Evaluating the Liverpool Care Pathway for care of the terminally ill in rural Australia

© 2015, Springer-Verlag Berlin Heidelberg. Purpose: This study evaluates a pilot implementation of the Liverpool Care Pathway (LCP), a clinical tool used to guide the care of dying patients in the last days of life, on the end-of-life care for dying patients in three regions in rural Australia. Methods: The LCP was implemented at 13 participating sites: nine hospitals (general wards), one community-based palliative care service, and three in-hospital palliative care units. To evaluate the implementation of the LCP, 415 eligible patient records were examined: 223 pre-implementation and 192 post-implementation (116 on the LCP and 76 receiving usual care). The primary analysis compared all patients pre-implementation of the LCP versus all patients post-implementation. Results: Increases were found post-implementation for communication with other health professionals and with patients or family (pre-69 %, post-87 %; p ≤ 0.000), use of palliative medications (pre-87 %, post-98 %; p ≤ 0.000) and frequency of symptom assessments (pre-66 %, post-82 %; p ≤ 0.000). Fewer blood and radiological investigations were conducted and venous access devices used in the post-implementation groups than in the pre-implementation period. Conclusions: This study suggests that when rigorously implemented, the LCP improves important components of end-of-life care for dying patients and their families

A qualitative investigation into the cultural master narrative for overcoming trauma and adversity in the United Kingdom.

esearch in the field of narrative psychology has found that redemption—a narrative sequence in which people recount emotionally negative experiences as having positive endings—is a useful mechanism for coping with adversity. Redemption has been viewed as a cultural master narrative in North America, providing individuals with a socially valued script for narrating challenging life experiences. Presently little research has examined the presence and function of the redemption narrative outside of North American contexts. The aim of this qualitative study, therefore, was to identify themes in U.K. individuals’ narratives of trauma and adversity to gain insight into the content of the master narrative for meaning-making in the U.K. Sixty-five participants (57 females, Mage = 21.97, SD = 7.24) with little to no experience of lifetime adversity were recruited into an online survey. Participants answered open-ended questions adopting the perspective of a survivor from a selected U.K. national tragedy, focusing on how they felt survivors could recover from trauma. We identified 2 themes in our thematic analysis that were relevant to recovery: recuperation and redemption. Recuperation was most commonly reported, it was described as a gradual lessening of symptoms over time and the ability to cope with the lasting emotional and physical scars. Our findings suggest that redemption is not necessarily the dominant cultural script in the U.K. for guiding recovery in the aftermath of trauma. (APA PsycInfo Database Record (c) 2020 APA, all rights reserved

Separation and identification of dominant mechanisms in double photoionization

Double photoionization by a single photon is often discussed in terms of two contributing mechanisms, {\it knock-out} (two-step-one) and {\it shake-off} with the latter being a pure quantum effect. It is shown that a quasi-classical description of knock-out and a simple quantum calculation of shake-off provides a clear separation of the mechanisms and facilitates their calculation considerably. The relevance of each mechanism at different photon energies is quantified for helium. Photoionization ratios, integral and singly differential cross sections obtained by us are in excellent agreement with benchmark experimental data and recent theoretical results.Comment: 4 pages, 5 figure

Electron-impact-ionization cross sections of H₂ for low outgoing electron energies from 1 to 10 eV

Theoretical and experimental fully differential cross sections are presented for electron-impact ionization of molecular hydrogen in a plane perpendicular to the incident beam direction. The experimental data exhibit a maximum for 1-eV electrons detected 180° apart and a minimum for 10-eV electrons. We investigate the different physical effects which cause back-to-back scattering and demonstrate that, over the energy range from 10 to 1 eV, a direct transition is observed from a region where Wannier threshold physics is essentially unimportant to where it completely dominates

Differential Cross Sections for the Ionization of Oriented H₂ Molecules by Electron Impact

A nonperturbative close-coupling technique is used to calculate differential cross sections for the electron-impact ionization of H2 at an energy of 35.4 eV. Our approach allows cross sections for any orientation of the molecule with respect to the incident electron beam to be analyzed. New features in the resulting cross sections are found compared with the case where the molecular orientation is averaged, and also with cross sections for He at equivalent electron kinematics. When averaged over all possible molecular orientations, good agreement is found with recent experimental results

