Talking to patients about death and dying

Copyright © 2004 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.INTRODUCTION: Talking about death and dying, either with patients terminally ill or well, presents challenges for the general practitioner. There are few Australian educational resources and little Australian research into this area. METHODS: We undertook two focus groups, an interview process, and a final consultation with palliative care experts and GPs. RESULTS: General practitioners felt they needed support and education in talking about death and dying. This is separate from discussions about 'Advanced Health Care Directives'. General practitioners were open to learning new ways to help patients and families approach dying, but require support and education around initiating discussions, asking the right questions and accessing services. Participating GPs emphasised the importance of utilising palliative care supports and resources to provide ongoing spiritual and physical care. Many were particularly concerned with access to support for dying patients for both indigenous patients and those from other cultures. Advance Health Care Directives were regarded by participating GPs to be tools to facilitate a discussion around death and dying, rather than their primary purpose. DISCUSSION: We developed a booklet to provide practical, useful guidelines for GPs in their daily practice.Teresa A. Burgess, Mary Brooksbank and Justin Beilb

Microbiology managers: managerial training in the RItrain project

Leaders of research infrastructures (RIs) in Europe who are scientists require competencies in management. RItrain has addressed this issue by identifying skills required, locating relevant courses and finding gaps, whilst establishing a Master of Management programme. We describe how one contributing microbiology RI determined the most relevant skills.The RItrain project is funded by the European Commission, grant agreement number 654156.info:eu-repo/semantics/publishedVersio

Division, adjoints, and dualities of bilinear maps

The distributive property can be studied through bilinear maps and various morphisms between these maps. The adjoint-morphisms between bilinear maps establish a complete abelian category with projectives and admits a duality. Thus the adjoint category is not a module category but nevertheless it is suitably familiar. The universal properties have geometric perspectives. For example, products are orthogonal sums. The bilinear division maps are the simple bimaps with respect to nondegenerate adjoint-morphisms. That formalizes the understanding that the atoms of linear geometries are algebraic objects with no zero-divisors. Adjoint-isomorphism coincides with principal isotopism; hence, nonassociative division rings can be studied within this framework. This also corrects an error in an earlier pre-print; see Remark 2.11

The experience of patients with advanced chronic obstructive pulmonary disease and advance care-planning: a South Australian perspective

Advance care-planning conversations with people who have chronic obstructive pulmonary disease (COPD) are important because of the severity of the disease and the unpredictable timing of death. Advance care-planning is a process involving conversations about future wishes, including end-of-life care and the appointment of a substitute decision-maker. This qualitative research explored issues relating to end-of-life decisions with 15 individuals and their carers living in the community who had severe COPD. Findings indicated that, although patients and carers would welcome the opportunity to discuss end-of-life decisions, almost no conversation about care-planning had been initiated by health professionals with any of the participants. It also demonstrated that professional support is required to assist with advance care-planning and the completion of the legal advance directive documents.M. Brown, M.A. Brooksbank, T.A. Burgess, M. Young and G.B. Crawfordhttp://www.ncbi.nlm.nih.gov/pubmed/2343185

STITCH: interaction networks of chemicals and proteins

The knowledge about interactions between proteins and small molecules is essential for the understanding of molecular and cellular functions. However, information on such interactions is widely dispersed across numerous databases and the literature. To facilitate access to this data, STITCH (‘search tool for interactions of chemicals’) integrates information about interactions from metabolic pathways, crystal structures, binding experiments and drug–target relationships. Inferred information from phenotypic effects, text mining and chemical structure similarity is used to predict relations between chemicals. STITCH further allows exploring the network of chemical relations, also in the context of associated binding proteins. Each proposed interaction can be traced back to the original data sources. Our database contains interaction information for over 68 000 different chemicals, including 2200 drugs, and connects them to 1.5 million genes across 373 genomes and their interactions contained in the STRING database. STITCH is available at http://stitch.embl.de

