Palliative care phase : inter-rater reliability and acceptability in a national study

Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding. Aim: To test the reliability and acceptability of revised definitions of Palliative Care Phase. Design: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. Setting/participants: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. Results: A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians’ rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61–0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase. Conclusion: Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.

Triphasic pattern in the ex vivo response of human proliferative phase endometrium to oestrogens

The aim of this study was to evaluate the ex vivo oestrogen responsiveness of human proliferative phase endometrium using short-term explant cultures. The effects of oestrogen (17beta-E2) on proliferation and the expression of oestrogen-responsive genes known to be involved in regulating endometrial function were evaluated. Three distinct response patterns could be distinguished: (1) the menstrual (M) phase pattern (cycle days 2-5), which is characterised by a complete lack in the proliferative response to 17beta-E2, while an increased expression of AR (2.6-fold, P<0.01), PR (2.7-fold, P<0.01) and COX-2 (3.5-fold, P<0.01) at the mRNA level was observed and a similar upregulation was also found for AR, PR and COX-2 at the protein level; (2) the early proliferative (EP) phase pattern (cycle days 6-10) with 17beta-E2 enhanced proliferation in the stroma (1.7-fold, P<0.05), whereas the expression of AR, PR and COX-2 were not affected at the mRNA and protein levels and ER-a mRNA and protein levels were significantly reduced by 17beta-E2; (3) the late proliferative (LP) phase pattern (cycle days 11-14), which is characterised by a moderate stimulation of proliferation (1.4-fold, P<0.05) and PR mRNA expression (1.7-fold, P<0.01) by 17beta-E2. In conclusion, three distinct response patterns to 17beta-E2 could be identified with respect to proliferation and the expression of known oestrogen-responsive genes in human proliferative phase endometrium explant cultures.

Migrants, refugees and mobility : how useful are information communication technologies in the first phase of resettlement?

The rate at which people move and resettle around the world is unprecedented. Mobility and resettlement is now greatly assisted by the use of inexpensive internet communication technologies (ICTs) for a wide variety of functions: to communicate locally and across territories, for localised information seeking, geo – locational mapping and for forging new social connections in host countries and cities. This article is based on a qualitative study of newly arrived migrants and mobile people from non English speaking backgrounds (NESB) to the city of Brisbane, Australia and investigates how the internet is used to assist the initial period of settling into the city. As increasing amounts of essential information is placed online, the study asks how people from NESB communities manage to negotiate the types of information they require during the early stages of resettlement, given varying levels of access to ICTs, digital and language literacy. The study finds that the internet is widely used for specific location information seeking (such as accommodation and job-seeking), but this is often supplemented with other non-mediated sources of information. The study identified implications for social policy in regard to the resourcing and access of information. While findings are specific to the study location, it is feasible that the patterns of internet use for resettlement have relevance in a broader context.

Optimal HMM processing of differentially phase modulated communication systems

This paper investigates demodulation of differentially phase modulated signals DPMS using optimal HMM filters. The optimal HMM filter presented in the paper is computationally of order N3 per time instant, where N is the number of message symbols. Previously, optimal HMM filters have been of computational order N4 per time instant. Also, suboptimal HMM filters have be proposed of computation order N2 per time instant. The approach presented in this paper uses two coupled HMM filters and exploits knowledge of ...

Correlation based method for phase identification in a three phase LV distribution network

Low voltage distribution networks feature a high degree of load unbalance and the addition of rooftop photovoltaic is driving further unbalances in the network. Single phase consumers are distributed across the phases but even if the consumer distribution was well balanced when the network was constructed changes will occur over time. Distribution transformer losses are increased by unbalanced loadings. The estimation of transformer losses is a necessary part of the routine upgrading and replacement of transformers and the identification of the phase connections of households allows a precise estimation of the phase loadings and total transformer loss. This paper presents a new technique and preliminary test results for a method of automatically identifying the phase of each customer by correlating voltage information from the utility's transformer system with voltage information from customer smart meters. The techniques are novel as they are purely based upon a time series of electrical voltage measurements taken at the household and at the distribution transformer. Experimental results using a combination of electrical power and current of the real smart meter datasets demonstrate the performance of our techniques.

Consumer phase identification in a three phase unbalanced LV distribution network

A new technique is presented for automatically identifying the phase connection of domestic customers. Voltage information from a reference three phase house is correlated with voltage information from other customer electricity meters on the same network to determine the highest probability phase connection. The techniques are purely based upon a time series of electrical voltage measurements taken by the household smart meters and no additional equipment is required. The method is demonstrated using real smart meter datasets to correctly identify the phase connections of 75 consumers on a low voltage distribution feeder.

