”Hvordan har du sovet i nat, Per?”: En samtaleanalytisk undersøgelse af navne i hjemmeplejesamtaler

When names occur in utterances, they can function as selecting a new speaker in conversations. Butwhat happens when names occur in two-party conversations where using names for selecting a newspeaker then seems irrelevant?This paper investigates the use of names in a conversation from the Danish homecare system. Theconversation is between an elderly male citizen and his caretaker. There were several occurrencesof the citizen’s name in the conversation, and these form the basis for the analysis. Using acollection based analysis a hypothesis was developed for the name-phenomenon to see if there wasa pattern.One line of research suggests that names in this position serve a special purpose like the one foundto hold true in this paper, where others say that the position of the name in the end of utterancesmake it an object for deletion which may question its role. The paper concludes that the followingtendency is present in the data under question: The name occurs primarily turn finally in utterancesthat start a new sequence and which furthermore contain something problematic, especiallyconcerning something intimate and integrity threatening according to the citizen where reestablishmentof a mutual relation is attempted. This paper thus contributes to the understanding ofthe use of names in two-party conversations in line with the former view, and disagrees with thelatter

Association mapping in Scandinavian winter wheat for yield, plant height and traits important for second-generation bioethanol production

A collection of 100 wheat varieties representing more than 100 years of wheat-breeding history in Scandinavia was established in order to identify marker-trait associations for plant height, grain yield and biomass potential for bioethanol production. The field-grown material showed variations in plant height from 54 to 122 cm and in grain yield from 2 to 6.61 t ha-1. The release of monomeric sugars was determined by high-throughput enzymatic treatment of ligno-cellulosic material and varied between 0.169 and 0.312 g/g dm for glucose and 0.146 and 0.283 g/g dm for xylose. As expected, plant height and grain yield showed to be highly influenced by genetic factors with repeatability (R) equal to 0.75 and 0.53 respectively, while this was reduced for glucose and xylose (R=0.09 for both) . The study of trait correlations showed how old, low-yielding, tall varieties released higher amounts of monomeric sugars after straw enzymatic hydrolysis, showing reduced recalcitrance to bioconversion compared to modern varieties. 93 lines from the collection were genotyped with the DArTseq® genotypic platform and 5525 markers were used for genome-wide association mapping. Six QTLs for grain yield, plant height and glucose released from straw were mapped. One QTL for plant height was previously reported, while the remaining QTLs constituted new genomic regions linked to trait variation. This paper is one of the first studies in wheat to identify QTLs that are important for bioethanol production based on a genome-wide association approach

Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review

Objective: To summarise evidence on how multidisciplinary team (MDTs) make decisions about identification of imminently dying patients. Design Scoping review. Setting: Any clinical setting providing care for imminently dying patients, excluding studies conducted solely in acute care settings. Data sources: The databases AMED, CINAHL, Embase, MEDLINE, PsychINFO and Web of Science were searched from inception to May 2021. Included studies presented original study data written in English and reported on the process or content of MDT discussions about identifying imminently dying adult patients. Results: 40 studies were included in the review. Studies were primarily conducted using interviews and qualitative analysis of themes. MDT members involved in decision-making were usually doctors and nurses. Some decisions focused on professionals recognising that patients were dying, other decisions focused on initiating specific end-of-life care pathways or clarifying care goals. Most decisions provided evidence for a partial collaborative approach, with information-sharing being more common than joint decision-making. Issues with decision-making included disagreement between staff members and the fact that doctors were often regarded as final or sole decision-makers. Conclusions: Prognostic decision-making was often not the main focus of included studies. Based on review findings, research explicitly focusing on MDT prognostication by analysing team discussions is needed. The role of allied and other types of healthcare professionals in prognostication needs further investigation as well. A focus on specialist palliative care settings is also necessary

What outcomes do studies use to measure the impact of prognostication on people with advanced cancer? Findings from a systematic review of quantitative and qualitative studies

