Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

Objectives: To explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. Methods: Postal survey of 356 London-based GPs, assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. Results: Currently, 65% of GPs were providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role; and 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that 'palliative care is mainly district nursing (DN) work'. Many were unaware of out-of-hours DN and specialist palliative care services. Multi-variable analysis found four GP characteristics - larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of palliative care - were associated with agreement that palliative care was central to a GP's role. Conclusion: A minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care

Statistical classification techniques for engineering and climatic data samples

Fisher's sample linear discriminant function is modified through an appropriate alteration of the common sample variance-covariance matrix. The alteration consists of adding nonnegative values to the eigenvalues of the sample variance covariance matrix. The desired results of this modification is to increase the number of correct classifications by the new linear discriminant function over Fisher's function. This study is limited to the two-group discriminant problem

Asymmetric synthesis of 2-substituted oxetan-3-ones via metalated SAMP/RAMP hydrazones

2-Substituted oxetan-3-ones can be prepared in good yields and enantioselectivities (up to 84% ee) by the metalation of the SAMP/RAMP hydrazones of oxetan-3-one, followed by reaction with a range of electrophiles that include alkyl, allyl, and benzyl halides. Additionally, both chiral 2,2- and 2,4-disubstituted oxetan-3-ones can be made in high ee (86–90%) by repetition of this lithiation/alkylation sequence under appropriately controlled conditions. Hydrolysis of the resultant hydrazones with aqueous oxalic acid provides the 2-substituted oxetan-3-ones without detectable racemization

Spectroscopic characterization and detection of Ethyl Mercaptan in Orion

New laboratory data of ethyl mercaptan, CH$_{3}$CH$_{2}$SH, in the millimeter and submillimeter-wave domains (up to 880 GHz) provided very precise values of the spectroscopic constants that allowed the detection of $gauche$-CH$_3$CH$_2$SH towards Orion KL. 77 unblended or slightly blended lines plus no missing transitions in the range 80-280 GHz support this identification. A detection of methyl mercaptan, CH$_{3}$SH, in the spectral survey of Orion KL is reported as well. Our column density results indicate that methyl mercaptan is $\simeq$ 5 times more abundant than ethyl mercaptan in the hot core of Orion KL.Comment: Accepted for publication in ApJL (30 January 2014)/ submitted (8 January 2014

PREHISTORIC CREMATIONS FROM NOGALES, ARIZONA *

In October, 1969, the Highway Salvage Section of the Arizona State Museum conducted emergency salvage excavations in conjunction with the construction of the Tucson-Nogales Highway. Ten cremations were recovered from a backhoe trench which had been placed within the city limits of Nogales, Arizona. Analysis of the cremations indicated cultural contact between the Trincheras culture of Sonora, Mexico, and the Hohokam culture of the Santa Cruz River Valley in southern Arizona

Regio- and stereocontrolled synthesis of 3-substituted 1,2-diazetidines by asymmetric allylic amination of vinyl epoxide

Pd-catalyzed asymmetric allylic amination of rac-vinyl epoxide with unsymmetrical 1,2-hydrazines proceeds with excellent regio- and stereocontrol, which after further ring closure provides differentially protected 3-vinyl-1,2-diazetidines in good yields. The chirality at C–3 exerts stereocontrol over the nitrogen centers in the 1,2-diazetidine with all substituents orientat-ing themselves trans to their neighbours. Efficient functionalization without rupture of the strained ring is demonstrated (e.g. by cross-metathesis), establishing the first general route to C–3 substituted 1,2-diazetidines in enantioenriched form

Material Properties Measurements for Selected Materials

Hugoniot equation of state measurements were made on Coconino sandstone, Vacaville basalt, Kaibab limestone, Mono Crater, pumice and Zelux (a polycarbonate resin) for pressures to 2 Mb. A single data point was obtained for fused quartz at 1.6 Mb. In addition to the hugoniot studies, the uniaxial compressive stress behavior of Vacaville basalt and Zelux was investigated at strain rates from about 10(exp -5)/sec to 10(exp 3)/second. The data presented include the stress - strain relations as a function of strain rate for these two materials

Managing bereavement in the classroom: a conspiracy of silence?

