Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

BACKGROUND: The accuracy of prognostication has important implications for patients, families, and health services since it may be linked to clinical decision-making, patient experience and outcomes and resource allocation. Study aim is to evaluate the accuracy of temporal predictions of survival in patients with cancer, dementia, heart, or respiratory disease. METHODS: Accuracy of clinical prediction was evaluated using retrospective, observational cohort study of 98,187 individuals with a Coordinate My Care record, the Electronic Palliative Care Coordination System serving London, 2010-2020. The survival times of patients were summarised using median and interquartile ranges. Kaplan Meier survival curves were created to describe and compare survival across prognostic categories and disease trajectories. The extent of agreement between estimated and actual prognosis was quantified using linear weighted Kappa statistic. RESULTS: Overall, 3% were predicted to live "days"; 13% "weeks"; 28% "months"; and 56% "year/years". The agreement between estimated and actual prognosis using linear weighted Kappa statistic was highest for patients with dementia/frailty (0.75) and cancer (0.73). Clinicians' estimates were able to discriminate (log-rank p < 0.001) between groups of patients with differing survival prospects. Across all disease groups, the accuracy of survival estimates was high for patients who were likely to live for fewer than 14 days (74% accuracy) or for more than one year (83% accuracy), but less accurate at predicting survival of "weeks" or "months" (32% accuracy). CONCLUSION: Clinicians are good at identifying individuals who will die imminently and those who will live for much longer. The accuracy of prognostication for these time frames differs across major disease categories, but remains acceptable even in non-cancer patients, including patients with dementia. Advance Care Planning and timely access to palliative care based on individual patient needs may be beneficial for those where there is significant prognostic uncertainty; those who are neither imminently dying nor expected to live for "years"

Acceptance and uptake of improved biomass cookstoves in Peru: learning from system level approaches to transform large-scale cooking interventions

Improved biomass cookstoves (ICS) are cooking technologies that increase wellbeing and reduce household air pollution. With the goal of identifying factors influencing ICS acceptance and uptake at five system levels (intrapersonal, interpersonal, community, institutional, and policy), we carried out a qualitative study in three regions in Peru. We conducted 32 focus group discussions (243 ICS users) and 26 semi-structured interviews with key stakeholders, applying a combination of two system-level frameworks for analysis: the socio-ecological model and the ICS adoption domain. Enabling and impeding factors at each level were closely related to each other. Decisions made by policy makers - often centralised and not considering local/regional realities - strongly influenced acceptance and barriers at lower levels. ICS acceptance and uptake tended to be low when ICS users were not involved from the start. Most ICS programmes focused on stove distribution outputs, without considering community needs, such as training on ICS building, maintenance and repair, or issues related to spare part availability, which is a strong barrier to sustained uptake of ICS. Using a combination of models that allows one to examine facilitators and barriers at multiple levels, as well as the interactions of those levels, was useful in assessing potential improvements to intervention design, facilitating programme success, preventing unforeseen programme adaptations, and improving cost-effectiveness of interventions

A "cookbook" for vulnerability research

There is a growing need to facilitate the interdisciplinary study of the relationship between the environment and human health and well-being. It is increasingly recognized that vulnerability is a key construct allowing discipline-specific research questions on these topics to be meaningfully contextualized. However, there is little consensus regarding the meaning of the concept of vulnerability or how it can best be utilized in research studies. In this perspective article, we use the metaphor of a "cookbook" to review promising trends in vulnerability research and to make this body of research accessible to a multi-disciplinary audience. Specifically, we discuss a selection of "recipes" (theoretical frameworks), "ingredients" (vulnerability domains), "cooking tools" (qualitative and quantitative methods), and approaches to "meal presentation" (communication of results) drawn from vulnerability studies published in the past 15 years. Our aim is for this short "cookbook" to serve as a jumping-off point for scholars unfamiliar with the vulnerability literature and an inspiration for scholars more familiar with this topic to develop new ways to navigate the tension between locally-specific assessments of vulnerability and attempts at standardization. Our ultimate take-home message is that the specifics theories and methods used in vulnerability research are less important than attention to what we see as the 3 'T's of transparency, triangulation, and transferability, and to efforts to make vulnerability research both "place-based" and comparable

Solvothermal synthesis of a new 3-D mixed-metal sulfide framework, (H1.33tren)[In2.67Sb1.33S8]∙tren

A new indium(III) antimony(V) sulfide, (H1.33tren)[In2.67Sb1.33S8]∙tren, has been prepared solvothermally at 433 K. The compound crystallises in the tetragonal space group I-42d (lattice parameters, a = 12.6248(5) and c = 19.4387(18) Å at 150 K) and contains adamantane-like T2 supertetrahedral units comprised of corner-sharing InS45- and SbS43- tetrahedra. The adamantane-like units are then linked through sulfur vertices to generate an open, 3-D framework structure containing large pores in which neutral, protonated tren (tris(2-aminoethylene)amine) molecules reside. The presence of the organic components was confirmed by solid-state 13C NMR (10 kHz), combustion and thermogravimetric analysis. The band gap, obtained from UV-vis diffuse reflectance measurements, is 2.7(2) eV. Stirring with either water or alkali-metal salt solution leads to removal of the neutral tren molecules and an ~9 % reduction in unit-cell volume on formation of (H1.33tren)[In2.67Sb1.33S8]∙(H2O)4

