What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city

Objective For patients with advanced cancer, several randomised controlled trials have shown that access to palliative care at least 6 months before death can improve symptoms, reduce unplanned hospital admissions, minimize aggressive cancer treatments and enable patients to make choices about their end of life care, including exercising the choice to die at home. This study determines in a UK population the duration of palliative care before death and explores influencing factors. Design This retrospective cohort study analysed referrals to three specialist palliative care services; a hospital based inpatient palliative care team, and two community based services (hospices). For each patient referred to any of the above services we identified the date of first referral to that team and calculated the median interval between first referral and death. We also calculated how referral time varied by age, sex, diagnosis and type of palliative care service. Participants 4,650 patients referred to specialist palliative care services in Leeds UK between April 2012 and March 2014. Results Median age of the sample was 75 years. 3,903 (84.0%) patients had a diagnosis of cancer. Age, diagnosis and place of referral were significant predictors of duration of palliative care before death. Age was independently associated (J = 2672078, z = -392046.14, r = .01) with duration of palliative care regardless of diagnosis. Patients over 75 years have 29 fewer days of palliative care than patients under 50. Patients with non-cancer diagnoses have 13 fewer days of palliative care than patients with cancer. Additionally, patients referred to hospital palliative care receive 24.5 fewer days palliative care than those referred to community palliative care services. Conclusions The current timing of referral to palliative care may limit the benefits to patient in terms of improvements in end of life care, particularly for older patients and patients with conditions other than cancer

Sistema de alerta para procesos torrenciales a escala regional combinando mapas de susceptibilidad y datos del radar meteorológico

Los procesos torrenciales como las corrientes de derrubios o flujos hiperconcentrados causan frecuentemente daños importantes e incluso muertos en zonas montañosas. Para afrontar este peligro, los sistemas de alerta son una herramienta muy útil en la mitigación de los impactos de estos procesos hidro-morfológicos. El presente estudio ha desarrollado, implementado y validado un sistema de alerta a escala regional que determina en tiempo real el nivel de alerta en cada subcuenca de una zona seleccionada. Los principales datos de entrada son un mapa de susceptibilidad y la situación meteorológica que se obtiene mediante el radar. Mediante la aplicación de la técnica de lógica difusa y funciones de pertenencia, el mapa de susceptibilidad y el campo de lluvia se determina en cada subcuenca una de tres posibles clases, y finalmente con una matriz de alerta se calcula uno de los tres niveles de alerta (baja, media o alta). Los resultados del sistema de alerta y su validación han sido muy positivos y demuestran la gran utilidad de estas herramientas.Postprint (published version

Strong Balmer lines in old stellar populations: No need for young ages in ellipticals?

Comparing models of Simple Stellar Populations (SSP) with observed line strengths generally provides a tool to break the age-metallicity degeneracy in elliptical galaxies. Due to the wide range of Balmer line strengths observed, ellipticals have been interpreted to exhibit an appreciable scatter in age. In this paper, we analyze Composite Stellar Population models with a simple mix of an old metal-rich and an old metal-poor component. We show that these models simultaneously produce strong Balmer lines and strong metallic lines without invoking a young population. The key to this result is that our models are based on SSPs that better match the steep increase of Hbeta in metal-poor globular clusters than models in the literature. Hence, the scatter of Hbeta observed in cluster and luminous field elliptical galaxies can be explained by a spread in the metallicity of old stellar populations. We check our model with respect to the so-called G-dwarf problem in ellipticals. For a galaxy subsample covering a large range in UV-V colors we demonstrate that the addition of an old metal-poor subcomponent does not invalidate other observational constraints like colors and the flux in the mid-UV.Comment: Accepted for publication in ApJ Main Journal, 9 pages, 5 figure

Distinct Contributions of Eroding and Depositional Profiles to Land-Atmosphere CO2 Exchange in Two Contrasting Forests

