The Economic Costs and Benefits of Dental Education: An Empirical Analysis

The rising costs associated with obtaining a dental education have caused some to question the financial benefit of pursuing a dental degree. There is a concern that recent graduates may have difficulty finding professional opportunities that provide the income necessary to service their accumulated educational debt. The aim of this study was to evaluate the trends in educational costs to aid in making an accurate appraisal of the financial benefit of a dental education. Adjusted into constant dollar terms, data from a variety of sources were collected for economic variables such as tuition, fees, student indebtedness, and dentists’ earnings. These variables were then analyzed to determine the true costs and benefits of obtaining a dental education. The results showed that, over the course of the last decade, educational costs increased faster than the real net income of practicing dentists, which led to a decline in the return on investment in dental education. However, regardless of an applicant’s choice of public or private dental school, there continues to be a positive economic return on students’ commitment of both financial resources and time to receive a dental education

The VOICE Study: Valuing Opinions, Individual Communication and Experience: Building the evidence base for undertaking patient-centred family meetings in palliative care - a mixed methods study

Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives. Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site. The patient will set the meeting agenda a priori allowing an opportunity for their issues to be prioritised and addressed. At the control site, usual care will be maintained which may include a family meeting. Each site will recruit 20 dyads comprising a terminally ill inpatient and their nominated family member. Pre- and post-test administration of the Distress Thermometer, QUAL-EC, QUAL-E, and Patient Health Questionnaire-4 will assess patient and family distress and satisfaction with quality of life. Patient, family, and clinician interviews post-meeting will provide insights into the meeting feasibility and outcome measures. Recruitment percentages and outcome measure completion will also inform feasibility. Descriptive statistics will summarise pre- and post-meeting data generated by the outcome measures. SPSS will analyse the quantitative data. Grounded theory will guide the qualitative data analysis. Discussion: This study will determine whether planned Patient-Centred Family Meetings are feasible and acceptable and assess the suitability and feasibility of the outcome measures. It will inform a future phase III randomised controlled trial. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616001083482 on 11 August 201

Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: A cohort study

Context: The short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated. Objectives: The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers. Methods: A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = 301). Sociodemographic, mental health, and bereavement-related data were collected from the caregiver upon the patient\u27s admission to palliative care (T1). Further data addressing circumstances around the death and psychological health were collected at six (T2, n = 167), 13 (T3, n = 143), and 37 months (T4, n = 85) after bereavement. Results: At T4, 5% and 14% of bereaved caregivers met criteria for PGD and subthreshold PGD, respectively. Applying the total PGD score at T4, linear regression analysis found preloss anticipatory grief measured at T1 and self-reported coping measured at T2 were highly statistically significant predictors (both p \u3c 0.0001) of PGD in the longer term. Conclusion: For almost 20% of caregivers, the symptoms of PGD appear to persist at least three years post bereavement. These findings support the importance of screening caregivers upon the patient\u27s admission to palliative care and at six months after bereavement to ascertain their current mental health. Ideally, caregivers at risk of developing PGD can be identified and treated before PGD becomes entrenched

Recovery-Oriented Training and Staff Attitudes Over Time in Two State Hospitals

Recovery attitudes and concepts are often promoted to community mental health staff through educational and in-service trainings, but no study found has examined this in state hospitals. The current observational study aimed to examine the types of recovery-oriented trainings that occurred at two state hospitals over 1 year and subsequent changes in staff recovery attitudes. A total of 184 state hospital staff completed questionnaires assessing their personal optimism, consumer optimism, and agency recovery orientation at baseline and 1 year later. The types of recovery-oriented trainings staff received were categorized as general/inspirational or specific/practical training. Results found that the majority of staff at the two state hospitals received some recovery-oriented training, mostly general/inspirational training. Staff who received specific/practical training had a greater increase in agency recovery attitudes than staff who received only general/inspirational training or no training. However, the more trainings staff had, the higher their consumer optimism. These results suggest state hospitals are incorporating recovery-oriented staff trainings, but more specific trainings may be needed and all staff involved in different levels of care need to be included

An integrable multicomponent quad equation and its Lagrangian formulation

We present a hierarchy of discrete systems whose first members are the lattice modified Korteweg-de Vries equation, and the lattice modified Boussinesq equation. The N-th member in the hierarchy is an N-component system defined on an elementary plaquette in the 2-dimensional lattice. The system is multidimensionally consistent and a Lagrangian which respects this feature, i.e., which has the desirable closure property, is obtained.Comment: 10 page

