End-of-life care pathways for improving outcomes in caring for the dying

This is an updated version of a Cochrane review published in Issue 11, 2013 in the Cochrane Library. In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans that detail essential steps in caring for patients with specific clinical problems. In particular, care pathways for the dying have been developed as a model to improve care of patients who are in the last days of life. The care pathways were designed with an aim of ensuring that the most appropriate management occurs at the most appropriate time, and that it is provided by the most appropriate health professional. Since the last update, there have been sustained concerns about the safety of implementing end-of-life care pathways, particularly in the United Kingdom (UK). Therefore, there is a significant need for clinicians and policy makers to be informed about the effects of end-of-life care pathways via a systematic review.

A Decentralized Session Management Framework for Heterogeneous Ad-Hoc and Fixed Networks

Wireless technologies are continuously evolving. Second generation cellular networks have gained worldwide acceptance. Wireless LANs are commonly deployed in corporations or university campuses, and their diffusion in public hotspots is growing. Third generation cellular systems are yet to affirm everywhere; still, there is an impressive amount of research ongoing for deploying beyond 3G systems. These new wireless technologies combine the characteristics of WLAN based and cellular networks to provide increased bandwidth. The common direction where all the efforts in wireless technologies are headed is towards an IP-based communication. Telephony services have been the killer application for cellular systems; their evolution to packet-switched networks is a natural path. Effective IP telephony signaling protocols, such as the Session Initiation Protocol (SIP) and the H 323 protocol are needed to establish IP-based telephony sessions. However, IP telephony is just one service example of IP-based communication. IP-based multimedia sessions are expected to become popular and offer a wider range of communication capabilities than pure telephony. In order to conjoin the advances of the future wireless technologies with the potential of IP-based multimedia communication, the next step would be to obtain ubiquitous communication capabilities. According to this vision, people must be able to communicate also when no support from an infrastructured network is available, needed or desired. In order to achieve ubiquitous communication, end devices must integrate all the capabilities necessary for IP-based distributed and decentralized communication. Such capabilities are currently missing. For example, it is not possible to utilize native IP telephony signaling protocols in a totally decentralized way. This dissertation presents a solution for deploying the SIP protocol in a decentralized fashion without support of infrastructure servers. The proposed solution is mainly designed to fit the needs of decentralized mobile environments, and can be applied to small scale ad-hoc networks or also bigger networks with hundreds of nodes. A framework allowing discovery of SIP users in ad-hoc networks and the establishment of SIP sessions among them, in a fully distributed and secure way, is described and evaluated. Security support allows ad-hoc users to authenticate the sender of a message, and to verify the integrity of a received message. The distributed session management framework has been extended in order to achieve interoperability with the Internet, and the native Internet applications. With limited extensions to the SIP protocol, we have designed and experimentally validated a SIP gateway allowing SIP signaling between ad-hoc networks with private addressing space and native SIP applications in the Internet. The design is completed by an application level relay that permits instant messaging sessions to be established in heterogeneous environments. The resulting framework constitutes a flexible and effective approach for the pervasive deployment of real time applications.

Computationally Efficient Methods for MDL-Optimal Density Estimation and Data Clustering

The Minimum Description Length (MDL) principle is a general, well-founded theoretical formalization of statistical modeling. The most important notion of MDL is the stochastic complexity, which can be interpreted as the shortest description length of a given sample of data relative to a model class. The exact definition of the stochastic complexity has gone through several evolutionary steps. The latest instantation is based on the so-called Normalized Maximum Likelihood (NML) distribution which has been shown to possess several important theoretical properties. However, the applications of this modern version of the MDL have been quite rare because of computational complexity problems, i.e., for discrete data, the definition of NML involves an exponential sum, and in the case of continuous data, a multi-dimensional integral usually infeasible to evaluate or even approximate accurately. In this doctoral dissertation, we present mathematical techniques for computing NML efficiently for some model families involving discrete data. We also show how these techniques can be used to apply MDL in two practical applications: histogram density estimation and clustering of multi-dimensional data.

Arginine Decarboxylase from Lathyrus sativus Seedlings Purification and Properties

