Three cases of intentional isoniazid overdose – a life-threatening condition

Currently, isoniazid (INH) overdose seems to be a growing and life-threatening problem, partly due to the recent national roll-out of INH preventive therapy (IPT) for HIV-positive adults. We present three cases, two of which were fatal, seen at Frere and Cecilia Makiwane hospitals, East London, South Africa over the past 16 months

Hidden Symmetries and Integrable Hierarchy of the N=4 Supersymmetric Yang-Mills Equations

We describe an infinite-dimensional algebra of hidden symmetries of N=4 supersymmetric Yang-Mills (SYM) theory. Our derivation is based on a generalization of the supertwistor correspondence. Using the latter, we construct an infinite sequence of flows on the solution space of the N=4 SYM equations. The dependence of the SYM fields on the parameters along the flows can be recovered by solving the equations of the hierarchy. We embed the N=4 SYM equations in the infinite system of the hierarchy equations and show that this SYM hierarchy is associated with an infinite set of graded symmetries recursively generated from supertranslations. Presumably, the existence of such nonlocal symmetries underlies the observed integrable structures in quantum N=4 SYM theory.Comment: 24 page

Collecting biological material from palliative care patients in the last weeks of life: a feasibility study

Objective To assess the feasibility of prospectively collecting biological samples (urine) from palliative care patients in the last weeks of life. Setting A 30-bedded specialist hospice in the North West of England. Participants Participants were adults with a diagnosis of advanced disease and able to provide written informed consent. Method Potential participants were identified by a senior clinician over a 12-week period in 2014. They were then approached by a researcher and invited to participate according to a developed recruitment protocol. Outcomes Feasibility targets included a recruitment rate of 50%, with successful collection of samples from 80% who consented. Results A total of 58 patients were approached and 33 consented (57% recruitment rate). Twenty-five patients (43%) were unable to participate or declined; 10 (17%) became unwell, too fatigued, lost capacity, died or were discharged home; and 15 (26%) refused, usually these patients had distressing pain, low mood or profound fatigue. From the 33 recruited, 20 participants provided 128 separate urine samples, 12 participants did not meet the inclusion criteria at the time of consent and 1 participant was unable to provide a sample. The criterion for a urinary catheter was removed for the latter 6 weeks. The collection rate during the first 6 weeks was 29% and 93% for the latter 6 weeks. Seven people died while the study was ongoing, and another 4 participants died in the following 4 weeks. Conclusions It is possible to recruit and collect multiple biological samples over time from palliative care patients in the last weeks and days of life even if they have lost capacity. Research into the biological changes at the end of life could develop a greater understanding of the biology of the dying process. This may lead to improved prognostication and care of patients towards the end of life

Socially-Mediated Internet Surveys (SMIS): Recruiting participants for online experiments

The Socially Mediated Internet Survey (SMIS) method is a cost-effective technique used to obtain web-based, adult samples for experimental research in political science. SMIS engages central figures in online social networks to help recruit participants among visitors to these websites, yielding sizable samples for experimental research. We present data from six samples collected using the SMIS method and compare them to those gathered by other sampling approaches such as Amazon's Mechanical Turk. While not representative of the general adult population, our SMIS samples are significantly more diverse than undergraduate convenience samples, not only demographically but also politically. We discuss the applicability of the method to experimental research and its usefulness for obtaining samples of special, politically relevant subpopulations such as political sophisticates and activists. We argue that the diversity of SMIS samples, along with the ability to capture highly engaged citizens, can circumvent questions about the artificiality of political behavior experiments entirely based on student samples and help to document sources of heterogeneous experimental treatment effects

Non-invasive technology to assess hydration status in advanced cancer to explore relationships between fluid status and symptoms: an observational study using bioelectrical impedance analysis

Background Oral fluid intake decreases in advanced cancer in the dying phase of illness. There is inadequate evidence to support the assessment, and management, of hydration in the dying. Bioelectrical impedance analysis (BIA) is a body composition assessment tool. BIA has the potential to inform clinal management in advanced cancer, by examining the relationships between hydration status and clinical variables. Aim BIA was used to determine the association between hydration status, symptoms, clinical signs, quality-of-life and survival in advanced cancer, including those who are dying (i.e. in the last week of life). Materials and methods We conducted a prospective observational study of people with advanced cancer in three centres. Advance consent methodology was used to conduct hydration assessments in the dying. Total body water was estimated using the BIA Impedance index (Height – H (m)2 /Resistance – R (Ohms)). Backward regression was used to identify factors (physical signs, symptoms, quality of life) that predicted H2/R. Participants in the last 7 days of life were further assessed with BIA to assess hydration changes, and its relationship with clinical outcomes. Results One hundred and twenty-five people participated (males n = 74 (59.2%), females, n = 51 (40.8%)). We used backward regression analysis to describe a statistical model to predict hydration status in advanced cancer. The model demonstrated that ‘less hydration’ (lower H2/R) was associated with female sex (Beta = -0.39, p < 0.001), increased appetite (Beta = -0.12, p = 0.09), increased dehydration assessment scale score (dry mouth, dry axilla, sunken eyes - Beta = -0.19, p = 0.006), and increased breathlessness (Beta = -0.15, p = 0.03). ‘More hydration’ (higher H2/R) was associated with oedema (Beta = 0.49, p < 0.001). In dying participants (n = 18, 14.4%), hydration status (H2/R) was not significantly different compared to their baseline measurements (n = 18, M = 49.6, SD = 16.0 vs. M = 51.0, SD = 12.1; t(17) = 0.64, p = 0.53) and was not significantly associated with agitation (rs = -0.85, p = 0.74), pain (rs = 0.31, p = 0.23) or respiratory tract secretions (rs = -0.34, p = 0.19). Conclusions This is the first study to use bioimpedance to report a model (using clinical factors) to predict hydration status in advanced cancer. Our data demonstrates the feasibility of using an advance consent method to conduct research in dying people. This method can potentially improve the evidence base (and hence, quality of care) for the dying. Future BIA research can involve hydration assessment of cancers (according to type and stage) and associated variables (e.g., stage of illness, ethnicity and gender). Further work can use BIA to identify clinically relevant outcomes for hydration studies and establish a core outcome set to evaluate how hydration affects symptoms and quality-of-life in cancer

