Critical illness survivorship and implications for care provision; a constructivist grounded theory

Background In the context of increasing survivorship from critical illness it is important to enhance our understanding of the subjective experience of survivors and their families. The critical illness experience is enormously complex, varied and multifaceted. The need to consider the legacy of critical care beyond physiological survival is imperative. Aims of the study The study aimed to formulate a substantive, middle range theory in relation to patient and family’s critical illness trajectory. Further, to discern and understand the responses of critical care nurses to survivorship needs. Methods Working within a relativist ontology and a constructivist grounded theory methodology, a series of in-depth interviews were undertaken with survivors of critical illness (n=16), family members (n=15) (phase 1) and critical care nurses (n=11) (phase 2). Interviews were undertaken in a District General Hospital setting in England. All interviews were transcribed verbatim. Constant comparative analysis and data collection occurring concurrently with theoretical sampling commencing from the outset. Findings Survivors of critical illness invariably entered a liminal state between life and death on admission and during their stay in the Adult General Critical Care Unit (AGCCU). They frequently experienced vivid, hallucinatory experiences which placed them in a different world or liminal space where they could move or transcend in and out of different realities or worlds. The core difficulty can be summarised as follows; survivors have little recall of the factual events of their critical illness within AGCCU but relatives have lived the whole event in a very real and ingraining manner. This can result in family members and survivors experiencing totally different versions or narratives of the critical illness episode; constructing the concept of dualistic worlds. Nurses working within AGCCU found themselves bounded by the walls of the critical care unit and experienced personal and professional conflicts in their role, as they bear witness to critically ill patients and their families. The critical care environment was identified as a demanding place of work which appeared to limit nurses to immediacy of care in the here and now. The specialist knowledge and skill that nurses provided were central to physiological survival but they are unable to support the onward survivorship trajectory. Conclusion Survivors of critical illness, together with family members experience numerous challenges and adversities when endeavouring to readjust to life post critical care. This study has identified a middle range theory of dualistic worlds between and within the survivor and family member experiences. These temporal events occur during and after critical illness and expose a non-linear, fluid journey towards a new normal. Exploring the dynamic interplay between intrapersonal, interpersonal and societal factors has provided theoretical insights into critical illness survivorship and the legacy of critical care. Nurses in AGCCU bear witness to the early stages of the survivorship trajectory and provide complex care in support of survival; however they, are bounded by the walls of AGCCU such is the proximity to death and the pressure of work. They are unable to support the onward survivorship journey

Macroeconomic Modeling of Tax Policy: A Comparison of Current Methodologies

The macroeconomic effects of tax reform are a subject of significant discussion and controversy. In 2015, the House of Representatives adopted a new “dynamic scoring” rule requiring a point estimate within the budget window of the deficit effect due to the macroeconomic response to certain proposed tax legislation. The revenue estimates provided by the staff of the Joint Committee on Taxation (JCT) for major tax bills often play a critical role in Congressional deliberations and public discussion of those bills. The JCT has long had macroeconomic analytic capability, and in recent years, responding to Congress’ interest in macrodynamic estimates for purposes of scoring legislation, outside think tank groups — notably the Tax Policy Center and the Tax Foundation — have also developed macrodynamic estimation models. The May 2017 National Tax Association (NTA) Spring Symposium brought together the JCT with the Tax Foundation and the Tax Policy Center for a panel discussion regarding their respective macrodynamic estimating approaches. This paper reports on that discussion. Below each organization provides a general description of their macrodynamic modeling methodology and answers five questions posed by the convening authors

Constructing a grounded theory of critical illness survivorship; the dualistic worlds of survivors and family members

