Managing palliative care for adults with advanced heart failure

The purpose of this study was to explore the care processes experienced by community-dwelling adults dying from advanced heart failure, their family caregivers, and their health-care providers. A descriptive qualitative design was used to guide data collection, analysis, and interpretation. The sample comprised 8 patients, 10 informal caregivers, 11 nurses, 3 physicians, and 3 pharmacists. Data analysis revealed that palliative care was influenced by unique contextual factors (i.e., cancer model of palliative care, limited access to resources, prognostication challenges). Patients described choosing interventions and living with fatigue, pain, shortness of breath, and functional decline. Family caregivers described surviving caregiver burden and drawing on their faith. Health professionals described their role as trying to coordinate care, building expertise, managing medications, and optimizing interprofessional collaboration. Participants strove towards 3 outcomes: effective symptom management, satisfaction with care, and a peaceful death. © McGill University School of Nursing.

Quantification of interpoint topographic correlations of threshold values in glaucomatous visual fields

Purpose: The authors sought to quantify neighboring and distant interpoint correlations of threshold values within the visual field in patients with glaucoma. Methods: Visual fields of patients with confirmed or suspected glaucoma were analyzed (n = 255). One eye per patient was included. Patients were examined using the 32 program of the Octopus 1-2-3. Linear regression analysis among each of the locations and the rest of the points of the visual field was performed, and the correlation coefficient was calculated. The degree of correlation was categorized as high (r > 0.66), moderate (0.66 = r > 0.33), or low (r = 0.33). The standard error of threshold estimation was calculated. Results: Most locations of the visual field had high and moderate correlations with neighboring points and with distant locations corresponding to the same nerve fiber bundle. Locations of the visual field had low correlations with those of the opposite hemifield, with the exception of locations temporal to the blind spot. The standard error of threshold estimation increased from 0.6 to 0.9 dB with an r reduction of 0.1. Conclusion: Locations of the visual field have highest interpoint correlation with neighboring points and with distant points in areas corresponding to the distribution of the retinal nerve fiber layer. The quantification of interpoint correlations may be useful in the design and interpretation of visual field tests in patients with glaucoma.

Soil Moisture Deficit as a predictor of the trend in soil water status of grass fields

Nutrient loss from agricultural land following organic fertilizer spreading can lead to eutrophication and poor water quality. The risk of pollution is partly related to the soil water status during and after spreading. In response to these issues, a decision support system (DSS) for nutrient management has been developed to predict when soil and weather conditions are suitable for slurry spreading. At the core of the DSS, the Hybrid Soil Moisture Deficit (HSMD) model estimates soil water status relative to field capacity (FC) for three soil classes (well, moderately and poorly drained) and has potential to predict the occurrence of a transport vector when the soil is wetter than FC. Three years of field observation of volumetric water content was used to validate HSMD model predictions of water status and to ensure correct use and interpretation of the drainage classes. Point HSMD model predictions were validated with respect to the temporal and spatial variations in volumetric water content and soil strength properties. It was found that the HSMD model predictions were well related to topsoil water content through time, but a new class intermediate between poor and moderate, perhaps ‘imperfectly drained’, was needed. With correct allocations of a field into a drainage class, the HSMD model predictions reflect field scale trends in water status and therefore the model is suitable for use at the core of a DSS.

Using ancestry-informative markers to identify fine structure across 15 populations of European origin

The Wellcome Trust Case Control Consortium 3 anorexia nervosa genome-wide association scan includes 2907 cases from 15 different populations of European origin genotyped on the Illumina 670K chip. We compared methods for identifying population stratification, and suggest list of markers that may help to counter this problem. It is usual to identify population structure in such studies using only common variants with minor allele frequency (MAF) >5%; we find that this may result in highly informative SNPs being discarded, and suggest that instead all SNPs with MAF >1% may be used. We established informative axes of variation identified via principal component analysis and highlight important features of the genetic structure of diverse European-descent populations, some studied for the first time at this scale. Finally, we investigated the substructure within each of these 15 populations and identified SNPs that help capture hidden stratification. This work can provide information regarding the designing and interpretation of association results in the International Consortia. 