This work is licensed under a Creative Commons Attribution 4.0 International License.Lateral movements of soil organic C (SOC) influence Earth's C budgets by transporting organic C across landscapes and by modifying soil-profile fluxes of CO2. We extended a previously presented model (Soil Organic C Erosion Replacement and Oxidation, SOrCERO) and present SOrCERODe, a model with which we can project how erosion and subsequent deposition of eroded material can modify biosphere-atmosphere CO2 fluxes in watersheds. The model permits the user to quantify the degree to which eroding and depositional profiles experience a change in SOC oxidation and production as formerly deep horizons become increasingly shallow, and as depositional profiles are buried. To investigate the relative importance of erosion rate, evolving SOC depth distributions, and mineralization reactivity on modeled soil C fluxes, we examine two forests exhibiting distinct depth distributions of SOC content and reactivity, hydrologic regimes and land use. Model projections suggest that, at decadal to centennial timescales: (1) the quantity of SOC moving across a landscape depends on erosion rate and the degree to which SOC production and oxidation at the eroding profile are modified as deeper horizons become shallower, and determines the degree to which depositional profile SOC fluxes are modified; (2) erosional setting C sink strength increases with erosion rate, with some sink effects reaching more than 40% of original profile SOC content after 100 y of a relatively high erosion rate (i.e., 1 mm y−1); (3) even large amounts of deposited SOC may not promote a large depositional profile C sink even with large gains in autochthonous SOC post-deposition if oxidation of buried SOC is not limited; and (4) when modeled depositional settings receive a disproportionately large amount of SOC, simulations of strong C sink scenarios mimic observations of modest preservation of buried SOC and large SOC gains in surficial horizons, suggesting that C sink scenarios have merit in these forests. Our analyses illuminate the importance of cross-landscape linkages between upland and depositional environments for watershed-scale biosphere-atmosphere C fluxes, and emphasize the need for accurate representations and observations of time-varying depth distributions of SOC reactivity across evolving watersheds if we seek accurate projections of ecosystem C balances

Frictional cooling of positively charged particles

One of the focuses of research and development towards the construction of a muon collider is muon beam preparation. Simulation of frictional cooling shows that it can achieve the desired emittance reduction to produce high-luminosity muon beams. We show that for positively charged particles, charge exchange interactions necessitate significant changes to schemes previously developed for negatively charged particles. We also demonstrate that foil-based schemes are not viable for positive particles.Comment: 15 pages, 6 figure

A new common functional coding variant at the DDC gene change renal enzyme activity and modify renal dopamine function.

The intra-renal dopamine (DA) system is highly expressed in the proximal tubule and contributes to Na+ and blood pressure homeostasis, as well as to the development of nephropathy. In the kidney, the enzyme DOPA Decarboxylase (DDC) originating from the circulation. We used a twin/family study design, followed by polymorphism association analysis at DDC locus to elucidate heritable influences on renal DA production. Dense single nucleotide polymorphism (SNP) genotyping across the DDC locus on chromosome 7p12 was analyzed by re-sequencing guided by trait-associated genetic markers to discover the responsible genetic variation. We also characterized kinetics of the expressed DDC mutant enzyme. Systematic polymorphism screening across the 15-Exon DDC locus revealed a single coding variant in Exon-14 that was associated with DA excretion and multiple other renal traits indicating pleiotropy. When expressed and characterized in eukaryotic cells, the 462Gln variant displayed lower Vmax (maximal rate of product formation by an enzyme) (21.3 versus 44.9 nmol/min/mg) and lower Km (substrate concentration at which half-maximal product formation is achieved by an enzyme.)(36.2 versus 46.8 μM) than the wild-type (Arg462) allele. The highly heritable DA excretion trait is substantially influenced by a previously uncharacterized common coding variant (Arg462Gln) at the DDC gene that affects multiple renal tubular and glomerular traits, and predicts accelerated functional decline in chronic kidney disease

The Evolution of Early-Type Galaxies in Distant Clusters II: Internal Kinematics of 55 Galaxies in the z=0.33 Cluster CL1358+62

We define a large sample of galaxies for use in a study of the fundamental plane in the intermediate redshift cluster CL1358+62 at $z=0.33$. We have analyzed high resolution spectra for 55 members of the cluster. The data were acquired with the Low Resolution Imaging Spectrograph on the Keck I 10m telescope. A new algorithm for measuring velocity dispersions is presented and used to measure the internal kinematics of the galaxies. This algorithm has been tested against the Fourier Fitting method so the data presented here can be compared with those measured previously in nearby galaxies. We have measured central velocity dispersions suitable for use in a fundamental plane analysis. The data have high $S/N$ and the resulting random errors on the dispersions are very low, typically $<5$. Uncertainties due to mismatch of the stellar templates has been minimized through several tests and the total systematic error is of order \about 5%. Good seeing enabled us to measure velocity dispersion profiles and rotation curves for most of the sample and although a large fraction of the galaxies display a high level of rotation, the gradients of the total second moment of the kinematics are all very regular and similar to those in nearby galaxies. We conclude that the data therefore can be reliably corrected for aperture size in a manner consistent with nearby galaxy samples.Comment: 30 pages, 13 figures; for publication in the ApJ (accepted on 23 August 1999