With comfort and dignity and support: An evaluation of the Hospice at Home service delivered by Milford Care Centre

Copyright @ 2011 University of LimerickMilford Care Centre is the lead organisation that provides a comprehensive range of services for the elderly and palliative care patients in the Mid West Region. In tandem with the growing requirement for specialist palliative care in the community, it expanded its existing and limited community-based services in 2006 to include a specialist ‘Hospice at Home’ service for patients who require palliative care in their own homes. With inputs from a multi-disciplinary clinical team, the Hospice at Home Service delivered by Milford Care Centre represents the first service of its kind within the Republic of Ireland. The Hospice at Home Service is supported by funding from the HSE and donations from the public, as well as a significant donation from The Atlantic Philanthropies. A condition of the funding from The Atlantic Philanthropies was that the Service would be evaluated, thus providing Milford Care Centre with research information regarding various of aspects of the service, including the viewpoints of carers and patients. In 2009, Milford Care Centre commissioned the University of Limerick to undertake an independent evaluation of the Hospice at Home Service, with the aim of examining whether it offered a viable and effective model for delivering a range of palliative care services to patients and their families in the community. The evaluation was conducted between February 2009 and June 2011. It should be noted that an evaluation of the cost effectiveness of the Service was also commissioned and will be undertaken by another group

Coupling molecular spin states by photon-assisted tunneling

Artificial molecules containing just one or two electrons provide a powerful platform for studies of orbital and spin quantum dynamics in nanoscale devices. A well-known example of these dynamics is tunneling of electrons between two coupled quantum dots triggered by microwave irradiation. So far, these tunneling processes have been treated as electric dipole-allowed spin-conserving events. Here we report that microwaves can also excite tunneling transitions between states with different spin. In this work, the dominant mechanism responsible for violation of spin conservation is the spin-orbit interaction. These transitions make it possible to perform detailed microwave spectroscopy of the molecular spin states of an artificial hydrogen molecule and open up the possibility of realizing full quantum control of a two spin system via microwave excitation.Comment: 13 pages, 9 figure

Masculinity as Governance: police, public service and the embodiment of authority, c. 1700-1850

About the book: Public Men offers an introduction to an exciting new field: the history of masculinities in the political domain and will be essential reading for students and specialists alike with interests in gender or political culture. By building upon new work on gender and political culture, these new case studies explore the gendering of the political domain and the masculinities of the men who have historically dominated it. As such, Public Men is a major contribution to our understanding of the history of Britain between the Eighteenth and the Twentieth centuries

Conservation laws and tachyon potentials in the sliver frame

Conservation laws have provided an elegant and efficient tool to evaluate the open string field theory interaction vertex, they have been originally implemented in the case where the string field is expanded in the Virasoro basis. In this work we derive conservation laws in the case where the string field is expanded in the so-called sliver $\mathcal{L}_0$-basis. As an application of these conservation laws derived in the sliver frame, we compute the open string field action relevant to the tachyon condensation and in order to present not only an illustration but also an additional information, we evaluate the action without imposing a gauge choice.Comment: 26 pages, some typos fixed, comments added, references adde

Effect of COVID-19 vaccination on transmission of Alpha and Delta variants

BACKGROUND: Before the emergence of the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vaccination reduced transmission of SARS-CoV-2 from vaccinated persons who became infected, potentially by reducing viral loads. Although vaccination still lowers the risk of infection, similar viral loads in vaccinated and unvaccinated persons who are infected with the delta variant call into question the degree to which vaccination prevents transmission. METHODS: We used contact-testing data from England to perform a retrospective observational cohort study involving adult contacts of SARS-CoV-2–infected adult index patients. We used multivariable Poisson regression to investigate associations between transmission and the vaccination status of index patients and contacts and to determine how these associations varied with the B.1.1.7 (alpha) and delta variants and time since the second vaccination. RESULTS: Among 146,243 tested contacts of 108,498 index patients, 54,667 (37%) had positive SARS-CoV-2 polymerase-chain-reaction (PCR) tests. In index patients who became infected with the alpha variant, two vaccinations with either BNT162b2 or ChAdOx1 nCoV-19 (also known as AZD1222), as compared with no vaccination, were independently associated with reduced PCR positivity in contacts (adjusted rate ratio with BNT162b2, 0.32; 95% confidence interval [CI], 0.21 to 0.48; and with ChAdOx1 nCoV-19, 0.48; 95% CI, 0.30 to 0.78). Vaccine-associated reductions in transmission of the delta variant were smaller than those with the alpha variant, and reductions in transmission of the delta variant after two BNT162b2 vaccinations were greater (adjusted rate ratio for the comparison with no vaccination, 0.50; 95% CI, 0.39 to 0.65) than after two ChAdOx1 nCoV-19 vaccinations (adjusted rate ratio, 0.76; 95% CI, 0.70 to 0.82). Variation in cycle-threshold (Ct) values (indicative of viral load) in index patients explained 7 to 23% of vaccine-associated reductions in transmission of the two variants. The reductions in transmission of the delta variant declined over time after the second vaccination, reaching levels that were similar to those in unvaccinated persons by 12 weeks in index patients who had received ChAdOx1 nCoV-19 and attenuating substantially in those who had received BNT162b2. Protection in contacts also declined in the 3-month period after the second vaccination. CONCLUSIONS: Vaccination was associated with a smaller reduction in transmission of the delta variant than of the alpha variant, and the effects of vaccination decreased over time. PCR Ct values at diagnosis of the index patient only partially explained decreased transmission. (Funded by the U.K. Government Department of Health and Social Care and others.

