WHO analgesic ladder gone astray: wider implications

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Payout Policy in the 21st Century

We survey 384 CFOs and Treasurers, and conduct in-depth interviews with an additional two dozen, to determine the key factors that drive dividend and share repurchase policies. We find that managers are very reluctant to cut dividends, that dividends are smoothed through time, and that dividend increases are tied to long-run sustainable earnings but much less so than in the past. Rather than increasing dividends, many firms now use repurchases as an alternative. Paying out with repurchases is viewed by managers as being more flexible than using dividends, permitting a better opportunity to optimize investment. Managers like to repurchase shares when they feel their stock is undervalued and in an effort to affect EPS. Dividend increases and the level of share repurchases are generally paid out of residual cash flow, after investment and liquidity needs are met. Financial executives believe that retail investors have a strong preference for dividends, in spite of the tax disadvantage relative to repurchases. In contrast, executives believe that institutional investors as a class have no strong preference between dividends and repurchases. In general, management views provide at most moderate support for agency, signaling, and clientele hypotheses of payout policy. Tax considerations play only a secondary role. By highlighting where the theory and practice of corporate payout policy are consistent and where they are not, we attempt to shed new light on important unresolved issues related to payout policy in the 21st century.

Nausea and vomiting in people with cancer and other chronic diseases

Introduction Nausea and vomiting occur in 40%–70% of people with cancer, and are also common in other chronic conditions such as hepatitis C and inflammatory bowel disease. Nausea and vomiting become more common as disease progresses. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for nausea and vomiting occurring as a result of either the disease or its treatment in adults with cancer? What are the effects of treatments for nausea and vomiting occurring as a result of either the disease or its treatment in adults with chronic diseases other than cancer? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5HT3 antagonists, antihistamines, antimuscarinics, atypical antipsychotics, benzodiazepines, butyrophenones, cannabinoids, corticosteroids, haloperidol, metoclopramide, NK1 antagonists, phenothiazines, prokinetics, 5HT3 antagonists plus corticosteroids, and venting gastrostomy

Variation in suicide rates between Health Board areas

This paper examines variations in suicide in the eight Health Boards of the Republic of Ireland for the years 1976 to 1995. It is found that while all have experienced a rise in male suicide, it has been much less pronounced in the Eastern Health Board which is somewhat surprising when one considers Dublin’s much-publicised problems with homelessness and hard drug misuse. Since the mid-eighties, female rates have been somewhat higher in the southern half of the country, comprising the Southern, Mid-Western and South-Eastern Health Boards. This variation may reflect a difficulty with contacting services for psychological distress in rural areas, either because of stigma or simple practical problems associated with transport. The development of appropriate services, especially in rural areas, should be at the top of the agenda of any Resource Officer to be appointed subsequent to the Final Report of the Task Force

Adverse childhood experiences and lifetime suicide ideation: a cross-sectional study in a non-psychiatric hospital setting

We have assessed the effect of adverse childhood experiences on the lifetime prevalence of suicide ideation in a cross-sectional study involving 182 patients aged 18 to 44 years, consecutive attenders at an A&E review clinic. All participants were interviewed by a psychologist using standardised questionnaire instruments addressing participants’ demographic characteristics, drug use, depressed mood, eight major categories of adverse childhood experiences (including physical, emotional and sexual abuse) and suicide ideation. The response rate was 73%. In multivariate logistic regression analyses, those with a history of two or more forms of childhood adversity relative to those with none were at increased risk of depressed mood (OR = 5.5, 95% CI = 2.3-13.3) and suicide ideation (OR = 3.5, 95% CI = 1.5-8.3). The findings emphasise the need to set suicide prevention within the broader context of society’s obligation to protect children from physical, emotional and sexual abuse

Space Time Coding Over a Multiple-Channel Free Space Optical Link

Free space optical (FSO) communications in the atmosphere are characterized by additive white Gaussian noise (AWGN) and turbulent fading. We propose a combination of spatial and temporal forward error correction (FEC) coding to instantaneously correct for long-duration fades over a multiple channel link. We simulate this over a turbulent channel and identify the probability of outage of such a channel as the most significant channel parameter

COVID-19 and Hospital Palliative Care – a service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care

Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population. Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a ‘typical’ caseload from 2019. Design: Service evaluation based on a retrospective cohort review of patient records. Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020. Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a ‘typical’ caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced ‘typical’ caseload; overall numbers of referrals were not increased. Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from ‘typical’ caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines

Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market

BACKGROUND: Distalgesic, the prescription-only analgesic compound of paracetamol (325 mg) and dextropropoxyphene (32.5 mg) known as co-proxamol in the UK, was withdrawn from the Irish market as of January 2006. This study aimed to evaluate the impact of the withdrawal of distalgesic in terms of intentional drug overdose (IDO) presentations to hospital emergency departments (EDs) nationally. METHODS: A total of 42,849 IDO presentations to 37 of the 40 hospitals EDs operating in Ireland in 2003-2008 were recorded according to standardised procedures. Data on sales of paracetamol-containing drugs to retail pharmacies for the period 1998-2008 were obtained from IMS Health. RESULTS: The withdrawal of distalgesic from the Irish market resulted in an immediate reduction in sales to retail pharmacies from 40 million tablets in 2005 to 500,000 tablets in 2006 while there was a 48% increase in sales of other prescription compound analgesics. The rate of IDO presentations to hospital involving distalgesic in 2006- 2008 was 84% lower than in the three years before it was withdrawn (10.0 per 100,000). There was a 44% increase in the rate of IDO presentations involving other prescription compound analgesics but the magnitude of this rate increase was five times smaller than the magnitude of the decrease in distalgesic-related IDO presentations. There was a decreasing trend in the rate of presentations involving any paracetamol-containing drug that began in the years before the distalgesic withdrawal. CONCLUSIONS: The withdrawal of distalgesic has had positive benefits in terms of IDO presentations to hospital in Ireland and provides evidence supporting the restriction of availability of means as a prevention strategy for suicidal behaviour

A Recommender Model for the Personalized Adaptive CHUNK Learning System

Recommender systems attempt to influence one’s behavior based on explicit and implicit information provided by the users of the system. Users who take part in e-commerce or watch cat videos online will be familiar with this concept. Different algorithms exist that determine what objects or concepts to recommend to users, but every one of them has the similar goal of providing a good recommendation. In this context, good means that the recommendation will be user relevant suggesting accurate topics, and will influence the user’s behavior. Additionally, a good recommendation system is adaptive, consistently seeking feedback from the user. Feedback is then used to make the next recommendation better. In this work, we develop a recommendation methodology for an existing personalized learning system, where both content and teaching methodology options are presented to the user. Our methodology provides solutions to both the user and the network coldstart problems, where little up-front information is available in order to make good recommendations. Using real system data, we show how our method recommends the most relevant learning topics and styles and incorporates user feedback to improve future recommendations.Do