Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Genome sequence of Listeria monocytogenes 2542, a serotype 4b strain from a cheese-related outbreak in Portugal

We report here the draft genome sequence of Listeria monocytogenes 2542, a serotype 4b clinical strain recovered from a placental sample during a cheese-related listeriosis outbreak in Portugal.Work done by T.C. and T.H. was supported by LOEWE Medical RNomics (B3) and theGermanCentre for Infection Research, Justus-Liebig University Giessen. Financial sup-port for R.M. and V.F. was provided by Fundação para a Ciência e a Tecnologia(FCT)through Ph.D. (SFRH/BD/71704/2010) and postdoctoral (SFRH/BPD/72617/2010) fellow-ships, respectively. Open-access publication was cofinanced by the NEWFOOD NORTE-01-0246-FEDER-000043 project supported by the Norte Portugal Regional OperationalProgramme (NORTE 2020), under the Portugal 2020 Partnership Agreement throughthe European Regional Development Fund (ERDF). We also acknowledge the scientificcollaboration under the FCT project UID/Multi/50016/2013

Thermal-Based Evaporative Stress Index for Monitoring Surface Moisture Depletion

The standard suite of indicators currently used in operational drought monitoring reflects anomalous conditions in several major components of the hydrologic budget—representing deficits in precipitation, soil moisture content, runoff, surface and groundwater storage, snowpack, and streamflow. In principle, it is useful to have a diversity of indices because drought can assume many forms (meteorological, agricultural, hydrological, and socioeconomic), over broad ranges in timescale (weeks to years), and with varied impacts of interest to different stakeholder groups. Farmers, for example, may be principally interested in soil moisture deficits, river forecasters will focus on streamflow fluctuations, and water managers will be concerned with longer-term stability in municipal water supply and reservoir levels. Only recently has actual evapotranspiration (ET) been considered as a primary indicator of drought conditions (e.g., Anderson et al., 2007b; Labedzki and Kanecka- Geszke, 2009; Li et al., 2005; Mo et al., 2010). ET is a valuable drought indicator because it reflects not only moisture availability but also the rate at which water is being consumed. Because transpiration (T) and carbon uptake by vegetation are tightly coupled through stomatal exchange, ET anomalies are indicative of vegetation health and growing conditions. In addition, the importance of so-called flash droughts is becoming increasingly evident, where hot, dry, and windy atmospheric conditions can lead to unusually rapid soil moisture depletion and, in some cases, devastating crop failure. Such events cannot be easily identified using local precipitation anomalies but should have a detectable ET signature

Fluorodeoxyglucose positron emission tomography in the evaluation of germ cell tumours at relapse

Differentiation of active disease from fibrosis/mature teratoma in patients with residual masses or identifying of sites of recurrence in patients with raised markers following treatment of their testicular cancer remains a problem.18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has the potential to identify active disease and thereby influence further management in these patients. We performed a retrospective study of the use of FDG-PET in detecting residual/recurrent testicular carcinoma in 55 patients (seventy FDG-PET scans). Forty-seven scans were for the assessment of residual masses (18 had raised markers) and 23 scans were for the investigation of raised markers in the presence of normal CT scans. True positive results were based on positive histology or clinical follow-up. FDG-PET had a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 90% in patients with residual masses. This PPV was equivalent to that of markers (94%) but FDG-PET had the advantage of identifying the site of that recurrence. The NPV was higher than that of markers. In patients with raised markers alone the PPV of FDG-PET was 92% but the NPV was only 50%. However, subsequent FDG-PET imaging was frequently the first imaging modality to identify the site of disease. FDG-PET effected a management change in 57% of cases. FDG-PET scanning detected viable tumour in residual masses and identified sites of disease in suspected recurrence. © 2000 Cancer Research Campaig

Kanamycin resistance during in vitro development of pollen from transgenic tomato plants

Effects of kanamycin on pollen germination and tube growth of pollen from non-transformed plants and from transgenic tomato plants containing a chimaeric kanamycin resistance gene were determined. Germination of pollen was not affected by the addition of kanamycin to the medium in both genotypes. Kanamycin, however, severely affected tube growth of pollen from non-transformed plants, while pollen from plants containing the chimaeric gene were less sensitive and produced significantly longer tubes at kanamycin concentrations between 200-400 mg l-1. Apparently, this resistance for kanamycin correlates with the expression of the chimaeric gene during male gametophytic development.

