GPs' recognition of death in the foreseeable future and diagnosis of a fatal condition: a national survey

Background: Nowadays, palliative care is considered as a care continuum that may start early in the course of the disease. In order to address the evolving needs of patients for palliative care in time, GPs should be aware in good time of the diagnosis and of the imminence of death. The aim of the study was to gain insight into how long before a non-sudden death the diagnosis of the disease ultimately leading to death is made and on what kind of information the diagnosis is based. In addition, we aimed to explore when, and based on what kind of information, GPs become aware that death of a patient will be in the foreseeable future. Methods: A written questionnaire focusing on the GPs' experiences with their last patient who died non-suddenly was sent to a random representative sample of 850 GPs in the Netherlands. Results: The data were analysed of the 297 GPs who responded. 76% of the reported cases were cancer patients and 24% were patients with another non-sudden cause of death. The diagnosis was made only in the last week of life for 15% of the non-cancer patients and 1% of the patients with cancer. GPs were most likely to have been informed of the diagnosis by the medical specialist, although particularly in the case of non-cancer patients GPs also relied on their own assessment of the diagnosis or on other information sources. The GP remained unaware that the patient would die in the foreseeable future until the last week of life in 26% of the non-cancer group, while this was the case for only 6% of the cancer patients. GP's awareness was most likely to be based on the GP's own observations of problems and/or symptoms. Conclusions: The GP often only becomes aware of a fatal diagnosis and of death in the foreseeable future at a late stage in the disease trajectory, particularly in the case of non-cancer patients. It can be assumed that if the diagnosis and the nearing death are only recognised at a late stage, palliative care is either started at a very late stage or not at all

Pollen-based temperature and precipitation changes in the Ohrid Basin (western Balkans) between 160 and 70 ka

Our study aims to reconstruct climate changes that occurred at Lake Ohrid (south-western Balkan Peninsula), the oldest extant lake in Europe, between 160 and 70&thinsp;ka (covering part of marine isotope stage 6, MIS 6; all of MIS 5; and the beginning of MIS 4). A multi-method approach, including the “Modern Analog Technique” and the “Weighted Averaging Partial Least-Squares Regression”, is applied to the high-resolution pollen sequence of the DEEP site, collected from the central part of Lake Ohrid, to provide quantitative estimates of climate and bioclimate parameters. This allows us to document climatic change during the key periods of MIS 6 and MIS 5 in southern Europe, a region where accurate climate reconstructions are still lacking for this time interval. Our results for the penultimate glacial show cold and dry conditions, while the onset of the “last interglacial” is characterized by wet and warm conditions, with temperatures higher than today (by ca. 2&thinsp;∘C). The Eemian also shows the well-known climatic tri-partition in the Balkans, with an initial pre-temperate phase of abrupt warming (128–121&thinsp;ka), a central temperate phase with decreasing temperatures associated with wet conditions (121–118&thinsp;ka), followed by a post-temperate phase of progressive change towards cold and dry conditions (118–112&thinsp;ka). After the Eemian, an alternation of four warm/wet periods with cold/dry ones, likely related to the succession of Greenland stadials and cold events known from the North Atlantic, occurred. The observed pattern is also consistent with hydrological and isotopic data from the central Mediterranean. The Lake Ohrid climate reconstruction shows greater similarity with climate patterns inferred from northern European pollen records than with southern European ones, which is probably due to its intermediate position and the mountainous setting. However, this hypothesis needs further testing as very few climate reconstructions are available for southern Europe for this key time period.</p

Genome-wide analysis points to roles for extracellular matrix remodeling, the visual cycle, and neuronal development in myopia

Myopia, or nearsightedness, is the most common eye disorder, resulting primarily from excess elongation of the eye. The etiology of myopia, although known to be complex, is poorly understood. Here we report the largest ever genome-wide association study (43,360 participants) on myopia in Europeans. We performed a survival analysis on age of myopia onset and identified 19 significant associations (p < 5e-8), two of which are replications of earlier associations with refractive error. These 19 associations in total explain 2.7% of the variance in myopia age of onset, and point towards a number of different mechanisms behind the development of myopia. One association is in the gene PRSS56, which has previously been linked to abnormally small eyes; one is in a gene that forms part of the extracellular matrix (LAMA2); two are in or near genes involved in the regeneration of 11-cis-retinal (RGR and RDH5); two are near genes known to be involved in the growth and guidance of retinal ganglion cells (ZIC2, SFRP1); and five are in or near genes involved in neuronal signaling or development. These novel findings point towards multiple genetic factors involved in the development of myopia and suggest that complex interactions between extracellular matrix remodeling, neuronal development, and visual signals from the retina may underlie the development of myopia in humans

Інноваційний розвиток у моделі становлення підприємницького середовища України

В статті пропонується розглядати та оцінювати інноваційну модель діяльності підприємства через так звану бінарну природу створюваного ним продукту (послуги), що з одного боку має конкурентний зміст, тобто напряму пов’язаний з певними показниками, реально втіленими в товарі перевагами над іншим товаром-аналогом, а з іншого – підвищує науково-технологічний рівень підприємства, зумовлюючи інноваційні переваги інституціонального характеру, що і надалі стимулюють його розвиток до самовдосконалення. Ці переваги ми відносимо до структурно-інноваційних, тобто таких, що мають вплив на подальшу модель розвитку підприємства з огляду інноваційності його функціонування

Corrigendum to “Pollen-based paleoenvironmental and paleoclimatic change at Lake Ohrid (south-eastern Europe) during the past 500 ka” published in Biogeosciences, 13, 1423–1437, 2016

