Non-medical prescribing in palliative care: a regional survey

Background: The United Kingdom is considered to be the world leader in nurse prescribing, no other country having the same extended non-medical prescribing rights. Arguably, this growth has outpaced research to evaluate the benefits, particularly in areas of clinical practice where patients have complex co-morbid conditions such as palliative care. This is the first study of non-medical prescribing in palliative care in almost a decade. Aim: To explore the current position of nurse prescribing in palliative care and establish the impact on practice of the 2012 legislative changes. Design: An online survey circulated during May and June 2013. Participants: Nurse members (n = 37) of a regional cancer network palliative care group (61% response rate). Results: While this survey found non-medical prescribers have embraced the 2012 legislative changes and prescribe a wide range of drugs for cancer pain, we also identified scope to improve the transition from qualified to active non-medical prescriber by reducing the time interval between the two. Conclusion: To maximise the economic and clinical benefit of non-medical prescribing, the delay between qualifying as a prescriber and becoming an active prescriber needs to be reduced. Nurses who may be considering training to be a non-medical prescriber may be encouraged by the provision of adequate study leave and support to cover clinical work. Further research should explore the patients' perspective of non-medical prescribing

Spatial patterns in the cover and composition of macroalgal assemblages on fringing and nearshore coral reefs

Context: Although increases in macroalgal cover on coral reefs are often reported alongside declines in coral, the composition of algal assemblages and their spatial dynamics are not commonly investigated. Aims: To quantify changes in macroalgal assemblage composition over two spatial environmental gradients, depth and distance from shore, within a nearshore reef system in Kimbe Bay, Papua New Guinea, where coral cover has declined. Methods: Benthic cover was quantified at three depths (reef flat, 10 and 15 m) on the windward reef slopes of six reefs located three distances from shore (fringing reefs, and platform reefs 100–200 m and 0.7−1 km offshore). Key results: Macroalgal cover was highest on the reef flat, and assemblage composition varied among depths and distances from shore. Macroalgal cover was not correlated with coral cover except where macroalgal cover was greater than 20%, where a negative correlation occurred. There was no correlation between macroalgal cover and turf algal cover. All three benthic groups were negatively correlated with the combined total cover of sand and gravel. Conclusions: These results indicated a fine-scale spatial structure of macroalgal assemblages on coral reefs over a narrow depth range and short distance from shore and highlighted the importance of a solid substratum. Implications: It is likely that the ecological interactions between corals and macroalgae vary considerably over narrow spatial gradients

Metastatic model of HPV+ oropharyngeal squamous cell carcinoma demonstrates heterogeneity in tumor metastasis

Human papillomavirus induced (HPV+) cancer incidence is rapidly rising, comprising 60–80% of oropharyngeal squamous cell carcinomas (OPSCCs); while rare, recurrent/metastatic disease accounts for nearly all related deaths. An in vivo pre-clinical model for these invasive cancers is necessary for testing new therapies. We characterize an immune competent recurrent/metastatic HPV+ murine model of OPSSC which consists of four lung metastatic (MLM) cell lines isolated from an animal with HPV+ OPSCC that failed cisplatin/radiation treatment. These individual metastatic clonal cell lines were tested to verify their origin (parental transgene expression and define their physiological properties: proliferation, metastatic potential, heterogeneity and sensitivity/resistance to cisplatin and radiation. All MLMs retain expression of parental HPV16 E6 and E7 and degrade P53 yet are heterogeneous from one another and from the parental cell line as defined by Illumina expression microarray. Consistent with this, reverse phase protein array defines differences in protein expression/activation between MLMs as well as the parental line. While in vitro growth rates of MLMs are slower than the parental line, in vivo growth of MLM clones is greatly enhanced. Moreover, in vivo resistance to standard therapies is dramatically increased in 3 of the 4 MLMs. Lymphatic and/or lung metastasis occurs 100% of the time in one MLM line. This recurrent/metastatic model of HPV+ OPSCC retains the characteristics evident in refractory human disease (heterogeneity, resistance to therapy, metastasis in lymph nodes/lungs) thus serving as an ideal translational system to test novel therapeutics. Moreover, this system may provide insights into the molecular mechanisms of metastasis

