A local lattice Boltzmann method for multiple immiscible fluids and dense suspensions of drops

The lattice Boltzmann method (LBM) for computational fluid dynamics benefits from a simple, explicit, completely local computational algorithm making it highly efficient. We extend LBM to recover hydrodynamics of multi-component immiscible fluids, whilst retaining a completely local, explicit and simple algorithm. Hence, no computationally expensive lattice gradients, interaction potentials or curvatures, that use information from neighbouring lattice sites, need be calculated, which makes the method highly scalable and suitable for high performance parallel computing. The method is analytic and is shown to recover correct continuum hydrodynamic equations of motion and interfacial boundary conditions. This LBM may be further extended to situations containing a high number (O(100)) of individually immiscible drops. We make comparisons of the emergent non-Newtonian behaviour with a power-law fluid model. We anticipate our method will have a range applications in engineering, industrial and biological sciences

Mesh-free modelling of liquid crystals using modified smoothed particle hydrodynamics

We present a generalisation of the Modified Smooth Particle Hydrodynamics simulation technique capable of simulating static and dynamic liquid crystalline behaviour. This generalisation is then implemented in the context of the Qian-Sheng description of nematodynamics. To test the method, we first use it to simulate switching in both a Freedericksz setup and a chiral hybrid aligned nematic cell. In both cases, the results obtained give excellent agreement with previously published results. We then apply the technique in a 3-dimensional simulation of the switching dynamics of the post aligned bistable nematic device

White Paper: Northwest Life Passages - Improving Care for Patients with Serious Illness in Whatcom County

Northwest Life Passages (NWLP) is a new collaborative service that aims to address shortcomings in care and improve services for people with serious illness and their families. The proposal is to operationally couple the outpatient palliative care services already provided by PeaceHealth and Family Care Network (FCN) with community-based support services being developed by the Whatcom Alliance for Health Advancement (WAHA). It is further being proposed that PeaceHealth and WAHA pursue a collaborative fundraising strategy that calls for WAHA to focus on the development of the community-based services and PeaceHealth Foundation to pursue support for the expansion of clinical services

Social work training or social work education? An approach to curriculum design

Population ageing, economic circumstances, and human behaviour are placing social welfare systems under great strain. In England extensive reform of the social work profession is taking place. Training curricula are being redesigned in the context of new standards of competence for social workers – the Professional Capabilities Framework (PCF). Students must be equipped on qualifying to address an extensive range of human problems, presenting major challenges to educators. Critical theory suggests an approach to tackle one such challenge – selecting the essential content required for areas of particular practice. Teaching on social work with older people is used to illustrate this. Habermas’ theory of cognitive interests highlights the different professional roles served by the social work knowledge base - instrumental, interpretive, and emancipatory. Howe’s application of sociological theory distinguished four social work roles corresponding to these. It is suggested that curriculum design decisions must enable practitioners to operate in each. When preparing students to work with older people, educators therefore need to include interpretive and emancipatory perspectives, and not construct social work purely as an instrumental response to problems older people present. This approach provides one useful rationale for curriculum design decisions, which is applicable to other areas of practice, and to contexts outside England

New investments in primary care in Australia

There is a crisis in primary care health workforce shortages in Australia. Its government has attempted to fix this by role-substitution (replacing medical work with nursing instead). This was not completely successful. Obstacles included entrenched social roles (leading to doctors 'checking' their nurse role-substituted work) and structures (nurses subservient to doctors) - both exacerbated by primary care doctors' ageing demographic; doctors owning their own practices; doctors feeling themselves to have primary responsibility for the care delivered; and greater attraction towards independence that may have selected doctors into primary care in the first place

Determining optimal outcome measures in a trial investigating no routine gastric residual volume measurement in critically ill children

