Managing Transition from Curative to Palliative: GP and Bereaved Parent Experiences

Background Children with cancer in the UK are treated in regional childhood cancer centres (RCCC). Families and health care professionals can develop close working relationships over the often-long duration of treatment. Cancer still accounts for largest numbers of childhood disease related deaths and as home is commonly the choice of location for palliative and end of life care, the child and family can face transitions both from curative to palliative care and from hospital to home. This paper reports on findings relating to these transitions from the perspectives of parents and family doctors highlighting implications for both hospital and community based health care practitioners. Aims To explore the experiences of bereaved parents and family doctors following the death of a child with cancer in the family home. Methods Ethical approval was sought and obtained. In this qualitative study one-to-one semi-structured interviews were undertaken with 18 GPs and 11 bereaved parents. The parents were those whose child had received treatment for cancer at a RCCC in the UK and who died at home, the GPs were those involved in the palliative care. Chronological comparative data analysis using grounded theory was completed. Results Cessation of contact with the RCCC when the child receives palliative care at home can be traumatic for parents. Hospital and community based health care professionals need to carefully consider how they establish, maintain and end working relationships with the child and family. Conclusions Findings from this study provide a new perspective to the effective management of transition in paediatric oncology palliative care; managing working relationships. Findings highlight the need for hospital and community based staff to identify and employ strategies that ensure working relationships with families are effectively managed prior to, during and following the child’s transition from curative to palliative care.

Conceptualising cosmopolitanism and entrepreneurship through the lens of the three-dimensional theory of power

Purpose – The paper aims to conceptualise cosmopolitanism drivers from the third-level power perspective by drawing on Lukes’ (1974; 2005) theory of power. In addition, the paper aims to investigate the relationship between entrepreneurs’ cosmopolitan dispositions and habitus, i.e. a pattern of an individual’s demeanour, as understood by Bourdieu. Design/methodology/approach – This conceptual paper makes use of Bourdieu’s framework (habitus) by extending it to the urban cosmopolitan environment and linking habitus to the three-dimensional theory of power and, importantly, to the power’s third dimension – preference-shaping. Findings – Once cosmopolitanism is embedded in the urban area’s values, this creates multiple endless rounds of mutual influence (by power holders onto entrepreneurs via political and business elites, and by entrepreneurs onto power holders via the same channels), with mutual benefit. Therefore, mutually beneficial influence that transpires in continuous support of a cosmopolitan city’s environment may be viewed as one of the factors that enhances cosmopolitan cities’ resilience to changes in macroeconomic conditions. Originality/value – The paper offers a theoretical model that enriches the understanding of the power-cosmopolitanism-entrepreneurship link, by emphasising the preference-shaping capacity of power, which leads to the embedment of cosmopolitanism in societal values. As a value shared by political and business elites, cosmopolitanism is also actively promoted by entrepreneurs through their disposition and habitus. This ensures not only their willing compliance with power and the environment, but also their enhancement of favourable business conditions. Entrepreneurs depart from mere acquiescence (to power and its explicit dominance), and instead practice their cosmopolitan influence by active preference-shaping.

Sasakian quiver gauge theories and instantons on cones over lens 5-spaces

We consider SU(3)-equivariant dimensional reduction of Yang Mills theory over certain cyclic orbifolds of the 5-sphere which are Sasaki-Einstein manifolds. We obtain new quiver gauge theories extending those induced via reduction over the leaf spaces of the characteristic foliation of the Sasaki-Einstein structure, which are projective planes. We describe the Higgs branches of these quiver gauge theories as moduli spaces of spherically symmetric instantons which are SU(3)-equivariant solutions to the Hermitian Yang-Mills equations on the associated Calabi-Yau cones, and further compare them to moduli spaces of translationally-invariant instantons on the cones. We provide an explicit unified construction of these moduli spaces as Kahler quotients and show that they have the same cyclic orbifold singularities as the cones over the lens 5-spaces. (C) 2015 The Authors. Published by Elsevier B.V.

Building digital capability: Employability lens on the Six Elements of Digital Capability

This is a version of the Jisc ‘Six Elements of Digital Capabilities’ model, developed to support student-facing sta working in Careers and Employability roles and curriculum sta working to embed employability issues into the curriculum. It draws on the work of the Jisc Developing Student Employability project e.g. on the model of the ‘employable student’ produced by Peter Chatterton for that project.

Rapid hydrothermal cooling above the axial melt lens at fast-spreading mid-ocean ridge

Axial melt lenses sandwiched between the lower oceanic crust and the sheeted dike sequences at fast-spreading mid-ocean ridges are assumed to be the major magma source of oceanic crust accretion. According to the widely discussed "gabbro glacier'' model, the formation of the lower oceanic crust requires efficient cooling of the axial melt lens, leading to partial crystallization and crystal-melt mush subsiding down to lower crust. These processes are believed to be controlled by periodical magma replenishment and hydrothermal circulation above the melt lens. Here we quantify the cooling rate above melt lens using chemical zoning of plagioclase from hornfelsic recrystallized sheeted dikes drilled from the East Pacific at the Integrated Ocean Drilling Program Hole 1256D. Weestimate the cooling rate using a forward modelling approach based on CaAl-NaSi interdiffusion in plagioclase. The results show that cooling from the peak thermal overprint at 1000-10506 degrees C to 6006 degrees C are yielded within about 10-30 years as a result of hydrothermal circulation above melt lens during magma starvation. The estimated rapid hydrothermal cooling explains how the effective heat extraction from melt lens is achieved at fast-spreading mid-ocean ridges.

