Developing a best practice model for partnership practice between specialist palliative care and intellectual disability services: a mixed methods study

Background: The lack of access to good quality palliative care for people with intellectual disabilities is highlighted in the international literature. In response, more partnership practice in end-of-life care is proposed. 
Aim: This study aimed to develop a best practice model to guide and promote partnership practice between specialist palliative care and intellectual disability services. 
Design: A mixed methods research design involving two phases was used, underpinned by a conceptual model for partnership practice. 
Setting/participants: Phase 1 involved scoping end-of-life care to people with intellectual disability, based on self-completed questionnaires. In all, 47 of 66 (71.2%) services responded. In Phase 2, semi-structured interviews were undertaken with a purposive sample recruited of 30 health and social care professionals working in intellectual disability and palliative care services, who had provided palliative care to someone with intellectual disability. For both phases, data were collected from primary and secondary care in one region of the United Kingdom. 
Results: In Phase 1, examples of good practice were apparent. However, partnership practice was infrequent and unmet educational needs were identified. Four themes emerged from the interviews in Phase 2: challenges and issues in end-of-life care, sharing and learning, supporting and empowering and partnership in practice. 
Conclusion: Joint working and learning between intellectual disability and specialist palliative care were seen as key and fundamental. A framework for partnership practice between both services has been developed which could have international applicability and should be explored with other services in end-of-life care.

Best friends and better coping: Facilitating psychological resilience through boys’ and girls’ closest friendships

This is a novel investigation of whether, and how, a single close supportive friendship may facilitate psychological resilience in socio-economically vulnerable British adolescents. A total of 409 adolescents (160 boys, 245 girls, four unknown), aged between 11 and 19 years, completed self-report measures of close friendship quality, psychological resilience, social support, and other resources. Findings revealed a significant positive association between perceived friendship quality and resilience. This relationship was facilitated through inter-related mechanisms of developing a constructive coping style (comprised of support-seeking and active coping), effort, a supportive friendship network, and reduced disengaged and externalising coping. While protective processes were encouragingly significantly present across genders, boys were more vulnerable to the deleterious effects of disengaged and externalizing coping than girls. We suggest that individual close friendships are an important potential protective mechanism accessible to most adolescents. We discuss implications of the resulting Adolescent Friendship and Resilience Model for resilience theories and integration into practice.

Empowering Human Services Organizations to Embrace Evidence-informed Practice: International Best Practices

Human service organizations are increasingly using knowledge as a mechanism for implementing change. Knowledge emerging from many sources that may include academic publications, grey literature, and service user and practitioner wisdom contributes toward informing best practice. The question is: how do we harness this knowledge to make practice more effective? This paper synthesizes the lessons learned from eight international organizations that have made a commitment to knowledge mobilization as an important priority in their mission and operation. The paper provides a conceptual model, tools and resources to help human services organizations create strategies for building, enhancing or sustaining their knowledge mobilization efforts. The paper describes a flexible blueprint for human service organizations to leverage knowledge mobilization efforts at all levels of service delivery.

Genetic provenance and best practice woodland management: a case study in native alder (Alnus glutinosa)

In recent years, the native woodlands of Europe, including those of Britain and Ireland, have increasingly come under threat from a range of biotic and abiotic factors, and are therefore a conservation priority demanding careful management in order to realise their inherent ecological and cultural benefits. Because the distribution of genetic variation across populations and regions is increasingly considered an important component of woodland management, we carried out a population genetic analysis on black alder (Alnus glutinosa) across Northern Ireland in order to inform “best practice” strategies. Our findings suggest that populations harbour high levels of genetic diversity, with very little differentiation between populations. Significant F IS values were observed in over half of the populations analysed, however, which could reflect inbreeding as a result of the patchy occurrence of alder in Northern Ireland, with scattered, favourable damp habitats being largely isolated from each other by extensive tracts of farmland. Although there is no genetic evidence to support the broad-scale implementation of tree seed zones along the lines of those proposed for native woodlands in Great Britain, we suggest that the localised occurrence of rare chloroplast haplotypes should be taken into account on a case-by-case basis. This, coupled with the identification of populations containing high genetic diversity and that are broadly representative of the region as a whole, will provide a sound genetic basis for woodland management, both in alder and more generally for species that exhibit low levels of genetic differentiation.

Selecting the best targeted agent in first-line treatment of unresectable liver metastases from colorectal cancer:does the bench have the answers?

For physicians facing patients with organ-limited metastases from colorectal cancer, tumor shrinkage and sterilization of micrometastatic disease is the main goal, giving the opportunity for secondary surgical resection. At the same time, for the majority of patients who will not achieve a sufficient tumor response, disease control remains the predominant objective. Since FOLFOX or FOLFIRI have similar efficacies, the challenge is to define which could be the most effective targeted agent (anti-EGFR or anti-VEGF) to reach these goals. Therefore, a priori molecular identification of patients that could benefit from anti-EGFR or anti-VEGF monoclonal antibodies (i.e. the currently approved targeted therapies for metastatic colorectal cancer) is of critical importance. In this setting, the KRAS mutation status was the first identified predictive marker of response to anti-EGFR therapy. Since it has been demonstrated that tumors with KRAS mutation do not respond to anti-EGFR therapy, KRAS status must be determined prior to treatment. Thus, for KRAS wild-type patients, the choices that remain are either anti-VEGF or anti-EGFR. In this review, we present the most updated data from translational research programs dealing with the identification of biomarkers for response to targeted therapies.

The use of erythropoiesis-stimulating agents with ruxolitinib in patients with myelofibrosis in COMFORT-II: an open-label, phase 3 study assessing efficacy and safety of ruxolitinib versus best available therapy in the treatment of myelofibrosis

BACKGROUND: Anemia is considered a negative prognostic risk factor for survival in patients with myelofibrosis. Most patients with myelofibrosis are anemic, and 35-54 % present with anemia at diagnosis. Ruxolitinib, a potent inhibitor of Janus kinase (JAK) 1 and JAK2, was associated with an overall survival benefit and improvements in splenomegaly and patient-reported outcomes in patients with myelofibrosis in the two phase 3 COMFORT studies. Consistent with the ruxolitinib mechanism of action, anemia was a frequently reported adverse event. In clinical practice, anemia is sometimes managed with erythropoiesis-stimulating agents (ESAs). This post hoc analysis evaluated the safety and efficacy of concomitant ruxolitinib and ESA administration in patients enrolled in COMFORT-II, an open-label, phase 3 study comparing the efficacy and safety of ruxolitinib with best available therapy for treatment of myelofibrosis. Patients were randomized (2:1) to receive ruxolitinib 15 or 20 mg twice daily or best available therapy. Spleen volume was assessed by magnetic resonance imaging or computed tomography scan.

RESULTS: Thirteen of 146 ruxolitinib-treated patients had concomitant ESA administration (+ESA). The median exposure to ruxolitinib was 114 weeks in the +ESA group and 111 weeks in the overall ruxolitinib arm; the median ruxolitinib dose intensity was 33 mg/day for each group. Six weeks before the first ESA administration, 10 of the 13 patients had grade 3/4 hemoglobin abnormalities. These had improved to grade 2 in 7 of the 13 patients by 6 weeks after the first ESA administration. The rate of packed red blood cell transfusions per month within 12 weeks before and after first ESA administration remained the same in 1 patient, decreased in 2 patients, and increased in 3 patients; 7 patients remained transfusion independent. Reductions in splenomegaly were observed in 69 % of evaluable patients (9/13) following first ESA administration.

CONCLUSIONS: Concomitant use of an ESA with ruxolitinib was well tolerated and did not affect the efficacy of ruxolitinib. Further investigations evaluating the effects of ESAs to alleviate anemia in ruxolitinib-treated patients are warranted (ClinicalTrials.gov identifier, NCT00934544; July 6, 2009).

Best Practice for Providing Social Care and Support to People Living with Concurrent Sight Loss and Dementia: Professional Perspectives

Purpose-Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach-The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings-Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications-Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications-There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications-People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value-This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care

Best practice factory for freight transport in Europe: demonstrating how ‘good’ urban freight cases are improving business profit and public sectors benefits

The objective of this study is to better understand why selected urban freight solutions represent innovations that are technically feasible, economically profitable in different contexts, sustainable, transferable, and with tangible beneficial impacts. A total of 15 solutions are evaluated in the fields of Urban Consolidation Centre, clean and electric vehicles, IT solutions, use of urban waterways, and others. Three solutions are analysed more thoroughly, the Cityporto Padova, the Basel Exhibition Centre logistics support system, and the Berlin laboratory area test of the Bentobox. This paper ends with a transversal analysis of the solutions observed, and with methodological conclusions.

Fat Mass Index Performs Best in Monitoring Management of Obesity in Prepubertal Children

An early and accurate recognition of success in treating obesity may increase the compliance of obese children and their families to intervention programs. This observational, prospective study aimed to evaluate the ability and the time to detect a significant reduction of adiposity estimated by body mass index (BMI), percentage of fat mass (%FM), and fat mass index (FMI) during weight management in prepubertal obese children.

A New Gridding Technique for High Density Microarray Images Using Intensity Projection Profile of Best Sub Image

As the technologies for the fabrication of high quality microarray advances rapidly, quantification of microarray data becomes a major task. Gridding is the first step in the analysis of microarray images for locating the subarrays and individual spots within each subarray. For accurate gridding of high-density microarray images, in the presence of contamination and background noise, precise calculation of parameters is essential. This paper presents an accurate fully automatic gridding method for locating suarrays and individual spots using the intensity projection profile of the most suitable subimage. The method is capable of processing the image without any user intervention and does not demand any input parameters as many other commercial and academic packages. According to results obtained, the accuracy of our algorithm is between 95-100% for microarray images with coefficient of variation less than two. Experimental results show that the method is capable of gridding microarray images with irregular spots, varying surface intensity distribution and with more than 50% contamination

Los mejores esfuerzos (best efforts) en el derecho contemporáneo de los contratos

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