Aim of the study: To understand the critical illness trajectory from patient and relative perspectives. Background: In the context of increasing survivorship from critical illness, it is important to enhance our understanding of the subjective experience of survivors and their families. The need to consider the legacy of critical care beyond physiological survival is imperative. Methods: Using a constructivist grounded theory methodology, in‐depth interviews were undertaken with survivors of critical illness (n = 16) and family members (n = 15). Constant comparative analysis and data collection occurring concurrently with theoretical sampling commencing from the outset. EQUATOR guidelines for qualitative research (COREQ) applied. Findings: Survivors of critical illness invariably experienced vivid, hallucinatory experiences which placed them in a different world or liminal space. The core difficulty can be summarised as follows: Survivors have little recall of the factual events of their critical illness but relatives have lived the whole event in a very real and ingraining manner. This can result in family members and survivors experiencing different versions of the critical illness episode. Conclusion: Survivors of critical illness, together with family members, experience challenges when endeavouring to readjust to life post critical care. This study has identified a middle range theory of dualistic worlds between and within the survivor and family member experiences. Exploring the dynamic interplay between intrapersonal, interpersonal and societal factors has provided theoretical insights with practice implications in relation to surviving critical illness. Relevance to clinical practice: The findings from this study highlight the need for a rehabilitation infrastructure following critical illness to support the existing UK national guidance, ensuring the individual and holistic needs of survivors and their families are met. Conversations with survivors and their families around critical illness survivorship are frequently absent and needed early in the recovery period

A Subset of Secreted Proteins in Ascites Can Predict Platinum-Free Interval in Ovarian Cancer

The time between the last cycle of chemotherapy and recurrence, the platinum-free interval (PFI), predicts overall survival in high-grade serous ovarian cancer (HGSOC). To identify secreted proteins associated with a shorter PFI, we utilized machine learning to predict the PFI from ascites composition. Ascites from stage III/IV HGSOC patients treated with neoadjuvant chemotherapy (NACT) or primary debulking surgery (PDS) were screened for secreted proteins and Lasso regression models were built to predict the PFI. Through regularization techniques, the number of analytes used in each model was reduced; to minimize overfitting, we utilized an analysis of model robustness. This resulted in models with 26 analytes and a root-mean-square error (RMSE) of 19 days for the NACT cohort and 16 analytes and an RMSE of 7 days for the PDS cohort. High concentrations of MMP-2 and EMMPRIN correlated with a shorter PFI in the NACT patients, whereas high concentrations of uPA Urokinase and MMP-3 correlated with a shorter PFI in PDS patients. Our results suggest that the analysis of ascites may be useful for outcome prediction and identified factors in the tumor microenvironment that may lead to worse outcomes. Our approach to tuning for model stability, rather than only model accuracy, may be applicable to other biomarker discovery tasks

Older and younger adults are influenced differently by dark pattern designs

Considering that prior research has found older users undergo a different privacy decision-making process compared to younger adults, more research is needed to inform the behavioral privacy disclosure effects of these strategies for different age groups. To address this gap, we used an existing dataset of an experiment with a photo-tagging Facebook application. This experiment had a 2x2x5 between-subjects design where the manipulations were common dark pattern design strategies: framing (positive vs. negative), privacy defaults (opt-in vs. opt-out), and justification messages (positive normative, negative normative, positive rationale, negative rationale, none). We compared older (above 65 years old, N=44) and young adults (18 to 25 years old, N=162) privacy concerns and disclosure behaviors (i.e., accepting or refusing automated photo tagging) in the scope of dark pattern design. Overall, we find support for the effectiveness of dark pattern designs in the sense that positive framing and opt-out privacy defaults significantly increased disclosure behavior, while negative justification messages significantly decreased privacy concerns. Regarding older adults, our results show that certain dark patterns do lead to more disclosure than for younger adults, but also to increased privacy concerns for older adults than for younger

A dose response study to assess the effects of New Zealand Pine Bark extract on glycaemic responses in healthy participants.

