Predictors of place of death for those in receipt of home-based palliative care services in Ontario, Canada

Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n=302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.

Long-term changes in oxygen depletion in a small temperate lake: effects of climate change and eutrophication

1. We analysed 41 years of data (1968–2008) from Blelham Tarn, U.K., to determine the consequences of eutrophication and climate warming on hypolimnetic dissolved oxygen (DO).
2. The establishment of thermal stratification was strongly related to the onset of DO depletion in the lower hypolimnion. As a result of a progressively earlier onset of stratification and later overturn, the duration of stratification increased by 38 ± 8 days over the 41 years.
3. The observed rate of volumetric hypolimnetic oxygen depletion (VHODobs) ranged from 0.131 to 0.252 g O2 m−3 per day and decreased significantly over the study period, despite the increase in the mean chlorophyll a (Chl a) concentration in the growing season. The vertical transport of DO represented from 0 to 30% of VHODobs, while adjustments for interannual differences in hypolimnetic temperature were less important, ranging from −11 to 9% of VHODobs.
4. The mean wind speed during May made the strongest significant contribution to the variation in VHODobs. VHODobs adjusted for the vertical transport of DO and hypolimnetic temperature differences, VHODadj, was significantly related to the upper mixed layer Chl a concentration during spring.
5. Hypolimnetic anoxia (HA) ranged from 27 to 168 days per year and increased significantly over time, which undoubtedly had negative ecological consequences for the lake.
6. In similar small temperate lakes, the negative effects of eutrophication on hypolimnetic DO are likely to be exacerbated by changes in lake thermal structure brought about by a warming climate, which may undermine management efforts to alleviate the effects of anthropogenic eutrophication.

Eutrophication assessment in China's coastal waters

Tese mest. , Gestão da Água e da Costa, 2009, Universidade do Algarve

Primary production in systems subject to natural and anthropogenic eutrophication

Tese dout., Química, Universidade do Algarve, 2005

Comparison of methods of eutrophication assessment in a coastal lagoon (Ria Formosa)

Dissertação de Mestrado, Gestão da Água e da Costa, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2010

Eutrophication and some European waters of restricted exchange

Regions of Restricted Exchange (RREs) are an important feature of the European coastline. They are historically preferred sites for human settlement and aquaculture and their ecosystems, and consequent human use, may be at risk from eutrophication. The OAERRE project (EVK3-CT1999-0002 concerns ‘Oceanographic Applications to Eutrophication in Regions of Restricted Exchange’. It began in July 2000, and studies six sites. Four of these sites are fjords: Kongsfjorden (west coast of Spitzbergen); Gullmaren (Skagerrak coast of Sweden); Himmerfj.arden (Baltic coast of Sweden); and the Firth of Clyde (west coast of Scotland). Two are bays sheltered by sand bars: Golfe de Fos (French Mediterranean); and Ria Formosa (Portuguese Algarve). Together they exemplify a range of hydrographic and enrichment conditions. The project aims to understand the physical, biogeochemical and biological processes, and their interactions, that determine the trophic status of these coastal marine RRE through the development of simple screening models to define, predict and assess eutrophication. This paper introduces the sites and describes the component parts of a basic screening model and its application to each site using historical data. The model forms the starting point for the OAERRE project and views an RRE as a well-mixed box, exchanging with the sea at a daily rate E determined by physical processes, and converting nutrient to phytoplankton chlorophyll at a fixed yield q: It thus uses nutrient levels to estimate maximum biomass; these preliminary results are discussed in relation to objective criteria used to assess trophic status. The influence of factors such as grazing and vertical mixing on key parameters in the screening model are further studied using simulations of a complex‘research’ model for the Firth of Clyde. The future development of screening models in general and within OAERRE in particular is discussed. In addition, the paper looks ahead with a broad discussion of progress in the scientific understanding of eutrophication and the legal and socioeconomic issues that need to be taken into account in managing the trophic status of RREs.

Validity, reliability and responsiveness of the French language translation of the Western Ontario Shoulder Instability Index (WOSI).

BACKGROUND: The WOSI (Western Ontario Shoulder Instability Index) is a self-administered quality of life questionnaire designed to be used as a primary outcome measure in clinical trials on shoulder instability, as well as to measure the effect of an intervention on any particular patient. It is validated and is reliable and sensitive. As it is designed to measure subjective outcome, it is important that translation should be methodologically rigorous, as it is subject to both linguistic and cultural interpretation. OBJECTIVE: To produce a French language version of the WOSI that is culturally adapted to both European and North American French-speaking populations. MATERIALS AND METHODS: A validated protocol was used to create a French language WOSI questionnaire (WOSI-Fr) that would be culturally acceptable for both European and North American French-speaking populations. Reliability and responsiveness analyses were carried out, and the WOSI-Fr was compared to the F-QuickDASH-D/S (Disability of the Arm, Shoulder and Hand-French translation), and Walch-Duplay scores. RESULTS: A French language version of the WOSI (WOSI-Fr) was accepted by a multinational committee. The WOSI-Fr was then validated using a total of 144 native French-speaking subjects from Canada and Switzerland. Comparison of results on two WOSI-Fr questionnaires completed at a mean interval of 16 days showed that the WOSI-Fr had strong reliability, with a Pearson and interclass correlation of r=0.85 (P=0.01) and ICC=0.84 [95% CI=0.78-0.88]. Responsiveness, at a mean 378.9 days after surgical intervention, showed strong correlation with that of the F-QuickDASH-D/S, with r=0.67 (P<0.01). Moreover, a standardized response means analysis to calculate effect size for both the WOSI-Fr and the F-QuickDASH-D/S showed that the WOSI-Fr had a significantly greater ability to detect change (SRM 1.55 versus 0.87 for the WOSI-Fr and F-QuickDASH-D/S respectively, P<0.01). The WOSI-Fr showed fair correlation with the Walch-Duplay. DISCUSSION: A French-language translation of the WOSI questionnaire was created and validated for use in both Canadian and Swiss French-speaking populations. This questionnaire will facilitate outcome assessment in French-speaking settings, collaboration in multinational studies and comparison between studies performed in different countries. TYPE OF STUDY: Multicenter cohort study. LEVEL OF EVIDENCE: II.

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