The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study

Objective: To investigate the role of medical emergency teams in end-of-life care planning.

Design: One month prospective audit of medical emergency team calls.

Setting: Seven university-affiliated hospitals in Australia, Canada, and Sweden.

Patients: Five hundred eighteen patients who received a medical emergency team call over 1 month.

Interventions: None.

Measurements and Main Results: There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%. Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p .089).

Conclusions: Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.

How easy can the barley brie : drinking culture and accounting failure at the end of the nineteenth century in Britain

Purpose – This paper seeks to extend the development of the historical accounting research agenda further into the area of popular culture. The work examines the discourses that surrounded the drinking of alcohol in nineteenth century Britain and explores how an accounting failure disrupted the tension between the two established competing discourses, leading to a significant impact on UK drinking culture at the end of the nineteenth century.

Design/methodology/approach – The paper employs both primary and secondary sources. Secondary sources are used to develop the main themes of the discourses deployed by the temperance societies and the whisky companies. Primary sources derived from the contemporary press are employed, as necessary, in support.

Findings – The paper demonstrates that accounting, although it may not be central to a discourse or other social structure, can still have a profound impact upon cultural practices. The potential for research into culture and accounting should not therefore be dismissed if no immediate or concrete relationship between culture and accounting can be determined. Further support is provided for studies that seek to expand the accounting research agenda into new territories.

Originality/value – The study of popular culture is relatively novel in accounting research. This paper seeks to add to this research by exploring an area of cultural activity that has hitherto been neglected by researchers, i.e. by exploring how an accounting incident impacted upon the historical consumption of Scotch whisky in the UK.

The end game in Afghanistan : Pakistan’s critical role

In the lead up to 2014, when the Coalition forces will be leaving Afghanistan, Pakistan will have a crucial role to play, not only in the negotiations but also in its relationship with the Afghan Taliban groups hiding in Pakistan. Indeed, there are historical, ethnic, operational and strategic reasons why Pakistan should have a seat at the negotiating table. Pakistan will want to make sure that its Taliban allies get a fair deal in the final outcome. While this may appear to be a good outcome for Islamabad in the medium term, it may not be good for Pakistan’s long-term stability.

Parametric investigation and measurement of near end and far end crosstalk in multiconductor microstrip transmission lines

This paper investigates and measures the near end and far end crosstalk in the multiconductor transmission line (MTL) mounted on the PCB by varying the parameters which are associated with physical dimension, characteristic of the substrate and the nature of input signal. With the variation of these factors, the coupling inductance and capacitance vary causing crosstalk. By using the method of moment (MoM), the per unit length parameters are calculated for microstrip lines. Subcircuit model is used to investigate the time domain and frequency domain analysis of near field and far field crosstalk. This parametric investigation is very useful for designing high speed interconnectors on PCB substrates. Some experimental results are presented to validate the analytical findings.

Bioethics, cultural differences and the problem of moral disagreements in end-Of-life care : a terror management theory

Cultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face a perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made.

Systematics and palaeoecology of Changhsingian (Late Permian) Ambocoeliidae brachiopods from South China and implications for the end-Permian mass extinction

Four Ambocoeliidae brachiopod species including one new species (Crurithyris tazawai sp. nov., Crurithyris sp., Paracrurithyris pygmaea and Attenuatella mengi) are described from the Changhsingian (Late Permian) deep-water facies of South China. Analysis of the morphology, palaeoecology and palaeogeographical and temporal distributions of these species revealed that the presence of a delthyrium and/or the micro-ornaments among three of the four species (Crurithyris tazawai sp. nov., Paracrurithyris pygmaea and Attenuatella mengi) favoured an epifaunal (epiphytic) lifestyle. Morphological differences suggest that Paracrurithyris pygmaea may have been more effective metabolically in forming the shell compared with Attenuatella mengi and Crurithyris tazawai. The temporal and palaeogeographical distribution of Attenuatella suggests that A. mengi inhabited cool or cold deep waters. Both Crurithyris tazawai and Attenuatella mengi disappeared earlier in the stratigraphic record than Paracrurithyis pygmaea during the Permian–Triassic mass extinction. These differences in timing of extinction, morphology and palaeogeographical distributions suggest that oxygen deficiency and trophic resource limitation (a consequence of the changing composition of marine phytoplankton in the seas) may have contributed to the end-Permian mass extinction.