Living with multiple myeloma: A focus group study of unmet needs and preferences for survivorship care

Purpose: To describe the unmet informational, psychological, emotional, social, practical, and physical needs and preferences for posttreatment survivorship care of individuals living with multiple myeloma to inform the development of relevant, personcentered, survivorship services. Methods: An exploratory, descriptive study using 2 focus groups with 14 participants, 6 to 49 months postdiagnosis. Results: Thematic analysis revealed 7 key themes: information needs, experience with health-care professionals, coping with side effects, communicating with family and friends, dealing with emotions, support needs, and living with the chronicity of myeloma. Participants described key characteristics of survivorship care relevant to their needs and indicated they would like a more whole of person approach to follow-up when the main treatment phases had completed. Conclusion: Participants in this study described unmet needs across a breadth of domains that varied over time. The development of flexible, person-centered approaches to comprehensive survivorship care is needed to address the considerable quality-of-life issues experienced by people living with multiple myeloma. Nurse-led care may offer 1 viable model to deliver enhanced patient experience—providing the vital “link” that people described as missing from their survivorship care

Orphan Drugs Assessment in Germany: A Comparison with Other International HTA Agencies

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Discrete-time Calogero-Moser system and Lagrangian 1-form structure

We study the Lagrange formalism of the (rational) Calogero-Moser (CM) system, both in discrete time as well as in continuous time, as a first example of a Lagrange 1-form structure in the sense of the recent paper [19]. The discrete-time model of the CM system was established some time ago arising as a pole-reduction of a semi-discrete version of the KP equation, and was shown to lead to an exactly integrable correspondence (multivalued map). In this paper we present the full KP solution based on the commutativity of the discrete-time flows in the two discrete KP variables. The compatibility of the corresponding Lax matrices is shown to lead directly to the relevant closure relation on the level of the Lagrangians. Performing successive continuum limits on both the level of the KP equation as well as of the CM system, we establish the proper Lagrange 1-form structure for the continuum case of the CM model. We use the example of the three-particle case to elucidate the implementation of the novel least-action principle, which was presented in [19], for the simpler case of Lagrange 1-forms.Comment: 37 pages, 8 figure

\u27Through the eyes of the dying\u27 - Identifying who may benefit from bereavement follow-up: A qualitative study

Introduction: Bereavement support is an integral element of palliative care. Emerging evidence stipulates that bereavement support should be reserved for those most at risk of poor outcomes. While this evidence makes identifying those at risk of experiencing a complex bereavement a necessary first step, it has been difficult to arrive at a consensus as to whom that should be. Aim: To explore whether palliative care in-patients with advanced disease are concerned about the bereavement needs of others and, if so, is it their next-of-kin. Design: A qualitative study using semi-structured interviews, and thematic analysis using a constant comparative method. Setting/participants: Patients identified by their physicians as being aware of their limited prognosis (n = 19) in a specialist palliative care service in Sydney, Australia. Findings: Three key themes emerged: 1) Families considered close and supportive may not require bereavement follow-up; 2) Families with previous significant losses or who have more complex lives are perceived by patients as having greater risk; and 3) Asking palliative care patients about whom they are most concerned in their network after their death is difficult but possible. Conclusions: There are potentially people in the palliative patients’ networks who may be in need of bereavement support, but who are unlikely to be informed about available bereavement services. New strategies are needed to identify people who may benefit from bereavement support

Current-voltage characteristics of diluted Josephson-junction arrays: scaling behavior at current and percolation threshold

Dynamical simulations and scaling arguments are used to study the current-voltage (IV) characteristics of a two-dimensional model of resistively shunted Josephson-junction arrays in presence of percolative disorder, at zero external field. Two different limits of the Josephson-coupling concentration $p$ are considered, where $p_c$ is the percolation threshold. For $p$ $>$ $p_c$ and zero temperature, the IV curves show power-law behavior above a disorder dependent critical current. The power-law behavior and critical exponents are consistent with a simple scaling analysis. At $p_c$ and finite temperature $T$, the results show the scaling behavior of a T=0 superconducting transition. The resistance is linear but vanishes for decreasing $T$ with an apparent exponential behavior. Crossover to non-linearity appears at currents proportional to $$, with a thermal-correlation length exponent $\nu_T$ consistent with the corresponding value for the diluted XY model at $p_c$.Comment: Revtex, 9 postscript pages, to appear in Phys. Rev.