The ways in which teachers in British schools manage bereaved children are under-reported. This article reports the impact of students' bereavement and their subsequent management in primary and secondary school classrooms in Southeast London. Thirteen school staff working in inner-city schools took part in in-depth interviews that focused on the impact of bereaved children on the school and how teachers responded to these children. All respondents had previously had contact with a local child bereavement service that aims to provide support, advice, and consultancy to children, their parents, and teachers. Interviews were audiotaped, transcribed verbatim, and analyzed using ATLAS-ti. Three main themes were identified from analysis of interview data. Firstly, British society, culture, local communities, and the family were significant influences in these teachers' involvement with bereaved students. Secondly, school staff managed bereaved students through contact with other adults and using practical classroom measures such as "time out" cards and contact books. Lastly, teachers felt they had to be strong, even when they were distressed. Surprise was expressed at the mature reaction of secondary school students to deaths of others. The article recommends that future research needs to concentrate on finding the most effective way of supporting routinely bereaved children, their families, and teachers

Readily accessible sp3-rich cyclic hydrazine frameworks exploiting nitrogen fluxionality

Increased molecular complexity correlates with improved chances of success in the drug development process. Here, a strategy for the creation of sp3-rich, non-planar heterocyclic scaffolds suitable for drug discovery is described that obviates the need to generate multiple stereogenic centers with independent control. Asymmetric transfer hydrogenation using a tethered Ru-catalyst is used to efficiently produce a range of enantiopure cyclic hydrazine building blocks (up to 99% ee). Iterative C–N functionalization at the two nitrogen atoms of these compounds produces novel hydrazine and hydrazide based chemical libraries. Wide chemical diversification is possible through variation in the hydrazine structure, use of different functionalization chemistries and coupling partners, and controlled engagement of each nitrogen of the hydrazine in turn. Principal Moment of Inertia (PMI) analysis of this small hydrazine library reveals excellent shape diversity and three-dimensionality. NMR and crystallographic studies confirm these frameworks prefer to orient their substituents in three-dimensional space under the control of a single stereogenic center through exploitation of the fluxional behavior of the two nitrogen atoms

Recent progress toward reducing seawalls in Puget Sound

Recovery efforts for Puget Sound have focused on improving shoreline function by reducing seawalls (e.g. rock and concrete bank protection) and encouraging alternatives, such as soft shore protection. Shoreline armor was one of the key stressors identified by the Puget Sound Partnership in 2010 to protect and restore habitat. Armor is one of the Puget Sound Vital Signs, those measures used by the Puget Sound Partnership to track ecosystem health. One of the targets associated with the Vital Sign, a net reduction of the total extent of armor between 2011 and 2020, is tracked using the Hydraulic Project Approval (HPA) permitting database maintained by the Washington Department of Fish and Wildlife. Projects are categorized as new, replacement and removed armor. A summary of permit information indicates that generally, trend in new shoreline armor decreased from 2005 – 2016, while the pace of hard armor removal increased. Two additional targets identified by the Partnership, emphasizes the importance of keeping intact eroding bluffs (locally referred to as feeder bluffs) that maintain Puget Sound beaches, and encouraging the use of softer, nature-based approaches to erosion control. The HPA data, combined with recent detailed mapping of coastal landforms, provide an indication of progress towards the feeder bluff target. Soft shoreline techniques have long been of interest on Puget Sound, but have been slow to be widely adopted. These soft techniques are difficult to categorize, as many are hybrids, combining natural elements and beach nourishment with more conventional rock or concrete structural measures. New technical guidance, combined with increased regulatory emphasis and locally-based outreach efforts, have led to improvements in the implementation and the success of new methods of addressing erosion. We describe significant regulatory, educational, scientific, and restoration efforts focused on this issue in Puget Sound