The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings.

BACKGROUND: Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. METHODS: A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding 'work as done'. Data were analysed using an adapted "Qualitative Rapid Appraisal, Rigorous Analysis" approach. RESULTS: Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients "falling through the cracks." Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. CONCLUSIONS: The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of 'work-as-done' may help OPCs to sustain high-quality care in the face of escalating service demand

'Sending Dollars Shows Feeling' - Emotions and Economies in Filipino Migration

This paper analyses the conceptualization of gender, relationships, and emotions that underpin ‘care chains’ approaches to Filipino labour migration. In a case study of long‐distance intimacy and economic transfers in an extended Filipino family, I show how contextualizing migration within local understandings of emotion fractures expectations created by care chains accounts. This case instead reveals agency, diversity, and new forms of global subjectivity emerging through long‐distance emotional connections within the translocal field shaped by labour mobility

Providing outpatient cancer care for CALD patients: a qualitative study

Objective There have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically diverse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs). Results Analysis of data from our ethnographic study of four OPCs identified three themes: “Identifying CALD patient language-related needs”; “Capacity and resources to meet CALD patient needs”, and “Making it work for CALD communities.” The care team comprises not only clinicians but also families and non-clinical staff; OPCs serve as “touchpoints” facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery

Free-Surface Optical Scattering as an Indicator of the Shock-Induced Solid-Liquid Phase Transition in Tin

When highly polished metal surfaces melt upon release after shock loading, they exhibit features that suggest significant surface changes accompany the phase transition. The reflection of light from such surfaces changes from specular (pre-shock) to diffuse upon melting. A familiar manifestation of this phenomenon is the loss of signal light in VISAR measurements, which occurs at pressures high enough to melt the free surface. Unlike many other potential material phase-sensitive diagnostics (e.g., reflectometry, conductivity) that show relatively small (1%–10%) changes, the specularity of reflection provides a more sensitive and definitive indication of the solid-liquid phase transition. Data will be presented that support the hypothesis that specularity changes indicate melt in a way that can be measured easily and unambiguously

(M,Ru)O2 (M = Mg, Zn, Cu, Ni, Co) rutiles and their use as oxygen evolution electrocatalysts in membrane electrode assemblies under acidic conditions

The rutiles (M,Ru)O2 (M = Mg, Zn, Co, Ni, Cu) are formed directly under hydrothermal conditions at 240 °C from potassium perruthenate and either peroxides of zinc or magnesium, or poorly crystalline oxides of cobalt, nickel or copper. The polycrystalline powders consist of lath-shaped crystallites, tens of nanometres in maximum dimension. Powder neutron diffraction shows that the materials have expanded a axis and contracted c axis compared to the parent RuO2, but there is no evidence of lowering of symmetry to other AO2-type structures, supported by Raman spectroscopy. Rietveld refinement shows no evidence for oxide non-stoichiometry and provides a formula (MxRu1-x)O2 with 0.14 < x < 0.2, depending on the substituent metal. This is supported by energy-dispersive X-ray analysis on the transmission electron microscope, while Ru K-edge XANES spectroscopy shows that upon inclusion of the substituent the average Ru oxidation state is increased to balance charge. Variable temperature magnetic measurements provide evidence for atomic homogeneity of the mixed metal materials, with suppression of the high temperature antiferromagnetism of RuO2 and increased magnetic moment. The new rutiles all show enhanced electrocatalysis compared to reference RuO2 materials for oxygen evolution in 1 M H2SO4 electrolyte at 60 °C, with higher specific and mass activity (per Ru) than a low surface area crystalline RuO2, and with less Ru dissolution over 1000 cycles compared to an RuO2 with a similar surface area. Magnesium substitution provides the optimum balance between stability and activity, despite leaching of the Mg2+ into solution, and this was proved in membrane electrode assemblies

Policies, Political-Economy, and Swidden in Southeast Asia

For centuries swidden was an important farming practice found across the girth of Southeast Asia. Today, however, these systems are changing and sometimes disappearing at a pace never before experienced. In order to explain the demise or transitioning of swidden we need to understand the rapid and massive changes that have and are occurring in the political and economic environment in which these farmers operate. Swidden farming has always been characterized by change, but since the onset of modern independent nation states, governments and markets in Southeast Asia have transformed the terms of swiddeners’ everyday lives to a degree that is significantly different from that ever experienced before. In this paper we identified six factors that have contributed to the demise or transformation of swidden systems, and support these arguments with examples from China (Xishuangbanna), Laos, Thailand, Malaysia, and Indonesia. These trends include classifying swiddeners as ethnic minorities within nation-states, dividing the landscape into forest and permanent agriculture, expansion of forest departments and the rise of conservation, resettlement, privatization and commoditization of land and land-based production, and expansion of market infrastructure and the promotion of industrial agriculture. In addition we note a growing trend toward a transition from rural to urban livelihoods and expanding urban-labor markets

Mapping a beautiful voice : theoretical considerations

The prime purpose of this paper is to draw on a range of diverse literatures to clarify those elements thatare perceived to constitute a ‘beautiful’ sung performance. The text rehearses key findings from existingliteratures in order to determine the extent to which particular elements might appear the most salientfor an individual listener and also ‘quantifiable’ (in the sense of being open to empirical study). Thepaper concludes with a theoretical framework for the elements that are likely to construct and shape ourresponses to particular sung performances

Effects of muscarinic receptor stimulation on Ca2+ transient, cAMP production and pacemaker frequency of rabbit sinoatrial node cells

We investigated the contribution of the intracellular calcium (Cai2+) transient to acetylcholine (ACh)-mediated reduction of pacemaker frequency and cAMP content in rabbit sinoatrial nodal (SAN) cells. Action potentials (whole cell perforated patch clamp) and Cai2+ transients (Indo-1 fluorescence) were recorded from single isolated rabbit SAN cells, whereas intracellular cAMP content was measured in SAN cell suspensions using a cAMP assay (LANCE®). Our data show that the Cai2+ transient, like the hyperpolarization-activated “funny current” (If) and the ACh-sensitive potassium current (IK,ACh), is an important determinant of ACh-mediated pacemaker slowing. When If and IK,ACh were both inhibited, by cesium (2 mM) and tertiapin (100 nM), respectively, 1 μM ACh was still able to reduce pacemaker frequency by 72%. In these If and IK,ACh-inhibited SAN cells, good correlations were found between the ACh-mediated change in interbeat interval and the ACh-mediated change in Cai2+ transient decay (r2 = 0.98) and slow diastolic Cai2+ rise (r2 = 0.73). Inhibition of the Cai2+ transient by ryanodine (3 μM) or BAPTA-AM (5 μM) facilitated ACh-mediated pacemaker slowing. Furthermore, ACh depressed the Cai2+ transient and reduced the sarcoplasmic reticulum (SR) Ca2+ content, all in a concentration-dependent fashion. At 1 μM ACh, the spontaneous activity and Cai2+ transient were abolished, but completely recovered when cAMP production was stimulated by forskolin (10 μM) and IK,ACh was inhibited by tertiapin (100 nM). Also, inhibition of the Cai2+ transient by ryanodine (3 μM) or BAPTA-AM (25 μM) exaggerated the ACh-mediated inhibition of cAMP content, indicating that Cai2+ affects cAMP production in SAN cells. In conclusion, muscarinic receptor stimulation inhibits the Cai2+ transient via a cAMP-dependent signaling pathway. Inhibition of the Cai2+ transient contributes to pacemaker slowing and inhibits Cai2+-stimulated cAMP production. Thus, we provide functional evidence for the contribution of the Cai2+ transient to ACh-induced inhibition of pacemaker activity and cAMP content in rabbit SAN cells

Intravenous fluid restriction after major abdominal surgery: a randomized blinded clinical trial

Background: Intravenous (IV) fluid administration is an essential part of postoperative care. Some studies suggest that a restricted post-operative fluid regime reduces complications and postoperative hospital stay after surgery. We investigated the effects of postoperative fluid restriction in surgical patients undergoing major abdominal surgery. Methods: In a blinded randomized trial, 62 patients (ASA I-III) undergoing elective major abdominal surgical procedures in a university hospital were allocated either to a restricted (1.5 L/24 h) or a standard postoperative IV fluid regime (2.5 L/24 h). Primary endpoint was length of postoperative hospital stay (PHS). Secondary endpoints included postoperative complications and time to restore gastric functions. Results: After a 1-year inclusion period, an unplanned interim analysis was made because of many protocol violations due to patient deterioration. In the group with the restricted regime we found a significantly increased PHS (12.3 vs. 8.3 days; p = 0.049) and significantly more major complications: 12 in 30 (40%) vs. 5 in 32 (16%) patients (Absolute Risk Increase: 0.24 [95%CI: 0.03 to 0.46], i.e. a number needed to harm of 4 [95%CI: 2-33]). Therefore, the trial was stopped prematurely. Intention to treat analysis showed no differences in time to restore gastric functions between the groups. Conclusion: Restricted postoperative IV fluid management, as performed in this trial, in patients undergoing major abdominal surgery appears harmful as it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital stay