Validation of “Care of the Dying Evaluation” in emergency medicine (CODEEM): pilot phase of End-of-life Management Protocol Offered Within Emergency Room (EMPOWER) study

Background: An increasing number of patients who present to emergency departments are at their endof-life phase and have significant palliative care needs such as in symptom control for pain and dyspnoea. Evaluating quality of care provided is imperative, yet there is no suitable tool validated in the emergency and Asian settings. We aim to examine the face and construct validity, and reliability of a newly developed questionnaire, Care of the Dying Evaluation - Emergency Medicine, for measuring the quality of end-of-life care in an Asian emergency context. Methods: A mixed methods pilot study was conducted. Participants composed of the next-of-kin to thirty dying patients who presented to the emergency departments of three public hospitals in Singapore. Qualitative evaluation, using cognitive "think-aloud" interviews, and quantitative analysis were employed. Percentage agreement and κ statistic were measured to evaluate temporal stability of the questionnaire. Cronbach's α and item-total correlations were used to assess internal consistency within the constructs. Confirmatory factor analysis was performed for construct validity. Results: All participants reported clear understanding of the questionnaire with no ambiguity; a minority felt the questions caused emotional distress (7/30, 23.3%). The questions showed moderate to good testretest reliability. Internal consistencies within the constructs were good for "ENVIRONMENT" and "CARE", and moderate for "COMMUNICATION". Factor loadings range from 0.40 to 0.99. Conclusions: The Care of the Dying Evaluation - Emergency Medicine questionnaire may be valid and reliable for use in an Asian emergency setting. Our prospective multicentre study using this evaluation tool may provide more insight on the quality of care rendered to dying patients and identify areas for improvement. Trial registration: ClinicalTrials.gov (NCT03906747)

Search for Anomalous Couplings in the Higgs Sector at LEP

Anomalous couplings of the Higgs boson are searched for through the processes e^+ e^- -> H gamma, e^+ e^- -> e^+ e^- H and e^+ e^- -> HZ. The mass range 70 GeV < m_H < 190 GeV is explored using 602 pb^-1 of integrated luminosity collected with the L3 detector at LEP at centre-of-mass energies sqrt(s)=189-209 GeV. The Higgs decay channels H -> ffbar, H -> gamma gamma, H -> Z\gamma and H -> WW^(*) are considered and no evidence is found for anomalous Higgs production or decay. Limits on the anomalous couplings d, db, Delta(g1z), Delta(kappa_gamma) and xi^2 are derived as well as limits on the H -> gamma gamma and H -> Z gamma decay rates

Neutral-Current Four-Fermion Production in e+e- Interactions at LEP

Neutral-current four-fermion production, e+e- -> ffff is studied in 0.7/fb of data collected with the L3 detector at LEP at centre-of-mass energies root(s)=183-209GeV. Four final states are considered: qqvv, qqll, llll and llvv, where l denotes either an electron or a muon. Their cross sections are measured and found to agree with the Standard Model predictions. In addition, the e+e- -> Zgamma* -> ffff process is studied and its total cross section at the average centre-of-mass energy 196.6GeV is found to be 0.29 +/- 0.05 +/- 0.03 pb, where the first uncertainty is statistical and the second systematic, in agreement with the Standard Model prediction of 0.22 pb. Finally, the mass spectra of the qqll final states are analysed to search for the possible production of a new neutral heavy particle, for which no evidence is found

Measurement of Exclusive rho+rho- Production in Mid-Virtuality Two-Photon Interactions and Study of the gamma gamma* -> rho rho Process at LEP

