Health care restructuring and family physician care for those who died of cancer

BACKGROUND: During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992) to 30% (1998). These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP) visits to advanced cancer patients in Nova Scotia (NS) during the years of health care restructuring. METHODS: Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics), the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000). Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212). Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department), time of day (regular hours, after hours), total length of inpatient hospital stay and number of hospital admissions during the last six months of life. RESULTS: In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED), 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP visits over time compared to 1992–93 levels (for 1997–98, adjusted RR = 0.88, 95%CI = 0.81–0.95) and an increase in FP ED visits (for 1997–98, adjusted RR = 1.18, 95%CI = 1.05–1.34). CONCLUSION: Despite hospital downsizing and fewer deaths occurring in hospitals, FP ambulatory visits (except for ED visits) did not rise correspondingly. Although such restructuring resulted in more people dying out of hospital, it does not appear FPs responded by providing more medical care to them in the community

Wittgensteinian content‐externalism

Content-externalism is the view that a subject’s relations to a context can play a role in individuating the content of her mental states. According to social content-externalists, relations to a socio-linguistic context can play a fundamental individuating role. Åsa Wikforss has suggested that ‘social externalism depends on the assumption that individuals have an incomplete grasp of their own concepts’ (Wikforss 2004, p. 287). In this paper, I show that this isn’t so. I develop and defend an argument for social content-externalism which does not depend on this assumption. The argument is animated by strands of thought in the later work of Wittgenstein. In addition to demonstrating that social externalists are not necessarily committed to thinking that a subject can have thoughts involving concepts which she incompletely understands, this argument is important insofar as it: (1) supports a form of content-externalism with extended scope; (2) avoids the controversy surrounding the claim that subjects can think with concepts which they incompletely understand; and (3) situates Wittgenstein’s later work with respect to contemporary debates about content-externalism

Context Dependence, MOPs,WHIMs and procedures Recanati and Kaplan on Cognitive Aspects in Semantics

After presenting Kripke’s criticism to Frege’s ideas on context dependence of thoughts, I present two recent attempts of considering cognitive aspects of context dependent expressions inside a truth conditional pragmatics or semantics: Recanati’s non-descriptive modes of presentation (MOPs) and Kaplan’s ways of having in mind (WHIMs). After analysing the two attempts and verifying which answers they should give to the problem discussed by Kripke, I suggest a possible interpretation of these attempts: to insert a procedural or algorithmic level in semantic representations of indexicals. That a function may be computed by different procedures might suggest new possibilities of integrating contextual cognitive aspects in model theoretic semanti

Relevance of pseudospin symmetry in proton-nucleus scattering

The manifestation of pseudospin-symmetry in proton-nucleus scattering is discussed. Constraints on the pseudospin-symmetry violating scattering amplitude are given which require as input cross section and polarization data, but no measurements of the spin rotation function. Application of these constraints to p-58Ni and p-208Pb scattering data in the laboratory energy range of 200 MeV to 800 MeV, reveals a significant violation of the symmetry at lower energies and a weak one at higher energies. Using a schematic model within the Dirac phenomenology, the role of the Coulomb potential in proton-nucleus scattering with regard to pseudospin symmetry is studied. Our results indicate that the existence of pseudospin-symmetry in proton-nucleus scattering is questionable in the whole energy region considered and that the violation of this symmetry stems from the long range nature of the Coulomb interaction.Comment: 22 pages including 9 figures, correction of 1 reference, revision of abstract and major modification of chapter 4, Fig. 6, and Fig. 7; addition of Fig. 8 and Fig.

Why Should ACT Work When CBT Has Failed? a Study Assessing Acceptability and Feasibility of Acceptance and Commitment Therapy (ACT) for Paediatric Patients With Chronic Fatigue Syndrome/myalgic Encephalomyelitis (CFS/ME)

AIMS: Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) effects 0.5–3.28% of children. NICE guidance recommends Activity Management, Graded Exercise Therapy or Cognitive Behavioural Therapy for fatigue (CBT-f). Approximately 15% of patients do not achieve full recovery within one year with current treatments. Acceptance and Commitment Therapy (ACT) is an effective treatment in many chronic illnesses. There are no studies investigating ACT for paediatric CFS/ME. This feasability study aimed to assess if ACT is a feasible and acceptable alternative treatment when current treatment has not led to recovery. METHODS: This feasability cohort study aimed to enrol a minimum of 12 participants aged 11–18 yearswith CFS/ME attending the Royal United Hospitals Bath NHS Foundation Trust Specialist Paediatric CFS/ME Service, who were still symptomatic after 12 months or 12 sessions of standard treatment and were offered six to 12 sessions of ACT. Retention and recruitment data were analysed. Participants were asked to complete questionnaires before, during and after treatment. A selection of participants and their parents were interviewed about their experience of the study. Interviews were analysed using thematic analysis. RESULTS: 19 participants (95% of those approached) were recruited. Only 4 participants of this hard-to-reach group did not complete treatment. In almost all sessions participants reported that they felt ‘totally’ listened to in post session questionnaires (31/33 sessions). Preliminary interviews (n = 12) indicate acceptability of ACT, with all young people and their parents stating that they thought ACT should be offered to this population. Participants particularly commented that the absence of thought challenging (used in CBT-f) was a positive element of ACT. Participant's openness to try new approaches and altruistic desire to be in a study was noted. CONCLUSION: Recruitment data indicate that it is feasible to recruit and retain 11–18-year-olds with CFS/ME to a study offering ACT. Interviews with participants and parents were broadly positive suggesting ACT is an acceptable treatment in this population. Results indicated that it is both feasible and acceptable to offer ACT to 11–18-year-olds with CFS/ME using this protocol, supporting the prospect of an RCT in this area

