Development of a patient-reported palliative care-specific health classification system: the POS-E

BackgroundGeneric preference-based measures are commonly used to estimate quality-adjusted life-years (QALYs) to inform resource-allocation decisions. However, concerns have been raised that generic measures may be inappropriate in palliative care.ObjectiveOur objective was to derive a health-state classification system that is amenable to valuation from the ten-item Palliative Care Outcome Scale (POS), a widely used patient-reported outcome measure in palliative care.MethodsThe dimensional structure of the original POS was assessed using factor analysis. Item performance was assessed, using Rasch analysis and psychometric criteria, to enable the selection of items that represent the dimensions covered by the POS. Data from six studies of patients receiving palliative care were combined (N = 1011) and randomly split into two halves for development and validation. Analysis was undertaken on the development data, and results were validated by repeating the analysis with the validation dataset.ResultsFollowing Rasch and factor analyses, a classification system of seven items was derived. Each item had two to three levels. Rasch threshold map helped identify a set of 14 plausible health states that can be used for the valuation of the instrument to derive a preference-based index.ConclusionCombining factor analysis and Rasch analysis with psychometric criteria provides a valid method of constructing a classification system for a palliative care-specific preference-based measure. The next stage is to obtain preference weights so the measure can be used in economic evaluations in palliative care

Mumford dendrograms and discrete p-adic symmetries

In this article, we present an effective encoding of dendrograms by embedding them into the Bruhat-Tits trees associated to $p$-adic number fields. As an application, we show how strings over a finite alphabet can be encoded in cyclotomic extensions of $\mathbb{Q}_p$ and discuss $p$-adic DNA encoding. The application leads to fast $p$-adic agglomerative hierarchic algorithms similar to the ones recently used e.g. by A. Khrennikov and others. From the viewpoint of $p$-adic geometry, to encode a dendrogram $X$ in a $p$-adic field $K$ means to fix a set $S$ of $K$-rational punctures on the $p$-adic projective line $\mathbb{P}^1$. To $\mathbb{P}^1\setminus S$ is associated in a natural way a subtree inside the Bruhat-Tits tree which recovers $X$, a method first used by F. Kato in 1999 in the classification of discrete subgroups of $\textrm{PGL}_2(K)$. Next, we show how the $p$-adic moduli space $\mathfrak{M}_{0,n}$ of $\mathbb{P}^1$ with $n$ punctures can be applied to the study of time series of dendrograms and those symmetries arising from hyperbolic actions on $\mathbb{P}^1$. In this way, we can associate to certain classes of dynamical systems a Mumford curve, i.e. a $p$-adic algebraic curve with totally degenerate reduction modulo $p$. Finally, we indicate some of our results in the study of general discrete actions on $\mathbb{P}^1$, and their relation to $p$-adic Hurwitz spaces.Comment: 14 pages, 6 figure

Funding models in palliative care: lessons from international experience

Background:Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.Aim:To assess national models and methods for financing and reimbursing palliative care.Design:Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.Results:Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following:Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision.Funding is frequently characterised as a mixed system of charitable, public and private payers.The basis on which providers are paid for services rarely reflects individual care input or patient needs.Conclusion:Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

A pp-adic RanSaC algorithm for stereo vision using Hensel lifting

A $p$-adic variation of the Ran(dom) Sa(mple) C(onsensus) method for solving the relative pose problem in stereo vision is developped. From two 2-adically encoded images a random sample of five pairs of corresponding points is taken, and the equations for the essential matrix are solved by lifting solutions modulo 2 to the 2-adic integers. A recently devised $p$-adic hierarchical classification algorithm imitating the known LBG quantisation method classifies the solutions for all the samples after having determined the number of clusters using the known intra-inter validity of clusterings. In the successful case, a cluster ranking will determine the cluster containing a 2-adic approximation to the "true" solution of the problem.Comment: 15 pages; typos removed, abstract changed, computation error remove

A Self-Consistent Model for Positronium Formation from Helium Atoms

The differential and total cross sections for electron capture by positrons from helium atoms are calculated using a first-order distorted wave theory satisfying the Coulomb boundary conditions. In this formalism a parametric potential is used to describe the electron screening in a consistent and realistic manner. The present procedure is self consistent because (i) it satisfies the correct boundary conditions and post-prior symmetry, and (ii) the potential and the electron binding energies appearing in the transition amplitude are consistent with the wave functions describing the collision system. The results are compared with the other theories and with the available experimental measurements. At the considered range of collision energies, the results agree reasonably well with recent experiments and theories. [Note: This paper will be published on volume 42 of the Brazilian Journal of Physics

Kepler Cycle 1 Observations of Low Mass Stars: New Eclipsing Binaries, Single Star Rotation Rates, and the Nature and Frequency of Starspots