Exclusive rho+rho- production in two-photon collisions between a quasi-real photon, gamma, and a mid-virtuality photon, gamma*, is studied with data collected at LEP at centre-of-mass energies root(s)=183-209GeV with a total integrated luminosity of 684.8pb^-1. The cross section of the gamma gamma* -> rho+ rho- process is determined as a function of the photon virtuality, Q^2, and the two-photon centre-of-mass energy, W_gg, in the kinematic region: 0.2GeV^2 < Q^2 <0.85GeV^2 and 1.1GeV < W_gg < 3GeV. These results, together with previous L3 measurements of rho0 rho0 and rho+ rho- production, allow a study of the gamma gamma* -> rho rho process over the Q^2-region 0.2GeV^2 < Q^2 < 30 GeV^2

Z Boson Pair-Production at LEP

Events stemming from the pair-production of Z bosons in e^+e^- collisions are studied using 217.4 pb^-1 of data collected with the L3 detector at centre-of-mass energies from 200 GeV up to 209 GeV. The special case of events with b quarks is also investigated. Combining these events with those collected at lower centre-of-mass energies, the Standard Model predictions for the production mechanism are verified. In addition, limits are set on anomalous couplings of neutral gauge bosons and on effects of extra space dimensions

Measurement of the Running of the Electromagnetic Coupling at Large Momentum-Transfer at LEP

The evolution of the electromagnetic coupling, alpha, in the momentum-transfer range 1800GeV^2 < -Q^2 < 21600GeV^2 is studied with about 40000 Bhabha-scattering events collected with the L3 detector at LEP at centre-of-mass energies 189-209GeV. The running of alpha is parametrised as: alpha(Q^2) = alpha_0/(1-C Delta alpha(Q^2)), where alpha_0=\alpha(Q^2=0) is the fine-structure constant and C=1 corresponds to the evolution expected in QED. A fit to the differential cross section of the e+e- ->e+e- process for scattering angles in the range |cos theta|<0.9 excludes the hypothesis of a constant value of alpha, C=0, and validates the QED prediction with the result: C = 1.05 +/- 0.07 +/- 0.14, where the first uncertainty is statistical and the second systematic

Inclusive Lambda Production in Two-Photon Collisions at LEP

The reactions e^+e^- -> e^+e^- Lambda X and e^+e^- -> e^+e^- Lambda X are studied using data collected at LEP with the L3 detector at centre-of-mass energies between 189 and 209 GeV. Inclusive differential cross sections are measured as a function of the lambda transverse momentum, p_t, and pseudo-rapidity, eta, in the ranges 0.4 GeV < p_t < 2.5 GeV and |\eta| < 1.2. The data are compared to Monte Carlo predictions. The differential cross section as a function of p_t is well described by an exponential of the form A exp (- p_t / )$

Search for Charged Higgs Bosons at LEP

A search for pair-produced charged Higgs bosons is performed with the L3 detector at LEP using data collected at centre-of-mass energies between 189 and 209GeV, corresponding to an integrated luminosity of 629.4/pb. Decays into a charm and a strange quark or into a tau lepton and its neutrino are considered. No significant excess is observed and lower limits on the mass of the charged Higgs boson are derived at the 95% confidence level. They vary from 76.5 to 82.7GeV, as a function of the H->tv branching ratio

Search for Colour Singlet and Colour Reconnection Effects in Hadronic Z Decays at LEP

A search is performed in symmetric 3-jet hadronic Z decay events for evidence of colour singlet production or colour reconnection effects. Asymmetries in the angular separation of particles are found to be sensitive indicators of such effects. Upper limits on the level of colour singlet production and colour reconnection effects are established for a variety of models

Proton-Antiproton Pair Production in Two-Photon Collisions at LEP

The reaction e^+e^- -> e^+e^- proton antiproton is studied with the L3 detector at LEP. The analysis is based on data collected at e^+e^- center-of-mass energies from 183 GeV to 209 GeV, corresponding to an integrated luminosity of 667 pb^-1. The gamma gamma -> proton antiproton differential cross section is measured in the range of the two-photon center-of-mass energy from 2.1 GeV to 4.5 GeV. The results are compared to the predictions of the three-quark and quark-diquark models