Arginine decarboxylase which makes its appearance in Lathyrus sativus seedlings after 24 h of seed germination reaches its highest level around 5–7 days, the cotyledons containing about 60% of the total activity in the seedlings at day 5. The cytosol enzyme was purified 977-fold from whole seedlings by steps involving manganese chloride treatment, ammonium sulphate and acetone fractionations, positive adsorption on alumina C-γ gel, DEAE-Sephadex chromatography followed by preparative disc gel electrophoresis. The enzyme was shown to be homogeneous by electrophoretic and immunological criteria, had a molecular weight of 220000 and appears to be a hexamer with identical subunits. The optimal pH and temperature for the enzyme activity were 8.5 and 45 °C respectively. The enzyme follows typical Michaelis-Menten kinetics with a Km value of 1.73 mM for arginine. Though Mn2+ at lower concentrations stimulated the enzyme activity, there was no dependence of the enzyme on any metal for the activity. The arginine decarboxylase of L. sativus is a sulfhydryl enzyme. The data on co-factor requirement, inhibition by carbonyl reagents, reducing agents and pyridoxal phosphate inhibitors, and a partial reversal by pyridoxal phosphate of inhibition by pyridoxal · HCl suggests that pyridoxal 5'-phosphate is involved as a co-factor for the enzyme. The enzyme activity was inhibited competitively by various amines including the product agmatine. Highest inhibition was obtained with spermine and arcain. The substrate analogue, l-canavanine, homologue l-homoarginine and other basic amino acids like l-lysine and l-ornithine inhibited the enzyme activity competitively, homoarginine being the most effective in this respect.

Formation of Pb(Ti,Zr)O3, from thermal decomposition of oxalate precursors

Lead zir conyl oxalate hexahydrate (LZO) and lead titanyl zirconyl oxalate hydrate (LTZO) are prepared and characterized. Their thermal decompositions have been investigated by thermoanalytical and gas analysis techniques. The decomposition in air or oxygen has three steps — dehydration, decomposition of the oxalate to a carbonate and the decomposition of carbonate to PbZrO3. In non oxidising atmosphere, partial reduction of Pb(II) to Pb(0) takes place at the oxalate decomposition step. The formation of free metallic lead affects the stoichiometry of the intermediate carbonate and yields a mixture of Pb(Ti,Zr)O3 and ZrO2 as the final products. By maintaining oxidising atmosphere and low heating rate, direct preparation of stoichiometric, crystalline Pb(Ti,Zr)O3 at 550°C is possible from the corresponding oxalate precursor.

Thermal decomposition of rare-earth trioxalatocobaltates

The thermal decomposition of rare-earth trioxalatocobaltates LnCo(C2O4)3 · x H2O, where Ln = La, Pr, Nd, has been studied in flowing atmospheres of air/oxygen, argon/ nitrogen, carbon dioxide and a vacuum. The compounds decompose through three major steps, viz. dehydration, decomposition of the oxalate to an intermediate carbonate, which further decomposes to yield rare-earth cobaltite as the final product. The formation of the final product is influenced by the surrounding gas atmosphere. Studies on the thermal decomposition of photodecomposed lanthanum trioxalatocobaltate and a mechanical mixture of lanthanum oxalate and cobalt oxalate in 1 : 2 molar ratio reveal that the decomposition behaviour of the two samples is different. The drawbacks of the decomposition scheme proposed earlier have been pointed out, and logical schemes based on results obtained by TG, DTA, DTG, supplemented by various physico-chemical techniques such as gas and chemical analyses, IR and mass spectroscopy, surface area and magnetic susceptibility measurements and X-ray powder diffraction methods, have been proposed for the decomposition in air of rare-earth trioxalatocobaltates as well as for the photoreduced lanthanum salt and a mechanical mixture of lanthanum and cobalt oxalates.

Jungle Perch Kuhlia Rupestris Fingerling Production Manual

This manual consists of written descriptions of jungle perch Kuhlia rupestris production and video material to demonstrate each of the key production steps. Video links are at the end of each major written section in the document. To activate the link use ctrl click. The videos enhance the instructive ability of this manual. The keys to producing jungle perch are:  maintaining broodstock in freshwater or low salinity water less than 5 ppt  spawning fish in full seawater at 28C  incubating eggs in full seawater. Salinities must not be less than 32 ppt  ensuring that first feed jungle perch larvae have an adequate supply of copepod nauplii  rearing larvae in full seawater under bright light  use of gentle aeration in tanks  postponing spawns until adequate densities of copepod nauplii are present in ponds  sustaining copepod blooms in ponds for at least 20 days  avoiding use of paddlewheels in ponds  supplementary feeding with Artemia salina and weaning diets from 20 days after hatch  harvesting of fingerlings or fry after they are 25-30 mm in length (50 to 60 days post hatch)  covering tanks of fingerlings with 5 mm mesh and submerging freshwater inlets to prevent jumping.

Infrared thermal imaging for automated detection of diabetic foot complications

Background Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. Methods The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had difuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs). Results No diferences in mean temperature >1.5 °C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with difuse complications, mean temperature diferences of >3 °C between ipsilateral and contralateral foot were found. Conclusions With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or difuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings.