On the origin of 140 GHz emission from the 4 July 2012 solar flare

The sub-THz event observed on the 4 July 2012 with the Bauman Moscow State Technical University Radio Telescope RT-7.5 at 93 and 140~GHz as well as Kislovodsk and Mets\"ahovi radio telescopes, Radio Solar Telescope Network (RSTN), GOES, RHESSI, and SDO orbital stations is analyzed. The spectral flux between 93 and 140 GHz has been observed increasing with frequency. On the basis of the SDO/AIA data the differential emission measure has been calculated. It is shown that the thermal coronal plasma with the temperature above 0.5~MK cannot be responsible for the observed sub-THz flare emission. The non-thermal gyrosynchrotron mechanism can be responsible for the microwave emission near $10$~GHz but the observed millimeter spectral characteristics are likely to be produced by the thermal bremsstrahlung emission from plasma with a temperature of about 0.1~MK.Comment: 18 pages, 6 figure

An optimal hydrodynamic model for the normal Type IIP supernova 1999em

There is still no consensus about progenitor masses of Type IIP supernovae. We study a normal Type IIP SN 1999em in detail and compare it to a peculiar Type IIP SN 1987A. We computed the hydrodynamic and time-dependent atmosphere models interpreting simultaneously both the photometric and spectroscopic observations. The bolometric light curve of SN 1999em and the spectral evolution of its H-alpha line are consistent with a presupernova radius of 500 Rsun, an ejecta mass of 19.0 Msun, an explosion energy of 1.3x10^51 erg, and a radioactive 56Ni mass of 0.036 Msun. A mutual mixing of hydrogen-rich and helium-rich matter in the inner layers of the ejecta guarantees a good fit of the calculated light curve to that observed. Based on the hydrodynamic models in the vicinity of the optimal model, we derive the approximate relationships between the basic physical and observed parameters. We find that the hydrogen recombination in the atmosphere of a normal Type IIP SN 1999em, as well as most likely other Type IIP supernovae at the photospheric epoch, is essentially a time-dependent phenomenon. It is also shown that in normal Type IIP supernovae the homologous expansion of the ejecta in its atmosphere takes place starting from nearly the third day after the supernova explosion. A comparison of SN 1999em with SN 1987A reveals two very important results for supernova theory. First, the comparability of the helium core masses and the explosion energies implies a unique explosion mechanism for these core collapse supernovae. Second, the optimal model for SN 1999em is characterized by a weaker 56Ni mixing up to 660 km/s compared to a moderate 56Ni mixing up to 3000 km/s in SN 1987A, hydrogen being mixed deeply downward to 650 km/s.Comment: 21 pages, 24 figures. Accepted for publication in Astronomy & Astrophysic

Planck pre-launch status: HFI beam expectations from the optical optimisation of the focal plane

Planck is a European Space Agency (ESA) satellite, launched in May 2009, which will map the cosmic microwave background anisotropies in intensity and polarisation with unprecedented detail and sensitivity. It will also provide full-sky maps of astrophysical foregrounds. An accurate knowledge of the telescope beam patterns is an essential element for a correct analysis of the acquired astrophysical data. We present a detailed description of the optical design of the High Frequency Instrument (HFI) together with some of the optical performances measured during the calibration campaigns. We report on the evolution of the knowledge of the pre-launch HFI beam patterns when coupled to ideal telescope elements, and on their significance for the HFI data analysis procedure

Evaluation of Dry Distillers Grains Plus Solubles Inclusion on Performance and Economics of Finishing Beef Steers

A 167-d feedlot study was conducted to evaluate feeding increasing levels of dry distillers grains plus solubles (DDGS) to finishing cattle and the impact on performance and profitability. Crossbred steer calves (n = 240, BW = 306 ± 24.5 kg) were used in 30 pens with dietary treatments of 0, 10, 20, 30, and 40% DDGS dietary inclusion (DM basis). Quadratic relationships (P \u3c 0.05) were observed for final BW and ADG as dietary DDGS increased, with the greatest ADG observed at 20% inclusion. The DMI was not affected (P \u3e 0.15) by DDGS level, but G:F tended to be quadratic (P = 0.10) as 20% DM inclusion had the greatest value, although steers fed all levels of DDGS had numerically greater G:F compared with steers fed no DDGS. Carcass characteristics, other than hot carcass weight, were not affected by DDGS treatment. Energy value of DDGS at 10 to 40% dietary inclusion resulted in a quadratic trend (P = 0.10) and remained above corn, with the highest values at 10 and 20% inclusion averaging 127% of corn. When DDGS was priced equally to corn, all levels of DDGS from 10 to 40% inclusion resulted in higher profits compared with a dry-rolled corn based diet regardless of corn price. The greatest returns were observed when cattle were fed 20% DDGS. These data indicate that DDGS can be fed up to 40% DM to improve cattle performance and result in economic profits, with optimum levels at 20 to 30% diet DM