Advance care planning documentation strategies; goals-of-care as an alternative to not-for-resuscitation in medical and oncology patients. A pre-post controlled study on quantifiable outcomes

Background: Health services in Tasmania, Victoria and now Western Australia are changing to goals-of-care (GOC) advance care planning (ACP) documentation strategies. Aim: To compare the clinical impact of two different health department-sanctioned ACP documentation strategies. Methods: A non-blinded, pre–post, controlled study over two corresponding 6-month periods in 2016 and 2017 comparing the current discretional not-for-resuscitation (NFR) with a new, inclusive GOC strategy in two medical/oncology wards at a large private hospital. Main outcomes were the uptake of ACP forms per hospitalisation and the timing between hospital admission, ACP form completion and in-patient death. Secondary outcomes included utilisation of the rapid response team (RRT), palliative and critical care services. Results: In total, 650 NFR and 653 GOC patients underwent 1885 admissions (mean Charlson Comorbidity Index = 3.7). GOC patients had a higher uptake of ACP documentation (346 vs 150 ACP forms per 1000 admissions, P \u3c 0.0001) and a higher proportion of ACP forms completed within the first 48 h of admission (58 vs 39%, P = 0.0002) but a higher incidence of altering the initial ACP level of care (P = 0.003). All other measures, including ACP documentation within 48 h of death (P = 0.50), activation of RRT (P = 0.73) and admission to critical (P = 0.62) or palliative (P = 0.81) care services, remained similar. GOC documentation was often incomplete, with most sub-sections left blank between 74 and 87% of occasions. Conclusion: Despite an increased uptake of the GOC form, overall use remained low, written completion was poor, and most quantitative outcomes remained statistically unchanged. Further research is required before a wider GOC implementation can be supported in Australia’s healthcare systems

Comparing plasma and faecal measures of steroid hormones in Adelie penguins Pygoscelis adeliae

Physiological measurements of both stress and sex hormones are often used to estimate the consequences of natural or human-induced change in ecological studies of various animals. Different methods of hormone measurement exist, potentially explaining variation in results across studies; methods should be cross-validated to ensure that they correlate. We directly compared faecal and plasma hormone measurements for the first time in a wild free-living species, the Adelie penguin (Pygoscelis adeliae). Blood and faecal samples were simultaneously collected from individual penguins for comparison and assayed for testosterone and corticosterone (or their metabolites). Sex differences and variability within each measure, and correlation of values across measures were compared. For both hormones, plasma samples showed greater variation than faecal samples. Males had higher mean corticosterone concentrations than females, but the difference was only statistically significant in faecal samples. Plasma testosterone, but not faecal testosterone, was significantly higher in males than females. Correlation between sample types was poor overall, and weaker in females than in males, perhaps because measures from plasma represent hormones that are both free and bound to globulins, whereas measures from faeces represent only the free portion. Faecal samples also represent a cumulative measure of hormones over time, as opposed to a plasma ‘snapshot’ concentration. Our data indicate that faecal sampling appears more suitable for assessing baseline hormone concentrations, whilst plasma sampling may best define immediate responses to environmental events. Consequently, future studies should ensure that they select the most appropriate matrix and method of hormone measurement to answer their research questions

Bragg spectroscopy with an accelerating Bose-Einstein condensate

We present the results of Bragg spectroscopy performed on an accelerating Bose-Einstein condensate. The Bose condensate undergoes circular micro-motion in a magnetic TOP trap and the effect of this motion on the Bragg spectrum is analyzed. A simple frequency modulation model is used to interpret the observed complex structure, and broadening effects are considered using numerical solutions to the Gross-Pitaevskii equation.Comment: 5 pages, 3 figures, to appear in PRA. Minor changes to text and fig

Novel, cross-restricted, conserved, and immunodominant Cytotoxic T Lymphocyte epitopes in slow progressors in HIV Type 1 infection