Agreeable Agreement : An Examination into the Quest for a Solid Consensus in Light of Bilateral Doctrinal Dialogues among Anglicans, Lutherans and Roman Catholics

The purpose of this study is to analyse the development and understanding of the idea of consensus in bilateral dialogues among Anglicans, Lutherans and Roman Catholics. The source material consists of representative dialogue documents from the international, regional and national dialogues from the 1960s until 2006. In general, the dialogue documents argue for agreement/consensus based on commonality or compatibility. Each of the three dialogue processes has specific characteristics and formulates its argument in a unique way. The Lutheran-Roman Catholic dialogue has a particular interest in hermeneutical questions. In the early phases, the documents endeavoured to describe the interpretative principles that would allow the churches to together proclaim the Gospel and to identify the foundation on which the agreement in the church is based. This investigation ended up proposing a notion of basic consensus , which later developed into a form of consensus that seeks to embrace, not to dismiss differences (so-called differentiated consensus ). The Lutheran-Roman Catholic agreement is based on a perspectival understanding of doctrine. The Anglican-Roman Catholic dialogue emphasises the correctness of interpretations. The documents consciously look towards a common future , not the separated past. The dialogue s primary interpretative concept is koinonia. The texts develop a hermeneutics of authoritative teaching that has been described as the rule of communion . The Anglican-Lutheran dialogue is characterised by an instrumental understanding of doctrine. Doctrinal agreement is facilitated by the ideas of coherence, continuity and substantial emphasis in doctrine. The Anglican-Lutheran dialogue proposes a form of sufficient consensus that considers a wide set of doctrinal statements and liturgical practices to determine whether an agreement has been reached to the degree that, although not complete , is sufficient for concrete steps towards unity. Chapter V discusses the current challenges of consensus as an ecumenically viable concept. In this part, I argue that the acceptability of consensus as an ecumenical goal is based not only the understanding of the church but more importantly on the understanding of the nature and function of the doctrine. The understanding of doctrine has undergone significant changes during the time of the ecumenical dialogues. The major shift has been from a modern paradigm towards a postmodern paradigm. I conclude with proposals towards a way to construct a form of consensus that would survive philosophical criticism, would be theologically valid and ecumenically acceptable.

Ett' varttuisi Suomenmaa : Suomalaisten kasvattaminen kulutusyhteiskuntaan kotimaisissa lyhytelokuvissa 1920-1969

The birth of the Modern Consumer Society in Finnish short films 1920-1969 The main subject of this research is Finnish short films in 1920-1969. These short films were produced by film studios for private enterprises, banks, advisory organizations, communities and the state. The evolution of short films on consumer affairs was greatly influenced by a special tax reduction system that was introduced in 1933 and lasted until 1964. The tax reduction system increased the production volumes of educational short films significantly. This study covers 342 Finnish short films, more than any other study in the field before this. The aim of this research is to examine how short films introduced Finns to modern consumer society. The cinemagoers were an excellent target group for different advisory groups as well as advertisers. Short films were used by organizations and private enterprises from very early on. In the 1920's Finns were still living in rural areas and agriculture was the dominant industry. Consumer society was still in its infancy, and the prevalent attitude to industrially produced goods was that of suspicion. From the cultural and ideological point of view the evolution of trust was one of the first steps towards the birth of the consumer society. Short films were an excellent means for helping to transform public attitudes. During the war period short films were an important means of propaganda. Short films were produced in abundance and shown for big audiences. They guided people how to survive shortages caused by the war. Even though the idea of rationalization was presented in short films somewhat in the 1920's and 1930's it became a national virtue during the war period. The idea of rationalization widened from the industry to households expecially in the late 1940's and the 1950's. New household apparati and the way in which daily chores were taken care of were presented not as luxury consumption but as a way of rationalization and saving money and effort. Banks and the advisory organizations guided the public to save their money for a specific target. Short films were use to help the public to acceps industrial goods and the notions of planning and saving. The ideological change from an agrarian society to consumer society was based on old acricultural ideas and self-sufficiency was evolved into rational and economizing consumerism. This made Finnish consumer society to value durable consumer goods and own homes. The public was also encouraged to consider their own decisions in the national context - especially after the second world war Finland laced capital, and personal savings were strongly presented as a way to help the whole nation. Modern hedonistic values were not dominant in Finland in the1950's and 1960's. Initial traces of modern hedonism can be seen in the films, but they were only marginal paths in the bigger.

Thermal decomposition of titanyl oxalates-I : Barium titanyl oxalate

Thermal decomposition of barium titanyl oxalate tetrahydrate (BTO) has been investigated employing TGA, DTG and DTA techniques and gas and chemical analysis. The decomposition proceeds through five steps and is not affected much by the surrounding gas atmosphere. The first step which is the dehydration of the tetrahydrate is followed by a low-temperature decomposition of the oxalate groups. In the temperature range 190–250°C half a mole of carbon monoxide is evolved with the formation of a transient intermediate containing both oxalate and carbonate groups. The oxalate groups are completely destroyed in the range 250–450°C, resulting in the formation of a carbonate which retains free carbon dioxide in the matrix. The trapped carbon dioxide is released in the temperature range of 460–600°C. The final decomposition of the carbonate takes place between 600–750°C and yields barium titanate. The i.r. spectra, surface area measurements and X-ray, powder diffraction data support entrapment of carbon dioxide in the matrix.

