Study protocol: Delayed intervention randomised controlled trial within the Medical Research Council (MRC) Framework to assess the effectiveness of a new palliative care service

Background: Palliative care has been proposed to help meet the needs of patients who suffer progressive non-cancer conditions but there have been few evaluations of service development initiatives. We report here a novel protocol for the evaluation of a new palliative care service in this context. Methods/Design: Using the MRC Framework for the Evaluation of Complex Interventions we modelled a new palliative care and neurology service for patients severely affected by Multiple Sclerosis (MS). We conducted qualitative interviews with patients, families and staff, plus a literature review to model and pilot the service. Then we designed a delayed intervention randomised controlled trial to test its effectiveness as part of phase II of the MRC framework. Inclusion criteria for the trial were patients identified by referring clinicians as having unresolved symptoms or psychological concerns. Referrers were advised to use a score of greater than 8 on the Expanded Disability Scale was a benchmark. Consenting patients newly referred to the new service were randomised to either receive the palliative care service immediately (fast-track) or after a 12-week wait (standard best practice). Face to face interviews were conducted at baseline (before intervention), and at 4–6, 10–12 (before intervention for the standard-practice group), 16– 18 and 22–24 weeks with patients and their carers using standard questionnaires to assess symptoms, palliative care outcomes, function, service use and open comments. Ethics committee approval was granted separately for the qualitative phase and then for the trial. Discussion: We publish the protocol trial here, to allow methods to be reviewed in advance of publication of the results. The MRC Framework for the Evaluation of Complex Interventions was helpful in both the design of the service, methods for evaluation in convincing staff and the ethics committee to accept the trial. The research will provide valuable information on the effects of palliative care among non-cancer patients and a method to evaluate palliative care in this context

The monopole mass in the three-dimensional Georgi-Glashow model

We study the three-dimensional Georgi-Glashow model to demonstrate how magnetic monopoles can be studied fully non-perturbatively in lattice Monte Carlo simulations, without any assumptions about the smoothness of the field configurations. We examine the apparent contradiction between the conjectured analytic connection of the `broken' and `symmetric' phases, and the interpretation of the mass (i.e., the free energy) of the fully quantised 't Hooft-Polyakov monopole as an order parameter to distinguish the phases. We use Monte Carlo simulations to measure the monopole free energy and its first derivative with respect to the scalar mass. On small volumes we compare this to semi-classical predictions for the monopole. On large volumes we show that the free energy is screened to zero, signalling the formation of a confining monopole condensate. This screening does not allow the monopole mass to be interpreted as an order parameter, resolving the paradox.Comment: 12 pages, 7 figures, uses revtex. Minor changes made to the text to match with the published version at http://link.aps.org/abstract/PRD/v65/e12500

Naturally-Occurring Zirconolites - Analogues for the Long-Term Encapsulation of Actinides in Synroc

The use of natural zirconolites to assess the effect of α-decay damage and geochemical alteration on the release of actinides from HLW wasteforms is critically examined. There is evidence that the natural zirconolites provide a good chemical and radi-ation damage analogy for the HLW wasteforms, but additional work is required to define the geochemical environments in which zirconolite is stable or unstable (e.g., suffering corrosion or chemical alteration, including loss of actinides)

Retention of Actinides in Natural Pyrochlores and Zirconolites

Natural pyrochlore and zirconolite undergo a crystalline-aperi­odic transformation caused by alpha-decay of 232Th and 2380 at dose levels between 2 X 1014 and 3 X 1017 a/mg. The principal effects of the transformation are volume expansion and micro­fracturing, providing potential pathways for fluids. Geochemical alteration of the minerals may occur under hydrothermal conditions or in low temperature, near surface environments, but Th and U usually remain immobile and can be retained for time scales up to 109 years. However, the Th-U isotope systematics of a zirconolite-bearing vein and dolomite host rock may provide evidence for disequilibrium between 230Th, 234U and 238U

Quark number susceptibilities of hot QCD up to g^6ln(g)

The pressure of hot QCD has recently been determined to the last perturbatively computable order g^6 ln(g) by Kajantie et al. using three-dimensional effective theories. A similar method is applied here to the pressure in the presence of small but non-vanishing quark chemical potentials, and the result is used to derive the quark number susceptibilities in the limit mu = 0. The diagonal quark number susceptibility of QCD with n_f flavours of massless quarks is evaluated to order g^6ln(g) and compared with recent lattice simulations. It is observed that the results qualitatively resemble the lattice ones, and that when combined with the fully perturbative but yet undetermined g^6 term they may well explain the behaviour of the lattice data for a wide range of temperatures.Comment: 11 pages, 3 figures Typos corrected, references added, figures modifie

Childhood and the politics of scale: Descaling children's geographies?

