The prognosis of incurable cachectic cancer patients on home parenteral nutrition: A multi-centre observational study with prospective follow-up of 414 patients

Background: The role of home parenteral nutrition (HPN) in incurable cachectic cancer patients unable to eat is extremely controversial. The aim of this study is to analyse which factors can influence the outcome. Patients and methods: We studied prospectively 414 incurable cachectic (sub)obstructed cancer patients receiving HPN and analysed the association between patient or clinical characteristics and surviving status. Results: Median weight loss, versus pre-disease and last 6-month period, was 24% and 16%, respectively. Median body mass index was 19.5, median KPS was 60, median life expectancy was 3 months. Mean/median survival was 4.7/3.0 months; 50.0% and 22.9% of patients survived 3 and 6 months, respectively. At the multivariable analysis, the variables significantly associated with 3- and 6-month survival were Glasgow Prognostic Score (GPS) and KPS, and GPS, KPS and tumour spread, respectively. By the aggregation of the significant variables, it was possible to dissect several classes of patients with different survival probabilities. Conclusions: The outcome of cachectic incurable cancer patients on HPN is not homogeneous. It is possible to identify groups of patients with a ≥6-month survival (possibly longer than that allowed in starvation). The indications for HPN can be modulated on these clinical/biochemical indices. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Traffic policing in ATM networks with multimedia traffic: the super leaky bucket

Traffic policing and bandwidth management strategies at the User Network Interface (UNI) of an ATM network are investigated by simulation. The network is assumed to transport real time (RT) traffic like voice and video as well as non-real time (non-RT) data traffic. The proposed policing function, called the super leaky bucket (S-LB), is based on the leaky bucket (LB), but handles the three types of traffic differently according to their quality of service (QoS) requirements. Separate queues are maintained for RT and non-RT traffic. They are normally served alternately, but if the number of RT cells exceeds a threshold, it gets non-pre-emptive priority. Further increase of the RT queue causes low priority cells to be discarded. Non-RT cells are buffered and the sources are throttled back during periods of congestion. The simulations clearly demonstrate the advantages of the proposed strategy in providing improved levels of service (delay, jitter and loss) for all types of traffic.

Issues in delivering multimedia content to mobile devices

The scalability of a computer system is its response to growth. It is also depended on its hardware, its operating system and the applications it is running. Most distributed systems technology today still depends on bus-based shared memory which do not scale well, and systems based on the grid or hypercube scheme requires significantly less connections than a full inter-connection that would exhibit a quadratic growth rate. The rapid convergence of mobile communication, digital broadcasting and network infrastructures calls for rich multimedia content that is adaptive and responsive to the needs of individuals, businesses and the public organisations. This paper will discuss the emergence of mobile Multimedia systems and provides an overview of the issues regarding design and delivery of multimedia content to mobile devices.

Evaluation of a suitable learning style for iLearn: a personalised e-learning platform

Brusilovsky and Millan (2007) state that learning styles are typically defined as the way people prefer to learn. Learning styles and how we learn is a vast research area and many research projects (SMILE, INSPIRE, iWeaver amongst others) attempt to incorporate these learning styles into e-Learning systems. This paper describes commonly used learning styles and how they are currently being used within the area of adaptive e-Learning. This work also builds upon current research and evaluates learning styles using criteria proposed by Sampson and Karagiannidis (2004) in order to select a suitable learning methodology for the iLearn e-Learning platform. The Sampson and Karagiannidis (2004) criteria is adapted for the purpose of the research and describes the measurability, time effectiveness and descriptiveness and prescriptiveness of the specific learning style. A suitable learning style for the iLearn e-Learning platform is then proposed within the paper and finally the research briefly introduces how the chosen learning style will be used for the proposed e-Learning platform.

Personalised e-learning, semantic web and learning ontologies

Kurzel(2004) points out that researchers in e-learning and educational technologists, in a quest to provide improved Learning Environments (LE) for students are focusing on personalising the experience through a Learning Management System (LMS) that attempts to tailor the LE to the individual (see amongst others Eklund & Brusilovsky, 1998; Kurzel, Slay, & Hagenus, 2003; Martinez,2000; Sampson, Karagiannidis, & Kinshuk, 2002; Voigt & Swatman; 2003). According to Kurzel (2004) this tailoring can have an impact on content and how it’s accessed; the media forms used; method of instruction employed and the learning styles supported. This project is aiming to move personalisation forward to the next generation, by tackling the issue of Personalised e-Learning platforms as pre-requisites for building and generating individualised learning solutions. The proposed development is to create an e-learning platform with personalisation built-in. This personalisation is proposed to be set from different levels of within the system starting from being guided by the information that the user inputs into the system down to the lower level of being set using information inferred by the system’s processing engine. This paper will discuss some of our early work and ideas.

Home is where my archive is

The miniaturization and dissemination of audiovisual media into small, mobile assemblages of cameras, screens and microphones has brought "database cinema" (Manovich) into pockets and handbags. In turn, this micro-portability of video production calls for a reconsideration of database cinema, not as an aesthetic but rather as a media ecology that makes certain experiences and forms of interaction possible. In this context the clip and the fragment become a social currency (showing, trading online, etc.), and the enjoyment of a moment or "occasion" becomes an opportunity for recording, extending, preserving and displaying. If we are now the documentarists of our lives (as so many mobile phone adverts imply), it follows that we are also our own archivists as well. From the folksonomies of Flickr and YouTube to the slick "media centres" of Sony, Apple and Microsoft, the audiovisual home archive is a prized territory of struggle among platforms and brands. The database is emerging as the dominant (screen) medium of popular creativity and distribution – but it also brings the categories of "home" and "person" closer to that of the archive.

Insolvency: ordering a sale of the family home

Comments on the Chancery Division ruling in Nicholls v Lan on whether the interests of a bankrupt husband's creditors prevailed over those of the wife, despite her circumstances being exceptional within the meaning of the Insolvency Act 1986 s.335A on account of her suffering from chronic schizophrenia, where the wife was the joint owner of another property which could be realised to buy out the trustee in bankruptcy's half share in the equity of the matrimonial home.

An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

Parent education and home-based behaviour analytic intervention: an examination of parents' perceptions of outcome

There is convincing evidence that applied behaviour analysis (ABA) offers a highly effective form of intervention for children with autistic spectrum disorder (ASD). There is less evidence, however, about how parents perceive and evaluate ABA programmes. In this paper an examination of parents’ perceptions of outcome is reported. Twenty-two questionnaires were completed by two groups of parents. The first group had just completed an introductory course in ABA and were in the early stages of implementing ABA programmes with their children. The second group had been involved in ABA education for more than 2 years. Overall, both groups of parents reported a positive impact of ABA on the lives of their children, their family life, and themselves. The long- term group reported that they had achieved complex goals with their children, whilst the short-term group reported an immediate positive impact on child and family functioning and parental self-esteem. Conclusions are drawn in the context of evidence-based practice.