The associations of palliative care experts regarding food refusal : a cross-sectional study with an open question evaluated by triangulation analysis

Introduction: Health professionals in oncologic and palliative care settings are often faced with the problem that patients stop eating and drinking. While the causes of food refusal are very different, the result is often malnutrition, which is linked to health comorbidities and a high mortality rate. However, the professionals lack the time and knowledge to clarify the cause for each patient. What associations do health professionals have when faced with food refusal? Objective: To investigate the associations that health professionals in oncological and palliative settings have about denied eating behavior. Methods: A cross-sectional study, starting with an open question focusing professionals’ associations regarding food refusal. The results were inductively analyzed, whereby generic categories were developed. Subsequently, the categories were transformed into quantitative data to calculate the relationships between the categories. Results: A total of 350 out of 2000 participants completed the survey, resulting in a response rate of 17.5%. Food refusal is primarily associated with physical and ethical aspects and with endof-life. Half of the participants frequently find that patients refuse to eat. The attitudes show that the autonomy of the patient is the highest good and is to be respected. Even in the case of patients with limited decision-making capacity, the refusal to eat is acceptable. Conclusion: Clarifying the cause of food refusal requires a great deal of knowledge and is strongly influenced by the associations of health professionals. While the associations have very negative connotations, information and training is needed to make professionals aware of this and to change their associations. With this knowledge and in an interprofessional cooperation, mis-labelling of patient settings can be avoided and fears can be reduce

Mapping the landscape of metabolic goals of a cell

Genome-scale flux balance models of metabolism provide testable predictions of all metabolic rates in an organism, by assuming that the cell is optimizing a metabolic goal known as the objective function. We introduce an efficient inverse flux balance analysis (invFBA) approach, based on linear programming duality, to characterize the space of possible objective functions compatible with measured fluxes. After testing our algorithm on simulated E. coli data and time-dependent S. oneidensis fluxes inferred from gene expression, we apply our inverse approach to flux measurements in long-term evolved E. coli strains, revealing objective functions that provide insight into metabolic adaptation trajectories.MURI W911NF-12-1-0390 - Army Research Office (US); MURI W911NF-12-1-0390 - Army Research Office (US); 5R01GM089978-02 - National Institutes of Health (US); IIS-1237022 - National Science Foundation (US); DE-SC0012627 - U.S. Department of Energy; HR0011-15-C-0091 - Defense Sciences Office, DARPA; National Institutes of Health; R01GM103502; 5R01DE024468; 1457695 - National Science Foundatio

Fractal scale-invariant and nonlinear properties of cardiac dynamics remain stable with advanced age: A new mechanistic picture of cardiac control in healthy elderly

We analyze heartbeat interval recordings from two independent databases: (a) 19 healthy young (avg. age 25.7 years) and 16 healthy elderly subjects (avg. age 73.8 years) during 2h under resting conditions from the Fantasia database; and (b) 29 healthy elderly subjects (avg. age 75.9 years) during $\approx{}8$h of sleep from the SHHS database, and the same subjects recorded 5 years later. We quantify: (1) The average heart rate ; (2) the SD $\sigma_{RR}$ and $\sigma_{\Delta{}RR}$ of the heartbeat intervals RR and their increments $\Delta{}RR$; (3) the long-range correlations in RR as measured by the scaling exponent $\alpha_{RR}$ using the Detrended Fluctuation Analysis; (4) fractal linear and nonlinear properties as represented by the scaling exponents $\alpha^{sign}$ and $\alpha^{mag}$ for the time series of the sign and magnitude of $\Delta{}RR$; (5) the nonlinear fractal dimension $D(k)$ of $RR$ using the Fractal Dimension Analysis. We find: (1) No significant difference in \left (P>0.05); (2) a significant difference in $\sigma_{RR}$ and $\sigma_{\Delta{}RR}$ for the Fantasia groups (P<10^{-4}) but no significant change with age between the elderly SHHS groups (P>0.5); (3) no significant change in the fractal measures $\alpha_{RR}$ (P>0.15), $\alpha^{sign}$ (P>0.2), $\alpha^{mag}$ (P>0.3), and D(k) with age. Our findings do not support the hypothesis that fractal linear and nonlinear characteristics of heartbeat dynamics break down with advanced age in healthy subjects. While our results indeed show a reduced SD of heartbeat fluctuations with advanced age, the inherent temporal fractal and nonlinear organization of these fluctuations remains stable.Comment: 19 pages, 14 figure

Over-diagnosis of malaria is not a lost cause.

