Study protocol: Delayed intervention randomised controlled trial within the Medical Research Council (MRC) Framework to assess the effectiveness of a new palliative care service

Background: Palliative care has been proposed to help meet the needs of patients who suffer progressive non-cancer conditions but there have been few evaluations of service development initiatives. We report here a novel protocol for the evaluation of a new palliative care service in this context. Methods/Design: Using the MRC Framework for the Evaluation of Complex Interventions we modelled a new palliative care and neurology service for patients severely affected by Multiple Sclerosis (MS). We conducted qualitative interviews with patients, families and staff, plus a literature review to model and pilot the service. Then we designed a delayed intervention randomised controlled trial to test its effectiveness as part of phase II of the MRC framework. Inclusion criteria for the trial were patients identified by referring clinicians as having unresolved symptoms or psychological concerns. Referrers were advised to use a score of greater than 8 on the Expanded Disability Scale was a benchmark. Consenting patients newly referred to the new service were randomised to either receive the palliative care service immediately (fast-track) or after a 12-week wait (standard best practice). Face to face interviews were conducted at baseline (before intervention), and at 4–6, 10–12 (before intervention for the standard-practice group), 16– 18 and 22–24 weeks with patients and their carers using standard questionnaires to assess symptoms, palliative care outcomes, function, service use and open comments. Ethics committee approval was granted separately for the qualitative phase and then for the trial. Discussion: We publish the protocol trial here, to allow methods to be reviewed in advance of publication of the results. The MRC Framework for the Evaluation of Complex Interventions was helpful in both the design of the service, methods for evaluation in convincing staff and the ethics committee to accept the trial. The research will provide valuable information on the effects of palliative care among non-cancer patients and a method to evaluate palliative care in this context

The Search for Neutrino Oscillations numubar->nuebar with KARMEN

The neutrino experiment KARMEN is situated at the beam stop neutrino source ISIS. It provides numu's, nue's and numubar's in equal intensities from the pi+ mu+ decay at rest (DAR). The oscillation channel numub->nueb is investigated in the appearance mode with a 56t liquid scintillation calorimeter at a mean distance of 17.7m from the nu source looking for p(nue,e+)n reactions. The cosmic induced background for this oscillation search could be reduced by a factor of 40 due to an additional veto counter installed in 1996. In the data collected through 1997 and 1998 no potential oscillation event was observed. Using a unified approach to small signals this leads to an upper limit for the mixing angle of sin**2(2t) < 1.3x10^{-3} (90%CL) at large Dm**2. The excluded area in (sin**2(2t),Dm**2) covers almost entirely the favored region defined by the LSND numub->nueb evidence.Comment: Proceedings Contribution to Neutrino98 in Takayama, Japan, June 4-9, 1998; 13 pages, including 4 figure

Results from the LSND Neutrino Oscillation Search

The Liquid Scintillator Neutrino Detector (LSND) at the Los Alamos Meson Physics Facility sets bounds on neutrino oscillations in the appearance channel nu_mu_bar --> nu_e_bar by searching for the signature of the reaction nu_e_bar p --> e^+ n: an e$^+$ followed by a 2.2MeV gamma ray from neutron capture. Five e^{+/-} -- gamma coincidences are observed in time with the LAMPF beam, with an estimated background of 6.2 events. The 90\% confidence limits obtained are: Delta (m^2) < 0.07eV^2 for sin^2 (2theta) = 1, and sin^2(2theta) < 6 10^{-3} for Delta (m^2) > 20 eV^2.Comment: 10 pages, uses REVTeX and epsf macro

Quadratic Poisson brackets compatible with an algebra structure

Quadratic Poisson brackets on a vector space equipped with a bilinear multiplication are studied. A notion of a bracket compatible with the multiplication is introduced and an effective criterion of such compatibility is given. Among compatible brackets, a subclass of coboundary brackets is described, and such brackets are enumerated in a number of examples.Comment: 6 page

Assessing the utility of the national student financial aid scheme towards skills development: A case of a rural university in South Africa

The National Student Financial Aid Scheme (NSFAS) was introduced in 1999 in South Africa to provide financial support for disadvantaged students through the provision of both loans and bursaries. This article reflects on the effects of the scheme on skills development within two faculties at the University of Limpopo. The research was undertaken in 2021 employing an exploratory qualitative methodology. A total of eighteen participants were purposively selected from two of the four faculties of the University of Limpopo. A semi-structured interview guide was utilised to elicit narrative data from all participating beneficiaries of the NSFAS. The narrative data were analysed using a thematic coding design and interpretations of the findings were subsequently made. The interpretation of the analysis focused on the effect of the NSFAS support on students’ skills development. The findings suggest that NSFAS funding contributed to the development of soft skills of beneficiaries which included financial security; spending prioritisation and collaborative budgeting; time-management skills; self-esteem and skills development opportunities. Whilst the findings are localised, they do suggest that further research could be undertaken into the potentials of NSFAS to boost students’ soft skills development during their time within a higher education institution

Quadratic Poisson brackets and Drinfeld theory for associative algebras

The paper is devoted to the Poisson brackets compatible with multiplication in associative algebras. These brackets are shown to be quadratic and their relations with the classical Yang--Baxter equation are revealed. The paper also contains a description of Poisson Lie structures on Lie groups whose Lie algebras are adjacent to an associative structure.Comment: 16 pages, latex, no figure

Numerical Computations with H(div)-Finite Elements for the Brinkman Problem

The H(div)-conforming approach for the Brinkman equation is studied numerically, verifying the theoretical a priori and a posteriori analysis in previous work of the authors. Furthermore, the results are extended to cover a non-constant permeability. A hybridization technique for the problem is presented, complete with a convergence analysis and numerical verification. Finally, the numerical convergence studies are complemented with numerical examples of applications to domain decomposition and adaptive mesh refinement.Comment: Minor clarifications, added references. Reordering of some figures. To appear in Computational Geosciences, final article available at http://www.springerlink.co

Quadratic Poisson brackets and Drinfel'd theory for associative algebras

Quadratic Poisson brackets on associative algebras are studied. Such a bracket compatible with the multiplication is related to a differentiation in tensor square of the underlying algebra. Jacobi identity means that this differentiation satisfies a classical Yang--Baxter equation. Corresponding Lie groups are canonically equipped with a Poisson Lie structure. A way to quantize such structures is suggested.Comment: latex, no figures

Body mass index, mini nutritional assessment, and their association with five-year mortality in very old people

Objectives: To investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people. Design: A prospective cohort study. Setting: A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community. Participants: Out of 1195 potential participants, 832 were included (mean age 90.2[+ or -]4.6 years). Measurements: Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed. Results: The mean BMI value for the whole population was 25.1[+ or -]4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5[+ or -]4.6 for the whole sample, and it was lower for women than for men (PA<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17--23.5) according to MNA. Also, 34.8% of those with a MNA score A<17 still had a BMI value a[yen]22.2 kg/m2. A BMI value A<22.2 kg/m2 and a MNA scoreA<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA. Conclusions: Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women