Neighborhood Deprivation and Adverse Birth Outcomes among Diverse Ethnic Groups

Living in a socioeconomically deprived neighborhood has been associated with an increased risk of adverse birth outcomes. However, variation in the effect of neighborhood deprivation among diverse ethnic groups has not been studied

Experiences of preparing children for a death of an important adult during the COVID-19 pandemic: a mixed methods study

Objective: The objectives of this study were to investigate how families prepared children for the death of a significant adult, and how health and social care professionals provided psychosocial support to families about a relative’s death during the COVID-19 pandemic. Design/setting: A mixed methods design; an observational survey with health and social care professionals and relatives bereaved during the COVID-19 pandemic in the UK, and in-depth interviews with bereaved relatives and professionals were conducted. Data were analysed thematically. Participants: A total of 623 participants completed the survey and interviews were conducted with 19 bereaved relatives and 16 professionals. Results: Many children were not prepared for a death of an important adult during the pandemic. Obstacles to preparing children included families’ lack of understanding about their relative’s declining health; parental belief that not telling children was protecting them from becoming upset; and parents’ uncertainty about how best to prepare their children for the death. Only 10.2% (n=11) of relatives reported professionals asked them about their deceased relative’s relationships with children. This contrasts with 68.5% (n=72) of professionals who reported that the healthcare team asked about patient’s relationships with children. Professionals did not provide families with psychosocial support to facilitate preparation, and resources were less available or inappropriate for families during the pandemic. Three themes were identified: (1) obstacles to telling children a significant adult is going to die, (2) professionals’ role in helping families to prepare children for the death of a significant adult during the pandemic, and (3) how families prepare children for the death of a significant adult. Conclusions: Professionals need to: provide clear and honest communication about a poor prognosis; start a conversation with families about the dying patient’s significant relationships with children; and reassure families that telling children someone close to them is dying is beneficial for their longer term psychological adjustment

Solar coronal jets:observations, theory, and modeling

Coronal jets represent important manifestations of ubiquitous solar transients, which may be the source of significant mass and energy input to the upper solar atmosphere and the solar wind. While the energy involved in a jet-like event is smaller than that of “nominal” solar flares and coronal mass ejections (CMEs), jets share many common properties with these phenomena, in particular, the explosive magnetically driven dynamics. Studies of jets could, therefore, provide critical insight for understanding the larger, more complex drivers of the solar activity. On the other side of the size-spectrum, the study of jets could also supply important clues on the physics of transients close or at the limit of the current spatial resolution such as spicules. Furthermore, jet phenomena may hint to basic process for heating the corona and accelerating the solar wind; consequently their study gives us the opportunity to attack a broad range of solar-heliospheric problems

The Topological B-model on a Mini-Supertwistor Space and Supersymmetric Bogomolny Monopole Equations

In the recent paper hep-th/0502076, it was argued that the open topological B-model whose target space is a complex (2|4)-dimensional mini-supertwistor space with D3- and D1-branes added corresponds to a super Yang-Mills theory in three dimensions. Without the D1-branes, this topological B-model is equivalent to a dimensionally reduced holomorphic Chern-Simons theory. Identifying the latter with a holomorphic BF-type theory, we describe a twistor correspondence between this theory and a supersymmetric Bogomolny model on R^3. The connecting link in this correspondence is a partially holomorphic Chern-Simons theory on a Cauchy-Riemann supermanifold which is a real one-dimensional fibration over the mini-supertwistor space. Along the way of proving this twistor correspondence, we review the necessary basic geometric notions and construct action functionals for the involved theories. Furthermore, we discuss the geometric aspect of a recently proposed deformation of the mini-supertwistor space, which gives rise to mass terms in the supersymmetric Bogomolny equations. Eventually, we present solution generating techniques based on the developed twistorial description together with some examples and comment briefly on a twistor correspondence for super Yang-Mills theory in three dimensions.Comment: 55 pages; v2: typos fixed, published versio

The palliative care needs and experiences of people with advanced head and neck cancer: a scoping review

Background: The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge. Aim: To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer. Design: A scoping literature review following the methods described by the Joanna Briggs Institute. Data sources: An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019. Results: People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre. Conclusion: This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent