Quality of health care according to people with Down syndrome, their parents and support staff—A qualitative exploration

Background: People with Down syndrome (PDS) have complex healthcare needs. Little is known about the quality of health care for PDS, let alone how it is appraised by PDS and their caregivers. This study explores the perspectives of PDS, their parents and support staff regarding quality in health care for PDS. Method: The present authors conducted semi-structured interviews with 18 PDS and 15 parents, and focus groups with 35 support staff members (of PDS residing in assisted living facilities) in the Netherlands. Results: According to the participants, healthcare quality entails well-coordinated health care aligned with other support and care systems, a person-centred and holistic approach, including respect, trust and provider–patient communication adapted to the abilities of PDS. Conclusions: Our findings may be used to improve health care for PDS, and provide insight into how health care could match the specific needs of PDS

Method and new tabulations for flux-weighted line opacity and radiation line force in supersonic media

In accelerating and supersonic media, the interaction of photons with spectral lines can be of ultimate importance. However, fully accounting for such line forces currently can only be done by specialised codes in 1-D steady-state flows. More general cases and higher dimensions require alternative approaches. We presented a comprehensive and fast method for computing the radiation line-force using tables of spectral line-strength distribution parameters, which can be applied in arbitrary (multi-D, time-dependent) simulations, including those accounting for the line-deshadowing instability, to compute the appropriate opacities. We assumed local thermodynamic equilibrium to compute a flux-weighted line opacity from $>4$ million spectral lines. We derived the spectral line strength and tabulated the corresponding line-distribution parameters for a range of input densities $\rho\in[10^{-20},10^{-10}]gcm^{-3}$ and temperatures $T\in[10^4,10^{4.7}]K$. We found that the variation of the line distribution parameters plays an essential role in setting the wind dynamics in our models. In our benchmark study, we also found a good overall agreement between the O-star mass-loss rates of our models and those derived from steady-state studies using more detailed radiative transfer. Our models reinforce that self-consistent variation of the line-distribution parameters is important for the dynamics of line-driven flows. Within a well-calibrated O-star regime, our results support the proposed methodology. In practice, utilising the provided tables, yielded a factor $>100$ speed-up in computational time compared to specialised 1-D model-atmosphere codes of line-driven winds, which constitutes an important step towards efficient multi-D simulations. We conclude that our method and tables are ready to be exploited in various radiation-hydrodynamic simulations where the line force is important

Empirical mass-loss rates and clumping properties of Galactic early-type O supergiants

International audienceAims. We investigate the impact of optically thick clumping on spectroscopic stellar wind diagnostics in O supergiants and constrain wind parameters associated with porosity in velocity space. This is the first time the effects of optically thick clumping have been investigated for a sample of massive hot stars, using models which include a full optically thick clumping description. Methods. We re-analyse existing spectroscopic observations of a sample of eight O supergiants previously analysed with the non-local-thermodynamic-equilibrium (NLTE) atmosphere code CMFGEN. Using a genetic algorithm wrapper around the NLTE atmosphere code FASTWIND we obtain simultaneous fits to optical and ultraviolet spectra and determine photospheric properties, chemical surface abundances and wind properties. Results. We provide empirical constraints on a number of wind parameters including the clumping factors, mass-loss rates and terminal wind velocities. Additionally, we establish the first systematic empirical constraints on velocity filling factors and interclump densities. These are parameters that describe clump distribution in velocity-space and density of the interclump medium in physical-space, respectively. We observe a mass-loss rate reduction of a factor of 3.6 compared to theoretical predictions from Vink et al. (2000), and mass-loss rates within a factor 1.4 of theoretical predictions from Björklund et al. (2021). Conclusions. We confirm that including optically thick clumping allows simultaneous fitting of optical recombination lines and ultraviolet resonance lines, including the unsaturated ultraviolet phosphorus lines (P v λλ1118-1128), without reducing the phosphorus abundance. We find that, on average, half of the wind velocity field is covered by dense clumps. We also find that these clumps are 25 times denser than the average wind, and that the interclump medium is 3-10 times less dense than the mean wind. The former result agrees well with theoretical predictions, the latter suggests that lateral filling-in of radially compressed gas might be critical for setting the scale of the rarefied interclump matter

Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

The costs of phenotypic adaptation to repeatedly fluctuating temperatures in a soil arthropod.

Costs of phenotypic adaptation to changing environments have often been studied in morphological structures. Such structures typically are irreversible for at least some stage in the organism's life. In this study we investigated whether recurrent and reversible adaptation to changes in the thermal environment incurs a cost in terms of some key life-history traits in the collembolan Orchesella cincta. We exposed juvenile O. cincta to two treatments differing in the frequency of temperature fluctuation but with equal total temperature sums. In the high frequency treatment temperature fluctuated daily between 10 and 20 °C, while in the low frequency treatment temperature fluctuated on a weekly schedule. During the treatments we measured juvenile growth rate and juvenile mortality, and after six weeks the animals were transferred to constant 15 °C and adult starvation resistance was assessed. We found no significant differences between the treatments in juvenile growth rate or juvenile survival. Also, adults that had grown up under high frequency temperature fluctuations did not suffer from reduced starvation resistance compared to animals growing under low frequency temperature fluctuations. This finding supports the hypothesis that selection minimizes the production costs of inducible phenotypes and suggests that the development of optimal phenotypes and evolution of temperature reaction norms are not constrained by such costs. © 2011 Elsevier Ltd

Quality of health care according to people with Down syndrome, their parents and support staff-A qualitative exploration

Contains fulltext : 229778.pdf (Publisher’s version ) (Open Access)BACKGROUND: People with Down syndrome (PDS) have complex healthcare needs. Little is known about the quality of health care for PDS, let alone how it is appraised by PDS and their caregivers. This study explores the perspectives of PDS, their parents and support staff regarding quality in health care for PDS. METHOD: The present authors conducted semi-structured interviews with 18 PDS and 15 parents, and focus groups with 35 support staff members (of PDS residing in assisted living facilities) in the Netherlands. RESULTS: According to the participants, healthcare quality entails well-coordinated health care aligned with other support and care systems, a person-centred and holistic approach, including respect, trust and provider-patient communication adapted to the abilities of PDS. CONCLUSIONS: Our findings may be used to improve health care for PDS, and provide insight into how health care could match the specific needs of PDS