With comfort and dignity and support: An evaluation of the Hospice at Home service delivered by Milford Care Centre

Copyright @ 2011 University of LimerickMilford Care Centre is the lead organisation that provides a comprehensive range of services for the elderly and palliative care patients in the Mid West Region. In tandem with the growing requirement for specialist palliative care in the community, it expanded its existing and limited community-based services in 2006 to include a specialist ‘Hospice at Home’ service for patients who require palliative care in their own homes. With inputs from a multi-disciplinary clinical team, the Hospice at Home Service delivered by Milford Care Centre represents the first service of its kind within the Republic of Ireland. The Hospice at Home Service is supported by funding from the HSE and donations from the public, as well as a significant donation from The Atlantic Philanthropies. A condition of the funding from The Atlantic Philanthropies was that the Service would be evaluated, thus providing Milford Care Centre with research information regarding various of aspects of the service, including the viewpoints of carers and patients. In 2009, Milford Care Centre commissioned the University of Limerick to undertake an independent evaluation of the Hospice at Home Service, with the aim of examining whether it offered a viable and effective model for delivering a range of palliative care services to patients and their families in the community. The evaluation was conducted between February 2009 and June 2011. It should be noted that an evaluation of the cost effectiveness of the Service was also commissioned and will be undertaken by another group

‘The Lady of Shalott’: Insights Gained from Using Visual Methods and Interviews Exploring the Lived Experience of Codependency

Codependency is a complex human experience with many meanings. The experiences of self-identified codependent individuals, who attend 12 steps groups are largely missing from the literature. In this article, we present how a combination of a visual method and interviews assisted deeper exploration and analysis of the experience of living with codependency, in an Interpretative Phenomenological Analysis (IPA) study. A case example, entitled the ‘Lady of Shalott’, is offered as an illustration of the data collection and multilevel interpretative analytical process, highlighting how the ambiguity in the meanings of the imagery aided the interpretation. The case study, demonstrates how the visual method enriched the data collection and analysis process assisting the researcher to reach deeper layers of meanings, capturing a better understanding of the lived experience portrayed by the participant

‘The Lady of Shalott’: Insights Gained from Using Visual Methods and Interviews Exploring the Lived Experience of Codependency

Codependency is a complex human experience with many meanings. The experiences of self-identified codependent individuals, who attend 12 steps groups are largely missing from the literature. In this article, we present how a combination of a visual method and interviews assisted deeper exploration and analysis of the experience of living with codependency, in an Interpretative Phenomenological Analysis (IPA) study. A case example, entitled the ‘Lady of Shalott’, is offered as an illustration of the data collection and multilevel interpretative analytical process, highlighting how the ambiguity in the meanings of the imagery aided the interpretation. The case study, demonstrates how the visual method enriched the data collection and analysis process assisting the researcher to reach deeper layers of meanings, capturing a better understanding of the lived experience portrayed by the participant

The skin you're in: Design of experiments optimization of lipid nanoparticle self-amplifying RNA formulations in human skin explants

Messenger RNA (mRNA) is a promising tool for biotherapeutics, and self-amplifying mRNA (saRNA) is particularly advantageous as it results in abundant protein expression and production is easily scalable. While mRNA therapeutics have been shown to be highly effective in small animals, the outcomes do not scale linearly when these formulations are translated to dose-escalation studies in humans. Here, we utilize a Design of Experiments (DoE) approach to optimize the formulation of saRNA lipid nanoparticles in human skin explants. We first observed that luciferase expression from saRNA peaked after 11 days in human skin. Using DoE inputs of complexing lipid identity, lipid nanoparticle dose, lipid concentration, particle concentration, and ratio of zwitterionic to cationic lipids, we optimized the saRNA-induced luciferase expression in skin explants. Lipid identity and lipid concentration were found to be significant parameters in the DoE model, and the optimized formulation resulted in ~7-fold increase in luciferase expression relative to initial DOTAP formulation. Using flow cytometry, we observed that optimized formulations delivered the saRNA to ~2% of the resident cells in the human skin explants. Although immune cells make up only 7% of the total population of cells in skin, immune cells were found to express ~50% of the RNA. This study demonstrates the powerful combination of using a DoE approach paired with clinically relevant human skin explants to optimize nucleic acid formulations. We expect that this system will be useful for optimizing both formulation and molecular designs of clinically translational nucleic acid vaccines and therapeutics

Integrated Polygenic Tool Substantially Enhances Coronary Artery Disease Prediction