Signalling in Malaria Parasites the Malsig Consortium

Depending on their developmental stage in the life cycle, malaria parasites develop within or outside host cells, and in extremely diverse contexts such as the vertebrate liver and blood circulation, or the insect midgut and hemocoel. Cellular and molecular mechanisms enabling the parasite to sense and respond to the intra- and the extra-cellular environments are therefore key elements for the proliferation and transmission of Plasmodium, and therefore are, from a public health perspective, strategic targets in the fight against this deadly disease. The MALSIG consortium, which was initiated in February 2009, was designed with the primary objective to integrate research ongoing in Europe and India on i) the properties of Plasmodium signalling molecules, and ii) developmental processes occurring at various points of the parasite life cycle. On one hand, functional studies of individual genes and their products in Plasmodium falciparum (and in the technically more manageable rodent model Plasmodium berghei) are providing information on parasite protein kinases and phosphatases, and of the molecules governing cyclic nucleotide metabolism and calcium signalling. On the other hand, cellular and molecular studies are elucidating key steps of parasite development such as merozoite invasion and egress in blood and liver parasite stages, control of DNA replication in asexual and sexual development, membrane dynamics and trafficking, production of gametocytes in the vertebrate host and further parasite development in the mosquito. This article, which synthetically reviews such signalling molecules and cellular processes, aims to provide a glimpse of the global frame in which the activities of the MALSIG consortium will develop over the next three years.

Meltdown - a tool for classification and analysis of DSF data

An application that translates raw thermal melt curve data into more easily assimilated knowledge is described. This program, called ‘Meltdown’, performs a number of data remediation steps before classifying melt curves and estimating melting temperatures. The final output is a report that summarizes the results of a differential scanning fluorimetry experiment. Meltdown uses a Bayesian classification scheme, enabling reproducible identification of various trends commonly found in DSF datasets. The goal of Meltdown is not to replace human analysis of the raw data, but to provide a sensible interpretation of the data to make this useful experimental technique accessible to naïve users, as well as providing a starting point for detailed analyses by more experienced users.

Star Camera Calibration Combined with Independent Spacecraft Attitude Determination

A methodology for determining spacecraft attitude and autonomously calibrating star camera, both independent of each other, is presented in this paper. Unlike most of the attitude determination algorithms where attitude of the satellite depend on the camera calibrating parameters (like principal point offset, focal length etc.), the proposed method has the advantage of computing spacecraft attitude independently of camera calibrating parameters except lens distortion. In the proposed method both attitude estimation and star camera calibration is done together independent of each other by directly utilizing the star coordinate in image plane and corresponding star vector in inertial coordinate frame. Satellite attitude, camera principal point offset, focal length (in pixel), lens distortion coefficient are found by a simple two step method. In the first step, all parameters (except lens distortion) are estimated using a closed-form solution based on a distortion free camera model. In the second step lens distortion coefficient is estimated by linear least squares method using the solution of the first step to be used in the camera model that incorporates distortion. These steps are applied in an iterative manner to refine the estimated parameters. The whole procedure is faster enough for onboard implementation.

Molecular mechanism for the specific inhibition of reverse transcriptase of rous sarcoma virus by the copper complexes of isonicotinic acid hydrazide

Isonicotinic acid hydrazide (isoniazid), one of the most potent antitubercular drugs, was recently shown, in our laboratory, to form two different complexes with copper, depending upon the oxidation state of the metal ion. Both the complexes have been shown to possess antiviral activity against Rous sarcoma virus, an RNA tumor virus. The antiviral activity of the complexes has been attributed to their ability to inhibit the endogenous reverse transcriptase activity of RSV. More recent studies in our laboratory indicate that both these complexes inhibit both endogenous and exogenous reactions. As low a final concentration as 50 μM of the cupric and the cuprous complexes inhibits the endogenous reaction to the extent of 93 and 75 per cent respectively. Inhibition of the exogenous reaction varies with the templates. The inhibition can be reversed by either β-mercaptoethanol or ethylene-diamine-tetra-acetic acid. The specificity of this inhibition has been ascertained by using a synthetic primer-template, −(dG)not, vert, similar15−(rCm)n, which is highly specific for reverse transcriptases. The inhibition is found to be template specific. The studies carried out, using various synthetic primer-templates, show the inhibition of both the steps of reverse transcription by the copper complexes of isoniazid.