We have analyzed Kepler light curves for 849 stars with T_eff < 5200 K from our Cycle 1 Guest Observer program. We identify six new eclipsing binaries, one of which has an orbital period of 29.91 d, and two of which are probably W UMa variables. In addition, we identify a candidate "warm Jupiter" exoplanet. We further examine a subset of 670 sources for variability. Of these objects, 265 stars clearly show periodic variability that we assign to rotation of the low-mass star. At the photometric precision level provided by Kepler, 251 of our objects showed no evidence for variability. We were unable to determine periods for 154 variable objects. We find that 79% of stars with T_eff < 5200 K are variable. The rotation periods we derive for the periodic variables span the range 0.31 < P_rot < 126.5 d. A considerable number of stars with rotation periods similar to the solar value show activity levels that are 100 times higher than the Sun. This is consistent with results for solar-like field stars. As has been found in previous studies, stars with shorter rotation periods generally exhibit larger modulations. This trend flattens beyond P_rot = 25 d, demonstrating that even long period binaries may still have components with high levels of activity and investigating whether the masses and radii of the stellar components in these systems are consistent with stellar models could remain problematic. Surprisingly, our modeling of the light curves suggests that the active regions on these cool stars are either preferentially located near the rotational poles, or that there are two spot groups located at lower latitudes, but in opposing hemispheres.Comment: 48 pages, 11 figure

The application of a Trous wave filtering and Monte Carlo analysis on SECIS 2001 solar eclipse observations

8000 images of the Solar corona were captured during the June 2001 total Solar eclipse. New software for the alignment of the images and an automated technique for detecting intensity oscillations using multi scale wavelet analysis were developed. Large areas of the images covered by the Moon and the upper corona were scanned for oscillations and the statistical properties of the atmospheric effects were determined. The a Trous wavelet transform was used for noise reduction and Monte Carlo analysis as a significance test of the detections. The effectiveness of those techniques is discussed in detail.Comment: 17 pages, 8 figures, accepted by Solar Physics Journal for publication in Topical Issue: "Frontiers in Solar Image Processing

Nighttime chlorine monoxide observations by the Odin satellite and implications for the ClO/Cl2O2 equilibrium

We use measurements of chlorine monoxide (ClO) by the SMR instrument onboard the Odin satellite to study the nighttime thermal equilibrium between ClO and its dimer Cl2O2. Observations performed in the polar vortex during the 2002–2003 Arctic winter showed enhanced amounts of nighttime ClO over a wide range of stratospheric temperatures (185 < T < 225 K). Odin/SMR measurements are here compared to three-dimensional model calculations using various published estimations of the Keq equilibrium constant between ClO and Cl2O2. Our results show that the value of Keq currently recommended by JPL (Sander et al., 2003) leads to a large underestimation of the observed nighttime ClO amounts, and that a realistic estimation of Keq must lie between the values determined by Cox and Hayman (1988) and Von Hobe et al. (2005)

Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research

BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriers and informal carers' roles in mediating communication; and contrasting cultures in end of life kidney care. CONCLUSIONS: Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.Peer reviewedFinal Published versio

Retrospective evaluation of thoracic computed tomography findings in dogs naturally infected by Angiostrongylus vasorum

Angiostrongylus vasorum (A. vasorum) is an important emerging disease of canidae. Cardiorespiratory signs are common in affected dogs, therefore thoracic imaging is critical for diagnosing andmonitoring disease. Descriptions of thoracic computed tomography (CT) findings in dogs naturallyinfected with A. vasorum are currently lacking. Aims of this multicenter, retrospective study were to describe thoracic CT findings in a group of dogs with confirmed disease, determine whether any changes were consistent among dogs, and propose standardized terms for describing thoracic CT findings. Nine UK-based referral centers’ clinical and imaging databases were searched for dogs that had a confirmed diagnosis of A. vasorum, and had undergone thoracic CT examination. Eighteen dogs, from seven of the centers, fulfilled the inclusion criteria. The lung lobes were divided into the following three zones and the CT changes described in each: pleural (zone 1), subpleural (zone 2), and peribronchovascular (zone 3). The predominent abnormality was increased lung attenuation due to poorly defined ground-glass opacity or consolidation. There were regions of mosaic attenuation due to peripheral bronchiectasis. Nine/18 (50%) dogs showed hyperattenuating nodules of varying sizes with ill-defined margins. The distribution always affected zones 1and 2 with varied involvement of zone 3; this resulted in clear delineation between zones 2 and 3.Tracheobronchial lymphadenomegaly was frequently noted. Findings were nonspecific and there was considerable overlap with other pulmonary conditions. However, authors recommend that A. vasorum be considered a likely differential diagnosis for dogs with a predominantly peripheral distribution of lung changes