Search-phase echolocation calls of the New Zealand lesser short-tailed bat (Mystacina tuberculata) and long-tailed bat (Chalinolobus tuberculatus).

This paper describes the search-phase echolocation calls of lesser short-tailed bats (Mystacina tuberculata) and long-tailed bats (Chalinolobus tuberculatus). Calls were recorded from all three subspecies of short-tailed bat and seven populations of long-tailed bat, three in Northland, two in the central North Island, and two in the lower South Island. The calls were recorded in the field and digitised, then three spectral components and one temporal component of the calls were measured. Calls of the lesser short-tailed bat could be loosely classified into subspecies by means of multivariate discriminant function analysis. Similarly, long-tailed bat calls showed regional variation, and discriminant function analysis was able to fit calls to regional groups with a high rate of success. The significance of the results presented is discussed in terms of the conservation of New Zealand bats and the unique ecology of the lesser short-tailed bat.

The entrepreneurial break-up : disengaging from the start-up phase

Research on firm exit has grown considerably in volume and sophistication in recent years, leading to new insights and strengthened research-based evidence. However, no framework explicitly explains nascent disengagement, i.e., termination of start-up efforts before the firm has reached an operational stage. Further, prior research has had limited success at explaining nascent entrepreneurial behaviour using theories based on logics of resource availability and economic rationality. In response, this chapter approaches nascent stage disengagement unconventionally by proposing to analogously apply Sternberg’s (1986) Triangular Theory of Love, arguing that founders are less likely to give up the start-up effort if they create strong, almost loving relations to their businesses. Nascent entrepreneurs who terminate the start-up process are proposed to lack one or more of the components – intimacy, passion, and commitment – which are essential according to Sternberg’s theory.

Breaking the DNA-vaccine bottleneck

Monash University in Australia has developed a new approach towards DNA vaccine development that has the potential to cut the time it takes to produce a vaccine from up to nine months to four weeks or less. The university has designed and filed a patent on a commercially viable, single-stage technology for manufacturing DNA molecules. The technology was used to produce malaria and measles DNA vaccines, which were tested to be homogeneous supercoiled DNA, free from RNA and protein contaminations and meeting FDA regulatory standards for DNA vaccines. The technique is based on customized, smart, polymeric, monolithic adsorbents that can purify DNA very rapidly. The design criteria of solid-phase adsorbent include rapid adsorption and desorption kinetics, physical composition, and adequate selectivity , capacity and recovery. The new show technology significantly improved binding capacities, higher recovery, drastically reduced use of buffers and processing time, less clogging, and higher yields of DNA.

Versatility of polymethacrylate monoliths for chromatographic purification of biomolecules

Polymethacrylate monoliths, specifically poly(glycidyl methacrylate-co-ethylene dimethacrylate) or poly(GMA-co-EDMA) monoliths, are a new generation of chromatographic supports and are significantly different from conventional particle-based adsorbents, membranes, and other monolithic supports for biomolecule purification. Similar to other monoliths, polymethacrylate monoliths possess large pores which allow convective flow of mobile phase and result in high flow rates at reduced pressure drop, unlike particulate supports. The simplicity of the adsorbent synthesis, pH resistance, and the ease and flexibility of tailoring their pore size to that of the target biomolecule are the key properties which differentiate polymethacrylate monoliths from other monoliths. Polymethacrylate monoliths are endowed with reactive epoxy groups for easy functionalization (with anion-exchange, hydrophobic, and affinity ligands) and high ligand retention. In this review, the structure and performance of polymethacrylate monoliths for chromatographic purification of biomolecules are evaluated and compared to those of other supports. The development and use of polymethacrylate monoliths for research applications have grown rapidly in recent times and have enabled the achievement of high through-put biomolecule purification on semi-preparative and preparative scales.

Synthesis of novel interlocked architectures in solution and solid phase

Mechanically interlocked molecules, such as catenanes and rotaxanes, are fascinating due to their unique sensing and catalytic properties and their potential to act as molecular motors or switches. Traditionally their synthesis has been laborious and expensive, however this research project endeavoured to overcome this challenge by exploring novel ways of preparing mechanically interlocked molecules both in solution and on surfaces. A series of disulfide-linked macrocycles, [2]catenanes and [2]rotaxanes were synthesised in solution using reversible dynamic covalent chemistry. Subsequently, the interlocked architectures were adapted into solid-tethered systems via attachment to swelling polystyrene resins.