Validation of a synoptic solar wind model

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94963/1/jgra19149.pd

Assessing the quality of models of the ambient solar wind

In this paper we present an assessment of the status of models of the global Solar Wind in the inner heliosphere. We limit our discussion to the class of models designed to provide solar wind forecasts, excluding those designed for the purpose of testing physical processes in idealized configurations. In addition, we limit our discussion to modeling of the ‘ambient’ wind in the absence of coronal mass ejections. In this assessment we cover use of the models both in forecast mode and as tools for scientific research. We present a brief history of the development of these models, discussing the range of physical approximations in use. We discuss the limitations of the data inputs available to these models and its impact on their quality. We also discuss current model development trends

Studies of the decays D^0 \rightarrow K_S^0K^-\pi^+ and D^0 \rightarrow K_S^0K^+\pi^-

The first measurements of the coherence factor R_{K_S^0K\pi} and the average strong--phase difference \delta^{K_S^0K\pi} in D^0 \to K_S^0 K^\mp\pi^\pm decays are reported. These parameters can be used to improve the determination of the unitary triangle angle \gamma\ in B^- \rightarrow $\widetilde{D}K^-$ decays, where $\widetilde{D}$ is either a D^0 or a D^0-bar meson decaying to the same final state, and also in studies of charm mixing. The measurements of the coherence factor and strong-phase difference are made using quantum-correlated, fully-reconstructed D^0D^0-bar pairs produced in e^+e^- collisions at the \psi(3770) resonance. The measured values are R_{K_S^0K\pi} = 0.70 \pm 0.08 and \delta^{K_S^0K\pi} = (0.1 \pm 15.7)$^\circ$ for an unrestricted kinematic region and R_{K*K} = 0.94 \pm 0.12 and \delta^{K*K} = (-16.6 \pm 18.4)$^\circ$ for a region where the combined K_S^0 \pi^\pm invariant mass is within 100 MeV/c^2 of the K^{*}(892)^\pm mass. These results indicate a significant level of coherence in the decay. In addition, isobar models are presented for the two decays, which show the dominance of the K^*(892)^\pm resonance. The branching ratio {B}(D^0 \rightarrow K_S^0K^+\pi^-)/{B}(D^0 \rightarrow K_S^0K^-\pi^+) is determined to be 0.592 \pm 0.044 (stat.) \pm 0.018 (syst.), which is more precise than previous measurements.Comment: 38 pages. Version 3 updated to include the erratum information. Errors corrected in Eqs (25), (26), 28). Fit results updated accordingly, and external inputs updated to latest best known values. Typo corrected in Eq(3)- no other consequence

Updated Measurement of the Strong Phase in D0 --> K+pi- Decay Using Quantum Correlations in e+e- --> D0 D0bar at CLEO

We analyze a sample of 3 million quantum-correlated D0 D0bar pairs from 818 pb^-1 of e+e- collision data collected with the CLEO-c detector at E_cm = 3.77 GeV, to give an updated measurement of \cos\delta and a first determination of \sin\delta, where \delta is the relative strong phase between doubly Cabibbo-suppressed D0 --> K+pi- and Cabibbo-favored D0bar --> K+pi- decay amplitudes. With no inputs from other experiments, we find \cos\delta = 0.81 +0.22+0.07 -0.18-0.05, \sin\delta = -0.01 +- 0.41 +- 0.04, and |\delta| = 10 +28+13 -53-0 degrees. By including external measurements of mixing parameters, we find alternative values of \cos\delta = 1.15 +0.19+0.00 -0.17-0.08, \sin\delta = 0.56 +0.32+0.21 -0.31-0.20, and \delta = (18 +11-17) degrees. Our results can be used to improve the world average uncertainty on the mixing parameter y by approximately 10%.Comment: Minor revisions, version accepted by PR

Observation of the Dalitz Decay Ds∗+→Ds+e+e−D_{s}^{*+} \to D_{s}^{+} e^{+} e^{-}

Using 586 $\textrm{pb}^{-1}$ of $e^{+}e^{-}$ collision data acquired at $\sqrt{s}=4.170$ GeV with the CLEO-c detector at the Cornell Electron Storage Ring, we report the first observation of $D_{s}^{*+} \to D_{s}^{+} e^{+} e^{-}$ with a significance of $5.3 \sigma$. The ratio of branching fractions \calB(D_{s}^{*+} \to D_{s}^{+} e^{+} e^{-}) / \calB(D_{s}^{*+} \to D_{s}^{+} \gamma) is measured to be $[ 0.72^{+0.15}_{-0.13} (\textrm{stat}) \pm 0.10 (\textrm{syst})]$, which is consistent with theoretical expectations