This is the post-print version of the final published paper that is available from the link below. Copyright @ 2008 SAGE Publications.The past decade has witnessed a resurgence of interest in the geographies of children's lives, and particularly in engaging the voices and activities of young people in geographical research. Much of this growing body of scholarship is characterized by a very parochial locus of interest — the neighbourhood, playground, shopping mall or journey to school. In this paper I explore some of the roots of children's geographies' preoccupation with the micro-scale and argue that it limits the relevance of research, both politically and to other areas of geography. In order to widen the scope of children's geographies, some scholars have engaged with developments in the theorization of scale. I present these arguments but also point to their limitations. As an alternative, I propose that the notion of a flat ontology might help overcome some difficulties around scalar thinking, and provide a useful means of conceptualizing sociospatiality in material and non-hierarchical terms. Bringing together flat ontology and work in children's geographies on embodied subjectivity, I argue that it is important to examine the nature and limits of children's spaces of perception and action. While these spaces are not simply `local', they seldom afford children opportunities to comment on, or intervene in, the events, processes and decisions that shape their own lives. The implications for the substance and method of children's geographies and for geographical work on scale are considered

The Effect of Weak Interactions on the Ultra-Relativistic Bose-Einstein Condensation Temperature

We calculate the ultra-relativistic Bose-Einstein condensation temperature of a complex scalar field with weak lambda Phi^4 interaction. We show that at high temperature and finite density we can use dimensional reduction to produce an effective three-dimensional theory which then requires non-perturbative analysis. For simplicity and ease of implementation we illustrate this process with the linear delta expansion.Comment: Latex2e, 12 pages, three eps figures, replacement with additional discussion and extra figur

The complexity of pluralistic ignorance in Republican climate change policy support in the United States

Most Americans fail to recognize widespread public support for climate change action. Here we investigate how this phenomenon differs for Republican supporters versus opponents of several climate change policies. Surveying a representative sample of Republican voters (N = 1000), we find that misperception of in-group support for climate action is primarily restricted to Republicans already opposed to action. Specifically, those in the minority (i.e., Republicans opposed to climate action) were more likely to erroneously perceive other Republicans as holding views on climate change policy similar to their own. While Republican supporters recognize that most Republicans support climate change policy, they may be discouraged from expressing their support due to an information environment disproportionately portraying Republicans as opposed to climate change action

Preliminary Report of the AMS analysis of tsunami deposits in Tohoku – Japan – 18 th to the 21 st Century

Sedimentary records of tsunamis are a precious tool to assess the occurrence of past events, as attested by an abundant literature, which has seen a particular 'boom' in the aftermath of the 2004 Indian Ocean tsunami and the 2011 Tohoku tsunami. Despite an extensive literature, there is very little to no understanding of the role that the changing coastal environment is playing on the record of a tsunami, and for a given location, it is still unclear whether the largest tsunamis leave the largest amount of deposits. To research this question, the present study took place in Japan, in the Tohoku Region at Agawa-pond, because the pond act as a sediment trap. Using a sediment-slicer, a 1 m thick deposit was retrieved, from which 4 tsunami sequences were identified, including the latest 2011 tsunami. Using a series of sedimentary proxies: the AMS (Anisotropy of Magnetic Susceptibility), grain size analysis, quartz morphoscopy (morphology and surface characteristics) and the analysis of microfossils, disparities between the tsunami deposits were identified and most importantly a clear thinning of the tsunami deposit towards the top. Provided the present evidences, the authors discuss that the upward fining is due to at least two components that are seldom assessed in tsunami research (1) a modification of the depositional environment, with the progressive anthropization of the coast, providing less sediments to remobilize; and (2) a progressive filling of the Agawa pond, which progressively loses its ability to trap tsunami materials