312 research outputs found
Response to Suffering of the Seriously Ill Child: A History of Palliative Care for Children
Most pediatric clinicians aspire to promote the physical, emotional, and developmental well-being of children, hoping to bestow a long and healthy life. Yet, some infants, children, and adolescents confront life-threatening illnesses and life-shortening conditions. Over the past 70 years, the clinician's response to the suffering of these children has evolved from veritable neglect to the development of pediatric palliative care as a subspecialty devoted to their care. In this article, we review the history of how clinicians have understood and responded to the suffering of children with serious illnesses, highlighting how an initially narrow focus on anxiety eventually transformed into a holistic, multidimensional awareness of suffering. Through this transition, and influenced by the adult hospice movement, pediatric palliative care emerged as a new discipline. Becoming a discipline, however, has not been a panacea. We conclude by highlighting challenges remaining for the next generation of pediatric palliative care professionals to address
Radio-frequency dressed state potentials for neutral atoms
Potentials for atoms can be created by external fields acting on properties
like magnetic moment, charge, polarizability, or by oscillating fields which
couple internal states. The most prominent realization of the latter is the
optical dipole potential formed by coupling ground and electronically excited
states of an atom with light. Here we present an experimental investigation of
the remarkable properties of potentials derived from radio-frequency (RF)
coupling between electronic ground states. The coupling is magnetic and the
vector character allows to design state dependent potential landscapes. On atom
chips this enables robust coherent atom manipulation on much smaller spatial
scales than possible with static fields alone. We find no additional heating or
collisional loss up to densities approaching atoms / cm compared
to static magnetic traps. We demonstrate the creation of Bose-Einstein
condensates in RF potentials and investigate the difference in the interference
between two independently created and two coherently split condensates in
identical traps. All together this makes RF dressing a powerful new tool for
micro manipulation of atomic and molecular systems
Sisyphus Cooling of Electrically Trapped Polyatomic Molecules
The rich internal structure and long-range dipole-dipole interactions
establish polar molecules as unique instruments for quantum-controlled
applications and fundamental investigations. Their potential fully unfolds at
ultracold temperatures, where a plethora of effects is predicted in many-body
physics, quantum information science, ultracold chemistry, and physics beyond
the standard model. These objectives have inspired the development of a wide
range of methods to produce cold molecular ensembles. However, cooling
polyatomic molecules to ultracold temperatures has until now seemed
intractable. Here we report on the experimental realization of opto-electrical
cooling, a paradigm-changing cooling and accumulation method for polar
molecules. Its key attribute is the removal of a large fraction of a molecule's
kinetic energy in each step of the cooling cycle via a Sisyphus effect,
allowing cooling with only few dissipative decay processes. We demonstrate its
potential by reducing the temperature of about 10^6 trapped CH_3F molecules by
a factor of 13.5, with the phase-space density increased by a factor of 29 or a
factor of 70 discounting trap losses. In contrast to other cooling mechanisms,
our scheme proceeds in a trap, cools in all three dimensions, and works for a
large variety of polar molecules. With no fundamental temperature limit
anticipated down to the photon-recoil temperature in the nanokelvin range, our
method eliminates the primary hurdle in producing ultracold polyatomic
molecules. The low temperatures, large molecule numbers and long trapping times
up to 27 s will allow an interaction-dominated regime to be attained, enabling
collision studies and investigation of evaporative cooling toward a BEC of
polyatomic molecules
"It's making contacts" : notions of social capital and implications for widening access to medical education
Acknowledgements Our thanks to the Medical Schools Council (MSC) of the UK for funding Study A; REACH Scotland for funding Study B; and Queen Mary University of London, and to the medical school applicants and students who gave their time to be interviewed. Our thanks also to Dr Sean Zhou and Dr Sally Curtis, and Manjul Medhi, for their help with data collection for studies A and B respectively. Our thanks also to Dr Lara Varpio, Uniformed Services University of the USA, for her advice and guidance on collating data sets and her comments on the draft manuscript.Peer reviewedPublisher PD
Clinical factors associated with fatigue over time in paediatric oncology patients receiving chemotherapy
The purpose of this study was to investigate the relationships between clinical factors (including haemoglobin value, chemotherapeutic agents, and corticosteroid use) and changing patterns of fatigue before and for the next 10 days following the start of a new round of chemotherapy in children with cancer. A prospective longitudinal design was used to collect data from 48 paediatric oncology patients who were about to begin a new round of chemotherapy and their parents. Fatigue levels were assessed using multidomain questionnaires with three categories of patient self-report (including ‘General Fatigue', ‘Sleep/Rest Fatigue', and ‘Cognitive Fatigue') and four categories of parent proxy-report (including ‘Lack of Energy', ‘Unable to Function', ‘Altered Sleep', and ‘Altered Mood'). The findings suggest that fatigue from both patient self-report and parent proxy-report changed significantly over time. The major findings from this study are that patients have more problems with fatigue in the first few days after the start of a cycle of chemotherapy. Corticosteroid use and haemoglobin value were associated with significant increases in fatigue that were sustained for several days and reached the highest level of fatigue at day 5 for those receiving concurrent steroids. The association of chemotherapeutic agents with fatigue varied between patient self-report and parent report, but the type of chemotherapeutic agents used was not associated with most changes in fatigue
