British pain clinic practitioners' recognition and use of the bio-psychosocial pain management model for patients when physical interventions are ineffective or inappropriate : results of a qualitative study

Background To explore how chronic musculoskeletal pain is managed in multidisciplinary pain clinics for patients for whom physical interventions are inappropriate or ineffective. Methods A qualitative study was undertaken using semi-structured interviews with twenty five members of the pain management team drawn from seven pain clinics and one pain management unit located across the UK. Results All clinics reported using a multidisciplinary bio-psychosocial model. However the chronic pain management strategy actually focussed on psychological approaches in preference to physical approaches. These approaches were utilised by all practitioners irrespective of their discipline. Consideration of social elements such as access to social support networks to support patients in managing their chronic pain was conspicuously absent from the approaches used. Conclusion Pain clinic practitioners readily embraced cognitive/behavioural based management strategies but relatively little consideration to the impact social factors played in managing chronic pain was reported. Consequently multidisciplinary pain clinics espousing a bio-psychosocial model of pain management may not be achieving their maximum potential

Oscar, Derrida's Cat, and Other Knowing Animals

International audienceIn confrontations with animals, particularly in circumstances involving death, human knowledge suddenly appears limited. Other forms of knowledge have to be taken into account. The case of Oscar, the cat who predicts patients' death in a Rhode Island hospital, indicates that animals know things that are concealed from us. Our knowledge is limited, a premise that Derrida analyses in The Animal that Therefore I Am, where he admits that the philosophical literature about animals does not satisfactorily justify his human difference. Barry Lopez shows that our knowledge is not only insufficient when it comes to accounting for the agony of a school of beached whales, but that it is a poor substitute for our perplexity in the face of death. Heidegger's analysis in Being and Time offers an affirmative conception of the confrontation with death. Death ceases to be the destabilizing nothingness that threatens our existence and instead provokes knowledge. The study of two correlated texts, by Dickey and Dillard helps nuance the heroic Heideggerian conception of death. Finally, Loren Eiseley hints at a possibility that only literature can afford. Instead of attempting to seize the world through culture or envying animals' authenticity, human beings can acquire tangential perspectives upon their world and that of animals.Dans ses confrontations avec les animaux, particulièrement dans des circonstances où la mort est présente, le savoir humain s'avère insuffisant. D'autres formes de savoir doivent être prises en compte. Le cas d'Oscar, le chat qui anticipe la mort des patients d'un hôpital du Rhode Island, montre que les animaux savent des choses que nous ignorons. Notre savoir est limité, point de départ de la réflexion de Derrida dans L'animal que donc je suis, dans lequel il constate que la littérature philosophique sur les animaux ne suffit pas à justifier son humaine différence. Barry Lopez montre que notre savoir est insuffisant pour rendre compte de l'agonie d'un groupe de baleines échouées ; il n'est qu'un expédient assez faible pour dissimuler notre perplexité devant la mort. L'analyse de Heidegger dans L'être et le temps présente une conception positive de la confrontation avec la mort. Loin d'être un néant déstabilisateur qui menace notre existence, la mort est source de savoir. L'étude en miroir de deux textes de Dickey et Dillard nous aide à nuancer la conception héroïque de la mort selon Heidegger. Finalement, Loren Eiseley signale une autre possibilité que seul la littérature est en mesure d'offrir. Au lieu d'appréhender le monde à travers leur culture ou d'envier l'authenticité des animaux, les êtres humains bénéficient de visées tangentielles sur le monde et sur les animaux

White paper – On the use of LiDAR data at AmeriFlux sites

Our aim is to inform the AmeriFlux community on existing and upcoming LiDAR technologies (atmospheric Doppler or Raman LiDAR often deployed at flux sites are not considered here), how it is currently used at flux sites, and how we believe it could, in the future, further contribute to the AmeriFlux vision. Heterogeneity in vegetation and ground properties at various spatial scales is omnipresent at flux sites, and 3D mapping of canopy, understory, and ground surface can help move the science forward

Discovery of a Spin-Down State Change in the LMC Pulsar B0540-69

We report the discovery of a large, sudden, and persistent increase in the spin-down rate of B0540-69, a young pulsar in the Large Magellanic Cloud, using observations from the Swift and RXTE satellites. The relative increase in the spin-down rate of 36% is unprecedented for B0540-69. No accompanying change in the spin rate is seen, and no change is seen in the pulsed X-ray emission from B0540-69 following the change in the spin-down rate. Such large relative changes in the spin-down rate are seen in the recently discovered class of 'intermittent pulsars', and we compare the properties of B0540-69 to such pulsars. We consider possible changes in the magnetosphere of the pulsar that could cause such a large change in the spin-down rate.Comment: 6 pages, 2 figures, accepted for publication in ApJ Letter

Are complex systems hard to evolve?

