Children with complex support needs in healthcare settings for prolonged periods: their numbers, characteristics and experiences

This report details the findings of research conducted in England and Scotland to identify how many children with complex support needs are spending longer than one month in healthcare settings in Scotland and England, how and why they are in hospital, why they have not been discharged home or to appropriate alternative community-based facilities, and how well the hospital or healthcare setting is meeting their emotional, social and educational needs. It finds that many of these children could and should be discharged but are not, for a variety of reasons: primarily the lack of appropriate resources in the community and poor discharge planning processes, coupled with the inability of their families to manage their care and supervision without intensive support. Hospitals and healthcare settings in many cases are not meeting their needs and these children are being denied the protection offered by UK legislation governing children's rights and welfare

Combined ultraviolet studies of astronomical sources

Ultraviolet studies of astronomical sources are discussed. Some studies utilized IVE data. Non-radiative shock at the edge of the Cygnses Loop, stellar flares, local interestellar medium, hot galaxies, stellar mass ejection, contact binaries, double quasars, and stellar chromosphere and coronae are discussed

Solar Carbon Monoxide, Thermal Profiling, and the Abundances of C, O, and their Isotopes

A solar photospheric "thermal profiling" analysis is presented, exploiting the infrared rovibrational bands of carbon monoxide (CO) as observed with the McMath-Pierce Fourier transform spectrometer (FTS) at Kitt Peak, and from above the Earth's atmosphere by the Shuttle-borne ATMOS experiment. Visible continuum intensities and center-limb behavior constrained the temperature profile of the deep photosphere, while CO center-limb behavior defined the thermal structure at higher altitudes. The oxygen abundance was self consistently determined from weak CO absorptions. Our analysis was meant to complement recent studies based on 3-D convection models which, among other things, have revised the historical solar oxygen (and carbon) abundance downward by a factor of nearly two; although in fact our conclusions do not support such a revision. Based on various considerations, an oxygen abundance of 700+/-100 ppm (parts per million relative to hydrogen) is recommended; the large uncertainty reflects the model sensitivity of CO. New solar isotopic ratios also are reported for 13C, 17O, and 18O.Comment: 90 pages, 19 figures (some with parts "a", "b", etc.); to be published in the Astrophysical Journal Supplement

Efficacy of Thermotherapy to Treat Cutaneous Leishmaniasis Caused by Leishmania tropica in Kabul, Afghanistan: A Randomized, Controlled Trial

BACKGROUND: Pentavalent antimony is the agent recommended for treatment of cutaneous leishmaniasis (CL). Its use is problematic, because it is expensive and because of the potential for drug-associated adverse effects during a lengthy and painful treatment course. METHODS: We tested the efficacy of thermotherapy for the treatment of CL due to Leishmania tropica in a randomized, controlled trial in Kabul, Afghanistan. We enrolled 401 patients with a single CL lesion and administered thermotherapy using radio-frequency waves (1 treatment of ≥1 consecutive application at 50°C for 30 s) or sodium stibogluconate (SSG), administered either intralesionally (a total of 5 injections of 25 mL every 57 days, depending on lesion size) or intramuscularly (20 mg/kg daily for 21 days). RESULTS: Cure, defined as complete reepithelialization at 100 days after treatment initiation, was observed in 75 (69.4%) of 108 patients who received thermotherapy, 70 (75.3%) of 93 patients who received intralesional SSG, and 26 (44.8%) of 58 patients who received intramuscular SSG. The OR for cure with thermotherapy was 2.80 (95% confidence interval [CI], 1.455.41), compared with intramuscular SSG treatment (P = .002). No statistically significant difference was observed in the odds of cure in comparison of intralesional SSG and thermotherapy treatments. The OR for cure with intralesional SSG treatment was 3.75 (95% CI, 1.867.54), compared with intramuscular SSG treatment (P 100 days, respectively; P = .003). CONCLUSIONS: Thermotherapy is an effective, comparatively well-tolerated, and rapid treatment for CL, and it should be considered as an alternative to antimony treatment

The Effects of Immobility on Long Bone Remodelling in the Rhesus Monkey

Using Frost\u27s method for undecalcified bone sections, long bones of the lower extremities of ten rhesus monkeys were examined following two months\u27 immobilization and compared with thirteen controls. A decrease in appositional rate and in the surface extent of the ossification process were noted in the immobilized animals. No typical change in resorption was noted. The immobilized animals showed a decreased cortical-total area ratio. These findings suggest that a decrease in activity affects bone by depressing functions mediated by the osteoblast without necessarily evoking an Increased remodelling response

The Case Against Cold, Dark Chromospheres

Is the solar chromosphere always hot, with relatively small temperature variations ($\delta T/T\sim0.1$); or is it cold most of the time, with temperature fluctuations that reach $\delta T/T\sim 10$ at the top of the chromosphere? Or, equivalently: Is the chromosphere heated continually, or only for a few seconds once every three minutes? Two types of empirical model, one essentially time independent and always hot, the other highly time dependent and mostly cold, come to fundamentally different conclusions. This paper analyzes the time-dependent model of the quiet, nonmagnetic chromosphere by Carlsson & Stein (1994: CS94) and shows that it predicts deep absorption lines, none of which is observed; intensity fluctuations in the Lyman continuum that are much larger than observed; and time-averaged emission that falls far short of the observed emission. The paper concludes that the solar chromosphere, while time dependent, is never cold and dark. The same conclusion applies for stellar chromospheres. A complete, time-dependent model of the nonmagnetic chromosphere must describe two phenomena: (1) dynamics, like that modeled by CS94 for chromospheric bright points but corrected for the geometrical properties of shocks propagating in an upward-expanding channel; and (2) the energetically more important general, sustained heating of the chromosphere, as described by current time-independent empirical models, but modified in the upper photosphere for the formation of molecular absorption lines of CO in a dynamical medium. This model is always hot and, except for absorption features caused by departures from local thermodynamic equilibrium, shows chromospheric lines only in emission.Comment: 22 pages, 5 figures (in 6 files

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