'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective

Background
Despite the recognized importance of end-of-life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking.

Objective
We sought to understand patient perspectives on physician behaviours during EOL communication.

Design
In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase. In the quantitative strand, we used the quality of communication tool (QOC) to measure physician behaviours that predict global rating of satisfaction in EOL communication skills, while in the qualitative strand we conducted semi-structured interviews. During the mixed methods analysis, we compared and contrasted qualitative and quantitative data.

Setting and Participants
Seriously ill inpatients at three tertiary care hospitals in Canada.

Results
We found convergence between qualitative and quantitative strands: patients desire candid information from their physician and a sense of familiarity. The quantitative results (n = 132) suggest a paucity of certain EOL communication behaviours in this seriously ill population with a limited prognosis. The qualitative findings (n = 16) suggest that at times, physicians did not engage in EOL communication despite patient readiness, while sometimes this may represent an appropriate deferral after assessment of a patient's lack of readiness.

Conclusions
Avoidance of certain EOL topics may not always be a failure if it is a result of an assessment of lack of patient readiness. This has implications for future tool development: a measure could be built in to assess whether physician behaviours align with patient readiness.

How Mothers Talk About Placement of Their Child With Autism Outside the Home

In this article I use insights offered by the poststructural shift and linguistic turn in social scientific inquiry, specifically discourse analysis, to explore mothers’ talk about the placement of their child with autism outside of the home. By viewing mothers’ talk as data, I bring to light the discourses and interpretive practices that mothers drew on to organize their talk of placement. In doing so, I provide insights into how mothers gave meaning to processes of placement while also expanding on commonsensical discursive notions of “good” mothering, caregiving, and family. Implications of the findings are discussed.

Memory Cost Analysis for OpenFlow Multiple Table Lookup

Multiple Table Lookup architectures in Software Defined Networking (SDN) open the door for exciting new network applications. The development of the OpenFlow protocol supported the SDN paradigm. However, the first version of the OpenFlow protocol specified a single table lookup model with the associated constraints in flow entry numbers and search capabilities. With the introduction of multiple table lookup in OpenFlow v1.1, flexible and efficient search to support SDN application innovation became possible. However, implementation of multiple table lookup in hardware to meet high performance requirements is non-trivial. One possible approach involves the use of multi-dimensional lookup algorithms. A high lookup performance can be achieved by using embedded memory for flow entry storage. A detailed study of OpenFlow flow filters for multi-dimensional lookup is presented in this paper. Based on a proposed multiple table lookup architecture, the memory consumption and update performance using parallel single field searches are evaluated. The results demonstrate an efficient multi-table lookup implementation with minimum memory usage.

N-linked glycosylation supports cross-talk between receptor tyrosine kinases and androgen receptor

Prostate cancer is the second most common cause of cancer-associated deaths in men and signalling via a transcription factor called androgen receptor (AR) is an important driver of the disease. Androgen treatment is known to affect the expression and activity of other oncogenes including receptor tyrosine kinases (RTKs). In this study we report that AR-positive prostate cancer cell-lines express 50% higher levels of enzymes in the hexosamine biosynthesis pathway (HBP) than AR-negative prostate cell-lines. HBP produces hexosamines that are used by endoplasmic reticulum and golgi enzymes to glycosylate proteins targeted to plasma-membrane and secretion. Inhibition of O-linked glycosylation by ST045849 or N-linked glycosylation with tunicamycin decreased cell viability by 20%. In addition, tunicamycin inhibited the androgen-induced expression of AR target genes KLK3 and CaMKK2 by 50%. RTKs have been shown to enhance AR activity and we used an antibody array to identify changes in the phosphorylation status of RTKs in response to androgen stimulation. Hormone treatment increased the activity of Insulin like Growth Factor 1-Receptor (IGF-1R) ten-fold and this was associated with a concomitant increase in the N-linked glycosylation of the receptor, analyzed by lectin enrichment experiments. Glycosylation is known to be important for the processing and stability of RTKs. Inhibition of N-linked glycosylation resulted in accumulation of IGF-1R pro-receptor with altered mobility as shown by immunoprecipitation. Confocal imaging revealed that androgen induced plasma-membrane localization of IGF-1R was blocked by tunicamycin. In conclusion we have established that the glycosylation of IGF-1R is necessary for the full activation of the receptor in response to androgen treatment and that perturbing this process can break the feedback loop between AR and IGF-1R activation in prostate cells. Achieving similar results selectively in a clinical setting will be an important challenge in the future.

XBP 1-deficiency abrogates neointimal lesion of injured vessels via cross talk with the PDGF signaling

Objective: Smooth muscle cell (SMC) migration and proliferation play an essential role in neointimal formation after vascular injury. In this study, we intended to investigate whether the X-box-binding protein 1 (XBP1) was involved in these processes.

Approach and Results: In vivo studies on femoral artery injury models revealed that vascular injury triggered an immediate upregulation of XBP1 expression and splicing in vascular SMCs and that XBP1 deficiency in SMCs significantly abrogated neointimal formation in the injured vessels. In vitro studies indicated that platelet-derived growth factor-BB triggered XBP1 splicing in SMCs via the interaction between platelet-derived growth factor receptor β and the inositol-requiring enzyme 1α. The spliced XBP1 (XBP1s) increased SMC migration via PI3K/Akt activation and proliferation via downregulating calponin h1 (CNN1). XBP1s directed the transcription of mir-1274B that targeted CNN1 mRNA degradation. Proteomic analysis of culture media revealed that XBP1s decreased transforming growth factor (TGF)-β family proteins secretion via transcriptional suppression. TGF-β3 but not TGF-β1 or TGF-β2 attenuated XBP1s-induced CNN1 decrease and SMC proliferation.