Evolutionary complexity is here measured by the number of trials/evaluations needed for evolving a logical gate in a non-linear medium. Behavioural complexity of the gates evolved is characterised in terms of cellular automata behaviour. We speculate that hierarchies of behavioural and evolutionary complexities are isomorphic up to some degree, subject to substrate specificity of evolution and the spectrum of evolution parameters

End of Life Care Education: A Service evaluation

EXECUTIVE SUMMARY Introduction and scope of report Following a successful pilot programme which combined End of Life Care (EoLC) education with leadership skills, St Wilfred’s Hospice Chichester, in partnership with Sue Nash from Action Learning Teams were awarded a grant from the Frances and Augustus Newman Foundation to fund a follow-up programme and independent evaluation. The action learning and education development programme for care home leaders focused on improving End of Life Care provision in a care home setting and was delivered over one year. Bournemouth University (BU) undertook the independent service evaluation on behalf of the project team. This report concerns the evaluation element of the project. Evaluation questions Following consultation with the education facilitators, two questions were determined to guide the evaluation: • What are the care home managers’ perceptions of the impact of the educational programme on their leadership role in the provision of end of life care in their workplace? • Has confidence and competence in delivering and facilitating the delivery of end of life care changed over the course over the programme? Evaluation design As the evaluation questions sought to explore the effectiveness of learning as well as the relevance of the action learning approach, the evaluation was designed on the basis of a mixed methods approach. Quantitative methods utilised three questionnaires to explore; • Demographic data • Assessment of Training Needs using the Hennessey & Hicks Training Needs Analysis (TNA) Tool (with permission). • Assessment of Confidence using an adapted questionnaire developed by the Advanced Connected Advanced Communication Skills Programme offered under the auspices of the NHS End of Life Care Programme. Scores from competency documents were also collated. Qualitative methods involved focus groups, a type of group interview that stimulates interaction between participants in order to generate data. A member of the BU team acted as a facilitator using prepared trigger questions with the goal of eliciting perceptions and attitudes about the programme and its impact on participants’ practice. Participants were encouraged to share their views, to expand on these and others invited to comment. The interaction was audio-recorded (with permission). Data Analysis Completed questionnaires were managed and analysed using SPSS (V18.0) for Windows and descriptive statistical analysis was utilised. Reliability analysis (Cronbach’s Alpha) was used to screen the TNA and Confidence elements (and sub-categories) ahead of generating scores for these domains. The threshold for reliability was set at 0.7 or above. The focus groups were analysed using a process of thematic and content analysis. This technique is used with qualitative data and involves a process of systematically searching for themes or patterns in the data related to the evaluation questions. Subsequently, these themes are able to provide small thematic case study examples of how the professional development programme has impacted on practice. Findings - questionnaires TNA tool (n=6) The integration of the EoLC competencies indicates the tool has good internal face and content validity. Overall there was an improved perception of performance in role but the results are limited given the numbers of participants and the very slight degree of change evident. However, the results were confirmed and elaborated upon within the focus group data. Confidence questionnaire (n=6) Use of the confidence questionnaire indicates that the managers’ perceptions of confidence in a range of their abilities related to EoLC increased in all sections. However, given the managers’ desire to undertake the programme, perceived confidence in their knowledge and skills pre-programme was surprisingly high. An over-assessment of abilities seems likely resulting in a smaller extent of change post-programme. This conclusion is supported by the frequency and strength of comments concerning increased levels of knowledge and confidence as a result of the programme captured within the focus group data. Competency profile document (n=5) The competency profile appeared to be a very useful educational tool as it was so closely linked to the programme content. From the perspective of the evaluation however it yielded limited information. Nevertheless, the competency rating provides confirmation of the scores related to the corresponding areas of the confidence questionnaire. Findings – focus groups The perceptions of the focus group participants indicates that the programme offered a valuable opportunity for the development of interpersonal and management skills related to EoLC. Three themes emerged. First communication abilities in terms of leading and managing staff in the provisions of informed EoLC were reported to have significantly developed, alongside an increased sense of self-confidence. Second the style of the programme, which used action learning, resulted in the sharing of practice knowledge and a valuing of actively engaging in support networks. These ways of working were new to the participants. Finally the data indicated that the programme resulted in a sustainable model of education for this particular professional group, firstly perceived more effective management of staff to cascade best practice; second, the skills taught in action learning motivated the participants to continue to meet and share experiences post-programme on a self-managed basis. Discussion The evaluation has indicated increased confidence in care home managers knowledge and skills related to end of life care via a number of measures: the confidence questionnaire (CQ), the competency profile and the focus group feedback. The TNA questionnaire also showed some positive movement towards perceived increase in role performance in most domains. As the TNA, CQ and competency profile were linked with the EoLC competencies (DoH, 2009), it is reasonable to assume that improved confidence and perception of competence will have positively impacted on EoLC for residents. In addition, the focus groups provide examples and case studies of improved inter-professional liaison, cascading of knowledge and more proactive communication with residents and families when making decisions about EoLC. This data also indicates that for most participants this educational experience has been both personally and professionally effective, and even for some, life changing. The evaluation provides support for the link between excellent communication skills, effective leadership ability and better quality provision (Shaw et al, 2007; Thomas and Noble, 2007; King et al, 2008; Shaw et al, 2010; Seymour et al, 2011; Badger et al, 2012). The findings show that this educational strategy appeared to have a positive influence on communication both within the specialty and in general teams when working with colleagues and residents. Further the link between evidence-based care and confidence to deliver has emerged as very significant factor (Badger et al, 2012). The action-learning model appeared to be a sustainable approach as participants carried on appreciating the benefits of this, with the only cost being staff time. However, the programme length and small group size could be perceived as expensive. Conclusions In order to enable high quality EoLC, professional development should equip participants to be able to positively influence not just the individual’s immediate team, but also resident’s family members, care home owners, and other external stakeholders such as general practitioners (GP) and emergency departments in hospitals. This evaluation provides compelling evidence that an action learning approach to EoLC education can be used to empower middle managers to have positive impacts on EoLC provision through not only increasing specialist knowledge but also enhancing their capability to engage in a confident and informed manner with a diverse range of stakeholders. Recommendations Evidence from this evaluation suggests that • Expertly taught EoLC knowledge and skills is essential for care home managers to fulfil their role effectively • An action learning approach enables the embedding of specialist knowledge in practice through the enhancement of leadership skills linked to increased self-confidence. • The EoLC action learning education model leads to sustainable educational outcome

