2,195 research outputs found
Palliative Care: Is Now the Time?
Palliative care is an approach that focuses on optimizing quality of life for patients and families affected by serious illness, regardless of prognosis. It comprises pain and symptom management; psychological, spiritual, and social support; assistance with treatment decision-making; and complex care coordination. Mounting evidence indicates that palliative care reduces symptom burden, improves mood, decreases healthcare utilization, and improves quality of life for both patients with end-stage heart disease and their caregivers. Indeed, there is a consensus among major clinical guidelines of the importance of early integration of palliative care as an essential component of high quality care for patients with heart failure, a growing use of palliative care in patients with end-stage heart disease, and a clear desire of patients for such care
Effect of humidity on transonic flow
An experimental investigation of the effects of humidity-induced condensation on shock/boundary-layer
interaction has been conducted in a transonic wind-tunnel test. The test geometry considered was a wall-mounted
bump model inserted in the test section of the wind tunnel. The formation of a λ-shape condensation shock wave was
shown from schlieren visualization and resulted in a forward movement of the shock wave, reduced shock wave
strength, and reduced separation. Empirical correlations of the shock wave strength and humidity/dew point
temperature were established. For humidity levels below 0.15 or a dew point temperature of 268 K, the effect of
humidity was negligible. The unsteady pressure measurements showed that if a condensation shock wave formed and
interacted with a main shock wave, the flow becomes unsteady with periodic flow oscillations occurring at 720 Hz
Origin of the giant magnetic moments of Fe impurities on and in Cs films
To explore the origin of the observed giant magnetic moments ()
of Fe impurities on the surface and in the bulk of Cs films, we have performed
the relativistic LSDA + U calculations using the linearized muffin-tin orbital
(LMTO) band method. We have found that Fe impurities in Cs behave differently
from those in noble metals or in Pd. Whereas the induced spin polarization of
Cs atoms is negligible, the Fe ion itself is found to be the source of the
giant magnetic moment. The 3d electrons of Fe in Cs are localized as the 4f
electrons in rare-earth ions so that the orbital magnetic moment becomes as
large as the spin magnetic moment. The calculated total magnetic moment of , which comes mainly from Fe ion, is close to the experimentally
observed value.Comment: 4 pages including 3 figures and 1 table. Submitted to PR
A concept analysis of analgesic nonadherence for cancer pain in a time of opioid crisis
Background
Pain is one of the most common symptoms identified along the cancer trajectory. Among patients with moderate to severe cancer pain, nonadherence to prescribed analgesics may complicate treatment plans and exacerbate pain severity. Nonadherent behaviors are likely due to a number of individual/family, provider, and system level factors and may lead to negative pain-related outcomes.
Purpose
The purpose of this concept analysis is to clarify the concept of analgesic nonadherence for cancer pain and qualify its utility in the context of the opioid crisis.
Method
Walker and Avant's (2019) method for concept analysis was used. We integrated empirical evidence, relevant literature, and sociopolitical considerations related to the opioid crisis to provide critical and timely analysis.
Data were collected from a search of PubMed, CINAHL, PsycINFO, and Scopus. The search yielded 418 individual records. Empirical articles using quantitative and qualitative methodologies pertaining to analgesic nonadherence for cancer pain in adult outpatient settings, written in English, with an abstract, and published between 2010 and 2018 were considered. Other relevant literature sources were used if additional criteria were met. A total of 33 records were selected for detailed review.
Findings
Few studies link analgesic nonadherence to patient outcomes highlighting a significant literature gap. Given the available evidence, a definition for analgesic nonadherence is proposed for future use in research, education, practice, and policy settings.