First comparison of French and Australian OsHV-1 µvars by bath exposure

Economically devastating mortality events of farmed and wild shellfish due to infectious disease have been reported globally. Currently, one of the most significant disease threats to Pacific oyster Crassostrea gigas culture is the ostreid herpesvirus 1 (OsHV-1), in particular the emerging OsHV-1 microvariant genotypes. OsHV-1 microvariants (OsHV-1 μvars) are spreading globally, and concern is high among growers in areas unaffected by OsHV-1. No study to date has compared the relative virulence among variants. We provide the first challenge study comparing survival of naïve juvenile Pacific oysters exposed to OsHV-1 μvars from Australia (AUS μvar) and France (FRA μvar). Oysters challenged with OsHV-1 μvars had low survival (2.5% exposed toAUS μvar and 10% to FRA μvar), and high viral copy number as compared to control oysters(100% survival and no virus detected). As our study was conducted in a quarantine facility located~320 km from the ocean, we also compared the virulence of OsHV-1 μvars using artificial seawater made from either facility tap water (3782 μmol kg−1seawater total alkalinity) or purchased distilled water (2003 μmol kg−1). Although no differences in survival or viral copy number were detected in oysters exposed to seawater made using tap or distilled water, more OsHV-1 was detected in tanks containing the lower-alkalinity seawater, indicating that water quality may be important for virus transmission, as it may influence the duration of viral viability outside of the hos

Dupuytren's disease in bosnia and herzegovina. An epidemiological study

BACKGROUND: It is generally held that Dupuytren's disease is more common in northern than in southern Europe, but there are very few studies from southern European countries. METHODS: We examined the hands of 1207 men and women over the age of 50 years in Bosnia and Herzegovina. RESULTS: The prevalence of Dupuytren's disease was highly age-dependent, ranging from 17% for men between 50–59 years to 60% in the oldest men. The prevalence among women was lower. The great majority only had palmar changes without contracture of the digit. The prevalence was significantly lower among Bosnian Muslim men than among Bosnian Croat and Serbian men and significantly increased among diabetics. No association could be detected between Dupuytren's disease and smoking, alcohol consumption or living in rural or urban areas. CONCLUSION: We conclude that, contrary to previous opinion, Dupuytren's disease is common in Bosnia and Herzegovina

Impact and feasibility of the Allied Health Professional Enhancement Program placements – experiences from rural and remote Queensland

Background: Allied health professionals practicing in rural and remote areas are often faced with barriers that prevent them from accessing professional development opportunities. In order to address this barrier, a tailored professional development program was developed and implemented by the Cunningham Centre in Queensland, Australia. The purpose of this study was to investigate the benefits of the program to participants and their work units. Methods: This study used a concurrent mixed methods longitudinal design to investigate the medium- to long-term benefits of one Allied Health Professional Enhancement Program placement. Surveys and individual interviews provided data at 2 weeks and at 6 months post-placement. The study participants included the placement participant (a physiotherapist), their line manager, clinical supervisor, and the placement facilitator. Results: Results demonstrated that the placement resulted in various reported benefits to the placement participant, as well as to service delivery in their home location. Benefits of the placement reported by the participant included increased confidence, improved knowledge and skills, increased access to professional networks, and validation of practice. Benefits to service delivery reported included improved efficiencies, improved patient outcomes, and positive impact on other team members. Discussion: This study found that the Allied Health Professional Enhancement Program placement investigated was beneficial to the participant and to service delivery. In addition, the benefits reported were sustained at 6 months post-placement. Despite the fact that this study showcases experiences from one setting, the findings from this study and the lessons learnt may be transferrable to other similar programs elsewhere due to its methodological strengths (such as rich descriptions of the program and use of typical case sampling). While this study provides emergent evidence of usefulness of the program to participants and their work units, further studies are warranted to investigate the direct benefits of such placements on patient care, which remains as the holy grail of the impact of professional development opportunities. Conclusion: Allied Health Professional Enhancement Program placements can result in important benefits to the participant, their health service, and positively influence health care service delivery.Priya Martin, Saravana Kumar, Melinda Stone, LuJuana Abernathy, Vanessa Burge, Lucylynn Lizarond

Biocurators and Biocuration: surveying the 21st century challenges

Curated databases are an integral part of the tool set that researchers use on a daily basis for their work. For most users, however, how databases are maintained, and by whom, is rather obscure. The International Society for Biocuration (ISB) represents biocurators, software engineers, developers and researchers with an interest in biocuration. Its goals include fostering communication between biocurators, promoting and describing their work, and highlighting the added value of biocuration to the world. The ISB recently conducted a survey of biocurators to better understand their educational and scientific backgrounds, their motivations for choosing a curatorial job and their career goals. The results are reported here. From the responses received, it is evident that biocuration is performed by highly trained scientists and perceived to be a stimulating career, offering both intellectual challenges and the satisfaction of performing work essential to the modern scientific community. It is also apparent that the ISB has at least a dual role to play to facilitate biocurators’ work: (i) to promote biocuration as a career within the greater scientific community; (ii) to aid the development of resources for biomedical research through promotion of nomenclature and data-sharing standards that will allow interconnection of biological databases and better exploit the pivotal contributions that biocurators are making