A proposed systems approach to the evaluation of integrated palliative care

Background. There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care. Methods. In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors. Results. The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network. Conclusions. Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations. © 2010 Bainbridge et al; licensee BioMed Central Ltd.

Total Addiction:The Life of an Eclipse Chaser

Seeing a total solar eclipse is often described as a once-in-a-lifetime experience. However, for many who have experienced totality, once-in-a-lifetime is simply not enough. They want more, and are willing to go to great lengths often at great expense to repeat the experience. What is it like to experience totality? What is it about the experience that motivates these eclipse chasers? Is there an eclipse chaser personality? Can eclipse chasing actually be described as an addiction? This book describes the people who dedicate their lives to chasing their dream.

North by Northwest: The Life and work of Liam McCormick:Donegal Calling

I became an architect because my father was an architect, and I returned to Donegal to practice architecture because Liam McCormick was able to make great buildings there. My father's first job after graduating was with Liam in Derry in 1958, so architecture and Liam McCormick have been with me since I was a child. When I was six years old I remember Creeslough church being completed. I remember my aunt being concerned and asking my father why the curtains were fitted in the priest's house in Creeslough before the roof was added. He explained to her it was a flat-roofed house and, as such there would be no conventional roof! I was fascinated by the idea and how such an important building could be inspired by Muckish mountain.

Coleoptera and microbe biomass in Antarctic Dry Valley paleosols adjacent to the Inland Ice: Implications for Mars

Bulk paleosol samples collected from a Middle to Early Miocene moraine in the New Mountain area of the Dry Valleys, Antarctica, yielded Coleoptera exoskeletons and occasional endoskeletons showing considerable diagenetic effects along with several species of bacteria, all lodged in a dry-frozen but salt-rich horizon at shallow depth to the land surface. The till is at the older end of a chronologic sequence of glacial deposits, thought to have been deposited before the transition from wet-based to cold-based ice (similar to 15 Ma), and hence, entirely weathered in contact with the subaerial atmosphere. It is possible, though not absolutely verifiable, that the skeletons date from this early stage of emplacement having undergone modifications whenever light snowmelt occurred or salt concentrations lowered the freezing temperature to maintain water as liquid. Correlation of the Coleoptera species with cultured bacteria in the sample and the likelihood of co-habitation with Beauveria bassiani found in two adjacent, although younger paleosols, leads to new questions about the antiquity of the Coleoptera and the source of N and glucose from chitinase derived from the insects. The skeletons in the 831 section may date close to the oldest preserved chitin (Oligocene) yet found on Earth. While harsh Martian conditions make it seemingly intolerable for complex, multicellular organisms such as insects to exist in the near-surface and subaerially, life within similar cold, dry paleosol microenvironments (Cryosols) of Antarctica point to life potential for the Red Planet, especially when considering the relatively diverse microbe (bacteria and fungi) population. (C) 2011 Elsevier Ltd. All rights reserved.

Advances in joint modelling: A review of recent developments with application to the survival of end stage renal disease patients

The use of joint modelling approaches is becoming increasingly popular when an association exists between survival and longitudinal processes. Widely recognized for their gain in efficiency, joint models also offer a reduction in bias compared with naïve methods. With the increasing popularity comes a constantly expanding literature on joint modelling approaches. The aim of this paper is to give an overview of recent literature relating to joint models, in particular those that focus on the time-to-event survival process. A discussion is provided on the range of survival submodels that have been implemented in a joint modelling framework. A particular focus is given to the recent advancements in software used to build these models. Illustrated through the use of two different real-life data examples that focus on the survival of end-stage renal disease patients, the use of the JM and joineR packages within R are demonstrated. The possible future direction for this field of research is also discussed. © 2013 International Statistical Institute.

Luce Irigaray: Back to the Beginning

In 2014 it will be 40 years since Luce Irigaray’s (second) doctoral thesis Speculum de l'autre femme was first published. That book, widely recognized as the most important text in feminist philosophy, was to introduce Irigaray’s critique of western philosophy and psychoanalysis and her ethics of sexual difference for which she was to become so well known. Irigaray, well into her eighties now, has published continuously since Speculum, despite her exclusion from French academic life after her expulsion in 1974 from the Université de Paris VIII Vincennes. That her latest book In the Beginning, She Was, released on the eve of Speculum’s anniversary, is perhaps the most personally revelatory of her works and revisits many of the same themes and issues that concerned her in Speculum cannot be coincidental. In this critical notice we examine Irigaray’s latest offering arguing that her contribution is twofold as she combines with new clarity her longstanding critique of phallocratic culture and her transformative vision of humanity as a culture of sexuate difference. There are a number of important themes addressed in the six chapters of the book, but for the purposes of this discussion our analysis will focus mostly on elaborating her critique of Western culture, on the usefulness of her work for rethinking masculine subject formation and on the figure of Antigone, as a feminine subject on her own terms, as a way of imagining a possible relation between two subjects within a culture of sexuate difference. We argue that this book continues to illustrate Irigaray’s importance as one of the most radical and prophetic philosophers of our time.

