Factors influencing medical decision- Making for seriously ill patients in the Acute Care Hospital

Aim: To acquire a fuller understanding of the influences on decision-making in an acute care hospital for seriously ill patients. Background: Fromthe moment of a diagnosis of serious, potentially life-limiting illness, patients and their families are faced withmultiple, complex and significant decisions that will influence the entire illness trajectory, including their end-of-life care (EOLC). Compounding personal factors is the complexity of dying today with acute ward areas in tertiary hospitals use of technological interventions to prolong life, at all costs being the norm. If hospice care is initiated, in these areas, it is often at too late a stage to relieve distressing symptoms and to offer the person the best possible path of care for a dignified death. Design and methods: A retrospective cohort research design was used for this study. Results: Thirty nine (39) medical records that met the inclusion criteria were audited. While medical records are limited in terms of the quality of the information contained in them in terms of social, behavioural and other qualitative information, the audit obtained detailed clinical information on patient characteristics, clinical care, and family and clinician involvement in the care of these patients. Communication between health professionals and patient and or family were limited. Poor documentation in the medical record did not support shared decision-making with decisions to amend the care pathway to palliative not undertaken in most instances despite no improvement in response to care or deterioration in the patient’s condition. Conclusion: Communication between health care professions, patients and their family’s needs to be addressed. The management of patients who are seriously ill in acute ward areas should be altered to reflect the patient’s condition. Nurses, using a person-centred approach, have a role in advocating for the patient and the family in times of stress. Discussions concerning end-oflife of seriously ill patients need to be open, transparent and communicated as these discussions are critical to ensuring the patient’s wishes are realised

Classical integrability and quantum aspects of the AdS(3) x S(3) x S(3) x S(1) superstring

In this paper we continue the investigation of aspects of integrability of the type IIA AdS(3) x S(3) x S(3) x S(1) and AdS(3) x S(3) x T(4) superstrings. By constructing a one parameter family of flat connections we prove that the Green-Schwarz string is classically integrable, at least to quadratic order in fermions, without fixing the kappa-symmetry. We then compare the quantum dispersion relation, fixed by integrability up to an unknown interpolating function h(lambda), to explicit one-loop calculations on the string worldsheet. For AdS(3) x S(3) x S(3) x S(1) the spectrum contains heavy, as well as light and massless modes, and we find that the one-loop contribution differs depending on how we treat these modes showing that similar regularization ambiguities as appeared in AdS(4)/CFT(3) occur also here.Comment: 29 pages; v2: updated references and acknowledgmen

Intimate partner violence and health-related quality of life in European men and women: findings from the DOVE study

Purpose: Little is known on the specific relation between being a perpetrator or both a victim and perpetrator of intimate partner violence (IPV) and health-related quality of life (HRQoL). We assessed the association between HRQoL and abuse, considering men and women as victims, perpetrators or reciprocally. Methods: Participants were adult men and women (n = 3,496), randomly selected from the general population of six European cities. The Revised-Conflict-Tactics-Scales and the Medical-Outcomes-Study 36-item Short-Form Health Survey (SF-36) were used to measure IPV and HRQoL. The age-, education-, and city-adjusted mean scores[standard error] of the physical and of the mental SF-36 component summaries were used to compare victims-only, perpetrators-only, and those involved in both (bidirectional or reciprocal cases) with those not involved in past-year and lifetime physical assault and/or sexual coercion. Results: The physical component summary was significantly lower in women involved in past-year bidirectional physical assault compared with non-abused women. The mental component summary in women not involved in IPV was significantly higher than in those physically abused, regardless of type of involvement. Women victims-only of past-year sexual coercion and victims or involved in bidirectional concomitant physical and sexual IPV also presented lower scores in the mental component summary than women not involved in IPV. In men, significantly lower scores in the mental component summary were found in the past-year bidirectional physically assaulted group and among those involved bidirectionally in both physical and sexual IPV compared with men not involved in IPV. Conclusion: Experiencing physical and sexual IPV is negatively associated with HRQoL. Lower scores in the mental component summary of the SF-36 are evident among female victims and among males and females involved in intimate partner violence as both victims and perpetrators when compared to females and males not involved in violence