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

BACKGROUND: Inpatient administrative datasets often exclude observation stays, as observation is considered to be outpatient care. The extent to which this status is applied to pediatric hospitalizations is not known. OBJECTIVE: To characterize trends in observation status code utilization and 1‐day stays among children admitted from the emergency department (ED), and to compare patient characteristics and outcomes associated with observation versus inpatient stays. DESIGN: Retrospective longitudinal analysis of the 2004–2009 Pediatric Health Information System (PHIS). SETTING: Sixteen US freestanding children's hospitals contributing outpatient and inpatient data to PHIS. PATIENTS: Admissions to observation or inpatient status following ED care in study hospitals. MEASUREMENTS: Proportions of observation and 1‐day stays among all admissions from the ED were calculated each year. Top ranking discharge diagnoses and outcomes of observation were determined. Patient characteristics, discharge diagnoses, and return visits were compared for observation and 1‐day stays. RESULTS: The proportion of short‐stays (including both observation and 1‐day stays) increased from 37% to 41% between 2004 and 2009. Since 2007, observation stays have outnumbered 1‐day stays. In 2009, more than half of admissions from the ED for 6 of the top 10 ranking discharge diagnoses were short‐stays. Fewer than 25% of observation stays converted to inpatient status. Return visits and readmissions following observation were no more frequent than following 1‐day stays. CONCLUSIONS: Children admitted under observation status make up a substantial proportion of acute care hospitalizations. Analyses of inpatient administrative databases that exclude observation stays likely result in an underestimation of hospital resource utilization for children. Journal of Hospital Medicine 2012; © 2012 Society of Hospital MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93720/1/1923_ftp.pd

Mapping daily evapotranspiration at Landsat spatial scales during the BEAREX’08 field campaign

Robust spatial information about environmental water use at field scales and daily to seasonal timesteps will benefit many applications in agriculture and water resource management. This information is particularly critical in arid climates where freshwater resources are limited or expensive, and groundwater supplies are being depleted at unsustainable rates to support irrigated agriculture as well as municipal and industrial uses. Gridded evapotranspiration (ET) information at field scales can be obtained periodically using land–surface temperature-based surface energy balance algorithms applied to moderate resolution satellite data from systems like Landsat, which collects thermal-band imagery every 16 days at a resolution of approximately 100 m. The challenge is in finding methods for interpolating between ET snapshots developed at the time of a clear-sky Landsat overpass to provide complete daily time-series over a growing season. This study examines the efficacy of a simple gap-filling algorithm designed for applications in data-sparse regions, which does not require local ground measurements of weather or rainfall, or estimates of soil texture. The algorithm relies on general conservation of the ratio between actual ET and a reference ET, generated from satellite insolation data and standard meteorological fields from a mesoscale model. The algorithm was tested with ET retrievals from the Atmosphere–Land Exchange Inverse (ALEXI) surface energy balance model and associated DisALEXI flux disaggregation technique, which uses Landsat-scale thermal imagery to reduce regional ALEXI maps to a finer spatial resolution. Daily ET at the Landsat scale was compared with lysimeter and eddy covariance flux measurements collected during the Bushland Evapotranspiration and Agricultural Remote sensing EXperiment of 2008 (BEAREX08), conducted in an irrigated agricultural area in the Texas Panhandle under highly advective conditions. The simple gap-filling algorithm performed reasonably at most sites, reproducing observed cumulative ET to within 5–10% over the growing period from emergence to peak biomass in both rainfed and irrigated fields

Advances in multispectral and hyperspectral imaging for archaeology and art conservation

Multispectral imaging has been applied to the field of art conservation and art history since the early 1990s. It is attractive as a noninvasive imaging technique because it is fast and hence capable of imaging large areas of an object giving both spatial and spectral information. This paper gives an overview of the different instrumental designs, image processing techniques and various applications of multispectral and hyperspectral imaging to art conservation, art history and archaeology. Recent advances in the development of remote and versatile multispectral and hyperspectral imaging as well as techniques in pigment identification will be presented. Future prospects including combination of spectral imaging with other noninvasive imaging and analytical techniques will be discussed

An NLO QCD analysis of inclusive cross-section and jet-production data from the ZEUS experiment

The ZEUS inclusive differential cross-section data from HERA, for charged and neutral current processes taken with e+ and e- beams, together with differential cross-section data on inclusive jet production in e+ p scattering and dijet production in \gamma p scattering, have been used in a new NLO QCD analysis to extract the parton distribution functions of the proton. The input of jet data constrains the gluon and allows an accurate extraction of \alpha_s(M_Z) at NLO; \alpha_s(M_Z) = 0.1183 \pm 0.0028(exp.) \pm 0.0008(model) An additional uncertainty from the choice of scales is estimated as \pm 0.005. This is the first extraction of \alpha_s(M_Z) from HERA data alone.Comment: 37 pages, 14 figures, to be submitted to EPJC. PDFs available at http://durpdg.dur.ac.uk/hepdata in LHAPDFv