The myth of patient centrality

Purpose: The purpose of this paper is to critically examine the extent of patient centrality within integrated chronic back pain management services and compare policy rhetoric with practice reality. Context: Integrated chronic back pain management services. Data sources: We have drawn on theories of integration and context specific journals related to integration and pain management between 1966 and 2006 to identify evidence of patient centrality within integrated chronic pain management services. Discussions: Despite policy rhetoric and guidelines which promote patient centrality within multidisciplinary services, we argue that evaluations of these services are scant. Many papers have focused on the assessment of pain in multidisciplinary services as opposed to the patient’s experience of these services. Conclusions: A latent measure of the reality of its magnitude needs to be captured through analysis of the patient perspectives. Capturing patient’s thoughts about integrated services will promote patient centrality and support the reality rather than endorse the rhetoric

Characteristics and classification of A-type supergiants in the Small Magellanic Cloud

We address the relationship between spectral type and physical properties for A-type supergiants in the SMC. We first construct a self-consistent classification scheme for A supergiants, employing the calcium K to H epsilon line ratio as a temperature-sequence discriminant. Following the precepts of the `MK process', the same morphological criteria are applied to Galactic and SMC spectra with the understanding there may not be a correspondence in physical properties between spectral counterparts in different environments. We then discuss the temperature scale, concluding that A supergiants in the SMC are systematically cooler than their Galactic counterparts at the same spectral type, by up to ~10%. Considering the relative line strengths of H gamma and the CH G-band we extend our study to F and early G-type supergiants, for which similar effects are found. We note the implications for analyses of extragalactic luminous supergiants, for the flux-weighted gravity-luminosity relationship and for population synthesis studies in unresolved stellar systems.Comment: 14 pages, 14 figures, accepted by MNRAS; minor section removed prior to final publicatio

Development of an Integrated Governance Strategy for the Voluntary and Community Sector

This report on governance provides a framework for thinking about how policy makers, funders,regulators and advisers can all work with Board members and staff to enhance the effectiveness of nonprofit organisations. It was commissioned by the Active Community Unit (ACU) of the Home Office, in parallel with other reviews designed to improve the capacity of the voluntary and community sector, at a time when the sector plays an increasingly important role in the delivery of services using public funds. That role has recently been investigated in two Government reports, the Cross Cutting Review carried out by the Treasury, and the Strategy Unit review of charities and nonprofits. Our report proposes actions of three types: some that can be taken immediately, some that require further discussion with key interests, and some integration with the other ACU reviews. Taken together they provide the starting point for an evolving strategy to improve governance across the sector. We recommend ACU chairs a group charged with the responsibility for planning and implementing this. Our focus is on governance as 'the systems and processes concerned with ensuring the overall direction, supervision and accountability of an organisation'. This is often taken to mean the way that a Board, management committee or other governing body steers the overall development of an organisation, where day-to-day management is in the hands of staff or volunteers. Sometimes, of course, the committee and volunteers are the same. They – like all governing bodies – have to balance the interests of the organisation and those they are trying to serve, while being conscious of financial and legal responsibilities, and the requirements of funders and other supporters

Discovery of a strong magnetic field on the O star HD 191612: new clues to the future of theta1 Orionis C?

From observations made with the ESPaDOnS spectropolarimeter, recently installed on the 3.6-m Canada--France--Hawaii Telescope, we report the discovery of a strong magnetic field in the Of?p spectrum variable HD 191612 -- only the second known magnetic O star (following theta1 Ori C). The stability of the observed Zeeman signature over four nights of observation, together with the non-rotational shape of line profiles, argue that the rotation period of HD 191612 is significantly longer than the 9-d value previously proposed. We suggest that the recently identified 538-d spectral-variability period is the rotation period, in which case the observed line-of-sight magnetic field of -220+-38 G implies a large-scale field (assumed dipolar) with a polar strength of about -1.5 kG. If confirmed, this scenario suggests that HD 191612 is, essentially, an evolved version of the near-ZAMS magnetic O star theta1 Ori C, but with an even stronger field (about 15 kG at an age similar to that of theta1Ori C). We suggest that the rotation rate of HD 191612, which is exceptionally slow by accepted O-star standards, could be due to angular-momentum dissipation through a magnetically confined wind.Comment: Accepted by MNRAS Letters, 5 pages, 2 figures, 2 table

Surface abundances of ON stars

Massive stars burn hydrogen through the CNO cycle during most of their evolution. When mixing is efficient, or when mass transfer in binary systems happens, chemically processed material is observed at the surface of O and B stars. ON stars show stronger lines of nitrogen than morphologically normal counterparts. Whether this corresponds to the presence of material processed through the CNO cycle or not is not known. Our goal is to answer this question. We perform a spectroscopic analysis of a sample of ON stars with atmosphere models. We determine the fundamental parameters as well as the He, C, N, and O surface abundances. We also measure the projected rotational velocities. We compare the properties of the ON stars to those of normal O stars. We show that ON stars are usually helium-rich. Their CNO surface abundances are fully consistent with predictions of nucleosynthesis. ON stars are more chemically evolved and rotate - on average - faster than normal O stars. Evolutionary models including rotation cannot account for the extreme enrichment observed among ON main sequence stars. Some ON stars are members of binary systems, but others are single stars as indicated by stable radial velocities. Hence, mass transfer is not a simple explanation for the observed chemical properties. We conclude that ON stars show extreme chemical enrichment at their surface, consistent with nucleosynthesis through the CNO cycle. Its origin is not clear at present.Comment: 18 pages, 10 figures (+ appendix). A&A accepte

The role of astrocytes in CNS tumors: pre-clinical models and novel imaging approaches

Brain metastasis is a significant clinical problem, yet the mechanisms governing tumor cell extravasation across the blood-brain barrier (BBB) and CNS colonization are unclear. Astrocytes are increasingly implicated in the pathogenesis of brain metastasis but in vitro work suggests both tumoricidal and tumor-promoting roles for astrocyte-derived molecules. Also, the involvement of astrogliosis in primary brain tumor progression is under much investigation. However, translation of in vitro findings into in vivo and clinical settings has not been realized. Increasingly sophisticated resources, such as transgenic models and imaging technologies aimed at astrocyte-specific markers, will enable better characterization of astrocyte function in CNS tumors. Techniques such as bioluminescence and in vivo fluorescent cell labeling have potential for understanding the real-time responses of astrocytes to tumor burden. Transgenic models targeting signaling pathways involved in the astrocytic response also hold great promise, allowing translation of in vitro mechanistic findings into pre-clinical models. The challenging nature of in vivo CNS work has slowed progress in this are a. Nonetheless, there has been a surge of interest in generating pre-clinical models, yiel ding insights into cell extravasation across the BBB, as well as immune cell recruitment to the parenchyma. While the function of astrocytes in the tumor microenvironment is still unknown, the relationship between astrogliosis and tumor growth is evident. Here, we review the role of astrogliosis in both primary and secondary brain tumors and outlin e the potential for the use of novel imaging modalities in research and clinical settings. These imaging approaches have the potential to enhance our understanding of the local host response to tumor progression in the brain, as well as providing new, more sensitive diagnostic imaging methods