Components of good end of life care within the paediatric intensive care setting – an online survey

BACKGROUND This study was undertaken to better understand the components of good end of life for children who are being cared for within the PICU. Cure rates from serious childhood illness are gradually improving every year. Despite this, there are still a small but significant number of children who will die within a Paediatric Intensive Care Unit. OBJECTIVES 1. The primary objective was to determine what the key aspects of End-of-Life-Care/palliative care in PICU as perceived by Health Professionals (including General Paediatricians) 2. This project will result in a schema of components of care which can be used by health professionals within in the intensive care setting to assist with excellent end of life care. METHOD An online survey of health professionals was used to rank various components of palliative care within the PICU context. Survey participants could also suggest other components of care that had not already been thought of within the survey. RESULTS There were 108 respondents who took the survey. The survey group were multidisciplinary (medical 32.4%; nursing 44.44% and allied health 23.15 %). There were also a variety of specialties represented in the survey (PICU 56.5 %; Paediatric Palliative Care 17.4%; General Paediatrics 13.9% and Other 12.2 %). The top 5 components of care ranked by the group included were identified by the interest groups after being ranked according to their importance. These included 1. Discussion of a Management Plan 2. Sensitive, compassionate use of language 3. Discussion of End of Life care 4. Discussion of anticipated changes in the patient's condition 5. Discussion of the caregiver's understanding of the illness. CONCLUSION It is hoped that the schema for good end of life care represents a consensus from a large and diverse group of health professionals. This schema should assist in the day to day care of patients. Further, it should also be of benefit in education, research and quality activities

Planned Missing Data Designs & Small Sample Size: How Small is Too Small?

Utilizing planned missing data (PMD) designs (ex. 3-form surveys) enables researchers to ask participants fewer questions during the data collection process. An important question, however, is just how few participants are needed to effectively employ planned missing data designs in research studies. This paper explores this question by using simulated three-form planned missing data to assess analytic model convergence, parameter estimate bias, standard error bias, mean squared error (MSE), and relative efficiency (RE).Three models were examined: a one-time point, cross-sectional model with 3 constructs; a two-time point model with 3 constructs at each time point; and a three-time point, mediation model with 3 constructs over three time points. Both full-information maximum likelihood (FIML) and multiple imputation (MI) were used to handle the missing data. Models were found to meet convergence rate and acceptable bias criteria with FIML at smaller sample sizes than with MI

Measurements of the Electric Form Factor of the Neutron up to Q2=3.4 GeV2 using the Reaction He3(e,e'n)pp

The electric form factor of the neutron was determined from studies of the reaction He3(e,e'n)pp in quasi-elastic kinematics in Hall A at Jefferson Lab. Longitudinally polarized electrons were scattered off a polarized target in which the nuclear polarization was oriented perpendicular to the momentum transfer. The scattered electrons were detected in a magnetic spectrometer in coincidence with neutrons that were registered in a large-solid-angle detector. More than doubling the Q2-range over which it is known, we find GEn = 0.0225 +/- 0.0017 (stat) +/- 0.0024 (syst), 0.0200 +/- 0.0023 +/- 0.0018, and 0.0142 +/- 0.0019 +/- 0.0013 for Q2 = 1.72, 2.48, and 3.41 GeV2, respectively.Comment: submitted to PR

On the Study of Hyperbolic Triangles and Circles by Hyperbolic Barycentric Coordinates in Relativistic Hyperbolic Geometry

Barycentric coordinates are commonly used in Euclidean geometry. Following the adaptation of barycentric coordinates for use in hyperbolic geometry in recently published books on analytic hyperbolic geometry, known and novel results concerning triangles and circles in the hyperbolic geometry of Lobachevsky and Bolyai are discovered. Among the novel results are the hyperbolic counterparts of important theorems in Euclidean geometry. These are: (1) the Inscribed Gyroangle Theorem, (ii) the Gyrotangent-Gyrosecant Theorem, (iii) the Intersecting Gyrosecants Theorem, and (iv) the Intersecting Gyrochord Theorem. Here in gyrolanguage, the language of analytic hyperbolic geometry, we prefix a gyro to any term that describes a concept in Euclidean geometry and in associative algebra to mean the analogous concept in hyperbolic geometry and nonassociative algebra. Outstanding examples are {\it gyrogroups} and {\it gyrovector spaces}, and Einstein addition being both {\it gyrocommutative} and {\it gyroassociative}. The prefix "gyro" stems from "gyration", which is the mathematical abstraction of the special relativistic effect known as "Thomas precession".Comment: 78 pages, 26 figure

Consumer and staff perspectives of the implementation frequency and value of recovery and wellbeing oriented practices