Clarifying the acquis humanitaire: a transnational legal perspective on the internalization of humanitarian norms

Although the international obligations and institutional frameworks for disaster response are not yet settled, as evidenced by the International Law Commission’s work on the protection of persons in the event of disasters and the on-going promotion of disaster laws by the Red Cross Movement; the diverse source and nature of such initiatives suggests that the international community is engaged in a process of norm creation, elaboration and interpretation reflecting a desire for legal clarity in humanitarian operations. Situated within the framework of transnational law, this paper argues that an acquis humanitaire, based on the principle of humanity, encapsulates the evolving body of law and practice specifically relating to the protection of persons in times of humanitarian crisis in both armed conflicts and natural or human-made disasters. Reflecting the non-traditional, non-statist, dynamic and normative basis of transnational legal process, as elaborated by Harold Koh, the constant flow of ideas and principles between the national, regional and international spheres provides an analytical framework for the on-going transnational dialogues on the social, political and legal internalization of humanitarian norms. Drawing on the internalization of humanitarian norms within the United Kingdom, this paper concludes that as the international community examines the codification of a universal legal framework for the protection of persons in the event of disasters it is necessary to understand the transnational process of interpretation and internalization of humanitarian norms, and how this may vary across different regions and countries.

An Event Driven Fusion Approach for Enjoyment Recognition in Real-time

Social signals and interpretation of carried information is of high importance in Human Computer Interaction. Often used for affect recognition, the cues within these signals are displayed in various modalities. Fusion of multi-modal signals is a natural and interesting way to improve automatic classification of emotions transported in social signals. Throughout most present studies, uni-modal affect recognition as well as multi-modal fusion, decisions are forced for fixed annotation segments across all modalities. In this paper, we investigate the less prevalent approach of event driven fusion, which indirectly accumulates asynchronous events in all modalities for final predictions. We present a fusion approach, handling short-timed events in a vector space, which is of special interest for real-time applications. We compare results of segmentation based uni-modal classification and fusion schemes to the event driven fusion approach. The evaluation is carried out via detection of enjoyment-episodes within the audiovisual Belfast Story-Telling Corpus.

An Intelligent Threat Prevention Framework with Heterogeneous Information

Three issues usually are associated with threat prevention intelligent surveillance systems. First, the fusion and interpretation of large scale incomplete heterogeneous information; second, the demand of effectively predicting suspects’ intention and ranking the potential threats posed by each suspect; third, strategies of allocating limited security resources (e.g., the dispatch of security team) to prevent a suspect’s further actions towards critical assets. However, in the literature, these three issues are seldomly considered together in a sensor network based intelligent surveillance framework. To address
this problem, in this paper, we propose a multi-level decision support framework for in-time reaction in intelligent surveillance. More specifically, based on a multi-criteria event modeling framework, we design a method to predict the most plausible intention of a suspect. Following this, a decision support model is proposed to rank each suspect based on their threat severity and to determine resource allocation strategies. Finally, formal properties are discussed to justify our framework.

PET/CT imaging for target volume delineation in curative intent radiotherapy of non-small cell lung cancer: IAEA consensus report 2014

This document describes best practice and evidence based recommendations for the use of FDG-PET/CT for the purposes of radiotherapy target volume delineation (TVD) for curative intent treatment of non-small cell lung cancer (NSCLC). These recommendations have been written by an expert advisory group, convened by the International Atomic Energy Agency (IAEA) to facilitate a Coordinated Research Project (CRP) aiming to improve the applications of PET based radiation treatment planning (RTP) in low and middle income countries. These guidelines can be applied in routine clinical practice of radiotherapy TVD, for NSCLC patients treated with concurrent chemoradiation or radiotherapy alone, where FDG is used, and where a calibrated PET camera system equipped for RTP patient positioning is available. Recommendations are provided for PET and CT image visualization and interpretation, and for tumor delineation using planning CT with and without breathing motion compensation.

The Science of a Lost Medieval Graveyard: The Ballyhanna Research Project

he Science of Lost Medieval Gaelic Graveyard tells the story of the discovery in 2003 of a graveyard and the foundations of a small forgotten stone church at Ballyhanna, in Ballyshannon, Co. Donegal, as part of the N15 Bundoran–Ballyshannon Bypass archaeological works. This led to the excavation of one of the largest collections of medieval burials ever undertaken on this island. Over 1,200 individuals were excavated from the site at Ballyhanna during the winter of 2003–4, representing 1,000 years of burial through the entire Irish medieval period. The discovery led to the establishment of a cross-border research collaboration—the Ballyhanna Research Project—between Queen’s University Belfast and the Institute of Technology, Sligo, which has brought to life this lost Gaelic graveyard.

This book shows how cutting-edge scientific research may aid our understanding and interpretation of archaeology and reveal new insights into past societies. For example, the use of ancient DNA analysis represented the first biomolecular archaeological evaluation of a medieval population to date and provided evidence that cystic fibrosis was much less prevalent in the medieval period than today. The Science of Lost Medieval Gaelic Graveyard is about a community who lived in Gaelic Ireland, about their lifestyles, health and diet. It tells us of their deaths and of their burial traditions, and through examining all of these aspects, it reveals the ebb and flow of their lives.

The book is accompanied by a CD-ROM which includes supplementary information from the Ballyhanna Research Project and the original excavation and survey reports for all of the archaeological sites on the N15 Bundoran–Ballyshannon Bypass.

Early childhood neurodevelopment after intrauterine growth restriction: a systematic review

BACKGROUND AND OBJECTIVE: Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR.

METHODS: PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines.

RESULTS: Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR.

CONCLUSIONS: Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.

Genomic markers for decision making:What is preventing us from using markers?

The advent of novel genomic technologies that enable the evaluation of genomic alterations on a genome-wide scale has significantly altered the field of genomic marker research in solid tumors. Researchers have moved away from the traditional model of identifying a particular genomic alteration and evaluating the association between this finding and a clinical outcome measure to a new approach involving the identification and measurement of multiple genomic markers simultaneously within clinical studies. This in turn has presented additional challenges in considering the use of genomic markers in oncology, such as clinical study design, reproducibility and interpretation and reporting of results. This Review will explore these challenges, focusing on microarray-based gene-expression profiling, and highlights some common failings in study design that have impacted on the use of putative genomic markers in the clinic. Despite these rapid technological advances there is still a paucity of genomic markers in routine clinical use at present. A rational and focused approach to the evaluation and validation of genomic markers is needed, whereby analytically validated markers are investigated in clinical studies that are adequately powered and have pre-defined patient populations and study endpoints. Furthermore, novel adaptive clinical trial designs, incorporating putative genomic markers into prospective clinical trials, will enable the evaluation of these markers in a rigorous and timely fashion. Such approaches have the potential to facilitate the implementation of such markers into routine clinical practice and consequently enable the rational and tailored use of cancer therapies for individual patients. © 2010 Macmillan Publishers Limited. All rights reserved.