Quantifying the impact of Covid-19 on the energy consumption in the low-income housing in Greater London

Covid-19 has caused great challenges to the energy sector, particularly in residential buildings with low-income households. This study investigates the impact of the confinement measures due to the Covid-19 outbreak on the energy demand of seven residential archetype buildings in Greater London. Three levels of confinement for occupant schedules are proposed and compared with the base case before Covid-19. The archetypes, their boundary conditions, and input parameters are set up according to statistics from English Housing Survey (EHS) sample data for low-income housing. The base case scenario (normal life without confinement measures) is validated against the measured data energy consumption from the National Energy Efficiency Data-Framework (NEED) statistics. The results show that electricity consumption is significantly lower than that for heating and hot water for all the archetypes. By comparing the base case scenario with the full Covid-19 lockdown scenario, the results indicate that heating and hot water consumption (kWh) for all the residential archetypes increases, on average, by 10%, and total electricity demand (kWh) increases by 13%. The study highlights the importance of introducing detailed occupancy profiles in multi-zone building energy simulation models during a pandemic that leads to a greater shift towards home working, which may increase the risk of fuel poverty in low-income housing

Digital PCR methods improve detection sensitivity and measurement precision of low abundance mtDNA deletions

Mitochondrial DNA (mtDNA) mutations are a common cause of primary mitochondrial disorders, and have also been implicated in a broad collection of conditions, including aging, neurodegeneration, and cancer. Prevalent among these pathogenic variants are mtDNA deletions, which show a strong bias for the loss of sequence in the major arc between, but not including, the heavy and light strand origins of replication. Because individual mtDNA deletions can accumulate focally, occur with multiple mixed breakpoints, and in the presence of normal mtDNA sequences, methods that detect broad-spectrum mutations with enhanced sensitivity and limited costs have both research and clinical applications. In this study, we evaluated semi-quantitative and digital PCR-based methods of mtDNA deletion detection using double-stranded reference templates or biological samples. Our aim was to describe key experimental assay parameters that will enable the analysis of low levels or small differences in mtDNA deletion load during disease progression, with limited false-positive detection. We determined that the digital PCR method significantly improved mtDNA deletion detection sensitivity through absolute quantitation, improved precision and reduced assay standard error

Role of F-18-fluorodeoxyglucose Positron Emission Tomography in the Monitoring of Inflammatory Activity in Crohn's Disease

BACKGROUND: 18Fluorine-fluorodeoxyglucose positron emission tomography (18F-FDG PET) has recently attracted interest for the measurement of disease activity in Crohn's disease (CD). The aim of this study was to assess the utility of FDG-PET as a marker of progression of inflammatory activity and its response to treatment in patients with CD. METHODS: Twenty-two patients with active CD were recruited prospectively to undergo FDG-PET scanning at 2 time points. All 22 index scans were used to assess sensitivity and specificity against a reference standard magnetic resonance imaging measure. Correlations with clinicopathological markers of severity (Harvey-Bradshaw Index, C-reactive protein, and calprotectin) were also performed. Of note, 17/22 patients participated in the longitudinal component and underwent scanning before and 12 weeks after the initiation of anti–tumor necrosis factor alpha therapy. Patients were subcategorized on the basis of a clinically significant response, and responsiveness of the PET measures was assessed using previously described indices. Of note, 5/22 patients took part in the test–retest component of the study and underwent scanning twice within a target interval of 1 week, to assess the reproducibility of the PET measures. RESULTS: The sensitivity and specificity of 18F-FDG PET were 88% and 70%, respectively. Standardized uptake value (SUV)-related PET measures correlated significantly both with C-reactive protein and Harvey-Bradshaw Index in cross-sectional and longitudinal analyses. (G)SUVMAX and (G)SUVMEAN demonstrated favorable responsiveness and reliability characteristics (responsiveness ratio of Guyatt >0.80 and % variability <20%) compared with volume-dependent FDG-PET measures. A proportion of the FDG signal (10%–30%) was found to originate from the lumen of diseased segments. CONCLUSIONS: 18F-FDG PET may be useful for longitudinal monitoring of inflammatory activity in CD

Synthetic Lethality of Chk1 Inhibition Combined with p53 and/or p21 Loss During a DNA Damage Response in Normal and Tumor Cells

Cell cycle checkpoints ensure genome integrity and are frequently compromised in human cancers. A therapeutic strategy being explored takes advantage of checkpoint defects in p53-deficient tumors in order to sensitize them to DNA-damaging agents by eliminating Chk1-mediated checkpoint responses. Using mouse models, we demonstrated that p21 is a key determinant of how cells respond to the combination of DNA damage and Chk1 inhibition (combination therapy) in normal cells as well as in tumors. Loss of p21 sensitized normal cells to the combination therapy much more than did p53 loss and the enhanced lethality was partially blocked by CDK inhibition. In addition, basal pools of p21 (p53 independent) provided p53 null cells with protection from the combination therapy. Our results uncover a novel p53-independent function for p21 in protecting cells from the lethal effects of DNA damage followed by Chk1 inhibition. As p21 levels are low in a significant fraction of colorectal tumors, they are predicted to be particularly sensitive to the combination therapy. Results reported in this study support this prediction

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps

Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical, Research Council and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged