Research Priorities in Pediatric Palliative Care: A Delphi Study

Pediatric palliative care is increasingly recognized to be a specialized type of care requiring specific skills and knowledge, yet, as found in several countries, there is little available research evidence on which to base care. Objectives: The goal of the project was to achieve consensus among palliative care practitioners and researchers regarding the identification of pertinents lines of research. Method: A Delphi technique was used with an interdisciplinary panel (n=14–16) of researchers and frontline clinicians in pediatric palliative care in Canada. Results: Four priority research questions were identified: What matters most for patients and parents receiving pediatric palliative services? What are the bereavement needs of families in pediatric palliative care? What are the best practice standards in pain and symptom management? What are effective strategies to alleviate suffering at the end of life? Conclusions: These identified priorities will provide guidance and direction for research efforts in Canada, and may prove useful in providing optimal care to patients and families in pediatric palliative care

Fast computation of Bernoulli, Tangent and Secant numbers

We consider the computation of Bernoulli, Tangent (zag), and Secant (zig or Euler) numbers. In particular, we give asymptotically fast algorithms for computing the first n such numbers in O(n^2.(log n)^(2+o(1))) bit-operations. We also give very short in-place algorithms for computing the first n Tangent or Secant numbers in O(n^2) integer operations. These algorithms are extremely simple, and fast for moderate values of n. They are faster and use less space than the algorithms of Atkinson (for Tangent and Secant numbers) and Akiyama and Tanigawa (for Bernoulli numbers).Comment: 16 pages. To appear in Computational and Analytical Mathematics (associated with the May 2011 workshop in honour of Jonathan Borwein's 60th birthday). For further information, see http://maths.anu.edu.au/~brent/pub/pub242.htm

Diversity of actions of GnRHs mediated by ligand-induced selective signaling

Geoffrey Wingfield Harris’ demonstration of hypothalamic hormones regulating pituitary function led to their structural identification and therapeutic utilization in a wide spectrum of diseases. Amongst these, Gonadotropin Releasing Hormone (GnRH) and its analogs are widely employed in modulating gonadotropin and sex steroid secretion to treat infertility, precocious puberty and many hormone-dependent diseases including endometriosis, uterine fibroids and prostatic cancer. While these effects are all mediated via modulation of the pituitary gonadotrope GnRH receptor and the G(q) signaling pathway, it has become increasingly apparent that GnRH regulates many extrapituitary cells in the nervous system and periphery. This review focuses on two such examples, namely GnRH analog effects on reproductive behaviors and GnRH analog effects on the inhibition of cancer cell growth. For both effects the relative activities of a range of GnRH analogs is distinctly different from their effects on the pituitary gonadotrope and different signaling pathways are utilized. As there is only a single functional GnRH receptor type in man we have proposed that the GnRH receptor can assume different conformations which have different selectivity for GnRH analogs and intracellular signaling proteins complexes. This ligand-induced selective-signaling recruits certain pathways while by-passing others and has implications in developing more selective GnRH analogs for highly specific therapeutic intervention

Degradation of haloaromatic compounds

An ever increasing number of halogenated organic compounds has been produced by industry in the last few decades. These compounds are employed as biocides, for synthetic polymers, as solvents, and as synthetic intermediates. Production figures are often incomplete, and total production has frequently to be extrapolated from estimates for individual countries. Compounds of this type as a rule are highly persistent against biodegradation and belong, as "recalcitrant" chemicals, to the class of so-called xenobiotics. This term is used to characterise chemical substances which have no or limited structural analogy to natural compounds for which degradation pathways have evolved over billions of years. Xenobiotics frequently have some common features. e.g. high octanol/water partitioning coefficients and low water solubility which makes for a high accumulation ratio in the biosphere (bioaccumulation potential). Recalcitrant compounds therefore are found accumulated in mammals, especially in fat tissue, animal milk supplies and also in human milk. Highly sophisticated analytical techniques have been developed for the detection of organochlorines at the trace and ultratrace level

(Re)visioning whole-person care : an interpretation of the health care experiences of culturally diverse persons living with a life-limiting illness

Trends in Canadian demographics reflect a growing multicultural population with diverse perspectives on health and illness. This phenomenon brings unique challenges and opportunities to health care professionals to provide excellence in Hospice Palliative Care (HPC). Cross-cultural care can be complex and cultural differences may result in poor health outcomes for minority persons at end-of-life. The purpose of this study was to explore the lived experience of health care for culturally diverse persons who had been diagnosed with a life-limiting illness. Guided by the principles of hermeneutic phenomenology, it aimed to identify what culturally diverse persons considered important to their health care and to understand how mainstream and minority cultural approaches to care were enacted in their experiences. Data were generated through in-depth interviews with ten participants with various palliative diagnoses. Data analysis included the contextual development of four paradigm cases to uncover primary themes related to the participants’ experience of health care. These cases were categorically compared and contrasted with the other cases to further develop the themes. A conceptual picture of whole-person care that included the key dimensions of holistic care, integration of multiple care knowledges, and prioritization of collaborative care emerged through this process. The findings revealed that the participants addressed gaps in whole-person care by drawing on both mainstream and minority cultural beliefs and practices to meet their physical, mental, emotional and spiritual needs. This study points to the need for social workers and other health care professionals to re-conceptualize biomedicine as one cultural approach to health and illness alongside others of HPC and culturally diverse persons.Arts, Faculty ofSocial Work, School ofGraduat

Health social work in Canada: Five trends worth noting

Highlighting a strong human rights and social justice orientation underlying health social work in Canada, this paper describes recent contributions of Canadian health social work practitioners and scholars to five areas identified by Auslander (2001) in a delphi study of health social work in its first century. Five current ‘trends’ are discussed which correspond with Auslander\u27s themes of professional legitimacy and scope, social causation, dissemination of knowledge, interventions, and cultural appropriateness. These trends are: 1) defining the scope of health social work practice; 2) addressing the social determinants of health; 3) promoting evidence-based practice in health social work; 4) delivering client and family-centered care; and 5) implementing cultural safety and trauma-informed practice. Suggestions are made to further strengthen the position of health social work in Canada

Addiction Social Work Fellowship Program in Canada

Substance use disorders (SUD) disproportionally contribute to the global social and economic cost of disease; however, their treatment has been inadequate in large part due to an enduring research to practice gap in which competencies for treating and preventing SUDs are often lacking from social work education curricula. Training social workers in managing SUDs has been separated from nurse and physician training, partly due to the long-standing divide between the behavioral health and medical care system. Recently, a new interdisciplinary fellowship in addiction social work, nursing and medicine has been established in Vancouver, Canada. We describe the novel fellowship program and outline initial impact of the training on knowledge and skills in addiction social work from our qualitative evaluation of the fellowship. We conclude that training social workers, and other allied health professionals alongside physicians and nurses may extend the reach of this type of training program even further.European Commission Horizon 20202020-03-12 JG: PDF updated at author's request to include corrected acknowledgements