Health care restructuring and family physician care for those who died of cancer

BACKGROUND: During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992) to 30% (1998). These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP) visits to advanced cancer patients in Nova Scotia (NS) during the years of health care restructuring. METHODS: Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics), the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000). Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212). Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department), time of day (regular hours, after hours), total length of inpatient hospital stay and number of hospital admissions during the last six months of life. RESULTS: In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED), 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP visits over time compared to 1992–93 levels (for 1997–98, adjusted RR = 0.88, 95%CI = 0.81–0.95) and an increase in FP ED visits (for 1997–98, adjusted RR = 1.18, 95%CI = 1.05–1.34). CONCLUSION: Despite hospital downsizing and fewer deaths occurring in hospitals, FP ambulatory visits (except for ED visits) did not rise correspondingly. Although such restructuring resulted in more people dying out of hospital, it does not appear FPs responded by providing more medical care to them in the community

SM(2,4k) fermionic characters and restricted jagged partitions

A derivation of the basis of states for the $SM(2,4k)$ superconformal minimal models is presented. It relies on a general hypothesis concerning the role of the null field of dimension $2k-1/2$. The basis is expressed solely in terms of $G_r$ modes and it takes the form of simple exclusion conditions (being thus a quasi-particle-type basis). Its elements are in correspondence with $(2k-1)$-restricted jagged partitions. The generating functions of the latter provide novel fermionic forms for the characters of the irreducible representations in both Ramond and Neveu-Schwarz sectors.Comment: 12 page

Epistemic Two-Dimensionalism and Arguments From Epistemic Misclassification

According to Epistemic Two-Dimensional Semantics (E2D), expressions have a counterfactual intension and an epistemic intension. Epistemic intensions reflect cognitive significance such that sentences with necessary epistemic intensions are a priori. We defend E2D against an influential line of criticism: arguments from epistemic misclassification. We focus in particular on the arguments of Speaks [2010] and Schroeter [2005]. Such arguments conclude that E2D is mistaken from (i) the claim that E2D is committed to classifying certain sentences as a priori, and (ii) the claim that such sentences are a posteriori. We aim to show that these arguments are unsuccessful as (i) and (ii) undercut each other. One must distinguish the general framework of E2D from a specific implementation of it. The framework is flexible enough to avoid commitment to the apriority of any particular sentence; only specific implementations are so committed. Arguments from epistemic misclassification are therefore better understood as arguments for favouring one implementation of E2D over another, rather than as refutations of E2D

Context Dependence, MOPs,WHIMs and procedures Recanati and Kaplan on Cognitive Aspects in Semantics

After presenting Kripke’s criticism to Frege’s ideas on context dependence of thoughts, I present two recent attempts of considering cognitive aspects of context dependent expressions inside a truth conditional pragmatics or semantics: Recanati’s non-descriptive modes of presentation (MOPs) and Kaplan’s ways of having in mind (WHIMs). After analysing the two attempts and verifying which answers they should give to the problem discussed by Kripke, I suggest a possible interpretation of these attempts: to insert a procedural or algorithmic level in semantic representations of indexicals. That a function may be computed by different procedures might suggest new possibilities of integrating contextual cognitive aspects in model theoretic semanti

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

n/

Mycobacteriosis-associated mortality in wild striped bass (Morone saxatilis) from Chesapeake Bay, USA

The striped bass (Morone saxatilis) is an economically and ecologically important finfish species along the Atlantic seaboard of the United States. Recent stock assessments in Chesapeake Bay (USA) indicate that non-fishing mortality in striped bass has increased since 1999, concomitant with very high (\u3e50%) prevalence of visceral and dermal disease caused by Mycobacterium spp. Current fishery assessment models do not differentiate between disease and other components of non-fishing mortality (e. g., senescence, predation); therefore, disease impact on the striped bass population has not been established. Specific measurement of mortality associated with mycobacteriosis in wild striped bass is complicated because the disease is chronic and mortality is cryptic. Epidemiological models have been developed to estimate disease-associated mortality from cross-sectional prevalence data and have recently been generalized to represent disease processes more realistically. Here, we used this generalized approach to demonstrate disease-associated mortality in striped bass from Chesapeake Bay. To our knowledge this is the first demonstration of cryptic mortality associated with a chronic infectious disease in a wild finfish. This finding has direct implications for management and stock assessment of striped bass, as it demonstrates population-level negative impacts of a chronic disease. Additionally, this research provides a framework by which disease-associated mortality may be specifically addressed within fisheries models for resource management

Multi-Channel Inverse Scattering Problem on the Line: Thresholds and Bound States

We consider the multi-channel inverse scattering problem in one-dimension in the presence of thresholds and bound states for a potential of finite support. Utilizing the Levin representation, we derive the general Marchenko integral equation for N-coupled channels and show that, unlike to the case of the radial inverse scattering problem, the information on the bound state energies and asymptotic normalization constants can be inferred from the reflection coefficient matrix alone. Thus, given this matrix, the Marchenko inverse scattering procedure can provide us with a unique multi-channel potential. The relationship to supersymmetric partner potentials as well as possible applications are discussed. The integral equation has been implemented numerically and applied to several schematic examples showing the characteristic features of multi-channel systems. A possible application of the formalism to technological problems is briefly discussed.Comment: 19 pages, 5 figure