Empirical approaches to improving the use of DNA in crime scene investigative practice

At the beginning of the 21st century, rural policy remains one of the most important areas of public policy; huge financial and human resources are devoted to the implementation of this policy measures. The aim of the article is to provide holistic evaluation of the goals, means and key achievements of Lithuanian agricultural policy and to identify possible areas and ways of improvement. The diversity of agricultural policy measures applied in Lithuania after the restoration of independence in 1990 and achievements of the policy are analysed on the basis of new approach – the theory of qualitative structures. The study explores how policy measures to accelerate the process of industrialization in Lithuanian agriculture after the privatization of kolkhozes and sovkhozes have encouraged and supported private farms to implement extensive growth, intensification, specialization, risk management, collaboration and innovation production strategies, and what results they have achieved.XXI a. pradžioje kaimo politika išlieka viena iš svarbiausių viešosios politikos sričių. Šios politikos priemonėms diegti skiriama labai daug finansinių ir žmogiškųjų išteklių. Straipsnio tikslas – holistiškai įvertinti Lietuvos žemės ūkio politikos tikslus, priemones ir pasiekimus, identifikuoti galimas tobulinimo kryptis. Žemės ūkio politikos priemonių, taikytų Lietuvoje po nepriklausomybės atgavimo 1990 m., įvairovė ir pasiekimai analizuojami remiantis kokybinių struktūrų analizės metodu. Aptariama, kaip politikos priemonėmis, siekiant paspartinti industrializacijos procesą Lietuvos žemės ūkyje, ūkininkai buvo skatinami panaudoti šių priemonių kokybinės struktūros galimybes, kad būtų įgyvendinamos ekstensyvaus augimo, intensifikacijos, specializacijos, rizikos valdymo, bendradarbiavimo ir inovacijų strategijos

Empirical approaches to improving the use of DNA in crime scene investigative practice

This article reports on a collaborative project that explored the targeted use of swabbing evidence sources which, up until now, have not been routinely recovered or utilised for DNA analysis. All genres of the forensic portfolio have undergone significant changes driven by economic, political and technological influencers, which have resulted in an array of interpretations on its frontline delivery, often based on local requirements. The approach reported here pertains to a research project bringing together a collaborative team of researchers, representing practitioners and academics, working in conjunction with forensic service providers. The project reviewed the process of swabbing glove marks at crime scenes, comparing the methods used with DNA profiling outcomes. The findings showed significant benefits in regards to DNA outcomes, providing six detections over a four-month period that were attributable to the swabbing of the glove marks. Furthermore, the study provided key data to guide practice and crime scene methods to meet new operational requirements

To What Extent Do the NRS and CRQ Capture Change in Patients' Experience of Breathlessness in Advanced Disease? Findings From a Mixed-Methods Double-Blind Randomized Feasibility Trial.

CONTEXT: Chronic or refractory breathlessness is common and distressing. To evaluate new treatments, outcome measures that capture change in patients' experience are needed. OBJECTIVES: To explore the extent to which the numerical rating scale (NRS) worst and average, and the Chronic Respiratory Questionnaire capture change in patients' experience during a trial of mirtazapine for refractory breathlessness. METHODS: Convergent mixed-methods design embedded within a randomized trial comprising 1) semi-structured qualitative interviews (considered to be the gold standard) and 2) outcome measure data collected pre- and post-intervention. Data were integrated, exploring examples where findings agreed and disagreed. Adults with advanced cancer, chronic obstructive pulmonary disease, interstitial lung disease, or chronic heart failure, with a modified Medical Research Council dyspnea scale grade 3 or 4 were recruited from three U.K. sites. RESULTS: Data were collected for 22 participants. Eleven had a diagnosis of chronic obstructive pulmonary disease, eight interstitial lung disease, two chronic heart failure, and one cancer. Median age was 71 (56-84) years. Sixteen participants were men. Changes in the qualitative data were commonly captured in the NRS (worst and average) and the Chronic Respiratory Questionnaire. The NRS worst captured change most frequently. Improvement in the emotional domain was associated with physical changes, improved confidence, and control. CONCLUSION: This study found that the NRS using the question "How bad has your breathlessness felt at its worst over the past 24 hours?" captured change across multiple domains, and therefore may be an appropriate primary outcome measure in trials in this population. Future work should confirm the construct validity of this question

Finding a 'new normal' following acute illness: A qualitative study of influences on frail older people's care preferences.