The impact of intimate partner violence on forgone healthcare: a population-based, multicentre European study

Background: To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both. Methods:This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18–64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare (‘Have you been in need of a certain care service in the past year, but did not seek any help?’). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain. Results: Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02–1.70). Conclusion: IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake

On the worldsheet theory of the type IIA AdS(4) x CP(3) superstring

We perform a detailed study of the type IIA superstring in AdS(4) x CP(3). After introducing suitable bosonic light-cone and fermionic kappa worldsheet gauges we derive the pure boson and fermion SU(2|2) x U(1) covariant light-cone Hamiltonian up to quartic order in fields. As a first application of our derivation we calculate energy shifts for string configurations in a closed fermionic subsector and successfully match these with a set of light-cone Bethe equations. We then turn to investigate the mismatch between the degrees of freedom of scattering states and oscillatory string modes. Since only light string modes appear as fundamental Bethe roots in the scattering theory, the physical role of the remaining $4_F+4_B$ massive oscillators is rather unclear. By continuing a line of research initiated by Zarembo, we shed light on this question by calculating quantum corrections for the propagators of the bosonic massive fields. We show that, once loop corrections are incorporated, the massive coordinates dissolve in a continuum state of two light particles.Comment: 40 pages, 2 figures. v3: Minor clarifications made and reference list updated. Published version

Light-cone gauge Hamiltonian for AdS_4 x CP^3 superstring

It is developed the phase-space formulation for the Type IIA superstring on the AdS_4 x CP^3 background in the kappa-symmetry light-cone gauge for which the light-like directions are taken from the D=3 Minkowski boundary of AdS_4. After fixing bosonic light-cone gauge the superstring Hamiltonian is expressed as a function of the transverse physical variables and in the quadratic approximation corresponds to the light-cone gauge-fixed IIA superstring in flat space.Comment: 12 pages, LaTeX; v2 minor improvements of the text, misprints corrected, reference added; v3: missing terms in Eqs.(8),(53) and (56) adde

The low-energy limit of AdS(3)/CFT2 and its TBA

We investigate low-energy string excitations in AdS3 × S3 × T4. When the worldsheet is decompactified, the theory has gapless modes whose spectrum at low energies is determined by massless relativistic integrable S matrices of the type introduced by Al. B. Zamolodchikov. The S matrices are non-trivial only for excitations with identical worldsheet chirality, indicating that the low-energy theory is a CFT2. We construct a Thermodynamic Bethe Ansatz (TBA) for these excitations and show how the massless modes’ wrapping effects may be incorporated into the AdS3 spectral problem. Using the TBA and its associated Y-system, we determine the central charge of the low-energy CFT2 to be c = 6 from calculating the vacuum energy for antiperiodic fermions — with the vacuum energy being zero for periodic fermions in agreement with a supersymmetric theory — and find the energies of some excited states

Strings in AdS_4 x CP^3: finite size spectrum vs. Bethe Ansatz

We compute the first curvature corrections to the spectrum of light-cone gauge type IIA string theory that arise in the expansion of $AdS_4\times \mathbb{CP}^3$ about a plane-wave limit. The resulting spectrum is shown to match precisely, both in magnitude and degeneration that of the corresponding solutions of the all-loop Gromov--Vieira Bethe Ansatz. The one-loop dispersion relation correction is calculated for all the single oscillator states of the theory, with the level matching condition lifted. It is shown to have all logarithmic divergences cancelled and to leave only a finite exponentially suppressed contribution, as shown earlier for light bosons. We argue that there is no ambiguity in the choice of the regularization for the self-energy sum, since the regularization applied is the only one preserving unitarity. Interaction matrices in the full degenerate two-oscillator sector are calculated and the spectrum of all two light magnon oscillators is completely determined. The same finite-size corrections, at the order 1/J, where $J$ is the length of the chain, in the two-magnon sector are calculated from the all loop Bethe Ansatz. The corrections obtained by the two completely different methods coincide up to the fourth order in $\lambda' =\lambda/J^2$. We conjecture that the equivalence extends to all orders in $\lambda$ and to higher orders in 1/J.Comment: 32 pages. Published version; journal reference adde