A life or “good death” situation? A worldwide ecological study of the national contexts of countries that have and have not implemented palliative care

Context Palliative care advocates argue that service implementation is feasible in all settings. Yet, services have developed patchily in low- and middle-income settings. Beyond Human Development Index indicators, there has been limited engagement with the broader development challenges facing nations tasked with implementing palliative care. Objective The objective of this study was to describe how indicators of national development relate to levels of palliative care services in 207 countries around the world. Methods We conducted a ecological study to identify relationships between potential predictor variables and the level of national palliative care development. A total of 28 predictor variables from the following six domains were selected using hypothesized relationships with levels of palliative care development: disease demographics, socioeconomics, health systems, politics, demographics, and economics. The outcome variable was level of national palliative care development on a six-point scale. Spearman's correlation was used to measure the strength of the association. Results Twenty-six of 28 variables were statistically significantly associated with levels of palliative care development in 207 countries. Palliative care is more developed in countries with high—percentage of deaths from noncommunicable disease, population proportion aged 65+ years, gross national income, and tourism. Development is lower in countries with high levels of political corruption, infant mortality, deaths by infectious diseases, and weak democracy. Prevalence of undernourishment and levels of private health expenditure were not significantly associated with palliative care development. Conclusion Palliative care development is highly consistent with broader national development indicators. It is less in countries where sudden deaths are more likely and benefits from palliative care provision are likely to be very limited. In such countries, resources may be prioritized toward life-prolonging therapies and key aspects of palliative care need only be implemented before fully integrated palliative services. Findings suggest that there may be a “tipping point” in societies, where the relative need for life-prolonging therapies becomes less than the need for integrated palliative care services

Beyond Goldwater-Nichols

This report culminated almost two years of effort at CSIS, which began by developing an approach for both revisiting the Goldwater-Nichols Department of Defense Reorganization Act of 1986 and for addressing issues that were beyond the scope of that landmark legislation

On dynamical mass generation in three dimensional supersymmetric U(1) gauge field theory

We investigate and contrast the non-perturbative infra red structure of N=1 and N=2 supersymmetric non-compact U(1) gauge field theory in three space-time dimensions with N matter flavours. We study the Dyson-Schwinger equations in a general gauge using superfield formalism; this ensures that supersymmetry is kept manifest, though leads to spurious infra red divergences which we have to avoid carefully. In the N=1 case the superfield formalism allows us to choose a vertex which satisfies the U(1) Ward identity exactly, and we find the expected critical behaviour in the wavefunction renormalization and strong evidence for the existence of a gauge independent dynamically generated mass, but with no evidence for a critical flavour number. We study the N=2 model by dimensional reduction from four dimensional N=1 electrodynamics, and we refine the old gauge dependence argument that there is no dynamical mass generation. We recognize that the refinement only holds after dimensional reduction.Comment: 32 pages RevTeX; 3 axodraw figures include

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Training in the Use of Psychotherapy Outcome Assessment Measures at Psychology Internship Sites

American Psychological Association accredited psychology internship training programs (N = 407) were surveyed concerning their attitudes, beliefs, and practices with regard to outcome assessment measures. Results indicated that 47% of surveyed sites use outcome measures for assessment, and 66% used these measures for diagnostic purposes. In addition, 79% of respondents supported using outcome assessment measures to evaluate client progress, 61% supported training interns in the use of outcome assessment measures, and 87% felt outcome assessment measures would increase in importance in the future. The discrepancy between support for outcome assessment measures and actual use is discussed and recommendations provided

Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study

We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment

Vacuum chamber and adaptors for shearography and holography

Study methods to excite aerospace components using a vacuum to induce deformations are presented. The deformations will be measured by shearography, holography, and image correlation

Microstructure Effects on Daily Return Volatility in Financial Markets

We simulate a series of daily returns from intraday price movements initiated by microstructure elements. Significant evidence is found that daily returns and daily return volatility exhibit first order autocorrelation, but trading volume and daily return volatility are not correlated, while intraday volatility is. We also consider GARCH effects in daily return series and show that estimates using daily returns are biased from the influence of the level of prices. Using daily price changes instead, we find evidence of a significant GARCH component. These results suggest that microstructure elements have a considerable influence on the return generating process.Comment: 15 pages, as presented at the Complexity Workshop in Aix-en-Provenc