Background: The current estimation of 451 million people diagnosed with diabetes is expected to increase to 693 million by 2045. Plant extracts have been shown to improve glycaemic control in humans. However, evidence is lacking regarding the hypoglycaemic effects of New Zealand pine bark obtained from Pinus radiata trees

Bridging a Bridge: Bringing Two HCI Communities Together

ACM SIGCHI is the largest association for professionals in HCI that bridges computer science, information science, as well as the social and psychological sciences. Meanwhile, a parallel HCI community was formed in 2001 within the Association of Information Systems (AIS SIGHCI) community. While some researchers have already bridged these two HCI subdisciplines, the history and core values of these respective fields are quite different, offering new insights for how we can move forward together to sustain the future of HCI research. The main goal of this workshop is to begin building a bridge between these two communities to maximize the relevance, rigor, and generalizability of HCI research.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140402/1/wks0159-djamasbi CHI 2018.pdfDescription of wks0159-djamasbi CHI 2018.pdf : Main Fil

A Subset of Secreted Proteins in Ascites Can Predict Platinum-Free Interval in Ovarian Cancer

Simple SummaryIdentifying proteins that correlate with better or worse outcomes may help to identify new treatment approaches for advanced high-grade serous ovarian cancer. Here, we utilize a machine learning technique to correlate the levels of 58 secreted proteins in tumor ascites with the time to disease recurrence after chemotherapy, which is known clinically as the platinum-free interval. We identify several candidate proteins correlated to shorter or longer platinum-free intervals and describe model analysis methods that may be useful for other studies aiming to identify factors impacting patient outcomes. Future validation of these factors in a prospective cohort would confirm their clinical utility, whereas a study of the mechanisms that they impact may identify new therapies. The time between the last cycle of chemotherapy and recurrence, the platinum-free interval (PFI), predicts overall survival in high-grade serous ovarian cancer (HGSOC). To identify secreted proteins associated with a shorter PFI, we utilized machine learning to predict the PFI from ascites composition. Ascites from stage III/IV HGSOC patients treated with neoadjuvant chemotherapy (NACT) or primary debulking surgery (PDS) were screened for secreted proteins and Lasso regression models were built to predict the PFI. Through regularization techniques, the number of analytes used in each model was reduced; to minimize overfitting, we utilized an analysis of model robustness. This resulted in models with 26 analytes and a root-mean-square error (RMSE) of 19 days for the NACT cohort and 16 analytes and an RMSE of 7 days for the PDS cohort. High concentrations of MMP-2 and EMMPRIN correlated with a shorter PFI in the NACT patients, whereas high concentrations of uPA Urokinase and MMP-3 correlated with a shorter PFI in PDS patients. Our results suggest that the analysis of ascites may be useful for outcome prediction and identified factors in the tumor microenvironment that may lead to worse outcomes. Our approach to tuning for model stability, rather than only model accuracy, may be applicable to other biomarker discovery tasks.</p

Ab initio constrained crystal-chemical Rietveld refinement of Ca10(VxP1-xO4)6F2 apatites

Extraction of reliable bond distances and angles for Ca10(VxP1-xO4)6F2 apatites using standard Rietveld refinement with Cu K(alpha) X-ray powder data was significantly impaired by large imprecision for the O-atom coordinates. An initial attempt to apply crystal-chemical Rietveld refinements to the same compounds was partly successful, and exposed the problematic determination of two oxygen\u8211metal\u8211oxygen angles. Ab initio modeling with VASP in space groups P63/m, P21/m and Pm showed that both these angular parameters exhibited a linear dependence with the vanadium content. Stable crystal-chemical Rietveld refinements in agreement with quantum results were obtained by fixing these angles at the values from ab initio simulations. Residuals were comparable with the less precise standard refinements. The larger vanadium ion is accommodated primarily by uniform expansion and rotation of BO4 tetrahedra combined with a rotation of the Ca\u8211Ca\u8211Ca triangular units. It is proposed that the reduction of symmetry for the vanadium end-member is necessary to avoid considerable departures from formal valences at the AII and B sites in P63/m. The complementarity of quantum methods and structural analysis by powder diffraction in cases with problematic least-squares extraction of the crystal chemistry is discussed.Peer reviewed: YesNRC publication: Ye