Background: Studies evaluating the impact of prognostication in advanced cancer patients vary in the outcomes they measure, and there is a lack of consensus about which outcomes are most important. Aim: To identify outcomes previously reported in prognostic research with people with advanced cancer, as a first step towards constructing a core outcome set for prognostic impact studies. Design: A systematic review was conducted and analysed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42022320117; 29/03/2022). Data sources: Six databases were searched from inception to September 2022. We extracted data describing (1) outcomes used to measure the impact of prognostication and (2) patients’ and informal caregivers’ experiences and perceptions of prognostication in advanced cancer. We classified findings using the Core Outcome Measures in Effectiveness Trials (COMET) initiative taxonomy, along with a narrative description. We appraised retrieved studies for quality, but quality was not a basis for exclusion. Results: We identified 42 eligible studies: 32 quantitative, 6 qualitative, 4 mixed methods. We extracted 70 outcomes of prognostication in advanced cancer and organised them into 12 domains: (1) survival; (2) psychiatric outcomes; (3) general outcomes; (4) spiritual/religious/existential functioning/wellbeing, (5) emotional functioning/wellbeing; (6) cognitive functioning; (7) social functioning; (8) global quality of life; (9) delivery of care; (10) perceived health status; (11) personal circumstances; and (12) hospital/hospice use. Conclusion: Outcome reporting and measurement varied markedly across the studies. A standardised approach to outcome reporting in studies of prognosis is necessary to enhance data synthesis, improve clinical practice and better align with stakeholders’ priorities

How does receiving a survival estimate affect the general health and wellbeing of people living with terminal cancer and their carers? Findings from a systematic review of qualitative experiences

Introduction: We are developing a core outcome set (COS) for palliative cancer care research into prognostication (prediction of survival). Studies in this field often measure a variety of clinical and service-level outcomes, but do not routinely measure outcomes that are important to patients and carers. The experiences of these stakeholders are essential for producing a meaningful COS. / Aims: To identify and synthesise qualitative data on patients’ and carers’ experiences of prognostication in palliative cancer care. / Methods: We searched five electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library) from inception up to March 2022. The search included qualitative or mixed methods studies exploring how adult cancer patients and/or carers are affected by prognostication. Data describing outcomes and experiences of prognostication were extracted and thematically synthesised, using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy as a framework to develop themes. / Results: From 8,075 results, we identified 9 papers describing patients’ and carers’ experiences of prognostication. We identified 28 themes from these papers and organised these into eight domains within the COMET taxonomy: 1) psychiatric outcomes; 2) spiritual, religious, and/or existential functioning/wellbeing; 3) emotional functioning/wellbeing; 4) social functioning; 5) global quality of life; 6) delivery of care; 7) perceived health status; 8) personal circumstances. The main themes identified were: avoidance/denial, maintaining hope, preparedness for end-of-life, and treatment preferences. / Conclusions: We have identified 28 themes as potential candidates for inclusion in the future COS. The next stage of the study will investigate stakeholders’ perspectives on these themes and other potentially suitable items for inclusion, identified through linked reviews. / Impact: Standardising outcome reporting through a COS will improve the comparability of future prognostic research, and match better with patient and carer experiences. This will lead to better evidence synthesis, clinical practice, and ultimately improve access to support for those living with terminal cancer when receiving a prognosis

How best to capture the impact of complementary therapies in palliative care: A systematic review to identify and assess the appropriateness and validity of multi-domain tools