Conclusions: This study demonstrates for the first time that XBP1 is crucial for SMC proliferation via modulating the platelet-derived growth factor/TGF-β pathways, leading to neointimal formation.

Influence of Soil and Irrigation Management on the Quality of Seedless Crimson Table Grapes

The market for table grapes is moving into mass production of specialty seed-less grapes in covered areas, aiming at obtaining premium prices with early or late production of high quality products. Production of quality seedless grapes is not straightforward since it is requires the correct combination of various independent characteristics, such as color, sugars, size and quantity at the right moment for successful harvesting and marketing. The present study was carried out at the two largest Portuguese producers located in Alentejo, and has the objective of studying the effect of irrigation management strategies and two different soils on the various relevant parameters for successful production and marketing. The management strategies were the application of ten day stress at the end of the cycle, in order to promote early maturing of the grapes. Three different timings of the stress were applied. Soil moisture, sap flow, bark thickness, as well as leaf water potential, stomatal conductance and chlorophyll content were measured regularly during the production season. The results indicate that the roots explore a rather large soil volume and the plants can successfully withstand reasonable periods of drought without significant changes to the plant physiology. Additionally late rains can mask the effect of any farmer applied drought and invalidate any farmer induced stress to the plants. Water-logged soils tend to cause early onset of maturity, but cause the ripening stage to extend over a longer period of time, and thus, in effect result in a delay in the harvest date. Topography also has some effect on the ripening, since hot air tends to accumulate under the plastic at the higher areas of the field. This work is funded by PRODER, 4.1, within the scope of project MORECRIMSON

Seismic retrofitting of RC buildings using CFRP and post-tensioned metal straps: shake table tests

This article examines the effectiveness of two innovative retrofitting solutions at enhancing the seismic behaviour of a substandard reinforced concrete building tested on a shake table as part of the Pan-European funded project BANDIT. To simulate typical substandard construction, the reinforcement of columns and beam-column joints of the full-scale structure had inadequate detailing. An initial series of shake table tests were carried out to assess the seismic behaviour of the bare building and the effectiveness of a first retrofitting intervention using Post-Tensioned Metal Straps. After these tests, columns and joints were repaired and subsequently retrofitted using a retrofitting solution consisting of Carbon Fibre Reinforced Polymers and Post-Tensioned Metal Straps applied on opposite frames of the building. The building was then subjected to unidirectional and three-dimensional incremental seismic excitations to assess the effectiveness of the two retrofitting solutions at improving the global and local building performance. The article provides details of the above shake table testing programme and retrofitting solutions, and discusses the test results in terms of the observed damage, global damage indexes, performance levels and local strains. It is shown that whilst the original bare building was significantly damaged at a peak ground acceleration (PGA) of 0.15g, the retrofitted building resisted severe threedimensional shake table tests up to PGA=0.60g without failure. Moreover, the retrofitting intervention enhanced the interstorey drift ratio capacity of the 1st and 2nd floors by 160% and 110%, respectively. Therefore, the proposed dual retrofitting system is proven to be very effective for improving the seismic performance of substandard buildings.

Full-Scale Shaking Table Tests on a Substandard RC Building Repaired and Strengthened with Post-Tensioned Metal Straps

The effectiveness of a novel Post-Tensioned Metal Strapping (PTMS) technique at enhancing the seismic behaviour of a substandard RC building was investigated through full-scale shake-table tests during the EU-funded project BANDIT. The building had inadequate reinforcement detailing in columns and joints to replicate old construction practices. After the bare building was initially damaged significantly, it was repaired and strengthened with PTMS to perform additional seismic tests. The PTMS technique improved considerably the seismic performance of the tested building. Whilst the bare building experienced critical damage at an earthquake of PGA=0.15g, the PTMS-strengthened building sustained a PGA=0.35g earthquake without compromising stability.

Fighting Talk: The Statements of 'The IRA/New IRA'

With the advent of the new violent dissident merger, ‘The IRA/New IRA’, the group and its affiliates have had to legitimise their new existence. They have utilised the maintenance of paramilitary activity to achieve this. However, they have also produced a number of organisational statements, justifying their position, tactics and strategies. This article analyses the evolution of these statements, both pre and post-merger from 2007 to 2015. 126 individual statements and 4 magazines are analysed using grounded theory. This analysis found that the statements have a dual strategy, aiming to foster trust in the movement and distrust in their perceived enemies. One of the dominant ways in which the group aims to foster trust, is by proposing their possession of an historical mandate from the republican forefathers of 1916, as well as the internally lauded paramilitaries from the Troubles era PIRA. The focus of the distrust narrative has been on the ‘constitutional nationalism’ of Sinn Féin. However, it also pours scorn on the PSNI, and capitalism, across the island of Ireland. The analysis of these statements can provide us with an understanding of the future direction of the group, as well as giving us insight, which can inform the development of any counter-narrative.

Writers talk: conversations with contemporary British novelists

Interviews with British novelists, plus critical overviews and bibliographic matter.

Invisible cities: the table of contents and the labyrinths of reality

In Invisible Cities (1972), Italo Calvino contrasts a rigid outline structure with a flexible textual content. The tension comprised by the numerical structure proposed in the table of contents stands out against the set of polissemic texts which make up the subject matter of the book. The opposition between form and content point to a fruitful dichotomy in the conception of the novel linked to the theories of the open and closed work. This essay will investigate the structural construction of Invisible Cities by looking at its table of contents, seeking to discuss some models of formalistic representation proposed by the criticism and the specific contribution they may, or may not, provide. The objective is to analyse the pertinence of such theories in the light of historical and cultural approaches. Aiming to uncover possible meanings which arise from the debate, this essay will question to what extent structural complexities can be considered literary if they are not ultimately related to the culture in which a text is found.