HIV-specific cytotoxic T lymphocytes (CTLs) play an important role in the immune response to HIV infection. Long-term nonprogressors (LTNPs) or slow progressors (SPs) in HIV infection may make qualitatively different CTL responses compared to those generated by seropositive individuals who progress to disease at a faster rate. The class I molecule HLA-B*57 has been identified as one restriction element overrepresented in SP groups studied, and, together with the closely related molecule HLA-B*58, occurs commonly in ethnic groups where HTV is most prevalent. In this study, we have identified five new HLA-B*57-restricted CTL epitopes recognized by SP donors, one of which is also HLA-B*5801 restricted. These HLA-B*57-restricted responses represent the dominant HIV-specific CTL response in each of the SP donors tested. These and other such epitopes may be an important component in future vaccine design

Think Global, Reconfigure the Local: How Intermediaries Articulate Pro-Environmental Values and Practices

Contemporary debates about the conservation of natural ecosystems and resources owe most of their influence to the rise of sustainable development, or, sustainability. Since its inception, ‘sustainability’ has become the dominant paradigm for addressing global ecological problems, as well as a strong motivator for changing patterns of behaviour at the level of individual people. The World Commission on Environment and Development (WCED) introduced this framework into global proenvironmental discourse in 1987, and it has since been the source of many debates and discussions within and between academic disciplines. One of the central issues has been the opposition between agency and structure. This is the problem of whether to appeal to agency (theories of individual behaviour change) or structure (theories of social practice) when addressing global environmental problems, as these fields are generally characterised as necessarily opposed to one another. However, each of them at least conceives of a particular kind of agency, meaning that both make an appeal to ‘the individual’ in one way or another. The ultimate aim of this thesis, then, is to reconfigure the way in which individual people are framed by and thus implicated in contemporary discussions about sustainability. In order to do this, I will be drawing heavily on Pierre Bourdieu’s (1984) concept of the ‘cultural intermediary,’ as well as Stuart Hall’s (cf. Grossberg, 1986) theory of ‘articulation.’ I propose a framework that characterises proenvironmental groups as ‘intermediaries,’ as each of these groups acts as a ‘mediator’ or ‘point of articulation’ between the structural dimensions of sustainability and the individual people that they address. I will analyse this framework by appealing to two close studies of two different intermediaries: Greenpeace, and its ‘Save the Reef’ campaign, and Sydney’s Inner West Council, and its ‘Home Eco Challenge.

Nematic Films and Radially Anisotropic Delaunay Surfaces

We develop a theory of axisymmetric surfaces minimizing a combination of surface tension and nematic elastic energies which may be suitable for describing simple film and bubble shapes. As a function of the elastic constant and the applied tension on the bubbles, we find the analogues of the unduloid, sphere, and nodoid in addition to other new surfaces.Comment: 15 pages, 18 figure

Couplings of light I=0 scalar mesons to simple operators in the complex plane

The flavour and glue structure of the light scalar mesons in QCD are probed by studying the couplings of the I=0 mesons $\sigma(600)$ and $f_0(980)$ to the operators $\bar{q}q$, $\alpha_s G^2$ and to two photons. The Roy dispersive representation for the $\pi\pi$ amplitude $t_0^0(s)$ is used to determine the pole positions as well as the residues in the complex plane. On the real axis, $t_0^0$ is constrained to solve the Roy equation together with elastic unitarity up to the K\Kbar threshold leading to an improved description of the $f_0(980)$. The problem of using a two-particle threshold as a matching point is discussed. A simple relation is established between the coupling of a scalar meson to an operator $j_S$ and the value of the related pion form-factor computed at the resonance pole. Pion scalar form-factors as well as two-photon partial-wave amplitudes are expressed as coupled-channel Omn\`es dispersive representations. Subtraction constants are constrained by chiral symmetry and experimental data. Comparison of our results for the $\bar{q}q$ couplings with earlier determinations of the analogous couplings of the lightest I=1 and $I=1/2$ scalar mesons are compatible with an assignment of the $\sigma$, $\kappa$, $a_0(980)$, $f_0(980)$ into a nonet. Concerning the gluonic operator $\alpha_s G^2$ we find a significant coupling to both the $\sigma$ and the $f_0(980)$.Comment: 31 pages, 5 figure