Chandra pulsar survey (ChaPS)

Taking advantage of the high sensitivity of the Chandra Advanced CCD Imaging Spectrometer, we have conducted a snap-shot survey of pulsars previously undetected in X-rays. We detected 12 pulsars and established deep flux limits for 11 pulsars. Using these new results, we revisit the relationship between the X-ray luminosity, L_psr_x, and spin-down power, Edot. We find that the obtained limits further increase the extremely large spread in the non-thermal X-ray efficiencies, eta_psr_x=L_psr_x/Edot, with some of them being now below 1e-5. Such a spread cannot be explained by poorly known distances or by beaming of pulsar radiation. We also find evidence of a break in the dependence of L_psr_x on Edot, such that pulsars become more X-ray efficient at Edot<~ 1e34-1e35 erg/s. We examine the relationship between the gamma-ray luminosity, L_psr_g, and Edot, which exhibits a smaller scatter compared to that in X-rays. This confirms that the very large spread in the X-ray efficiencies cannot be explained just by beaming because the gamma-ray emission is generally expected to be beamed stronger than the X-ray emission. Intriguingly, there is also an indication of a break in the L_psr_g(Edot) dependence at Edot~1e35 erg/s, with lower-Edot pulsars becoming less gamma-ray efficient. We also examine the distance-independent L_psr_f/L_psr_x ratio as a function of Edot for a sample of gamma-ray pulsars observed by Chandra and find that it peaks at Edot~1e35 erg/s, showing that the breaks cannot originate from poorly measured distances. We discuss the implications of our findings for existing models of magnetospheric emission and venues for further exploration.Comment: Submitted to Ap