Recession-oscopy : can universities be the light at the end?

This paper paints the philosophical and ethical backdrop to some of the issues raised in Australian Universities’ Review vol. 53, no. 2. It links academic performance pay; the measurement of research output; and the astonishing pay levels of vice chancellors to the present global financial crisis. These are explained as part of a general malaise of institutions, which has its roots in the early Enlightenment. Drawing from semioticians Charles Sanders Peirce and John Deely it uses the terms ideoscopy and cenoscopy to characterise the hijacking of unwarranted scientific status for much of the way our world is managed. But crisis can lead to opportunity. Consequently, the paper points to the glaring opportunity for thinkers who can articulate the present situation in a way which could avert disaster.

Home hemodialysis : a successful option for obese and bariatric people with end-stage kidney disease

The increasing prevalence of obesity in developed countries is reflected in the chronic kidney disease, dialysis, and transplant populations. The added risk factor of obesity increases the risk of vascular events, inflammation, insulin resistance, blood pressure, dyslipidemia, and mortality risk. Nephrology center policies may exclude obese people from transplantation programs resulting in many years of dialysis. The case of a 215-kg Australian male who has successfully dialyzed at home for more than 8 years will be used to illustrate the important considerations and clinical support that these people require for successful home dialysis treatment. The aim of this paper is to report on a program that has successfully trained 23 obese (body mass index >30) people who commenced on home hemodialysis between 2001 and 2009. Body weight ranged between 94.0 and 215 kg (mean 126, SD 26.19) and body mass index ranged between 34.9 and 71 (mean 43.38, SD 9.99) at the start of home training. During the 8.5 years of follow-up, average time on home dialysis was 43.7 months. Home hemodialysis is a feasible treatment for obese people to facilitate longer and more frequent dialysis, resulting in improved hemodynamic stability and improved quality of life. For obese people with end-stage kidney disease, home hemodialysis has shown to be cost-effective and can result in greater treatment efficacy than in-center hospital dialysis.

The end of the Keating-Howard-Rudd-Gillard era?

Australian political discourse is dominated by ahistorical hyperbole, every election defeat is a landslide, every consecutive electoral loss indicates complete political marginalisation, every poll slump is a crisis, and every struggling leader is the worst ever. Australian Labor is not faring well but we need to distinguish between the ebbs and flows of the political cycle and the fundamentals. Australian politics may be approaching a fundamental break. The political era that began in the early 1990s may be coming to an end and with it Labor's hegemonic position in Australian politics that has endured since Gough Whitlam.

Curtain call - end of the world party

BLINDSIDE’s project presented as part of our 'Curtain Call' curated event series, brings together artists who tease out notions of catastrophe, celebration and transformation against the backdrop of the last party on earth.
The 5,125 year Mayan Calendar comes to an end on the 21st of December and BLINDSIDE has invited artists to consider this cataclysmic event for its annual program Curtain Call.

Fresh from the LA Art Fair, Adelaide-based artist Patrick Rees along with Melbourne-based artists Kirsty Audrey Hulm, Boe-Lin Bastian, Drew Pettifer and Joel Zika & Simon Pericich consider the possibilities.

Internet cognitive behavioural therapy for panic disorder : does the inclusion of stress management information improve end-state functioning?

Previous research has established Internet-based cognitive behavioural therapy (CBT) for panic disorder (PD) as effective in reducing panic severity and frequency. There is evidence, however, that such programs are less effective at improving overall end-state functioning, defined by a PD clinician severity rating of ≤2 and panic free. In order to test the effect on end-state functioning of the incorporation of stress management material within a CBT program for PD, 32 people with PD were randomised to either Internet-based CBT (PO1), Internet-based CBT plus stress management (PO2) or an Internet-based information-only control condition (IC). Both CBT treatments were more effective at posttreatment assessment than the control condition in reducing PD severity, panic and agoraphobia-related cognition, negative affect and self-ratings of health. PO2 was more effective than PO1 at posttreatment assessment on PD severity and general anxiety, although at 3-month follow-up these differences were no longer apparent. This study provides further support for the efficacy of Internet-based CBT for PD and suggests that although the incorporation of stress management material confers short-term advantages over a standard program, it is not associated with any longer term improvements on panic severity and related cognitions, negative affect, general wellbeing and end-state functioning.

The P-Loop domain of yeast Clp1 mediates interactions between CF IA and CPF factors in Pre-mRNA 3′ end formation

 Cleavage factor IA (CF IA), cleavage and polyadenylation factor (CPF), constitute major protein complexes required for pre-mRNA 3' end formation in yeast. The Clp1 protein associates with Pcf11, Rna15 and Rna14 in CF IA but its functional role remained unclear. Clp1 carries an evolutionarily conserved P-loop motif that was previously shown to bind ATP. Interestingly, human and archaean Clp1 homologues, but not the yeast protein, carry 5' RNA kinase activity. We show that depletion of Clp1 in yeast promoted defective 3' end formation and RNA polymerase II termination; however, cells expressing Clp1 with mutant P-loops displayed only minor defects in gene expression. Similarly, purified and reconstituted mutant CF IA factors that interfered with ATP binding complemented CF IA depleted extracts in coupled in vitro transcription/3' end processing reactions. We found that Clp1 was required to assemble recombinant CF IA and that certain P-loop mutants failed to interact with the CF IA subunit Pcf11. In contrast, mutations in Clp1 enhanced binding to the 3' endonuclease Ysh1 that is a component of CPF. Our results support a structural role for the Clp1 P-loop motif. ATP binding by Clp1 likely contributes to CF IA formation and cross-factor interactions during the dynamic process of 3' end formation.

Coupled RNA polymerase II transcription and 3′ end formation with yeast whole-cell extracts

 RNA polymerase II (RNAP II) transcription and pre-mRNA 3' end formation are linked through physical and functional interactions. We describe here a highly efficient yeast in vitro system that reproduces both transcription and 3' end formation in a single reaction. The system is based on simple whole-cell extracts that were supplemented with a hybrid Gal4-VP16 transcriptional activator and supercoiled plasmid DNA templates encoding G-less cassette reporters. We found that the coupling of transcription and processing in vitro enhanced pre-mRNA 3' end formation and reproduced requirements for poly(A) signals and polyadenylation factors. Unexpectedly, however, we show that in vitro transcripts lacked m⁷G-caps. Reconstitution experiments with CF IA factor assembled entirely from heterologous components suggested that the CTD interaction domain of the Pcf11 subunit was required for proper RNAP II termination but not 3' end formation. Moreover, we observed reduced termination activity associated with extracts prepared from cells carrying a mutation in the 5'-3' exonuclease Rat1 or following chemical inhibition of exonuclease activity. Thus, in vitro transcription coupled to pre-mRNA processing recapitulates hallmarks of poly(A)-dependent RNAP II termination. The in vitro transcription/processing system presented here should provide a useful tool to further define the role of factors involved in coupling.

Diabetes and end-of-life care: ethical issues, practices and challenges

Abstract:
Diabetes is the most significant chronic disease and the global prevalence is increasing. Diabetes is associated with debilitating long term complications and other comorbidities that cause high rates of morbidity and mortality. Keeping blood glucose and other metabolic parameters within an acceptable, personalised range is important to comfort and quality of life but can be challenging, especially during end-of-life care. Guidelines can help clinicians make appropriate care decisions; however, there is little research about what constitutes best practice diabetes care at the end-of-life: existing recommendations and guidelines blend the best available evidence with consensus opinion. In addition, there are important ethical and methodological considerations concerning research involving vulnerable people at the end-of-life. Chapter 3 describes the ethical and methodological issues that needed to be considered when developing guidelines for managing diabetes at the end-of-life and the contribution interviews with dying people and their family carers made to developing a guiding philosophy and to person-centred guidelines.

Reluctant relaxation: The end of the iron ore export embargo and the origins of Australia's mining boom, 1960-1966

The Australian government embargoed any export of iron ore between 1938 and 1960. Joseph Lyons’s government imposed the ban on the eve of World War II for a strategic reason: to prevent the Japanese from importing ore from Yampi Sound in Western Australia. Another consideration, which underpinned the retention of the ban for more than two decades, was the Commonwealth of Australia's perception that Australia's iron ore reserves were limited. In the space of a few years after the partial lifting of the embargo in 1960, world-class reserves of iron ore, mainly in Western Australia, were discovered. Mined and exported from the mid-1960s, iron ore would become, in time, Australia’s best export earner. This article explores the reasons behind the lifting of the ban and how the relaxation of the embargo in stages between 1960 and 1966 shaped the emerging iron ore industry and therefore Australia’s mining boom.