Deformation analysis of a metropolis from C- to X-band PSI: proof-of-concept with Cosmo-Skymed over Rome, Italy
Stability of monuments and subsidence of residential
quarters in Rome (Italy) are depicted based on geospatial
analysis of more than 310,000 Persistent Scatterers (PS)
obtained from Stanford Method for Persistent Scatterers
(StaMPS) processing of 32 COSMO-SkyMed 3m-resolution
HH StripMap ascending mode scenes acquired between 21
March 2011 and 10 June 2013. COSMO-SkyMed PS
densities and associated displacement velocities are
compared with almost 20 years of historical C-band ERS-
1/2, ENVISAT and RADARSAT-1/2 imagery. Accounting
for differences in image processing algorithms and satellite
acquisition geometries, we assess the feasibility of ground
motion monitoring in big cities and metropolitan areas by
coupling newly acquired and legacy SAR in full time series.
Limitations and operational benefits of the transition from
medium resolution C-band to high resolution X-band PS
data are discussed, alongside the potential impact on the
management of expanding urban environments
Managing formalization to increase global team effectiveness and meaningfulness of work in multinational organizations
Global teams may help to integrate across locations, and yet, with formalized rules and procedures, responsiveness to those locations’ effectiveness, and the team members’ experiences of work as meaningful may suffer. We employ a mixed-methods approach to understand how the level and content of formalization can be managed to resolve these tensions in multinationals. In a sample of global teams from a large mining and resources organization operating across 44 countries, interviews, observations, and a quantitative 2-wave survey revealed a great deal of variability between teams in how formalization processes were enacted. Only those formalization processes that promoted knowledge sharing were instrumental in improving team effectiveness. Implementing rules and procedures in the set-up of the teams and projects, rather than during interactions, and utilizing protocols to help establish the global team as a source of identity increased this knowledge sharing. Finally, we found members’ personal need for structure moderated the effect of team formalization on how meaningful individuals found their work within the team. These findings have significant implications for theory and practice in multinational organizations
Multiple Colonization with S. pneumoniae before and after Introduction of the Seven-Valent Conjugated Pneumococcal Polysaccharide Vaccine
Simultaneous carriage of more than one strain of Streptococcus pneumoniae promotes horizontal gene transfer events and may lead to capsule switch and acquisition of antibiotic resistance. We studied the epidemiology of cocolonization with S. pneumoniae before and after introduction of the seven-valent conjugated pneumococcal vaccine (PCV7)
Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF.</p> <p>Methods</p> <p>Based on evidence extracted from a literature review, a curriculum for the self-management program was elaborated. The curriculum was reviewed and validated by an interdisciplinary expert group and the training-modules will be pretested with a small number of participants and discussed in terms of feasibility and acceptance.</p> <p>To determine the efficacy of the program a randomised controlled trial will be carried out: 300 patients will be recruited from oncological practices in Bremen, Germany, and will be allocated to intervention or control group. The intervention group participates in the program, whereas the control group receives standard care and the opportunity to take part in the program after the end of the follow-up (waiting control group). Primary outcome measure is the level of fatigue, secondary outcome measures are quality of life, depression, anxiety, self-efficacy and physical activity. Data will be collected before randomisation, after intervention, and after a follow-up of 6 months.</p> <p>Discussion</p> <p>Because there are no comparable self-management programs for cancer survivors with fatigue, the development of the curriculum has been complex; therefore, the critical appraisal by the experts was an important step to validate the program and their contributions have been integrated into the curriculum. The experts appreciated the program as filling a gap in outpatient cancer care.</p> <p>If the results of the evaluation prove to be satisfactory, the outpatient care of cancer patients can be broadened and supplemented.</p> <p>Trial Registration</p> <p>ClinicalTrials NCT00552552</p
Older patients' attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients
<p>Abstract</p> <p>Background</p> <p>Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. This study examines older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries.</p> <p>Methods</p> <p>A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach.</p> <p>Results</p> <p>Themes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment.</p> <p>Conclusions</p> <p>A variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in patients’ experiences.</p
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