A proposed systems approach to the evaluation of integrated palliative care

<p>Abstract</p> <p>Background</p> <p>There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care.</p> <p>Methods</p> <p>In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors.</p> <p>Results</p> <p>The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network.</p> <p>Conclusions</p> <p>Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations.</p

Photoelectrochemistry of bromonitrobenzenes: Mechanism and photoelectrochemically-induced halex reactions

The theory for homogeneous ECrevE, ECrevCE and ECECE mechanisms at macroscopically large channel electrodes is derived. The photoelectrochemical reductions of para-bromonitrobenzene and 2,4-dibromonitrobenzene in acetonitrile solutions and at macroscopic platinum channel electrodes are studied using irradiation at 330 and 470 nm, corresponding to absorption bands in the corresponding radical anions. The former compound is shown to follow a homogeneous ECrevCE pathway in acetonitrile solutions containing tetrabutylammonium-based supporting electrolytes; by changing the supporting electrolyte to a salt of the tetramethylammonium cation, the mechanism is changed qualitatively and follows an ECEE pathway. The photoelectrochemical reduction of 2,4-dibromonitrobenzene in acetonitrile solution containing supporting electrolytes derived from the tetrabutylammonium cation is shown to follow an overall ECECE mechanism, with both chemical steps being chemically-reversible, and with the loss of the ortho-bromo in the dark. In the presence of chloride supporting electrolytes, it is shown that light-induced rupture of a C-Br bond occurs reversibly with the competing formation of a C-Cl bond. Unoptimised bulk photoelectrosynthesis indicates that some halogen exchange occurs, demonstrating the viability of a novel approach to halex reactions. © 2002 Elsevier Science B.V. All rights reserved

Photoelectrochemistry of bromonitrobenzenes: mechanism and photoelectrochemically-induced halex reactions

The theory for homogeneous ECrevE, ECrevCE and ECECE mechanisms at macroscopically large channel electrodes is derived. The photoelectrochemical reductions of para-bromonitrobenzene and 2,4-dibromonitrobenzene in acetonitrile solutions and at macroscopic platinum channel electrodes are studied using irradiation at 330 and 470 nm, corresponding to absorption bands in the corresponding radical anions. The former compound is shown to follow a homogeneous ECrevCE pathway in acetonitrile solutions containing tetrabutylammonium-based supporting electrolytes; by changing the supporting electrolyte to a salt of the tetramethylammonium cation, the mechanism is changed qualitatively and follows an ECEE pathway. The photoelectrochemical reduction of 2,4-dibromonitrobenzene in acetonitrile solution containing supporting electrolytes derived from the tetrabutylammonium cation is shown to follow an overall ECECE mechanism, with both chemical steps being chemically-reversible, and with the loss of the ortho-bromo in the dark. In the presence of chloride supporting electrolytes, it is shown that light-induced rupture of a C-Br bond occurs reversibly with the competing formation of a C-Cl bond. Unoptimised bulk photoelectrosynthesis indicates that some halogen exchange occurs, demonstrating the viability of a novel approach to halex reactions. © 2002 Elsevier Science B.V. All rights reserved

Multiple populations of artemisinin-resistant Plasmodium falciparum in Cambodia.

We describe an analysis of genome variation in 825 P. falciparum samples from Asia and Africa that identifies an unusual pattern of parasite population structure at the epicenter of artemisinin resistance in western Cambodia. Within this relatively small geographic area, we have discovered several distinct but apparently sympatric parasite subpopulations with extremely high levels of genetic differentiation. Of particular interest are three subpopulations, all associated with clinical resistance to artemisinin, which have skewed allele frequency spectra and high levels of haplotype homozygosity, indicative of founder effects and recent population expansion. We provide a catalog of SNPs that show high levels of differentiation in the artemisinin-resistant subpopulations, including codon variants in transporter proteins and DNA mismatch repair proteins. These data provide a population-level genetic framework for investigating the biological origins of artemisinin resistance and for defining molecular markers to assist in its elimination

Heterogeneity of ventricular fibrillation dominant frequency during global ischemia in isolated rabbit hearts

Introduction: Ventricular fibrillation (VF) studies show that ECG-dominant frequency (DF) decreases as ischernia develops. This study investigates the contribution of the principle ischernic metabolic components to this decline. Methods and Results: Rabbit hearts were Langendorff-perfused at 40 mL/min with Tyrode's solution and loaded with RH237. Epicardial optical action potentials were recorded with a photodiode array (256 sites, 15 x 15 mm). After 60 seconds of VF (induced by burst pacing), global ischernia was produced by low flow (6 mL/min), or the solution changed to impose hypoxia (95 % N-2/5% CO2), low pH(o) (6.7, 80 % O-2/20% CO2), or raised [K+](o) (8 mM). DF of the optical signals was determined at each site. Conduction velocity (CV), action potential duration (APD90), effective refractory period (ERP), activation threshold, dV/dt(max) and membrane potential were measured in separate experiments during ventricular pacing. During VF, ischernia decreased DF in the left ventricle (LV) (to [58 6] %, P &lt; 0.001), but not the right (RV) ([93 5]%). Raised [K+]o reproduced this DF pattern (LV: [67 +/- 12]%, P &lt; 0.001; RV: [95 91%). LV DF remained elevated in hypoxia or low pH,,. During ventricular pacing, ischernia decreased CV in LV but not RV. Raised [K+](o) did not change CV in either ventricle. Ischernia and raised [K+](o) shortened APD90 without altering ERP. LV activation threshold increased in both ischernia and raised [K+](o) and was associated with diastolic depolarization and decreased dV/dt(max),Conclusions: These results suggest that during VF, decreased ECG DF in global ischemia is largely due to elevated [K+](o) affecting the activation thresholds in the LV rather than RV