7,170 research outputs found

    Advance care planning uptake among patients with severe lung disease: A randomised patient preference trial of a nurse-led, facilitated advance care planning intervention

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    Objective Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease. Design A multicentre open-label randomised controlled trial with preference arm. Setting Metropolitan teaching hospital and a rural healthcare network. Participants 149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease. Intervention Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD). Outcome measures The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm. Results At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors. Conclusions Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake. Trial registration number ACTRN12614000255684. © Published by the BMJ Publishing Group Limite

    Proton-counting radiography for proton therapy: a proof of principle using CMOS APS technology

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    Despite the early recognition of the potential of proton imaging to assist proton therapy (Cormack 1963 J. Appl. Phys. 34 2722), the modality is still removed from clinical practice, with various approaches in development. For proton-counting radiography applications such as computed tomography (CT), the water-equivalent-path-length that each proton has travelled through an imaged object must be inferred. Typically, scintillator-based technology has been used in various energy/range telescope designs. Here we propose a very different alternative of using radiation-hard CMOS active pixel sensor technology. The ability of such a sensor to resolve the passage of individual protons in a therapy beam has not been previously shown. Here, such capability is demonstrated using a 36 MeV cyclotron beam (University of Birmingham Cyclotron, Birmingham, UK) and a 200 MeV clinical radiotherapy beam (iThemba LABS, Cape Town, SA). The feasibility of tracking individual protons through multiple CMOS layers is also demonstrated using a two-layer stack of sensors. The chief advantages of this solution are the spatial discrimination of events intrinsic to pixelated sensors, combined with the potential provision of information on both the range and residual energy of a proton. The challenges in developing a practical system are discussed

    Outfoxing the fox: effect of prey odor on fox behavior in a pastoral landscape

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    Invasive mammalian predators have had a devastating effect on native species globally. The European red fox (Vulpes vulpes) is one such species where it has been introduced in Australia. A novel but unexplored tactic to reduce the impact of mammalian predators is the use of unrewarded prey odors to undermine the effectiveness of olfactory hunting behavior. To test the viability of unrewarded prey odors in an applied setting we investigated how foxes responded to the odors of three different prey species. We used the odors of two locally extinct native Australian marsupials; the eastern quoll (a smaller carnivore) and eastern bettong (a fungivore), and the European rabbit, an introduced herbivore. Conducting our research over a period of 3 weeks in a pastoral environment in South-eastern Australia, we used video observations of foxes' behaviors, as they encountered the different odors. We found a reduction in the number of fox visits to bettong odors in the third week. In contrast, we observed a sustained number of visits to rabbit odors. Foxes also spent more time investigating rabbit odors and displayed longer durations of vigilance behavior at quoll odors. Our results support the hypothesis that the exposure of wild foxes to unrewarded odors of novel prey species can reduce their interest in these odors, which might translate to a reduction in predation pressure. Our results also suggest, however, that olfactory pre-exposure may not be as effective at reducing fox interest in a competitor species' odor

    Universality of Performance Indicators based on Citation and Reference Counts

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    We find evidence for the universality of two relative bibliometric indicators of the quality of individual scientific publications taken from different data sets. One of these is a new index that considers both citation and reference counts. We demonstrate this universality for relatively well cited publications from a single institute, grouped by year of publication and by faculty or by department. We show similar behaviour in publications submitted to the arXiv e-print archive, grouped by year of submission and by sub-archive. We also find that for reasonably well cited papers this distribution is well fitted by a lognormal with a variance of around 1.3 which is consistent with the results of Radicchi, Fortunato, and Castellano (2008). Our work demonstrates that comparisons can be made between publications from different disciplines and publication dates, regardless of their citation count and without expensive access to the whole world-wide citation graph. Further, it shows that averages of the logarithm of such relative bibliometric indices deal with the issue of long tails and avoid the need for statistics based on lengthy ranking procedures.Comment: 15 pages, 14 figures, 11 pages of supplementary material. Submitted to Scientometric

