Does the use of specialist palliative care services modify the effect of socioeconomic status on place of death? A systematic review

© SAGE Publications. Background: Cancer patients in lower socioeconomic groups are significantly less likely to die at home and experience more barriers to access to palliative care. It is unclear whether receiving palliative care may mediate the effect of socioeconomic status on place of death. Aim: This review examines whether and how use of specialist palliative care may modify the effect of socioeconomic status on place of death. Design: A systematic review was conducted. Eligible papers were selected and the quality appraised by two independent reviewers. Data were synthesised using a narrative approach. Data sources: MEDLINE, Embase, CINAHL, PsycINFO and Web of Knowledge were searched (1997-2013). Bibliographies were scanned and experts contacted. Papers were included if they reported the effect of both socioeconomic status and use of specialist palliative care on place of death for adult cancer patients. Results: Nine studies were included. All study subjects had received specialist palliative care. With regard to place of death, socioeconomic status was found to have (1) no effect in seven studies and (2) an effect in one study. Furthermore, one study found that the effect of socioeconomic status on place of death was only significant when patients received standard specialist palliative care. When patients received more intense care adapted to their needs, the effect of socioeconomic status on place of death was no longer seen. Conclusion: There is some evidence to suggest that use of specialist palliative care may modify the effect of socioeconomic status on place of death

ETHOXOFUME 1000 (EtO): methyl bromide alternative update

Ethylene oxide (C2H4O = EtO) is made from the oxidation of ethylene and over 15 million tonnes are produced annually. For over 80 years EtO has been used as a sterilant / fumigant. EtO is lethal to bacteria, viruses, moulds, insects and their eggs. Historically EtO was used in the fumigation of bulk grain. EtO is still widely used in “cold” sterilization of medical devices and instruments. With the precondition of destroying vented EtO at the completion of fumigation, EtO could be a niche methyl bromide (CH3Br = MeBr) alternative. EtO is toxic by inhalation with an LD50 of 330 mg.kg-1 EtO is classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC). Occupational Limits: TLV-TWA (1 ppm); OEL (UK)-LTEL (5 ppm). EtO is a colourless, highly flammable gas (Lower Explosive Limit (LEL) = 3 vol% in air) which liquefies at 10.9oC. To reduce flammability EtO is mixed 12 vol% EtO in carbon dioxide (CO2). Onsite mixing of EtO and Air is an option, however the EtO must be kept below 54 g.m-3 (3 vol%) – higher doses of EtO would require on-site mixing with CO2 or N2. Quarantine fumigations using ETHOXOFUME 1000 are carried out using vacuum chambers to treat non-food import and export commodities. On completion of the fumigation the EtO/Air mixture can be exhausted using a high pressure fan and destroyed in a “burner” where it is converted to CO2 and H2O. The Ct product for the control of various species of insects show that EtO on a weight basis (g.m-3) has better efficacy than MeBr. A conservative recommended dose rate of 48 g.m-3 results in a concentration of 1.2 vol% for MeBr and 2.7 vol% for EtO (this is less than the LEL of 3 vol%). Keywords: Ethylene oxide, Fumigant, Sterilant, Insecticide, Incineratio

Attention deficits in dyslexia:Evidence for an automatisation deficit?

Both attentional difficulties and rapid processing deficits have recently been linked with dyslexia. We report two studies comparing the performance of dyslexic and control teenagers on attentional tasks. The two studies were based on two different conceptions of attention. Study 1 employed a design that allowed three key components of attention - focusing, switching, and sustaining - to be investigated separately. One hypothesis under investigation was that rapid processing problems - in particular impaired ability to switch attention rapidly - might be associated with dyslexia. However, although dyslexic participants were significantly less accurate than their controls in a condition where they had to switch attention between two target types, the nature of the deficit suggested that the problem was not in switching attention per se. Thus, in Study 2, we explored an alternative interpretation of the Study 1 results in terms of the classic capacity-limited models of "central" attention. We contrasted two hypotheses: (1) that dyslexic teenagers have reduced cognitive resources versus (2) that they suffer from a general impairment in the ability to automatise basic skills. To investigate the automaticity of the shape recognition component of the task a similar attention paradigm to that used in Study 1 was employed, but using degraded, as well as intact, stimuli. It was found that stimulus degradation led to relatively less impairment for dyslexic than for matched control groups. The results support the hypothesis that dyslexic people suffer from a general impairment in the ability to automatise skills - in this case the skill of automatic shape recognition

Block to granular-like transition in dense bubble flows

We have experimentally investigated 2-dimensional dense bubble flows underneath inclined planes. Velocity profiles and velocity fluctuations have been measured. A broad second-order phase transition between two dynamical regimes is observed as a function of the tilt angle $\theta$. For low $\theta$ values, a block motion is observed. For high $\theta$ values, the velocity profile becomes curved and a shear velocity gradient appears in the flow.Comment: Europhys. Lett. (2003) in pres

e-VLBI observations of Circinus X-1: monitoring of the quiescent and flaring radio emission on AU scales

A recent detection of the peculiar neutron star X-ray binary Circinus X-1 with electronic very long baseline interferometry (e-VLBI) prompted the suggestion that compact, non-variable radio emission persists through the entire 16.6-day orbit of the binary system. We present the results of a high angular resolution monitoring campaign conducted with the Australian Long Baseline Array in real-time e-VLBI mode. e-VLBI observations of Circinus X-1 were made on alternate days over a period of 20 days covering the full binary orbit. A compact radio source associated with Circinus X-1 was clearly detected at orbital phases following periastron passage but no compact radio emission was detected at any other orbital phase, ruling out the presence of a persistent, compact emitting region at our sensitivity levels. The jet was not resolved at any epoch of our 1.4-GHz monitoring campaign, suggesting that the ultrarelativistic flow previously inferred to exist in this source is likely to be dark. We discuss these findings within the context of previous radio monitoring of Circinus X-1.Comment: Accepted for publication in MNRAS. 7 pages, 5 figure

PD-L1 testing for lung cancer in the UK: recognizing the challenges for implementation.

A new approach to the management of non-small-cell lung cancer (NSCLC) has recently emerged that works by manipulating the immune checkpoint controlled by programmed death receptor 1 (PD-1) and its ligand programmed death ligand 1 (PD-L1). Several drugs targeting PD-1 (pembrolizumab and nivolumab) or PD-L1 (atezolizumab, durvalumab, and avelumab) have been approved or are in the late stages of development. Inevitably, the introduction of these drugs will put pressure on healthcare systems, and there is a need to stratify patients to identify those who are most likely to benefit from such treatment. There is evidence that responsiveness to PD-1 inhibitors may be predicted by expression of PD-L1 on neoplastic cells. Hence, there is considerable interest in using PD-L1 immunohistochemical staining to guide the use of PD-1-targeted treatments in patients with NSCLC. This article reviews the current knowledge about PD-L1 testing, and identifies current research requirements. Key factors to consider include the source and timing of sample collection, pre-analytical steps (sample tracking, fixation, tissue processing, sectioning, and tissue prioritization), analytical decisions (choice of biomarker assay/kit and automated staining platform, with verification of standardized assays or validation of laboratory-devised techniques, internal and external quality assurance, and audit), and reporting and interpretation of the results. This review addresses the need for integration of PD-L1 immunohistochemistry with other tests as part of locally agreed pathways and protocols. There remain areas of uncertainty, and guidance should be updated regularly as new information becomes available