Ultra-high-resolution Observations of MHD Waves in Photospheric Magnetic Structures

Here we review the recent progress made in the detection, examination, characterisation and interpretation of oscillations manifesting in small-scale magnetic elements in the solar photosphere. This region of the Sun's atmosphere is especially dynamic, and importantly, permeated with an abundance of magnetic field concentrations. Such magnetic features can span diameters of hundreds to many tens of thousands of km, and are thus commonly referred to as the `building blocks' of the magnetic solar atmosphere. However, it is the smallest magnetic elements that have risen to the forefront of solar physics research in recent years. Structures, which include magnetic bright points, are often at the diffraction limit of even the largest of solar telescopes. Importantly, it is the improvements in facilities, instrumentation, imaging techniques and processing algorithms during recent years that have allowed researchers to examine the motions, dynamics and evolution of such features on the smallest spatial and temporal scales to date. It is clear that while these structures may demonstrate significant magnetic field strengths, their small sizes make them prone to the buffeting supplied by the ubiquitous surrounding convective plasma motions. Here, it is believed that magnetohydrodynamic waves can be induced, which propagate along the field lines, carrying energy upwards to the outermost extremities of the solar corona. Such wave phenomena can exist in a variety of guises, including fast and slow magneto-acoustic modes, in addition to Alfven waves. Coupled with rapid advancements in magnetohydrodynamic wave theory, we are now in an ideal position to thoroughly investigate how wave motion is generated in the solar photosphere, which oscillatory modes are most prevalent, and the role that these waves play in supplying energy to various layers of the solar atmosphere.

A criança pinta o céu de “verde”. Até que ponto lhe devemos dizer que o céu é azul?

Relatório de estágio apresentado para a obtenção do grau de Mestre em Ensino pré-escolar e 1º ciclo do ensino básico

A cartografia educacional de um território como fator enriquecedor da oferta educativa. O caso da localidade de São José da Lamarosa

Com a elaboração da cartografia educacional do território da localidade de São José da Lamarosa, concelho de Coruche, pretendia-se identificar e caraterizar, com algum pormenor, as aprendizagens institucionais que estiveram disponíveis nesse território, no período 2005-2010. Aspirava-se identificar o potencial formador das várias instituições da sociedade civil, nos contextos formais e não formais de educação, assim como o seu contributo para a qualificação da população. Realizou-se uma primeira abordagem teórica, fundamentada nos contributos de diversos autores no campo de estudo em análise, tomando por base as palavras-chave estabelecidas e registadas nesta página. A fim de realizar o estudo empírico optou-se por uma metodologia de complementaridade entre o cariz qualitativo e o cariz quantitativo, com aproximação ao estudo de caso, optando-se por uma análise de dados efetuada de forma descritiva e interpretativa. A recolha de dados realizou-se através da aplicação de inquérito por questionário aplicado. Depois da recolha, análise e interpretação dos dados recolhidos estabeleceram-se algumas considerações, realçando-se o importante potencial formador das instituições inquiridas, que organizaram e disponibilizaram atividades propensas a situações de aprendizagem, e que constituíram uma maior valia para o território. Salientou-se ainda a necessidade de uma reestruturação organizacional a nível das instituições mais ativas do território, no sentido de se estabelecerem parcerias mais consistentes, contribuindo para a real qualificação do território. No final da dissertação expressaram-se recomendações e sugestões que poderão potenciar futuras investigações; ### Abstract: The cartography educational territory of the village of São José da Lamarosa aims to identify and characterize, in some detail, learned that were available at that territory in the period of 2005-2010. The aim of this study is to identify the potential forming for the various civil society institutions in formal and non-formal education, as well as it’s contribute to the population quality. Held to the first theoretical approach, based on the contributions from various authors on the field study analysis, established and make registered based to the keywords on this page. In the order to perform the empirical study chosen complementary methodology between the qualitative and quantitative methods, with the case study approach, opting for a data analysis performed in descriptive and interpretative. Collection data was realized through by the applicable questionnaires. After the collection, analysis and interpretation data had to settle down some considerations, underlying the important potential trainers from some institutions that organized and provided prone learning activities, which constitute the greater value to the territory. Also mention for the needs of some restructuring organizational within the more active institutions in that territory, in order to establish more consistent partnerships, to contribute for the real territory qualification. At the end of this thesis will express some recommendations and suggestions that may useful for the future research.