Discussion
The paucity of empirical data combined with the implications of the opioid crisis and conflicting pain management guidelines create uncertainty about the utility of analgesic nonadherence. The concept of analgesic nonadherence warrants further normative and empirical research to clarify the role of opioids and the meaning of nonadherence in shaping pain-related outcomes within the current sociopolitical environment
Early Paleogene wildfires in peat-forming environments at Schöningen, Germany
AbstractWildfire activity in early Paleogene greenhouse conditions can be used as an analogue to gauge the effect of future warming trends on wildfire in the current climate system. Inertinite (fossil charcoal in coal) from 11 autochthonous early Paleogene lignite seams from the Schöningen mine (Germany) was quantified using macerations, in situ pillars and industry standard crushed samples. A new three transect method was developed to quantify in situ charcoal. The combination of in situ pillars and crushed samples accounts for temporal and spatial variation in charcoal through a stratigraphically oriented pillar, whilst maintaining comparability with industry standards and previous work. Charcoal occurs as a range of randomly distributed particle sizes, indicating that fires were burning locally in the Schöningen peat-forming environment and in the surrounding areas, but according to petrological data, not in an episodic or periodic pattern. Although charcoal abundance is low (relative to previous high fire worlds such as the Cretaceous), three quantitative and semi-quantitative methods show increased wildfire activity (relative to the modern world) in the warmest parts of the early Paleogene. As atmospheric oxygen levels stabilised to modern values and precipitation and humidity became the main control on wildfire, increased rainfall followed by drier intervals would have created an environment rich in dry fuel in which wildfires could easily propagate if humidity was low enough. In the later part of the Early Eocene (Ypresian) charcoal abundance fell to levels similar to those found in modern peats. This indicates that the transition to the modern low fire world occurred within the Early Eocene, earlier than previous records suggest
Palliative Care in Heart Failure: Rationale, Evidence, and Future Priorities
Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course
The Fate of Children with Microdeletion 22q11.2 Syndrome and Congenital Heart Defect: Clinical Course and Cardiac Outcome
Background: This study aimed to evaluate the cardiac outcome for children with microdeletion 22q11.2 and congenital heart defect (CHD). Methods: A total of 49 consecutive children with 22q11.2 and CHD were retrospectively identified. The CHD consisted of tetralogy of Fallot and variances (n = 22), interrupted aortic arch (n = 10), ventricular septal defect (n = 8), truncus arteriosus (n = 6), and double aortic arch (n = 1). Extracardiac anomalies were present in 46 of 47 children. Results: The median follow-up time was 8.5 years (range, 3 months to 23.5 years). Cardiac surgical repair was performed for 35 children, whereas 5 had palliative surgery, and 9 never underwent cardiac surgery. The median age at repair was 7.5 months (range, 2 days to 5 years). The mean hospital stay was 35 days (range, 7-204 days), and the intensive care unit stay was 15 days (range, 3-194 days). Significant postoperative complications occurred for 26 children (74%), and surgery for extracardiac malformations was required for 21 patients (43%). The overall mortality rate was 22% (11/49), with 1-year survival for 86% and 5-year survival for 80% of the patients. A total of 27 cardiac reinterventions were performed for 16 patients (46%) including 15 reoperations and 12 interventional catheterizations. Residual cardiac findings were present in 25 patients (71%) at the end of the follow-up period. Conclusions: Children with microdeletion 22q11.2 and CHD are at high risk for mortality and morbidity, as determined by both the severity of the cardiac lesions and the extracardiac anomalies associated with the microdeletio
Self-care research: How to grow the evidence base?
Background and objective: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field.Method: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research.Results: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components.Conclusion: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work.Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care. (C) 2020 The Authors. Published by Elsevier Ltd
VLA OH and H I Zeeman Observations of the NGC 6334 Complex
We present OH and H I Zeeman observations of the NGC 6334 complex taken with
the Very Large Array. The OH absorption profiles associated with the complex
are relatively narrow (del-v_FWHM ~ 3 km s^1) and single-peaked over most of
the sources. The H I absorption profiles contain several blended velocity
components. One of the compact continuum sources in the complex (source A) has
a bipolar morphology. The OH absorption profiles toward this source display a
gradient in velocity from the northern continuum lobe to the southern continuum
lobe; this velocity gradient likely indicates a bipolar outflow of molecular
gas from the central regions to the northern and southern lobes. Magnetic
fields of the order of 200 microG have been detected toward three discrete
continuum sources in the complex. Virial estimates suggest that the detected
magnetic fields in these sources are of the same order as the critical magnetic
fields required to support the molecular clouds associated with the sources
against gravitational collapse.Comment: 14 pages, 9 postscript figures, accepted for publication in the
Astrophysical Journal (ApJ), tentatively scheduled for vol. 533, Apr. 20,
2000; also available at
http://www.pa.uky.edu/~sarma/RESEARCH/aps_research.htm
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