BACKGROUND:: The frail older population is growing, and many frail older people have episodes of acute illness. Patient preferences are increasingly considered important in the delivery of person-centred care and may change following acute illness. AIM:: To explore influences on the care preferences of frail older people with recent acute illness. DESIGN:: Qualitative in-depth individual interviews, with thematic analysis. SETTING/PARTICIPANTS:: Maximum variation sample of 18 patients and 7 nominated family carers from a prospective cohort study of people aged over 65, scoring ⩾5 on the Clinical Frailty Scale, and with recent acute illness, who were not receiving specialist palliative care. Median patient age was 84 (inter-quartile range 81–87), 53% female. Median frailty score 6 (inter-quartile range 5–7). RESULTS:: Key influences on preferences were illness and care context, particularly hospital care; adaptation to changing health; achieving normality and social context. Participants focused on the outcomes of their care; hence, whether care was likely to help them ‘get back to normal’, or alternatively ‘find a new normal’ influenced preferences. For some, acute illness inhibited preference formation. Participants’ social context and the people available to provide support influenced place of care preferences. We combined these findings to model influences on preferences. CONCLUSION:: ‘Getting back to normal’ or ‘finding a new normal’ are key focuses for frail older people when considering their preferences. Following acute illness, clinicians should discuss preferences and care planning in terms of an achievable normal, and carefully consider the social context. Longitudinal research is needed to explore the influences on preferences over time.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was independent research funded by Cicely Saunders International and the Atlantic Philanthropies (grant 24610). The sponsor had no role in the design, methods, subject recruitment, data collection, analysis or preparation of this article. This research was supported by the collaboration for Leadership in Applied Health Research and Care, South London, which is part of the National Institute for Health Research (NIHR), and is a partnership between King’s Health Partners, St. George’s University London, and St George’s Healthcare National Health Service (NHS) Trust. I.J.H. is an Emeritus NIHR Senior Investigator. The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care

Firefly luciferase in chemical biology: A compendium of inhibitors, mechanistic evaluation of chemotypes, and suggested use as a reporter

Firefly luciferase (FLuc) is frequently used as a reporter in high-throughput screening assays owing to the exceptional sensitivity, dynamic range, and rapid measurement that bioluminescence affords. However, interaction of small molecules with FLuc has, to some extent, confounded its use in chemical biology and drug discovery. To identify and characterize chemotypes interacting with FLuc, we determined potency values for 360,864 compounds, found in the NIH Molecular Libraries Small Molecule Repository, available in PubChem. FLuc inhibitory activity was observed for 12% of this library with discernible SAR. Characterization of 151 inhibitors demonstrated a variety of inhibition modes including FLuc-catalyzed formation of multisubstrate-adduct enzyme inhibitor complexes. As in some cell-based FLuc reporter assays compounds acting as FLuc inhibitors yield paradoxical luminescence increases, data on compounds acquired from FLuc-dependent assays requires careful analysis as described in this report

Influences on Care Preferences of Older People with Advanced Illness: A Systematic Review and Thematic Synthesis.