The outset of mental torture. Through the lens of the Ticking Time Bomb Scenario

No doubt shall be placed when qualifying torture as one of the cruellest crime offences against human beings. It is widely known that the first torture practices go back to the Middle Ages, where torture mechanisms and devices were used as a legitimate means of punishment, extraction of confessions or executions. Brutal techniques such as ‘Judas Cradle’, ‘The Rack’ or the ‘Rat Torture’ were indeed, the ones commonly used. Moreover, some centuries onwards, torture warrants were permitted and authorised by Privy Councils in legislations such as the English one. However, examples like that were the only ones which public accountability was given to, whereas off-the-book practices remained in silence in other countries for long lasting years. Nowadays, in the 21st century, there are innumerable enforced laws and provisions that prohibit the act of torture, to be precise, physical and psychological torture. Nonetheless, not only are these legislations necessary for fighting torture, but also ad hoc courts and specialised committees continuously report the existence of this crime offence.

Biomimetic accommodating intraocular lens

The crystalline lens allows the eye to focus on near and far objects. During the aging process, it loses its ability to focus and often becomes cloudy during cataract formation. At this point, traditional medical therapy replaces the lens with an artificial replacement lens. Although replacement lenses for the crystalline lens have been implanted since 1949 for cataract surgery, none of the FDA-approved lenses mimic the anatomy of the natural lens. Hence, they are not able to focus in a manner similar to the youthful lens. Instead, they function in a manner similar to the aged lens and only provide vision at a single distance or at a very limited range of focal distances. Patients with the newest implants are often obliged to use reading glasses when using near vision, or suffer from optical aberrations, halos, or glare. Therefore, there is a need to provide youthful vision after lens surgery in terms of focusing ability, accurate optical power, and sharp focus without distortion or optical aberrations.

This thesis presents an approach to restoring youthful vision after lens replacement. An intraocular lens (IOL) that can provide accurate visual acuity along with focusing ability is proposed. This IOL relies on the natural anatomy and physiology of the eye, and therefore is actuated in a manner identical to the natural lens. In addition, the lens has the capability for adjustment during or after implantation to provide high-acuity vision throughout life.

The natural anatomy and physiology of the eye is described, along with lens replacement surgery. A lens design is proposed to address the unmet need of lens-replacement patients. Specific care in the design is made for small surgical incisions, high visual acuity, adjustable acuity over years, and the ability to focus similar to the natural lens. Methods to test the IOL using human donor tissue are developed based upon prior experiments on the ex vivo natural lens. These tools are used to demonstrate efficacy of the newly developed accommodating intraocular lens.

To further demonstrate implant feasibility, materials and processes for building the lens are evaluated for biocompatibility, endurance, repeatable manufacture, and stability. The lens biomechanics are determined after developing an artificial anatomy testing setup inspired by the natural anatomy of the human focusing mechanism. Finally, based upon a mechanical and optical knowledge of the lens, several improved lens concepts are proposed and demonstrated for efficacy.

Conceptualising and measuring spatial indicators of employment through a liveability lens

Employment is a well-known social determinant of health and wellbeing and important for the liveability of a region. Yet, spatial data are rarely used to understand barriers and facilitators of accessing employment within a city. Therefore it remains challenging to plan cities that provide equitable opportunities for urban job seekers. This paper sought to: (1) identify urban planning and neighbourhood spatial attributes that facilitate access to employment; (2) conceptualise how neighbourhood attributes that facilitate accessible urban employment may be related to health and wellbeing behaviours and outcomes; and (3) isolate potentially important neighbourhood-level spatial measures that policy-makers and planners could use to assess urban employment accessibility. A conceptual framework was developed through a social determinants of health lens, where more upstream (e.g., neighbourhood attributes) and more downstream (e.g., behaviours, intermediate outcomes) determinants of urban employment were identified in relation to long-term health and social outcomes of interest. Six potential neighbourhood spatial measures of employment were identified. These were classified into measures of: access to employment (n = 4), local employment (n = 1), and neighbourhood employment level (n = 1). The spatial measures proposed rely on routinely collected administrative datasets existing within Australia (i.e., census data); therefore can be replicated over time and data are available nationally. Together, this research identified a suite of potential (and readily available) spatial measures that can be used to assess selected neighbourhood attributes as they relate to urban employment access. Such spatial measures can be used to inform future planning decisions that integrate policies across multiple sectors, thereby improving employment accessibility in an urban context.

Pathways, race and gender responsive reform: through an abolitionist lens

In this article we take stock of a recent moment in penal history in Victoria, Australia, where agencies have implemented gender responsive policies to address the disproportionate growth in women’s prison numbers, and in particular the overrepresentation of women constructed as ‘culturally diverse’. We draw upon abolitionist and intersectional frames to provide a theoretical critique of this political event. Our analysis extends beyond the unitary frame of gender, which has until recently dominated critiques in this area, to highlight the ways in which racializing logics are reproduced through such policies and practices. We explore the implications of the adoption of the criminological notion of pathways through the language of liberal feminist reform, which signifies a reinvestment in the myth of individual rehabilitation. The consequences of these discursive practices include the reproduction of pathologizing and risk-focused practices that can only yield more racializing, interventionist and expansionist responses within correctional spaces.