In this corrigendum we report an updated pollen record from the Lake Ohrid DEEP site spanning the past 500 ka whereby we have reprocessed and re-analyzed 104 samples affected by chemical procedure problems that occurred in one palynological laboratory. Firstly, these samples were affected by the use of wrong containers, causing in- adequate settling of particles at the set centrifuging speed. Secondly, HCl and HF treatments were combined without the prescribed intermediate centrifuging and decanting steps. The inaccuracy in the protocol resulted in the loss of smaller pollen grains and in the overrepresentation of bisaccate ones in most of the re-analyzed samples. We therefore provide an updated set of figures with the new data and have revised the description of the results, discussion and conclusions re- ported in Sadori et al. (2016) where necessary. We stress that the majority of the original results and conclusions remain valid, while the records’ reliability and resolution have improved as 12 samples that had been omitted in the original study because of low count sums are now included in the revised dataset (Sadori et al., 2018)

The development of a nursing subset of patient problems to support interoperability

Since the emergence of electronic health records, nursing information is increasingly being recorded and stored digitally. Several studies have shown that a wide range of nursing information is not interoperable and cannot be re-used in different health contexts. Difficulties arise when nurses share information with others involved in the delivery of nursing care. The aim of this study is to develop a nursing subset of patient problems that are prevalent in nursing practice, based on the SNOMED CT terminology to assist in the exchange and comparability of nursing information. Explorative qualitative focus groups were used to collect data. Mixed focus groups were defined. Additionally, a nursing researcher and a nursing expert with knowledge of terminologies and a terminologist participated in each focus group. The participants, who work in a range of practical contexts, discussed and reviewed patient problems from various perspectives. Sixty-seven participants divided over seven focus groups selected and defined 119 patient problems. Each patient problem could be documented and coded with a current status or an at-risk status. Sixty-six percent of the patient problems included are covered by the definitions established by the International Classification of Nursing Practice, the reference terminology for nursing practice. For the remainder, definitions from either an official national guideline or a classification were used. Each of the 119 patient problems has a unique SNOMED CT identifier. To support the interoperability of nursing information, a national nursing subset of patient problems based on a terminology (SNOMED CT) has been developed. Using unambiguously defined patient problems is beneficial for clinical nursing practice, because nurses can then compare and exchange information from different settings. A key strength of this study is that nurses were extensively involved in the development process. Further research is required to link or associate nursing patient problems to concepts from a nursing classification with the same meaning

Efficient Replication of Over 180 Genetic Associations with Self-Reported Medical Data

While the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for amassing large amounts of medical information in a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web-based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence). Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in-depth questions to refine self-reported diagnoses. Our data suggests that online collection of self-reported data in a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations

The Multiwavelength Survey By Yale-Chile (MUSYC) Wide K-Band Imaging, Photometric Catalogs, Clustering, And Physical Properties Of Galaxies At Z Similar To 2

We present K-band imaging of two similar to 30' x 30' fields covered by the Multiwavelength Survey by Yale-Chile (MUSYC) Wide NIR Survey. The SDSS 1030+05 and Cast 1255 fields were imaged with the Infrared Side Port Imager (ISPI) on the 4 m Blanco telescope at the Cerro Tololo Inter-American Observatory (CTIO) to a 5 sigma point-source limiting depth of K similar to 20 (Vega). Combining these data with the MUSYC optical UBVRIz imaging, we created multiband K-selected source catalogs for both fields. These catalogs, together with the MUSYC K-band catalog of the Extended Chandra Deep Field South (ECDF-S) field, were used to select K 20 BzK galaxies over an area of 0.71 deg(2). This is the largest area ever surveyed for BzK galaxies. We present number counts, redshift distributions, and stellar masses for our sample of 3261 BzK galaxies (2502 star-forming [sBzK] and 759 passively evolving [pBzK]), as well as reddening and star formation rate estimates for the star-forming BzK systems. We also present two-point angular correlation functions and spatial correlation lengths for both sBzK and pBzK galaxies and show that previous estimates of the correlation function of these galaxies were affected by cosmic variance due to the small areas surveyed. We have measured correlation lengths r(0) of 8.89 +/- 2.03 and 10.82 +/- 1.72 Mpc for sBzK and pBzK galaxies, respectively. This is the first reported measurement of the spatial correlation function of passive BzK galaxies. In the Lambda CDM scenario of galaxy formation, these correlation lengths at z similar to 2 translate into minimum masses of similar to 4 x 10(12) and similar to 9 x 10(12) M(circle dot) for the dark matter halos hosting sBzK and pBzK galaxies, respectively. The clustering properties of the galaxies in our sample are consistent with their being the descendants of bright Lyman break galaxies at z similar to 3, and the progenitors of present-day > 1L* galaxies.Astronom

Aligning MIS5 proxy records from Lake Ohrid (FYROM) with independently dated Mediterranean archives: implications for core chronology

The DEEP site sediment sequence obtained during the ICDP SCOPSCO project at Lake Ohrid was dated using tephrostratigraphic information, cyclostratigraphy, and orbital tuning through marine isotope record. Although this approach is suitable for the generation of a general chronological framework of the long succession, it is insufficient to resolve more detailed paleoclimatological questions, such as leads and lags of climate events between marine and terrestrial records or between different regions. In this paper, we demonstrate how the use of different tie points can affect cyclostratigraphy and orbital tuning for the period between ca. 140 and 70 ka and how the results can be correlated with directly/indirectly radiometrically-dated Mediterranean marine and continental proxy records. The alternative age model obtained shows consistent differences with that proposed by Francke et al. (2015) for the same interval, in particular at the level of the MIS6-5e transition. According to this age model, different proxies from the DEEP site sediment record support an increase of temperatures between glacial to interglacial conditions, which is almost synchronous with a rapid increase in sea surface temperature observed in the western Mediterranean. The results show how important a detailed study of independent chronological tie points is for synchronizing different records and to highlight asynchronisms of climate events