OBJECTIVES: To determine and explore the influences on care preferences of older people with advanced illness and integrate our results into a model to guide practice and research. DESIGN: Systematic review using Medline, Embase, PsychINFO, Web of Science, and OpenGrey databases from inception to February 2017 and reference and citation list searching. Included articles investigated influences on care preference using qualitative or quantitative methodology. Thematic synthesis of qualitative articles and narrative synthesis of quantitative articles were undertaken. SETTING: Hospital and community care settings. PARTICIPANTS: Older adults with advanced illness, including people with specific illnesses and markers of advanced disease, populations identified as in the last year of life, or individuals receiving palliative care (N = 15,164). MEASUREMENTS: The QualSys criteria were used to assess study quality. RESULTS: Of 12,142 search results, 57 articles were included. Family and care context, illness, and individual factors interact to influence care preferences. Support from and burden on family and loved ones were prominent influences on care preferences. Mechanisms by which preferences are influenced include the process of trading-off between competing priorities, making choices based on expected outcome, level of engagement, and individual ability to form and express preferences. CONCLUSION: Family is particularly important as an influence on care preferences, which are influenced by complex interaction of family, individual, and illness factors. To support preferences, clinicians should consider older people with illnesses and their families together as a unit of care.Cicely Saunders International Atlantic Philanthropies. Grant Number: 24610 Collaboration for Leadership in Applied Health Research and Care, South London National Institute for Health Research (NIHR) King's Health Partners St. George's University London St George's Healthcare National Health Service (NHS) Trus

Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer

Purpose: While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended Advance Care Plans and examine how accurately advance care planning documentation represented patient wishes. Methods: This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants’ existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate; Statement of Choices; and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Results: Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91) and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: Incomplete advance care planning understanding and confidence; Limited congruence for attitude and documentation; Advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants’ attitudes and their written document congruence was limited, but advance care planning was seen as helpful. Conclusions: This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation

Randomised, double-blind, multicentre, mixed-methods, dose-escalation feasibility trial of mirtazapine for better treatment of severe breathlessness in advanced lung disease (BETTER-B feasibility)

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. New treatments are required for severe breathlessness in advanced disease. We conducted a randomised feasibility trial of mirtazapine over 28 days in adults with a modified medical research council breathlessness scale score ≥3. Sixty-four patients were randomised (409 screened), achieving our primary feasibility endpoint of recruitment. Most patients had COPD or interstitial lung disease; 52 (81%) completed the trial. There were no differences between placebo and mirtazapine in tolerability or safety, and blinding was maintained. Worst breathlessness ratings at day 28 (primary clinical activity endpoint) were, 7.1 (SD 2.3, placebo) and 6.3 (SD 1.8, mirtazapine). A phase III trial of mirtazapine is indicated. Trial registration: ISRCTN 32236160; European Clinical Trials Database (EudraCT no: 2015-004064-11)

A brief, patient- and proxy-reported outcome measure in advanced illness: Validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS)

Background:Few measures capture the complex symptoms and concerns of those receiving palliative care.Aim:To validate the Integrated Palliative care Outcome Scale, a measure underpinned by extensive psychometric development, by evaluating its validity, reliability and responsiveness to change.Design:Concurrent, cross-cultural validation study of the Integrated Palliative care Outcome Scale – both (1) patient self-report and (2) staff proxy-report versions. We tested construct validity (factor analysis, known-group comparisons, and correlational analysis), reliability (internal consistency, agreement, and test–retest reliability), and responsiveness (through longitudinal evaluation of change).Setting/participants:In all, 376 adults receiving palliative care, and 161 clinicians, from a range of settings in the United Kingdom and GermanyResults:We confirm a three-factor structure (Physical Symptoms, Emotional Symptoms and Communication/Practical Issues). Integrated Palliative care Outcome Scale shows strong ability to distinguish between clinically relevant groups; total Integrated Palliative care Outcome Scale and Integrated Palliative care Outcome Scale subscale scores were higher – reflecting more problems – in those patients with ‘unstable’ or ‘deteriorating’ versus ‘stable’ Phase of Illness (F = 15.1, p  0.60). Longitudinal validity in form of responsiveness to change is good.Conclusion:The Integrated Palliative care Outcome Scale is a valid and reliable outcome measure, both in patient self-report and staff proxy-report versions. It can assess and monitor symptoms and concerns in advanced illness, determine the impact of healthcare interventions, and demonstrate quality of care. This represents a major step forward internationally for palliative care outcome measurement