Background Choosing trial outcome measures is important. When outcomes are not clinically relevant or important to parents/patients, trial evidence is less likely to be implemented into practice. This study aimed to determine optimal outcome measures for a trial of no routine gastric residual volume measurement in critically ill children. Methods: A mixed methods approach: a focused literature review, parent and clinician interviews, a modified two-round Delphi and a stakeholder consensus meeting. Results: The review generated 13 outcomes. 14 Pediatric Intensive Care Unit (PICU) parents proposed 3 additional outcomes, these 16 were then rated by 28 clinicians in Delphi round 1. Six further outcomes were proposed, and 22 outcomes were rated in the second round. No items were voted ‘consensus out’. The 18 ‘no-consensus’ items were voted in a face-to-face meeting by 30 participants. The final 12 outcome measures were: Time to reach energy targets; ventilator associated pneumonia; vomiting; time enteral feeds withheld per 24 hour; necrotizing enterocolitis; length of invasive ventilation; PICU length of stay; mortality; change in weight and markers of feed intolerance: parenteral nutrition administered; feed formula altered and changing to post-pyloric feeds all secondary to feed intolerance. Conclusion: We have identified 12 outcomes for a trial of no gastric residual volume measurement through a multi-stage process, seeking views of parents and clinicians. Clinical Relevancy statement: Twelve relevant outcomes have been identified for a trial of no routine gastric residual volume measurement in critically ill children

The Relationships among Pain, Nonpain Symptoms, and Quality of Life Measures in Older Adults with Cancer Receiving Hospice Care

Objective.  Gathering firsthand or reported information about patients in the final stages of terminal cancer is difficult due to patient frailty, cognitive impairment, excessive fatigue, and severity of illness, as well as gatekeeping by hospice providers and caregivers, and highly variable documentation practices. We sought to further understand and elucidate end‐of‐life experiences in older cancer patients through the application of validated tools employed in the hospice setting. This article summarizes data collected about pain, non‐pain symptoms, and other aspects of quality of life (QOL) as reported by older hospice patients or by their caregivers during the 2 weeks of hospice care. Design.  Data was collected from an ongoing Institutional Human Subjects Review Board‐approved research project with 94 older adults with cancer or their caregivers receiving service in a home setting from 14 Midwestern hospices. Participants completed one or two telephone interviews. Instruments used to gather information include the Brief Pain Inventory and the Brief Hospice Inventory. Results.  Data analysis showed mean “worst pain” ratings significantly decreased from Interview 1 to Interview 2, and pain reports were significantly correlated with fatigue, anxiety, appetite, comfort, symptom control, and overall QOL. Conclusions.  Our findings reinforce previously held views that older patients with cancer experience pain and non‐pain symptoms. And both pain and non‐pain symptoms can impact and confound the treatment of other symptoms and interfere with the patient's overall QOL. The results of this study support the assertion that hospice care can have a positive impact on pain severity and related suffering, as well as patient QOL as death approaches.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87068/1/j.1526-4637.2011.01113.x.pd

Consolidated health economic evaluation reporting standards (CHEERS) statement

<p>Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.</p> <p>The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp).</p> <p>We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.</p&gt

The Effect of a Translating Research into Practice (TRIP)‐Cancer Intervention on Cancer Pain Management in Older Adults in Hospice

Background.  Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain‐free death, and while outcomes are better in hospice, patients still die with poorly controlled pain. Objective.  This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidence‐based pain practices for older adults with cancer in community‐based hospices. Setting.  This Institutional Human Subjects Review Board‐approved study was a cluster randomized controlled trial implemented in 16 Midwestern hospices. Methods.  Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. Results.  Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidence‐based practices for the experimental sites, was not significantly greater than control sites. Decrease in patient pain severity from baseline to post‐intervention in the experimental group was greater; however, the result was not statistically significant ( P  = 0.1032). Conclusions.  Findings indicate a number of factors that may impact implementation of multicomponent interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest that future study is needed on specific factors to target when implementing a community‐based hospice intervention, including determining and measuring intervention fidelity prospectively.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93516/1/j.1526-4637.2012.01405.x.pd