Background: Despite advances in our understanding of what mental health systems and services can do to enhance recovery and wellbeing outcomes for people seeking support, there is limited evidence demonstrating that this body of work has translated successfully into mental health service practice. The Collaborative Recovery Model (CRM) is a practice framework that has been designed to support application of recovery and wellbeing oriented principles and practices within mental health service delivery. The aims of this study were to assess consumer and staff perceptions of implementation frequency during service engagement and the value of this approach for assisting recovery within a setting where the CRM approach had been adopted. Methods: The setting was a large Australian community managed mental health organisation. The study involved a cross-sectional analysis of consumer (n = 116) and staff practitioner (n = 62) perspectives. A series of paired sample t-tests assessed for differences between consumer and staff perceptions of the: (i) importance of key practice elements for assisting recovery, and the (ii) frequency that key practice elements are utilised during engagement sessions. Spearman\u27s r correlational analysis explored associations between importance, frequency and helpfulness of sessions. Results: Key practice elements of the model were applied during service interactions at a high level and perceived by the majority of consumers and staff participants as being important or very important for assisting recovery. Significant moderate correlations were found between the extent that practice elements were valued and the level at which they were applied. Higher levels of implementation of CRM practices were associated with higher ratings of perceived session helpfulness. The strongest association was between \u27encouragement to set tasks to complete between support visits\u27 and perceived helpfulness. Conclusions: Consumer and staff responses revealed that the key practice elements of the CRM were frequently implemented during service engagement interactions and were seen as valuable for assisting recovery. The level of agreement between raters suggests firstly, that the key practice elements were apparent and able to be rated as occurring, and secondly that the CRM approach is seen as responsive to consumer needs. The results have implications for translating recovery and wellbeing oriented knowledge into mental health service practice

The practice of 'doing' evaluation: Lessons learned from nine complex intervention trials in action

Background: There is increasing recognition among trialists of the challenges in understanding how particular 'real-life' contexts influence the delivery and receipt of complex health interventions. Evaluations of interventions to change health worker and/or patient behaviours in health service settings exemplify these challenges. When interpreting evaluation data, deviation from intended intervention implementation is accounted for through process evaluations of fidelity, reach, and intensity. However, no such systematic approach has been proposed to account for the way evaluation activities may deviate in practice from assumptions made when data are interpreted.Methods: A collective case study was conducted to explore experiences of undertaking evaluation activities in the real-life contexts of nine complex intervention trials seeking to improve appropriate diagnosis and treatment of malaria in varied health service settings. Multiple sources of data were used, including in-depth interviews with investigators, participant-observation of studies, and rounds of discussion and reflection.Results and discussion: From our experiences of the realities of conducting these evaluations, we identified six key 'lessons learned' about ways to become aware of and manage aspects of the fabric of trials involving the interface of researchers, fieldworkers, participants and data collection tools that may affect the intended production of data and interpretation of findings. These lessons included: foster a shared understanding across the study team of how individual practices contribute to the study goals; promote and facilitate within-team communications for ongoing reflection on the progress of the evaluation; establish processes for ongoing collaboration and dialogue between sub-study teams; the importance of a field research coordinator bridging everyday project management with scientific oversight; collect and review reflective field notes on the progress of the evaluation to aid interpretation of outcomes; and these approaches should help the identification of and reflection on possible overlaps between the evaluation and intervention.Conclusion: The lessons we have drawn point to the principle of reflexivity that, we argue, needs to become part of standard practice in the conduct of evaluations of complex interventions to promote more meaningful interpretations of the effects of an intervention and to better inform future implementation and decision-making. © 2014 Reynolds et al.; licensee BioMed Central Ltd

Bacillus anthracis Peptidoglycan Stimulates an Inflammatory Response in Monocytes through the p38 Mitogen-Activated Protein Kinase Pathway

We hypothesized that the peptidoglycan component of B. anthracis may play a critical role in morbidity and mortality associated with inhalation anthrax. To explore this issue, we purified the peptidoglycan component of the bacterial cell wall and studied the response of human peripheral blood cells. The purified B. anthracis peptidoglycan was free of non-covalently bound protein but contained a complex set of amino acids probably arising from the stem peptide. The peptidoglycan contained a polysaccharide that was removed by mild acid treatment, and the biological activity remained with the peptidoglycan and not the polysaccharide. The biological activity of the peptidoglycan was sensitive to lysozyme but not other hydrolytic enzymes, showing that the activity resides in the peptidoglycan component and not bacterial DNA, RNA or protein. B. anthracis peptidoglycan stimulated monocytes to produce primarily TNFα; neutrophils and lymphocytes did not respond. Peptidoglycan stimulated monocyte p38 mitogen-activated protein kinase and p38 activity was required for TNFα production by the cells. We conclude that peptidoglycan in B. anthracis is biologically active, that it stimulates a proinflammatory response in monocytes, and uses the p38 kinase signal transduction pathway to do so. Given the high bacterial burden in pulmonary anthrax, these findings suggest that the inflammatory events associated with peptidoglycan may play an important role in anthrax pathogenesis

Vegan diets : practical advice for athletes and exercisers.

With the growth of social media as a platform to share information, veganism is becoming more visible, and could be becoming more accepted in sports and in the health and fitness industry. However, to date, there appears to be a lack of literature that discusses how to manage vegan diets for athletic purposes. This article attempted to review literature in order to provide recommendations for how to construct a vegan diet for athletes and exercisers. While little data could be found in the sports nutrition literature specifically, it was revealed elsewhere that veganism creates challenges that need to be accounted for when designing a nutritious diet. This included the sufficiency of energy and protein; the adequacy of vitamin B12, iron, zinc, calcium, iodine and vitamin D; and the lack of the long-chain n-3 fatty acids EPA and DHA in most plant-based sources. However, via the strategic management of food and appropriate supplementation, it is the contention of this article that a nutritive vegan diet can be designed to achieve the dietary needs of most athletes satisfactorily. Further, it was suggested here that creatine and β-alanine supplementation might be of particular use to vegan athletes, owing to vegetarian diets promoting lower muscle creatine and lower muscle carnosine levels in consumers. Empirical research is needed to examine the effects of vegan diets in athletic populations however, especially if this movement grows in popularity, to ensure that the health and performance of athletic vegans is optimised in accordance with developments in sports nutrition knowledge