BACKGROUND: There is considerable interest in whether genetic data can be used to improve standard cardiovascular disease risk calculators, as the latter are routinely used in clinical practice to manage preventative treatment. METHODS: Using the UK Biobank resource, we developed our own polygenic risk score for coronary artery disease (CAD). We used an additional 60 000 UK Biobank individuals to develop an integrated risk tool (IRT) that combined our polygenic risk score with established risk tools (either the American Heart Association/American College of Cardiology pooled cohort equations [PCE] or UK QRISK3), and we tested our IRT in an additional, independent set of 186 451 UK Biobank individuals. RESULTS: The novel CAD polygenic risk score shows superior predictive power for CAD events, compared with other published polygenic risk scores, and is largely uncorrelated with PCE and QRISK3. When combined with PCE into an IRT, it has superior predictive accuracy. Overall, 10.4% of incident CAD cases were misclassified as low risk by PCE and correctly classified as high risk by the IRT, compared with 4.4% misclassified by the IRT and correctly classified by PCE. The overall net reclassification improvement for the IRT was 5.9% (95% CI, 4.7–7.0). When individuals were stratified into age-by-sex subgroups, the improvement was larger for all subgroups (range, 8.3%–15.4%), with the best performance in 40- to 54-year-old men (15.4% [95% CI, 11.6–19.3]). Comparable results were found using a different risk tool (QRISK3) and also a broader definition of cardiovascular disease. Use of the IRT is estimated to avoid up to 12 000 deaths in the United States over a 5-year period. CONCLUSIONS: An IRT that includes polygenic risk outperforms current risk stratification tools and offers greater opportunity for early interventions. Given the plummeting costs of genetic tests, future iterations of CAD risk tools would be enhanced with the addition of a person’s polygenic risk

Empathy, engagement, entrainment: the interaction dynamics of aesthetic experience

A recent version of the view that aesthetic experience is based in empathy as inner imitation explains aesthetic experience as the automatic simulation of actions, emotions, and bodily sensations depicted in an artwork by motor neurons in the brain. Criticizing the simulation theory for committing to an erroneous concept of empathy and failing to distinguish regular from aesthetic experiences of art, I advance an alternative, dynamic approach and claim that aesthetic experience is enacted and skillful, based in the recognition of others’ experiences as distinct from one’s own. In combining insights from mainly psychology, phenomenology, and cognitive science, the dynamic approach aims to explain the emergence of aesthetic experience in terms of the reciprocal interaction between viewer and artwork. I argue that aesthetic experience emerges by participatory sense-making and revolves around movement as a means for creating meaning. While entrainment merely plays a preparatory part in this, aesthetic engagement constitutes the phenomenological side of coupling to an artwork and provides the context for exploration, and eventually for moving, seeing, and feeling with art. I submit that aesthetic experience emerges from bodily and emotional engagement with works of art via the complementary processes of the perception–action and motion–emotion loops. The former involves the embodied visual exploration of an artwork in physical space, and progressively structures and organizes visual experience by way of perceptual feedback from body movements made in response to the artwork. The latter concerns the movement qualities and shapes of implicit and explicit bodily responses to an artwork that cue emotion and thereby modulate over-all affect and attitude. The two processes cause the viewer to bodily and emotionally move with and be moved by individual works of art, and consequently to recognize another psychological orientation than her own, which explains how art can cause feelings of insight or awe and disclose aspects of life that are unfamiliar or novel to the viewer

Being a Self-Employed Older Woman: From Discrimination to Activism

This article presents an autobiographical account of an older woman’s lived experience of self-employment. Little is known about women who experience ongoing self-employment into their 50s and beyond. Shoshanna’s personal narrative describes her experiences and the challenges she has faced as she reflects upon her attempts to grow and sustain her business and the implications of ageism and gender inequality in laying a claim to entrepreneurship. The narrative proceeds to reflect on her activist work, as it is constructed through the creation of a social enterprise to support older people. Shoshanna’s narrative provides valuable insights into the intersection of age and gender in self-employment moving from discrimination to active support

A conserved function of the zinc finger transcription factor Sp8/9 in allometric appendage growth in the milkweed bug Oncopeltus fasciatus

The genes encoding the closely related zinc finger transcription factors Buttonhead (Btd) and D-Sp1 are expressed in the developing limb primordia of Drosophila melanogaster and are required for normal growth of the legs. The D-Sp1 homolog of the red flour beetle Tribolium castaneum, Sp8 (appropriately termed Sp8/9), is also required for the proper growth of the leg segments. Here we report on the isolation and functional study of the Sp8/9 gene from the milkweed bug Oncopeltus fasciatus. We show that Sp8/9 is expressed in the developing appendages throughout development and that the downregulation of Sp8/9 via RNAi leads to antennae, rostrum, and legs with shortened and fused segments. This supports a conserved role of Sp8/9 in allometric leg segment growth. However, all leg segments including the claws are present and the expression of the leg genes Distal-less, dachshund, and homothorax are proportionally normal, thus providing no evidence for a role of Sp8/9 in appendage specification

Lunar exploration: opening a window into the history and evolution of the inner Solar System

The lunar geological record contains a rich archive of the history of the inner Solar System, including information relevant to understanding the origin and evolution of the Earth-Moon system, the geological evolution of rocky planets, and our local cosmic environment. This paper provides a brief review of lunar exploration to-date, and describes how future exploration initiatives will further advance our understanding of the origin and evolution of the Moon, the Earth-Moon system, and of the Solar System more generally. It is concluded that further advances will require the placing of new scientific instruments on, and the return of additional samples from, the lunar surface. Some of these scientific objectives can be achieved robotically, for example by in situ geochemical and geophysical measurements and through carefully targeted sample return missions. However, in the longer term, we argue that lunar science would greatly benefit from renewed human operations on the surface of the Moon, such as would be facilitated by implementing the recently proposed Global Exploration Roadmap