Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Influence of HiPIMS pulse widths on the deposition behaviour and properties of CuAgZr compositionally graded films

In this work, the influence of different pulse widths (25, 50 and 100 μs) during high power impulse magnetron sputtering (HiPIMS) of copper, silver and zirconium was investigated in terms of plasma properties and properties of combinatorial composition gradient CuAgZr film libraries. In situ plasma diagnostics via optical emission spectroscopy (OES), time-of-flight mass spectrometry (TOFMS), and modified quartz crystal microbalance (m-QCM), followed by film ex situ X-ray diffraction (XRD) and scanning electron microscopy (SEM) investigations allowed to determine the effect of deposition parameters on the thin films' microstructural changes. Changing the pulse width, while keeping the duty cycle constant, modified the discharge composition in the target region and the ionised fraction of the sputtered species in the substrate region. The maximum Cu ionised fraction (19 %) was found for 50 μs, resulting in compact and smooth morphology for Cu-rich films, whereas short 25 μs pulses provided porous columnar films with rough surfaces, as the result from Ar+ bombardment. For Ag-rich films, Ag segregation allowed the deposition of dense layers, regardless of the used pulse width. Furthermore, low Ag (<10 at.%) CuAgZr films produced via HiPIMS and direct-current magnetron sputtering (DCMS) were compared in terms of structural and mechanical property changes as a function of Zr contents. For the studied chemical composition range, a linear relationship between Zr content, XRD phase shift and mechanical properties was observed for HiPIMS films, in contrast to DCMS's more abrupt transitions. An increase in hardness and elastic modulus (up to 44 % and 22 %, respectively) was found for the HiPIMS films compared to DCMS ones. The obtained results highlight HiPIMS's flexibility in providing a wide range of tailoring possibilities to meet specific application requirements, such as crystalline microstructure, density and associated mechanical properties

Fluorodeoxyglucose positron emission tomography in the evaluation of germ cell tumours at relapse

Differentiation of active disease from fibrosis/mature teratoma in patients with residual masses or identifying of sites of recurrence in patients with raised markers following treatment of their testicular cancer remains a problem.18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has the potential to identify active disease and thereby influence further management in these patients. We performed a retrospective study of the use of FDG-PET in detecting residual/recurrent testicular carcinoma in 55 patients (seventy FDG-PET scans). Forty-seven scans were for the assessment of residual masses (18 had raised markers) and 23 scans were for the investigation of raised markers in the presence of normal CT scans. True positive results were based on positive histology or clinical follow-up. FDG-PET had a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 90% in patients with residual masses. This PPV was equivalent to that of markers (94%) but FDG-PET had the advantage of identifying the site of that recurrence. The NPV was higher than that of markers. In patients with raised markers alone the PPV of FDG-PET was 92% but the NPV was only 50%. However, subsequent FDG-PET imaging was frequently the first imaging modality to identify the site of disease. FDG-PET effected a management change in 57% of cases. FDG-PET scanning detected viable tumour in residual masses and identified sites of disease in suspected recurrence. © 2000 Cancer Research Campaig

Party finance reform as constitutional engineering? The effectiveness and unintended consequences of party finance reform in France and Britain

In both Britain and France, party funding was traditionally characterized by a laissez faire approach and a conspicuous lack of regulation. In France, this was tantamount to a 'legislative vacuum'. In the last two decades, however, both countries have sought to fundamentally reform their political finance regulation regimes. This prompted, in Britain, the Political Parties, Elections and Referendums Act 2000, and in France a bout of 'legislative incontinence' — profoundly transforming the political finance regime between 1988 and 1995. This article seeks to explore and compare the impacts of the reforms in each country in a bid to explain the unintended consequences of the alternative paths taken and the effectiveness of the new party finance regime in each country. It finds that constitutional engineering through party finance reform is a singularly inexact science, largely due to the imperfect nature of information, the limited predictability of cause and effect, and the constraining influence of non-party actors, such as the Constitutional Council in France, and the Electoral Commission in Britain

The MGB Challenge: Evaluating Multi-genre Broadcast Media Recognition

This paper describes the Multi-Genre Broadcast (MGB) Challenge at ASRU 2015, an evaluation focused on speech recognition, speaker diarization, and "lightly supervised" alignment of BBC TV recordings. The challenge training data covered the whole range of seven weeks BBC TV output across four channels, resulting in about 1,600 hours of broadcast audio. In addition several hundred million words of BBC subtitle text was provided for language modelling. A novel aspect of the evaluation was the exploration of speech recognition and speaker diarization in a longitudinal setting - i.e. recognition of several episodes of the same show, and speaker diarization across these episodes, linking speakers. The longitudinal tasks also offered the opportunity for systems to make use of supplied metadata including show title, genre tag, and date/time of transmission. This paper describes the task data and evaluation process used in the MGB challenge, and summarises the results obtained

Microbiome Analysis Reveals the Presence of Bartonella spp. and Acinetobacter spp. in Deer Keds (Lipoptena cervi)

The deer ked (Lipoptena cervi) is distributed in Europe, North America, and Siberia and mainly infests cervids as roe deer, fallow deer, and moose. From a one health perspective, deer keds occasionally bite other animals or humans and are a potential vector for Bartonella schoenbuchensis. This bacterium belongs to a lineage of ruminant-associated Bartonella spp. and is suspected to cause dermatitis and febrile diseases in humans. In this study, we analyzed the microbiome from 130 deer keds collected from roe deer, fallow deer and humans in the federal states of Hesse, Baden-Wuerttemberg, and Brandenburg, Germany. Endosymbiontic Arsenophonus spp. and Bartonella spp. represented the biggest portion (~90%) of the microbiome. Most Bartonella spp. (n = 93) were confirmed to represent B. schoenbuchensis. In deer keds collected from humans, no Bartonella spp. were detected. Furthermore, Acinetobacter spp. were present in four samples, one of those was confirmed to represent A. baumannii. These data suggest that deer keds harbor only a very narrow spectrum of bacteria which are potentially pathogenic for animals of humans

Phase diagram and critical properties in the Polyakov--Nambu--Jona-Lasinio model

We investigate the phase diagram of the so-called Polyakov--Nambu--Jona-Lasinio model at finite temperature and nonzero chemical potential with three quark flavours. Chiral and deconfinement phase transitions are discussed, and the relevant order-like parameters are analyzed. The results are compared with simple thermodynamic expectations and lattice data. A special attention is payed to the critical end point: as the strength of the flavour-mixing interaction becomes weaker, the critical end point moves to low temperatures and can even disappear.Comment: Talk given at the 9th International Conference on Quark Confinement and the Hadron Spectrum - QCHS IX, Madrid, Spain, 30 August - September 201