Letter from Lucy Stone, to Anne Whitney, circa 1900

https://repository.wellesley.edu/whitney_correspondence/3046/thumbnail.jp

Implementing intergenerational justice: Children at the heart of policy making

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Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review

Objective: To summarise evidence on how multidisciplinary team (MDTs) make decisions about identification of imminently dying patients. Design Scoping review. Setting: Any clinical setting providing care for imminently dying patients, excluding studies conducted solely in acute care settings. Data sources: The databases AMED, CINAHL, Embase, MEDLINE, PsychINFO and Web of Science were searched from inception to May 2021. Included studies presented original study data written in English and reported on the process or content of MDT discussions about identifying imminently dying adult patients. Results: 40 studies were included in the review. Studies were primarily conducted using interviews and qualitative analysis of themes. MDT members involved in decision-making were usually doctors and nurses. Some decisions focused on professionals recognising that patients were dying, other decisions focused on initiating specific end-of-life care pathways or clarifying care goals. Most decisions provided evidence for a partial collaborative approach, with information-sharing being more common than joint decision-making. Issues with decision-making included disagreement between staff members and the fact that doctors were often regarded as final or sole decision-makers. Conclusions: Prognostic decision-making was often not the main focus of included studies. Based on review findings, research explicitly focusing on MDT prognostication by analysing team discussions is needed. The role of allied and other types of healthcare professionals in prognostication needs further investigation as well. A focus on specialist palliative care settings is also necessary

Supersonic Cloud Collision - I

It has long been suggested that shocks might play an important role in altering the form of the interstellar medium (ISM). Shocks enhance gas density and sufficiently dense regions may become self gravitating. Potential star forming clouds within larger molecular clouds, move randomly at supersonic speeds. Depending on the precollision velocity, colliding molecular clouds produce a slab that is either shock compressed or pressure confined. In a sequel of two papers (I & II), we simulate molecular cloud collision and investigate the dynamical evolution of such slabs. Shocked slabs are susceptible to hydrodynamic instabilities and in the present paper (I) we study the effect of strong shear between slab layers on the dynamic evolution of a shock compressed gas slab. Both, head-on and off-centre cloud collisions have been examined in this work. We include self gravity in all our simulations. Simulations presented here, are performed using the smoothed particle hydrodynamics (SPH) numerical scheme. Individual, pre-collision clouds are modelled as pressure confined Bonnor-Ebert spheres. However, in the interest of brevity the thermodynamic details of the problem are simplified and the gas temperature is simply evolved by a barytropic equation of state. Obviously, the gas, to some extent suffers from thermal inertial effects. However, we note that the dynamical timescale is much smaller than the local sound crossing time so that such effects should have minimum influence.Comment: 16 pages, 13 figures, 1 table; A&A accepted Typographical errors have been attended to. The resolution of the figures has been deliberately lowered in order to accommodate them all within the prescribed size limit

rpSPH: a novel Smoothed Particle Hydrodynamics Algorithm

We suggest a novel discretisation of the momentum equation for Smoothed Particle Hydrodynamics (SPH) and show that it significantly improves the accuracy of the obtained solutions. Our new formulation which we refer to as relative pressure SPH, rpSPH, evaluates the pressure force in respect to the local pressure. It respects Newtons first law of motion and applies forces to particles only when there is a net force acting upon them. This is in contrast to standard SPH which explicitly uses Newtons third law of motion continuously applying equal but opposite forces between particles. rpSPH does not show the unphysical particle noise, the clumping or banding instability, unphysical surface tension, and unphysical scattering of different mass particles found for standard SPH. At the same time it uses fewer computational operations. and only changes a single line in existing SPH codes. We demonstrate its performance on isobaric uniform density distributions, uniform density shearing flows, the Kelvin-Helmholtz and Rayleigh-Taylor instabilities, the Sod shock tube, the Sedov-Taylor blast wave and a cosmological integration of the Santa Barbara galaxy cluster formation test. rpSPH is an improvement these cases. The improvements come at the cost of giving up exact momentum conservation of the scheme. Consequently one can also obtain unphysical solutions particularly at low resolutions.Comment: 17 pages, 13 figures. Final version. Including section of how to break i

Design of the Tocilizumab in Giant Cell Arteritis Trial

Overview. The GiACTA trial is a multicenter, randomized, double-blind, and placebo-controlled study designed to test the ability of tocilizumab (TCZ), an interleukin (IL)-6 receptor antagonist, to maintain disease remission in patients with giant cell arteritis (GCA). Design:. Approximately 100 centers will enroll 250 patients with active disease. The trial consists of a 52-week blinded treatment phase followed by 104 weeks of open-label extension. Patients will be randomized into one of four groups. Group A (TCZ 162 mg weekly plus a 6-month prednisone-taper); group B (TCZ 162 mg every other week plus a 6-month prednisone-taper); group C (placebo plus a 6-month prednisone-taper); and group D (placebo plus a 12-month prednisone taper). We hypothesize that patients assigned to TCZ in addition to a 6-month prednisone course are more likely to achieve the primary efficacy endpoint of sustained remission (SR) at 52 weeks compared with those assigned to a 6-month prednisone course alone, thus potentially minimizing the long-term adverse effects of corticosteroids. Conclusion:. GiACTA will test the hypothesis that interference with IL-6 signaling exerts a beneficial effect on patients with GCA. The objective of this paper is to describe the design of the trial and address major issues related to its development

How best to capture the impact of complementary therapies in palliative care: A systematic review to identify and assess the appropriateness and validity of multi-domain tools

BACKGROUND: Complementary therapies are widely used in palliative care settings. Qualitative research found that people with advanced disease report a range of physical and psychological benefits from complementary therapies, however evidence of their effectiveness from clinical trials is inconclusive. This may be because trials are limited by use of inappropriate outcome measures. AIMS: To identify tools which capture the impact of massage, reflexology and aromatherapy in people with advanced disease. We (1) identified multi-domain tools used to evaluate these therapies in populations with any chronic health condition and (2) assessed whether tools were valid and psychometrically robust in populations with advanced disease. DESIGN: A two-stage systematic review was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (PROSPERO: CRD42020161199). DATA SOURCES: Six databases were searched (August 2021). Study methodological quality, tool psychometric properties and evidence quality were assessed. A global comparison score was generated. RESULTS: Stage 1: 66 trials using 40 different multi-domain tools were identified. Stage 2: Of these tools, we identified papers for seven tools regarding development or validation in advanced disease populations. The majority of psychometric data were inconsistent or inconclusive. Data were mostly of low quality due to methodological issues. CONCLUSION: Of the tools identified, 'Functional Assessment of Cancer Therapy - General' appears to be the most suitable alternative tool against COMSIN criteria, for trials of massage, reflexology and aromatherapy in palliative care. Further tool validation is required before firm recommendations can be made. Co-development of a core outcome set could ensure relevant domains are assessed