Volatility Studies of Some Fission Product Fluorides

A preliminary study of the volatility behavior of molybdenum indicated that MoF/sub 5/ was converted to MoF/sub 6/ by F/sub 2/; MoF/sub 6/ and Tc fluoride are absorbed on NaF at 100; technetium fluoride is more strongly held than molybdenum fluoride on NaF; MoF/sub 6/ may not be completely trapped by a dry ice trap. The behavior of volatile fission product fluorides was such that (a) Ru and Nb fluorides were volatile from fused salts during fluorination, (b) Mo and technetium were not volatile during hydrofluorination but were in excess F/ sub 2/> 100 deg C(auth)

Persistent Homology Over Directed Acyclic Graphs

We define persistent homology groups over any set of spaces which have inclusions defined so that the corresponding directed graph between the spaces is acyclic, as well as along any subgraph of this directed graph. This method simultaneously generalizes standard persistent homology, zigzag persistence and multidimensional persistence to arbitrary directed acyclic graphs, and it also allows the study of more general families of topological spaces or point-cloud data. We give an algorithm to compute the persistent homology groups simultaneously for all subgraphs which contain a single source and a single sink in $O(n^4)$ arithmetic operations, where $n$ is the number of vertices in the graph. We then demonstrate as an application of these tools a method to overlay two distinct filtrations of the same underlying space, which allows us to detect the most significant barcodes using considerably fewer points than standard persistence.Comment: Revised versio

Rationale and design of the genotype-blinded trial of torasemide for the treatment of hypertension (BHF UMOD)

Background: There is evidence from genome wide association study that single-nucleotide polymorphisms (SNPs) in the 5' end of the uromodulin gene (UMOD) affect uromodulin excretion and blood pressure (BP). Uromodulin is almost exclusively expressed in the thick ascending limb of the loop of Henle (TAL) and its effect on BP appear to be mediated via the TAL sodium transporter, NKCC2. Loop-diuretics block NKCC2 but are not commonly used in hypertension management. As volume overload is considered as one of the primary drivers for uncontrolled hypertension, targeting loop-diuretics to individuals who are more likely to respond to this drug class, using UMOD genotype, could be an efficient precision medicine strategy. Methods: A genotype-blinded, multi-centre trial comparing the BP response to torasemide between individuals possessing the AA genotype of the SNP rs13333226 and those possessing the G allele. 240 participants with uncontrolled BP aged ≥18 years, on ≥1 antihypertensive agent for ≥3 months, will be included. Uncontrolled BP is average systolic BP (SBP) >135mmHg and/or diastolic BP >85mmHg on home monitoring. Torasemide, 5mg daily, is taken for 16 weeks. The primary outcome is the change in 24h ambulatory SBP area under the curve between baseline and end of treatment. Sample size was calculated to detect a 4mmHg difference between groups at 90% power. Approval by West of Scotland Research Ethics Committee 5 (16/WS/0160). Registration at https://clinicaltrials.gov/ct2/show/NCT03354897. Results: The study should conclude August 2021. Conclusions: If hypothesis confirmed, a targeted strategy will improve BP control and could reduce the burden of uncontrolled hypertension

Constructing female entrepreneurship policy in the UK : is the US a relevant benchmark?

Successive UK governments have introduced a range of policy initiatives designed to encourage more women to start new firms. Underpinning these policies has been an explicit ambition for the UK to achieve similar participation rates as those in the US where it is widely reported that women own nearly half the stock of businesses. The data underlying these objectives are critically evaluated and it is argued that the definitions and measures of female enterprise used in the UK and the US restrict meaningful comparisons between the two. It is suggested that the expansion of female entrepreneurship in the US is historically and culturally specific to that country. UK policy goals should reflect the national socioeconomic context, while drawing upon good practice examples from a range of other countries. The paper concludes by discussing the economic and social viability of encouraging more women in the UK to enter self-employment without fully recognising the intensely competitive sectors in which they are often located