    Assessing the equity and effectiveness of the GB energy price caps using smart meter data

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    © 2018 Elsevier Ltd Keeping homes at a comfortable temperature and reducing household fuel bills are priorities for many governments. In the UK, several interventions have been implemented to achieve these objectives. This paper investigates one such policy lever - the Energy Price Cap - to understand if it has been designed and implemented efficiently and equitably. The price cap was introduced for customers on prepayment meters to combat increased levels of fuel poverty and a lack of competition in this group. However, the price cap was based on several assumptions of how energy is used. In this work, we assess how well the price cap accounts for real energy use using smart meter data. Households on economy 7 (EC7) tariffs were found to spend more than those on standard rate tariffs, as EC7 customers use more electricity during peak hours than assumed in government calculations. Additionally, many of the EC7 customers in this sample still use a considerable amount of gas, suggesting the EC7 heating product is either not sufficient, or is not being utilised in a cost-effective manner. Revisions to the input assumptions in government models for EC7 customers would therefore be beneficial in future price cap levels

    Inheritance patterns in citation networks reveal scientific memes

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    Memes are the cultural equivalent of genes that spread across human culture by means of imitation. What makes a meme and what distinguishes it from other forms of information, however, is still poorly understood. Our analysis of memes in the scientific literature reveals that they are governed by a surprisingly simple relationship between frequency of occurrence and the degree to which they propagate along the citation graph. We propose a simple formalization of this pattern and we validate it with data from close to 50 million publication records from the Web of Science, PubMed Central, and the American Physical Society. Evaluations relying on human annotators, citation network randomizations, and comparisons with several alternative approaches confirm that our formula is accurate and effective, without a dependence on linguistic or ontological knowledge and without the application of arbitrary thresholds or filters.Comment: 8 two-column pages, 5 figures; accepted for publication in Physical Review

    Molecular Dynamics Simulations

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    A tutorial introduction to the technique of Molecular Dynamics (MD) is given, and some characteristic examples of applications are described. The purpose and scope of these simulations and the relation to other simulation methods is discussed, and the basic MD algorithms are described. The sampling of intensive variables (temperature T, pressure p) in runs carried out in the microcanonical (NVE) ensemble (N= particle number, V = volume, E = energy) is discussed, as well as the realization of other ensembles (e.g. the NVT ensemble). For a typical application example, molten SiO2, the estimation of various transport coefficients (self-diffusion constants, viscosity, thermal conductivity) is discussed. As an example of Non-Equilibrium Molecular Dynamics (NEMD), a study of a glass-forming polymer melt under shear is mentioned.Comment: 38 pages, 11 figures, to appear in J. Phys.: Condens. Matte

    PROMPT: Panchromatic Robotic Optical Monitoring and Polarimetry Telescopes

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    Funded by $1.2M in grants and donations, we are now building PROMPT at CTIO. When completed in late 2005, PROMPT will consist of six 0.41-meter diameter Ritchey-Chrétien telescopes on rapidly slewing mounts that respond to GRB alerts within seconds, when the afterglow is potentially extremely bright. Each mirror and camera coating is being optimized for a different wavelength range and function, including a NIR imager, two red-optimized imagers, a blue-optimized imager, an UV-optimized imager, and an optical polarimeter. PROMPT will be able to identify high-redshift events by dropout and distinguish these events from the similar signatures of extinction. In this way, PROMPT will act as a distance-finder scope for spectroscopic follow up on the larger 4.1-meter diameter SOAR telescope, which is also located at CTIO. When not chasing GRBs, PROMPT serves broader educational objectives across the state of North Carolina. Enclosure construction and the first two telescopes are now complete and functioning: PROMPT observed Swift’s first GRB in December 2004. We upgrade from two to four telescope in February 2005 and from four to six telescopes in mid-2005
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