Multidisciplinary team meetings in palliative care: an ethnographic study

OBJECTIVES: Multidisciplinary team meetings are a regular feature in the provision of palliative care, involving a range of professionals. Yet, their purpose and best format are not necessarily well understood or documented. This article describes how hospital and community-based palliative care multidisciplinary team meetings operate to elucidate some of their main values and offer an opportunity to share examples of good practice. METHODS: Ethnographic observations of over 70 multidisciplinary team meetings between May 2018 and January 2020 in hospital and community palliative care settings in intercity London. These observations were part of a larger study examining palliative care processes. Fieldnotes were thematically analysed. RESULTS: This article analyses how the meetings operated in terms of their setup, participants and general order of business. Meetings provided a space where patients, families and professionals could be cared for through regular discussions of service provision. CONCLUSIONS: Meetings served a variety of functions. Alongside discussing the more technical, clinical and practical aspects that are formally recognised aspects of the meetings, an additional core value was enabling affectual aspects of dealing with people who are dying to be acknowledged and processed collectively. Insight into how the meetings are structured and operate offer input for future practice

Bereavement during employment in Higher Education (UK): 2023 Survey Report

Very little is known about the bereavement experiences of staff in Higher Education Institutes (HEIs), despite bereavement being a common experience and one that can impact both one’s wellbeing and work performance. Members of Open Thanatology at the Open University surveyed staff across universities, open to all levels and roles, to find out more about staff knowledge of their institutions’ policies and their own bereavement experiences. A total of 539 responses were received within a three-week period in early 2023; over 70% of those who responded had experienced at least one bereavement whilst working. This document reports descriptive statistics based on the survey findings. Topics covered include: the ease of understanding any available policy, if workload was covered in their absence, sufficiency of leave period, and support from line managers and colleagues. The survey, and related reports such as this, set the scene for generating improvements within the sector for university employers to become more compassionate and champion staff wellbeing. On page 17 we provide our five recommendations for HEIs to improve workplace experiences of bereavement

Giant optical birefringence of semiconductor nanowire metamaterials

Semiconductor nanowires exhibit large polarization anisotropy for the absorption and emission of light, making them ideal building blocks for novel photonic metamaterials. Here, we demonstrate that a high density of aligned nanowires exhibits giant optical birefringence, a collective phenomenon observable uniquely for collections of wires. The nanowire material was grown on gallium phosphide (GaP) (111) in the form of vertically standing GaP nanowires. We obtain the largest optical birefringence to date, with a difference between the in-plane and out-of-plane refractive indices of 0.80 and a relative birefringence of 43%. These values exceed by a factor of 75 the natural birefringence of quartz and a by more than a factor of two the highest values reported so far in other artificial materials. By exploiting the specific crystallographic growth directions of the nanowires on the substrate, we further demonstrate full control over the orientation of the optical birefringence effect in the metamaterial.Comment: 10 pages, 4 figure

Intervention thresholds for osteoporosis in men and women: A study based on data from Sweden

The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35$200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk

The risk and burden of vertebral fractures in Sweden

The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis

PMS61 Health-Related Quality of Life After Vertebral Fracture: Differences Between the EQ-5D and Time-Trade-Off Instruments

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Coulomb effects in tunneling through a quantum dot stack

Tunneling through two vertically coupled quantum dots is studied by means of a Pauli master equation model. The observation of double peaks in the current-voltage characteristic in a recent experiment is analyzed in terms of the tunnel coupling between the quantum dots and the coupling to the contacts. Different regimes for the emitter chemical potential indicating different peak scenarios in the tunneling current are discussed in detail. We show by comparison with a density matrix approach that the interplay of coherent and incoherent effects in the stationary current can be fully described by this approach.Comment: 6 pages, 6 figure

Volcanic Risk System (SRV): ASI Pilot Project to Support The Monitoring of Volcanic Risk In Italy by Means of EO Data

The ASI-SRV(Sistema Rischio Vulcanico) project started at the beginning of the 2007 is funded by the Italian Space Agency (ASI) in the frame of the National Space Plan 2003-2005 under the Earth Observations section for natural risks management. Coordinated by the Istituto Nazionale di Geofisica e Vulcanologia (INGV), which is responsible at national level for the volcanic monitoring, the project has as main objective to develop a pre-operative system based on EO data and ground measurements integration to support the volcanic risk monitoring of the Italian Civil Protection Department. The project philosophy is to implement specific modules which allow to process, store and visualize through Web GIS tools EO derived parameters considering three activity phases: 1) knowledge and prevention; 2) crisis; 3) post crisis. In order to combine effectively the EO data and the ground networks measurements the system will implement a multi-parametric analysis tool, which represents and unique tool to analyze contemporaneously a large data set of data in “near real time”. The SRV project will be tested his operational capabilities on three Italian Volcanoes: Etna,Vesuvio and Campi Flegrei

SCOPE: a scorecard for osteoporosis in Europe

Summary The scorecard summarises key indicators of the burden of osteoporosis and its management in each of the member states of the European Union. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe. Introduction The scorecard for osteoporosis in Europe (SCOPE) is an independent project that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis. Methods The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union (EU27). The information researched covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap). Results There was a marked difference in fracture risk among the EU27. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27, only a minority of patients at high risk receive treatment for osteoporosis even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements were then assembled on a single sheet to provide a unique overview of osteoporosis in Europe. Conclusions The scorecard will enable healthcare professionals and policy makers to assess their country’s general approach to the disease and provide indicators to inform future provision of healthcare