BACKGROUND: Complementary therapies are widely used in palliative care settings. Qualitative research found that people with advanced disease report a range of physical and psychological benefits from complementary therapies, however evidence of their effectiveness from clinical trials is inconclusive. This may be because trials are limited by use of inappropriate outcome measures. AIMS: To identify tools which capture the impact of massage, reflexology and aromatherapy in people with advanced disease. We (1) identified multi-domain tools used to evaluate these therapies in populations with any chronic health condition and (2) assessed whether tools were valid and psychometrically robust in populations with advanced disease. DESIGN: A two-stage systematic review was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (PROSPERO: CRD42020161199). DATA SOURCES: Six databases were searched (August 2021). Study methodological quality, tool psychometric properties and evidence quality were assessed. A global comparison score was generated. RESULTS: Stage 1: 66 trials using 40 different multi-domain tools were identified. Stage 2: Of these tools, we identified papers for seven tools regarding development or validation in advanced disease populations. The majority of psychometric data were inconsistent or inconclusive. Data were mostly of low quality due to methodological issues. CONCLUSION: Of the tools identified, 'Functional Assessment of Cancer Therapy - General' appears to be the most suitable alternative tool against COMSIN criteria, for trials of massage, reflexology and aromatherapy in palliative care. Further tool validation is required before firm recommendations can be made. Co-development of a core outcome set could ensure relevant domains are assessed

Camel and bovine chymosin:the relationship between their structures and cheese-making properties

Bovine and camel chymosin are aspartic peptidases that are used industrially in cheese production. They cleave the Phe105-Met106 bond of the milk protein κ-casein, releasing its predominantly negatively charged C-terminus, which leads to the separation of the milk into curds and whey. Despite having 85% sequence identity, camel chymosin shows a 70% higher milk-clotting activity than bovine chymosin towards bovine milk. The activities, structures, thermal stabilities and glycosylation patterns of bovine and camel chymosin obtained by fermentation in Aspergillus niger have been examined. Different variants of the enzymes were isolated by hydrophobic interaction chromatography and showed variations in their glycosylation, N-terminal sequences and activities. Glycosylation at Asn291 and the loss of the first three residues of camel chymosin significantly decreased its activity. Thermal differential scanning calorimetry revealed a slightly higher thermal stability of camel chymosin compared with bovine chymosin. The crystal structure of a doubly glycosylated variant of camel chymosin was determined at a resolution of 1.6 Å and the crystal structure of unglycosylated bovine chymosin was redetermined at a slightly higher resolution (1.8 Å) than previously determined structures. Camel and bovine chymosin share the same overall fold, except for the antiparallel central β-sheet that connects the N-terminal and C-­terminal domains. In bovine chymosin the N-terminus forms one of the strands which is lacking in camel chymosin. This difference leads to an increase in the flexibility of the relative orientation of the two domains in the camel enzyme. Variations in the amino acids delineating the substrate-binding cleft suggest a greater flexibility in the ability to accommodate the substrate in camel chymosin. Both enzymes possess local positively charged patches on their surface that can play a role in interactions with the overall negatively charged C-terminus of κ-casein. Camel chymosin contains two additional positive patches that favour interaction with the substrate. The improved electrostatic interactions arising from variation in the surface charges and the greater malleability both in domain movements and substrate binding contribute to the better milk-clotting activity of camel chymosin towards bovine milk

Cancer centre supportive oncology service: health economic evaluation

Objectives: There have been many models of providing oncology and palliative care to hospitals. Many patients will use the hospital non-electively or semielectively, and a large proportion are likely to be in the last years of life. We describe our multidisciplinary service to treatable but not curable cancer patients at University Hospitals Sussex. The team was a mixture of clinical nurse specialists and a clinical fellow supported by dedicated palliative medicine consultant time and oncology expertise. / Methods: We identified patients with cancer who had identifiable supportive care needs and record activity with clinical coding. We used a baseline 2019/2020 dataset of national (secondary uses service) data with discharge code 79 (patients who died during that year) to compare a dataset of patients seen by the service between September 2020 and September 2021 in order to compare outcomes. While this was during COVID-19 this was when the funding was available. / Results: We demonstrated a reduction in length of stay by an average of 1.43 days per admission and a reduction of 0.95 episodes of readmission rates. However, the costs of those admissions were found to be marginally higher. Even with the costs of the service, there is a clear return on investment with a benefit cost ratio of 1.4. / Conclusions: A supportive oncology service alongside or allied to acute oncology but in conjunction with palliative care is feasible and cost-effective. This would support investment in such a service and should be nationally commissioned in conjunction with palliative care services seeing all conditions