Role of the community matron in advance care planning and ‘do not attempt CPR’ decision-making: a qualitative study

The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase

Permanent Superhumps in V1974 Cyg

We present results of 32 nights of CCD photometry of V1974 Cygni, from the years 1994 and 1995. We verify the presence of two distinct periodicities in the light curve: 0.0812585 day~1.95 hours and 0.0849767 d~2.04 hr. We establish that the shorter periodicity is the orbital period of the underlying binary system. The longer period oscillates with an average value of |dot(P)| ~ 3x10^(7)--typical to permanent superhumps. The two periods obey the linear relation between the orbital and superhump periods that holds among members of the SU Ursae Majoris class of dwarf novae. A third periodicity of 0.083204 d~2.00 hr appeared in 1994 but not in 1995. It may be related to the recently discovered anti-superhump phenomenon. These results suggest a linkage between the classical nova V1974 Cyg and the SU UMa stars, and indicate the existence of an accretion disk and permanent superhumps in the system no later than 30 months after the nova outburst. From the precessing disk model of the superhump phenomenon we estimate that the mass ratio in the binary system is between 2.2 and 3.6. Combined with previous results this implies a white dwarf mass of 0.75-1.07 M sun.Comment: 11 pages, 10 eps. figures, Latex, accepted for publication in MNRA

Water Quality in Selected Shallow Wells in Dar es Salaam

Majority of Dar es Salaam residents depend mostly on ground water fortheir domestic use because, they are not connected to the city water supply system,or the supply system is not reliable. Due to widespread use of groundwater (shallowand deep wells), the scientific determination of quality of this mass consumedproduct is essential. In this study the water quality parameters: physical, chemicaland biological contaminants on the shallow wells were investigated around Dar esSalaam City.Except for Total Dissolved Solids (TDS) and Total Hardness, other physicalparameters tested were within the WHO acceptable range. Levels of phosphate insamples from Temeke district ranges from 0.42 – 1.20 ppm, while samples fromIlala ranges from 0.16 – 0.36. Meanwhile chloride levels in samples from Temekeranges between 158.40 – 624.14 ppm and Ilala ranges between 142.34 – 359.52ppm. This could be due to human activities such as small industries and unplanned waste dumping sites close to water source.All water samples were contaminated with both Total Coliform (TC) and Fecal Coliform (FC). The highest TC and FC levels were detected in the sample from Vikunai Village in Temeke municipality (2160/100ml and 67/100ml respectively).This was due to proximity of pit latrines and runoff during rainfall because shallowwells are neither covered nor built up above ground level to create barriers againststorm water inflow.Generally, water from shallow wells in Dar es Salaam City is bacteriologically and chemically contaminated. The source of contamination is on-site waste disposal andpoor hygiene education. It is recommended that water from wells must be treatedprior to consumption in order to prevent potential infections. Residents ought to beprovided with water quality management education so that they could know how totreat, store and maintain the quality of drinking water.Key words: shallow well, phosphate, water quality, nitrate, faecal coliform,chloride

MR Spectroscopic Imaging of Peripheral Zone in Prostate Cancer Using a 3T MRI Scanner: Endorectal versus External Phased Array Coils.

Magnetic resonance spectroscopic imaging (MRSI) detects alterations in major prostate metabolites, such as citrate (Cit), creatine (Cr), and choline (Ch). We evaluated the sensitivity and accuracy of three-dimensional MRSI of prostate using an endorectal compared to an external phased array "receive" coil on a 3T MRI scanner. Eighteen patients with prostate cancer (PCa) who underwent endorectal MR imaging and proton (1H) MRSI were included in this study. Immediately after the endorectal MRSI scan, the PCa patients were scanned with the external phased array coil. The endorectal coil-detected metabolite ratio [(Ch+Cr)/Cit] was significantly higher in cancer locations (1.667 ± 0.663) compared to non-cancer locations (0.978 ± 0.420) (P < 0.001). Similarly, for the external phased array, the ratio was significantly higher in cancer locations (1.070 ± 0.525) compared to non-cancer locations (0.521 ± 0.310) (P < 0.001). The sensitivity and accuracy of cancer detection were 81% and 78% using the endorectal 'receive' coil, and 69% and 75%, respectively using the external phased array 'receive' coil

Identifying Employer Needs from Accounting Information Systems Programs

As the need for new hires with accounting and information technology knowledge increases, a new major in accounting information systems (AIS) has emerged. This new AIS degree is a hybrid of accounting concepts and common business subjects combined with key information technology issues. Employers were presented with 56 core content areas found in the curriculum for the AIS major and asked to rate the importance of each. We present the results of the survey along with company demographics. Conclusions are then drawn to determine if the employers are hiring new employees with the necessary knowledge and skills needed to fill these employment trends

Meta-analysis of sex difference in testosterone levels in umbilical cord blood

This meta-analysis reviewed published literature comparing human male and female umbilical cord total testosterone (T) levels. A total of 18 studies using 1,229 samples from 602 male and 627 female newborns were analysed using the RevMan 5 statistical package. Analysis using the inverse variance method based on a random-effects model revealed significantly higher cord T in boys than girls at a moderate effect size (Hedges' g = 0.57). There was significant heterogeneity between the 18 studies, although the five studies using direct assays showed no heterogeneity. For studies using extraction and chromatography, those that combined T from arterial and venous cord blood found a larger sex difference than those using only cord venous samples (Hedges' g = 0.94 vs 0.32); this suggests umbilical cord venous T is of maternal/placental origin and arterial T is of fetal origin. The wide range of T values between studies suggests high cross-reactivity in the assay methods reviewed

How many independent bets are there?