Community Engagement in Ireland's Developmental Welfare State: a study of the life cycle approach

The idea that people matter in modern democracies, often referred to as 'civic engagement' is recognised at the highest international level (United Nations 2008: 9). Civic or community engagement is essential to how budgets are decided, policy is developed and public services delivered. Significantly, community engagement is crucial in developing policy for sustained economic and social development. In Ireland the idea of the Developmental Welfare State (DWS) is based on the premise that the social policy system should support citizens so as to reach their full potential. Such a system comprises three overlapping elements: tax and welfare transfer, the provision of services and activist initiatives (National Economic and Social Council, 2005: ix-xviii). Civil Society Organisations have been challenged to 'operationalise the DWS' using a 'life cycle framework' as part of Ireland's corporatist partnership model (Department of Taoiseach, 2006: 40).

Age related differences in mental health scale scores and depression diagnosis: Adult responses to the CIDI-SF and MHI-5.

Inconsistencies surrounding the prevalence levels of depression in later life suggest that the measurement of depression in older people may be problematic. The current study aimed to map responses to a depressive symptom scale, the Mental Health Index-5 (MHI-5) which is part of the Short form 36 (SF-36, Ware et al., 1993) against the diagnostic screening items of the Composite International Diagnostic Instrument-Short Form (CIDI-SF, Kessler et al., 1998) to examine disagreement rates across age groups. The study examined data from a national random sample of 10,641 participants living in Ireland, 58.8% were female and 19% were over 65 (SLÁN, 2007). CIDI-SF depression screening endorsement was lower in older groups, whereas mean MHI-5 depressive symptoms showed less change across age groups. Results showed that the odds of MHI-5 endorsers aged 18–44 endorsing CIDI-SF screening questions were 5 times and 4.5 times (dysphoria and anhedonia, respectively) greater than the odds of people aged 75 or more endorsing these items. Findings suggest that although the risk of depressive disorder may decrease with age, complex diagnostic screening questions may exaggerate lower rates of depression among older people.

Wear analysis and prediction of the life of a riveting die used in the automotive industry

Knowledge on the life span of the riveting dies used in the automotive industry is sparse. It is often the case that only when faulty products are produced are workers aware that their tool needs to be changed. This is of course costly both in terms of time and money. Responding to this challenge, this paper proposes a methodology which integrates wear and stress analysis to quantify the life of a riveting die. Experiments are carried out to measure the applied load required to split a rivet. The obtained results (i.e. force curves) are used to validate the wear mechanisms of the die observed using scanning electron microscopy. Sliding, impact, and adhesive wears are observed on the riveting die after a certain number of riveting cycles. The stress distribution on the die during riveting is simulated using a finite element (FE) approach. In order to confirm the accuracy of the FE model, the experimental force results are compared with the ones produced from FE simulation. The maximum and minimum von Mises' stresses generated from the FE model are input into a Goodman diagram and an S-N curve to compute the life of the riveting die. It is found that the riveting die is predicted to run for 4 980 000 cycles before failure.

Making space: English women, letter-writing, and the life of the mind, c.1650-1750

This article uses women's letter-writing from the late seventeenth and early eighteenth centuries to explore the home as a site of female intellectual endeavour. Far from representing a static backdrop to the action of domestic life, the home played a dynamic role in women's experiences of the life of the mind and shaped the ways in which women thought and wrote. Letters were penned in dining rooms, parlours and closets, by firesides, and on desks and laps. In their letters, women projected images of themselves scribbling epistles to friends in order to maintain their mental intimacy. Space was both real and imagined and the physical realities of a hand-written and hand-delivered letter gave way to the imaginative possibilities brought by networks of epistolary exchange and the alternative spaces of creative thought. By reinstating the home more fully in the history of female intellectual experience, a more nuanced view of the domestic arena can be developed: one that sees the home not as a site of exclusion and confinement, but as a space for scholarship and exchange. 

Climatic signals in the life histories of insects:the distribution and abundance of heather psyllids (Strophingia spp.) in the UK

1. The population density and age structure of two species of heather psyllid Strophingia ericae and Strophingia cinereae, feeding on Calluna vulgaris and Erica cinerea, respectively, were sampled using standardized methods at locations throughout Britain. Locations were chosen to represent the full latitudinal and altitudinal range of the host plants.

2. The paper explains how spatial variation in thermal environment, insect life-history characteristics and physiology, and plant distribution, interact to provide the mechanisms that determine the range and abundance of Strophingia spp.

3. Strophingia ericae and S. cinereae, despite the similarity in the spatial distribution patterns of their host plants within Britain, display strongly contrasting geographical ranges and corresponding life-history strategies. Strophingia ericae is found on its host plant throughout Britain but S. cinereae is restricted to low elevation sites south of the Mersey-Humber line and occupies only part of the latitudinal and altitudinal range of its host plant. There is no evidence to suggest that S. ericae has reached its potential altitudinal or latitudinal limit in the UK, even though its host plant appears to reach its altitudinal limit.

4. There was little difference in the ability of the two Strophingia spp. to survive shortterm exposure to temperatures as low as - 15 degrees C and low winter temperatures probably do not limit distribution in S. cinereae.

5. Population density of S. ericae was not related to altitude but showed a weak correlation with latitude. The spread of larval instars present at a site, measured as an index of instar homogeneity, was significantly correlated with a range of temperature related variables, of which May mean temperature and length of growing season above 3 degrees C (calculated using the Lennon and Turner climatic model) were the most significant. Factor analysis did not improve the level of correlation significantly above those obtained for single climatic variables. The data confirmed that S. ericae has a I year life cycle at the lowest elevations and a 2 year life cycle at the higher elevations. However, there was no evidence, as previously suggested, for an abrupt change from a one to a 2 year life cycle in S. ericae with increasing altitudes or latitudes.

6. By contrast with S. ericae, S. cinereae had an obligatory 1 year life cycle, its population decreased with altitude and the index of instar homogeneity showed little correlation with single temperature variables. Moreover, it occupied only part of the range of its host plant and its spatial distribution in the UK could be predicted with 96% accuracy using selected variables in discriminant analysis.

7. The life histories of the congeneric heather psyllids reflect adaptations that allow them to exploit host plants with different distributions in climatic and thereby geographical space. Strophingia ericae has the flexible life history that enables it to exploit C. vulgaris throughout its European boreal temperate range. Strophingia cinereae has a less flexible life history and is adapted for living on an oceanic temperate host. While the geographic ranges of the two Strophingia spp. overlap within the UK, the psyllids appear to respond differently to variation in their thermal environment.

Fungal stress biology: A preface to the Fungal Stress Responses special edition

There is currently an urgent need to increase global food security, reverse the trends of increasing cancer rates, protect environmental health, and mitigate climate change. Toward these ends, it is imperative to improve soil health and crop productivity, reduce food spoilage, reduce pesticide usage by increasing the use of biological control, optimize bioremediation of polluted sites, and generate energy from sustainable sources such as biofuels. This review focuses on fungi that can help provide solutions to such problems. We discuss key aspects of fungal stress biology in the context of the papers published in this Special Issue of Current Genetics. This area of biology has relevance to pure and applied research on fungal (and indeed other) systems, including biological control of insect pests, roles of saprotrophic fungi in agriculture and forestry, mycotoxin contamination of the food-supply chain, optimization of microbial fermentations including those used for bioethanol production, plant pathology, the limits of life on Earth, and astrobiology.

The life and death of Irish social partnership: lessons for social pacts

From 1987 to 2009, Irish social partnership operated as a national framework for industrial relations. The contribution of the article is twofold. We seek to link the institutional dynamics of social partnership with the Régulation School's notions of modes of accumulation and regimes of régulation. This framework is used to explain the rise and fall of social partnership in Ireland. We argue that the regime of social partnership in Ireland can be divided into two distinct periods. In the first, social partnership contributed positively to a benign productivity-led mode of accumulation. In the second, it lost its economic functionality due mostly to financialisation taking a grip in the Irish economy. The conclusion is that social partnership had both positive and negative features, but it is unlikely to be repeated in the foreseeable future, at least not in Ireland.