BACKGROUND: Recent studies have highlighted the over-diagnosis of malaria in clinical settings in Africa. This study assessed the impact of a training programme implemented as part of an intervention trial on diagnostic behaviour of clinicians in a rural district hospital in a low-moderate malaria transmission setting. METHODS: From the beginning of 2005, a randomized controlled trial (RCT) of intermittent preventive treatment for malaria in infants (IPTi) has been conducted at the study hospital. As part of the RCT, the study team offered laboratory quality assurance, and supervision and training of paediatric ward staff using information on malaria epidemiology in the community. Data on clinical and blood slide confirmed cases of malaria from 2001 to 2005 were extracted from the hospital records. RESULTS: The proportion of blood slides positive for malaria parasites had decreased from 21% in 2001 to 7% in 2005 (p < .01). The proportion of outpatient and inpatient cases diagnosed as malaria ranged between 34% and 28% from 2001 to 2004 and this decreased substantially to 17% after the introduction of the package of training and support in 2005 (p < .01). There was no clear trend in the ratio of blood slide examined versus total diagnosis of malaria. CONCLUSION: It may be possible to change the diagnostic behaviour of clinicians by rigorous training using local malaria epidemiology data and supportive supervision

Morfología comparada de la escápula de primates humanos y no humanos mediante morfometría geométrica. Estudio preliminar.

Este trabajo estudia la morfología comparada de la escápula de primates humanos y no humanos mediante morfometría geométrica. Se han utilizado 62 omóplatos de individuos adultos de sexo desconocido (22 humanos actuales, 1 Neandertal y 39 primates no humanos), procedentes de las colecciones de las Universidades UAB, UB y del Museo de Ciencias Naturales de Barcelona. Cada escápula se fotografió ortogonalmente y se cuantificó su morfología mediante el uso de puntos anatómicos de referencia (12 para la cara posterior y 13 para la anterior). Después de evaluar la fiabilidad de las mediciones mediante un test de distancias euclídeas, se analizó la diversidad de este hueso en las diferentes especies de primates mediante un Análisis de Componentes Principales (ACP). Los resultados mostraron clara separación morfológica entre primates cuadrúpedos y no cuadrúpedos (suspensores, saltadores y bípedos). En este último conjunto los humanos se separan netamente del resto. En los primates cuadrúpedos predomina la dimensión horizontal (mayor anchura y menor altura), mientras que en los no cuadrúpedos se da la tendencia contraria (menor anchura y mayor altura). La espina escapular queda situada en posición más horizontal enprimates cuadrúpedos respecto a los no cuadrúpedos, aunque en el género Homo, esta inclinación está atenuada. La escápula analizada de Neandertal, si bien es más robusta y con menor inclinación de la espina escapular que la de los humanos actuales, se agrupa bien con éstos. Nuestros resultados muestran el potencial de la metodología utilizada para el estudio de la morfología escapular de Homo y demás géneros de primates

Karakteristik Area Tempat Bertelur Penyu Sisik (Eretmochelys imbricata) Pantai Faong Taman Nasional Manusela

This study aims to determine the Hawksbill Turtle nesting area (Eretmochelys imbricata) Faong Beach, Manusela National Park. The method used in this research is the survey method, namely the direct field data collection and the 2x2 meter square plot method to see the understorey vegetation. The results showed that the characteristics of the hawksbill nesting area (Eretmochelys imbricata) at Faong beach were chosen as one of the most suitable places for turtle nesting

Creation of Entanglement by Interaction with a Common Heat Bath

I show that entanglement between two qubits can be generated if the two qubits interact with a common heat bath in thermal equilibrium, but do not interact directly with each other. In most situations the entanglement is created for a very short time after the interaction with the heat bath is switched on, but depending on system, coupling, and heat bath, the entanglement may persist for arbitrarily long times. This mechanism sheds new light on the creation of entanglement. A particular example of two quantum dots in a closed cavity is discussed, where the heat bath is given by the blackbody radiation.Comment: 4 revtex pages, 1 eps figure; replaced with published version; short discussion on entanglement distillation adde

Abstract cluster expansion with applications to statistical mechanical systems

We formulate a general setting for the cluster expansion method and we discuss sufficient criteria for its convergence. We apply the results to systems of classical and quantum particles with stable interactions

Approximating Tverberg Points in Linear Time for Any Fixed Dimension

Let P be a d-dimensional n-point set. A Tverberg-partition of P is a partition of P into r sets P_1, ..., P_r such that the convex hulls conv(P_1), ..., conv(P_r) have non-empty intersection. A point in the intersection of the conv(P_i)'s is called a Tverberg point of depth r for P. A classic result by Tverberg implies that there always exists a Tverberg partition of size n/(d+1), but it is not known how to find such a partition in polynomial time. Therefore, approximate solutions are of interest. We describe a deterministic algorithm that finds a Tverberg partition of size n/4(d+1)^3 in time d^{O(log d)} n. This means that for every fixed dimension we can compute an approximate Tverberg point (and hence also an approximate centerpoint) in linear time. Our algorithm is obtained by combining a novel lifting approach with a recent result by Miller and Sheehy (2010).Comment: 14 pages, 2 figures. A preliminary version appeared in SoCG 2012. This version removes an incorrect example at the end of Section 3.

Biomass and biological fuels

The analysis of results obtained at national and international level on the utilization of renewable energy sources pointed out the opportunity of over-passing the energy crisis by the orientation of world economy to produce energy by the help of biomass. The high plant mass volume present in the world could compensate the relatively low output of light energy conversion through photosynthesis. The climatic conditions from Romania favourable to plant growing with high capacity of biomass multiplication, as well as farming by-product, animal dejections, domestic garbage, can ensure the biogas necessary to cover a great percentage of the energy necessary for animal breeding farms or heating dwellings