UK end-of-life care services in dementia, initiatives and sustainability: results of a national online survey

BACKGROUND: People living and dying with non-cancer diagnoses, including dementia, have poorer access to generalist and specialist palliative care than people with cancer, and experience worse outcomes in terms of pain and symptom control, and quality and experience of care. In the UK, the National Council for Palliative Care (NCPC) ran a national survey of services for end-of-life care for people with dementia (2008) in which 16 services were identified, and reported on case studies and examples of good practice. We updated the NCPC survey to review progress in previously identified services, identify factors that lead to sustainable services and identify new initiatives in this area of care. METHODS: An online survey was developed and piloted before use. Initiatives were contacted via targeted (N=63) and open call invitations. The survey was made up of 5 sections. Quantitative data were analysed using descriptive statistics. RESULTS: 15 services responded. They engaged in a wide range of activities predominately providing direct care (80%) and workforce development/advisory or educational activities (87%). Results suggest that sustainability of services is reliant on clinicians with a leadership role and wider system support through funding mechanisms and a minimum level of integration within normal service provision. CONCLUSIONS: Recent initiatives are largely built on the expertise of the nursing profession (with or without input from medical consultants), and driven mainly by the charity and hospice sector. This has generated a potential new model of care provision in end of life dementia care, 'Hospice-enabled Dementia Care'

Time Resolved Correlation measurements of temporally heterogeneous dynamics

Time Resolved Correlation (TRC) is a recently introduced light scattering technique that allows to detect and quantify dynamic heterogeneities. The technique is based on the analysis of the temporal evolution of the speckle pattern generated by the light scattered by a sample, which is quantified by $c\_I(t,\tau)$, the degree of correlation between speckle images recorded at time $t$ and $t+\tau$. Heterogeneous dynamics results in significant fluctuations of $c\_I(t,\tau)$ with time $t$. We describe how to optimize TRC measurements and how to detect and avoid possible artifacts. The statistical properties of the fluctuations of $c\_I$ are analyzed by studying their variance, probability distribution function, and time autocorrelation function. We show that these quantities are affected by a noise contribution due to the finite number $N$ of detected speckles. We propose and demonstrate a method to correct for the noise contribution, based on a $N\to \infty$ extrapolation scheme. Examples from both homogeneous and heterogeneous dynamics are provided. Connections with recent numerical and analytical works on heterogeneous glassy dynamics are briefly discussed.Comment: 19 pages, 15 figures. Submitted to PR

Regular and chaotic motion in softened gravitational systems

The stability of the dynamical trajectories of softened spherical gravitational systems is examined, both in the case of the full $N$-body problem and that of trajectories moving in the gravitational field of non-interacting background particles. In the latter case, for $N \ge 10000$, some trajectories, even if unstable, had exceedingly long diffusion times, which correlated with the characteristic e-folding timescale of the instability. For trajectories of $N \approx 100000$ systems this timescale could be arbitrarily large --- and thus appear to correspond to regular orbits. For centrally concentrated systems, low angular momentum trajectories were found to be systematically more unstable. This phenomenon is analogous to the well known case of trajectories in generic centrally concentrated non-spherical smooth systems, where eccentric trajectories are found to be chaotic. The exponentiation times also correlate with the conservation of the angular momenta along the trajectories. For $N$ up to a few hundred, the instability timescales of $N$-body systems and their variation with particle number are similar to those of the most chaotic trajectories in inhomogeneous non-interacting systems. For larger $N$ (up to a few thousand) the values of the these timescales were found to saturate, increasing significantly more slowly with $N$. We attribute this to collective effects in the fully self-gravitating problem, which are apparent in the time-variations of the time dependent Liapunov exponents. The results presented here go some way towards resolving the long standing apparent paradoxes concerning the local instability of trajectories of gravitational systems (abridged).Comment: 16 pages, 11 figures, Monthly Notices styl

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

n/

Simulation of networks of spiking neurons: A review of tools and strategies

We review different aspects of the simulation of spiking neural networks. We start by reviewing the different types of simulation strategies and algorithms that are currently implemented. We next review the precision of those simulation strategies, in particular in cases where plasticity depends on the exact timing of the spikes. We overview different simulators and simulation environments presently available (restricted to those freely available, open source and documented). For each simulation tool, its advantages and pitfalls are reviewed, with an aim to allow the reader to identify which simulator is appropriate for a given task. Finally, we provide a series of benchmark simulations of different types of networks of spiking neurons, including Hodgkin-Huxley type, integrate-and-fire models, interacting with current-based or conductance-based synapses, using clock-driven or event-driven integration strategies. The same set of models are implemented on the different simulators, and the codes are made available. The ultimate goal of this review is to provide a resource to facilitate identifying the appropriate integration strategy and simulation tool to use for a given modeling problem related to spiking neural networks.Comment: 49 pages, 24 figures, 1 table; review article, Journal of Computational Neuroscience, in press (2007

On The Power of Tree Projections: Structural Tractability of Enumerating CSP Solutions

The problem of deciding whether CSP instances admit solutions has been deeply studied in the literature, and several structural tractability results have been derived so far. However, constraint satisfaction comes in practice as a computation problem where the focus is either on finding one solution, or on enumerating all solutions, possibly projected to some given set of output variables. The paper investigates the structural tractability of the problem of enumerating (possibly projected) solutions, where tractability means here computable with polynomial delay (WPD), since in general exponentially many solutions may be computed. A general framework based on the notion of tree projection of hypergraphs is considered, which generalizes all known decomposition methods. Tractability results have been obtained both for classes of structures where output variables are part of their specification, and for classes of structures where computability WPD must be ensured for any possible set of output variables. These results are shown to be tight, by exhibiting dichotomies for classes of structures having bounded arity and where the tree decomposition method is considered

Towards Controlling the Acceptance Factors for a Collaborative Platform in Engineering Design

International audienceThis paper might serve as a guide to take step towards a better acceptance of computer-based Knowledge management (KM) tools in institutional setting. At first time, it investigates a set of factors with different origins which are proved to have an effect on usage decision. Secondly, we set a list of candidate factor which are supposed to influence future users of a collaborative KM platform (Dimocode). At the end, we develop a methodology to take into account the selected factors and master their positive or negative impacts. The contents of this paper would be an appropriate framework in the way of Knowledge management systems (KMS) deployment

Computable de Finetti measures

We prove a computable version of de Finetti's theorem on exchangeable sequences of real random variables. As a consequence, exchangeable stochastic processes expressed in probabilistic functional programming languages can be automatically rewritten as procedures that do not modify non-local state. Along the way, we prove that a distribution on the unit interval is computable if and only if its moments are uniformly computable.Comment: 32 pages. Final journal version; expanded somewhat, with minor corrections. To appear in Annals of Pure and Applied Logic. Extended abstract appeared in Proceedings of CiE '09, LNCS 5635, pp. 218-23