The unrecognised cost of cancer patients' unrelieved symptoms:a nationwide follow-up of their surviving partners

We investigated if a cancer patient's unrelieved symptoms during the last 3 months of life increase the risk of long-term psychological morbidity of the surviving partner. All women (n=506) living in Sweden under 80 years of age, who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were asked to answer an anonymous postal questionnaire, 2–4 years after their loss. The widows' psychological morbidity was associated with the patient's unrelieved mental symptoms. When the patient was perceived to have been very anxious during last three months of life (compared to no observed symptoms) the relative risks for the widows' psychological morbidity were: 2.5 (1.4–4.3) for depression and 3.4 (1.4–8.2) for anxiety. When comparing reports of the patient's pain (much vs no), the relative risks were 0.8 (0.5–1.2) for widowhood depression, and 0.8 (0.4–1.7) for widowhood anxiety. The patients were found to have had adequate access to physical pain control but poor access to psychological symptom control. Efficiency in diagnosing and treating psychological complications of terminally ill cancer patients may not only improve their quality of life but possibly also prevent long-term psychological morbidity of their surviving partners

Sensitivity and optimal forcing response in separated boundary layer flows

Publisher version : http://pof.aip.org/resource/1/phfle6/v21/i6/p064108_s1?isAuthorized=noThe optimal asymptotic response to time harmonic forcing of a convectively unstable two-dimensional separated boundary layer on a flat plate is numerically revisited from a global point of view. By expanding the flow disturbance variables and the forcing term as a summation of temporal modes, the linear convective instability mechanism associated with the response leading to the maximum gain in energy is theoretically investigated. Such a response is driven by a pseudoresonance of temporal modes due to the non-normality of the underlying linearized evolution operator. In particular, the considered expansion on a limited number of modes is found able to accurately simulate the linear instability mechanism, as suggested by a comparison between the global linear stability analysis and a linearized direct numerical simulation. Furthermore, the dependence of such a mechanism on the Reynolds number and the adverse pressure gradient is investigated, outlining a physical description of the destabilization of the flow induced by the rolling up of the shear layer. Therefore, the convective character of the problem suggests that the considered flat plate separated flows may act as a selective noise amplifier. In order to verfy such a possibility, the responses of the flow to the optimal forcing and to a small level of noise are compared, and their connection to the onset of self-excited vortices observed in literature is investigated. For that purpose, a nonlinear direct numerical simulation is performed, which is initialized by a random noise superposed to the base flow at the inflow boundary points. The band of excited frequencies as well as the associated peak match with the ones computed by the asymptotic global analysis. Finally, the connection between the onset of unsteadiness and the optimal response is further supported by a comparison between the optimal circular frequency and a typical Strouhal number predicted by numerical simulations of previous authors in similar cases