A Draft Regional Guidebook for Applying the Hydrogeomorphic Approach to Wet Hardwood Flats on Mineral Soils in the Coastal Plain of Virginia

The hydrogeomorphic (HGM) approach applies functional indices to the assessment of functions by comparing functions across a suite of reference sites that range from severely altered to unaltered. This Draft Regional Guidebook is the result of applying the HGM approach to Hardwood Mineral Flats in the coastal plain of Virginia. In developing the Draft Regional Guidebook, various models from Kentucky, Pennsylvania, and North Carolina, as well as, input from a workshop held in Wakefield, Virginia on May 13-14, 1998 were used to provide a template for model development. The workshop was attended by hydrologists, biogeochemists, soil scientists, wildlife biologists, and botanists from the public, private and academic sectors who have extensive knowledge of Hardwood Mineral Flats (Table 1 ). This Draft Regional Guidebook incorporates material from the Regional Guidebook for Applying the Hydrogeomorphic Approach to Wet Pine Flats on Mineral Soils in the Atlantic and Gulf Coastal Plains by Richard Rheinhardt, Martha Rheinhardt, and Mark Brinson (1999). Excerpted material includes the overview of the HGM approach and the hydrology section (since the approach utilized for pine flats is also appropriate for hardwood flats). Additional input was gained from the Draft Functional Assessment for Deciduous Mineral Flat Wetlands, Version 5 - 1999 by the Natural Resources Conservation Service staff. Valuable suggestions from end-users of other HGM guidebooks regarding the pros and cons of various sampling methods were considered and incorporated into this draft guidebook where possible. An attempt was made to incorporate data that is routinely collected as part of wetlands delineations to reduce duplication of field data and expedite the assessment procedure. The field sampling time for this assessment will depend on the size of the site, and the skill level and number of personnel. The sampling assessment protocol can be conducted by one person (though sampling of microtopography will require the use of a measured stake that can be installed temporarily in the ground). Two people can collect field data on a three- plot site in three to four hours

AuCl3-Catalyzed Hemiacetal Activation for the Stereoselective Synthesis of 2-Deoxy Trehalose Derivatives

[Image: see text] A new practical, catalytic, and highly stereoselective method for directly accessing 1,1-α,α′-linked 2-deoxy trehalose analogues via AuCl(3)-catalyzed dehydrative glycosylation using hemiacetal glycosyl donors and acceptors is described. The method relies on the chemoselective Brønsted acid-type activation of tribenzylated 2-deoxy hemiacetals in the presence of other less reactive hemiacetals

Chapter 08: Conclusions and Recommendations

Here we review brief summaries by chapter and then derive some integrated conclusions across chapters. Recommendations are presented with respect to further research, outreach and policy consideration. Because several years have passed between the end of our field work and publication of this synthesis volume, we end with an epilogue that highlights changes and key events that happened at San José Llanga (SJL) and with collaborating institutions in Bolivia between 1996-9.https://digitalcommons.usu.edu/sustaining_agropastoralism/1007/thumbnail.jp

Liaison Old Age Psychiatry Service in a Medical Setting: Description of the Newcastle Clinical Service

Liaison Old Age Psychiatry services (LOAP) have begun to emerge in the UK and further development of the service is supported by the latest health policies. Since qualitative and quantitative studies in this area are lacking, we have undertaken a detailed quantitative prospective review of referrals to the Newcastle LOAP to evaluate the clinical activity of the service. We report high referral rates and turnover for the LOAP service. Reasons for referral are diverse, ranging from requests for level of care and capacity assessments and transfer to other clinical services to management of behaviour, diagnosis, and treatment. We outline the value of a multidisciplinary model of LOAP activity, including the important role of the liaison nursing team, in providing a rapid response, screening, and followup of high number of clinical referrals to the service