The benefits of portfolio diversification is a central tenet implicit to modern financial theory and practice. Linked to diversification is the notion of breadth. Breadth is correctly thought of as the number of in- dependent bets available to an investor. Conventionally applications us- ing breadth frequently assume only the number of separate bets. There may be a large discrepancy between these two interpretations. We uti- lize a simple singular-value decomposition (SVD) and the Keiser-Gutman stopping criterion to select the integer-valued effective dimensionality of the correlation matrix of returns. In an emerging market such as South African we document an estimated breadth that is considerably lower than anticipated. This lack of diversification may be because of market concentration, exposure to the global commodity cycle and local currency volatility. We discuss some practical extensions to a more statistically correct interpretation of market breadth, and its theoretical implications for both global and domestic investors.Comment: Less technical rewrite. 12 Pages, 6 Figures (.eps

Hepatic fibrogenesis requires sympathetic neurotransmitters

Background and aims: Hepatic stellate cells (HSC) are activated by liver injury to become proliferative fibrogenic myofibroblasts. This process may be regulated by the sympathetic nervous system (SNS) but the mechanisms involved are unclear. Methods: We studied cultured HSC and intact mice with liver injury to test the hypothesis that HSC respond to and produce SNS neurotransmitters to promote fibrogenesis. Results: HSC expressed adrenoceptors, catecholamine biosynthetic enzymes, released norepinephrine (NE), and were growth inhibited by α- and β-adrenoceptor antagonists. HSC from dopamine β-hydroxylase deficient (Dbh(−/−)) mice, which cannot make NE, grew poorly in culture and were rescued by NE. Inhibitor studies demonstrated that this effect was mediated via G protein coupled adrenoceptors, mitogen activated kinases, and phosphatidylinositol 3-kinase. Injury related fibrogenic responses were inhibited in Dbh(−/−) mice, as evidenced by reduced hepatic accumulation of α-smooth muscle actin(+ve) HSC and decreased induction of transforming growth factor β1 (TGF-β1) and collagen. Treatment with isoprenaline rescued HSC activation. HSC were also reduced in leptin deficient ob/ob mice which have reduced NE levels and are resistant to hepatic fibrosis. Treating ob/ob mice with NE induced HSC proliferation, upregulated hepatic TGF-β1 and collagen, and increased liver fibrosis. Conclusions: HSC are hepatic neuroglia that produce and respond to SNS neurotransmitters to promote hepatic fibrosis

Garden varieties: how attractive are recommended garden plants to butterflies?

One way the public can engage in insect conservation is through wildlife gardening, including the growing of insect-friendly flowers as sources of nectar. However, plant varieties differ in the types of insects they attract. To determine which garden plants attracted which butterflies, we counted butterflies nectaring on 11 varieties of summer-flowering garden plants in a rural garden in East Sussex, UK. These plants were all from a list of 100 varieties considered attractive to British butterflies, and included the five varieties specifically listed by the UK charity Butterfly Conservation as best for summer nectar. A total of 2659 flower visits from 14 butterfly and one moth species were observed. We performed a principal components analysis which showed contrasting patterns between the species attracted to Origanum vulgare and Buddleia davidii. The “butterfly bush” Buddleia attracted many nymphalines, such as the peacock, Inachis io, but very few satyrines such as the gatekeeper, Pyronia tithonus, which mostly visited Origanum. Eupatorium cannibinum had the highest Simpson’s Diversity score of 0.75, while Buddleia and Origanum were lower, scoring 0.66 and 0.50 respectively. No one plant was good at attracting all observed butterfly species, as each attracted only a subset of the butterfly community. We conclude that to create a butterfly-friendly garden, a variety of plant species are required as nectar sources for butterflies. Furthermore, garden plant recommendations can probably benefit from being more precise as to the species of butterfly they attract

Multi-Objective Big Data Optimization with jMetal and Spark

Big Data Optimization is the term used to refer to optimization problems which have to manage very large amounts of data. In this paper, we focus on the parallelization of metaheuristics with the Apache Spark cluster computing system for solving multi-objective Big Data Optimization problems. Our purpose is to study the influence of accessing data stored in the Hadoop File System (HDFS) in each evaluation step of a metaheuristic and to provide a software tool to solve these kinds of problems. This tool combines the jMetal multi-objective optimization framework with Apache Spark. We have carried out experiments to measure the performance of the proposed parallel infrastructure in an environment based on virtual machines in a local cluster comprising up to 100 cores. We obtained interesting results for computational e ort and propose guidelines to face multi-objective Big Data Optimization problems.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech