries, and they were often known as having "special relations" or a "historically friendly relationship." Such relations were guaranteed by the sentiments and experiences of the leaders of both countries. Among others, Ne Win, former strongman throughout the socialist period (1962-1988), was educated and trained by the Japanese army officers of the Minami Kikan, leading to the birth of the Burma Independence Army (BIA). Huge official development assistance provided by the Japanese government also cemented this special relationship. However, the birth of the present military government (SLORC/SPDC) in 1988 drastically changed this favorable relationship between the two countries. When the military seized power in a coup, Japan was believed to be the only country that possessed sufficient meaningful influence on Myanmar to encourage a move toward national reconciliation between the junta and the opposition party led by Aung San Suu Kyi. In reality, Japan failed to exert such an influence due to its sour relations with the military government and reduced influence in the new international and regional political landscape. What is worse, Japan seems to be losing its say on Myanmar issues in the international political arena, as it has been wavering in limbo between the sanctionist forces, such as the United States and the European Union, and engagement forces, such as China and ASEAN.

Industrial Policy in Asia

This paper examines three types of industrialization that have occurred in East Asia: the Japanese, Chinese and generic Asian models. Industrial policies in Japan and the Republic of Korea (ROK) initially protected local companies from foreign investors by imposing high tariffs on foreign investors. But Japan began introducing liberalization policies to attract foreign direct investment (FDI) in the 1960s, and the ROK began to welcome foreign technology in the 1970s. Meanwhile, the governments of the ASEAN countries and Taiwan established export-processing zones (EPZ) to invite FDI by offering preferential treatment, such as tax deductions and exemptions. China adopted similar industrial policies and also established EPZs, attracting the capital and know-how of multinationals and thereby strengthening the international competitiveness of local enterprises. This paper reaches the following three conclusions. First, it would have been difficult for East Asian countries to grow without FDI. Second, central governments were a crucial factor in these countries' growth strategies. Third, EPZs offering preferential treatment can effectively enhance aggregate growth in developing countries, and the Asian experience shows that this strategy can be applied to other countries that satisfy certain preconditions.

Digital libraries for the preservation of research methods and associated artifacts

New digital artifacts are emerging in data-intensive science. For example, scientific workflows are executable descriptions of scientific procedures that define the sequence of computational steps in an automated data analysis, supporting reproducible research and the sharing and replication of best-practice and know-how through reuse. Workflows are specified at design time and interpreted through their execution in a variety of situations, environments, and domains. Hence it is essential to preserve both their static and dynamic aspects, along with the research context in which they are used. To achieve this, we propose the use of multidimensional digital objects (Research Objects) that aggregate the resources used and/or produced in scientific investigations, including workflow models, provenance of their executions, and links to the relevant associated resources, along with the provision of technological support for their preservation and efficient retrieval and reuse. In this direction, we specified a software architecture for the design and implementation of a Research Object preservation system, and realized this architecture with a set of services and clients, drawing together practices in digital libraries, preservation systems, workflow management, social networking and Semantic Web technologies. In this paper, we describe the backbone system of this realization, a digital library system built on top of dLibra.

Quality of experience and HTTP adaptive streaming: a review of subjective studies

HTTP adaptive streaming technology has become widely spread in multimedia services because of its ability to provide adaptation to characteristics of various viewing devices and dynamic network conditions. There are various studies targeting the optimization of adaptation strategy. However, in order to provide an optimal viewing experience to the end-user, it is crucial to get knowledge about the Quality of Experience (QoE) of different adaptation schemes. This paper overviews the state of the art concerning subjective evaluation of adaptive streaming QoE and highlights the challenges and open research questions related to QoE assessment.

Experience and lessons learnt from the SMART 2013 Benchmark

The French CEA, together with EDF and the IAEA, recently organised an international benchmark to evaluate the ability to model the mechanical behaviour of a typical nuclear reinforced concrete structure subjected to seismic demands. The participants were provided with descriptions of the structure and the testing campaign; they had to propose the numerical model and the material laws for the concrete (stage #1). A mesh of beam and shell elements was generated; for modelling the concrete a damaged plasticity model was used, but a smeared crack model was also investigated. Some of the initial experimental results, with the mock-up remaining in the elastic range, were provided to the participants for calibrating their models (stage #2). Predictions had to be produced in terms of eigen-frequencies and motion time histories. The calculated frequencies reproduced reasonably the experimental ones; the time histories, calculated by modal response analysis, also reproduced adequately the observed amplifications. The participants were then expected to predict the structural response under strong ground motions (stage #3), which increased progressively up to a history recorded during the 1994 Northridge earthquake, followed by an aftershock. These results were produced using an explicit solver and a damaged plasticity model for the concrete, although an implicit solver with a smeared crack model was also investigated. The paper presents the conclusions of the pre-test exercise, as well as some observations from additional simulations conducted after the experimental results were made available.

A Ciência nos Telejornais Brasileiros (O papel educativo e a compreensão pública das matérias de CT&I)

Este trabalho investiga a cobertura de Ciência, Tecnologia e Inovação (CT&I) nos telejornais brasileiros de canal aberto, no horário nobre (das 19h15 às 22h), para verificar a função educativa da mídia na abordagem de assuntos de CT&I. O corpus desta pesquisa compõe-se de um recorte dos seguintes telejornais: Jornal da Band, Jornal Nacional, Jornal da Record, Jornal da Cultura e SBT Brasil. A proposta foi avaliar, comparativamente, as matérias jornalísticas que tratam especificamente de CT&I, em relação ao formato, à linguagem e aos conteúdos de cada um dos programas estudados. Este trabalho empregou a metodologia de Análise de Discurso de linha Francesa (AD). Esta pesquisa, de natureza qualitativa, também englobou um Estudo de Recepção sobre as reportagens selecionadas. O procedimento utilizado para isso foi o de Grupos Focais. Dessa forma, buscou-se analisar o processo de Comunicação que envolve as matérias telejornalísticas de CT&I das mensagens à recepção. Este estudo verificou que CT&I é um assunto presente nos telejornais brasileiros mesmo quando ocorrem fatos imprevisíveis (de outras editorias) que influenciam significativamente a cobertura dos noticiários televisivos. Constatou também que não há, entre os telejornais selecionados, um padrão de aprofundamento e contextualização dos assuntos CT&I, mas que a abordagem varia até dentro de uma única edição. As emissoras, mesmo reconhecendo a importância de CT&I, ainda oscilam entre uma abordagem contextualizada e a simples descrição do fato principal. A linguagem empregada pelos telejornais para o tratamento de assuntos de Ciência, Tecnologia e Inovação é, predominantemente, clara e simples. No entanto, foi possível verificar algumas nuances, com o uso de termos específicos da linguagem científica sem que a matéria oferecesse qualquer explicação sobre tais conceitos. A experiência dos Grupos Focais revelou que os telespectadores não são passivos em relação aos conteúdos científicos dos programas telejornalísticos. De modo geral, o público se interessa por CT&I e sabe avaliar qualitativamente as matérias. Analisar como as matérias sobre CT&I produzem sentidos e qual a contribuição que estas podem dar à Compreensão Pública da Ciência possibilitou reflexões relevantes sobre as limitações e os potenciais da televisão e das mensagens veiculadas, assim como o interesse e a visão crítica a respeito dos assuntos de CT&I.(AU)