Social and structural conditions for the avoidance of advance care planning in neuro-oncology: a qualitative study

BACKGROUND: Primary brain tumours newly affect >260 000 people each year worldwide. In the UK, every year >10 000 people are diagnosed with a brain tumour while >5000 die annually from the disease. Prognoses are poor, cognitive deterioration common and patients have prolonged palliative needs. Advance care planning (ACP) may enable early discussion of future care decisions. Although a core commitment in the UK healthcare strategy, and the shared responsibility of clinical teams, ACP appears uncommon in practice. Evidence around ACP practice in neuro-oncology is limited. OBJECTIVES: We aimed to elicit key social and structural conditions contributing to the avoidance of ACP in neuro-oncology. DESIGN: A cross-sectional qualitative study design was used. SETTING: One tertiary care hospital in the UK. PARTICIPANTS: Fifteen healthcare professionals working in neuro-oncology participated in this study, including neuro-oncologists, neurosurgeons, clinical nurse specialists, allied healthcare professionals and a neurologist. METHOD: Semi-structured interviews were conducted with participants to explore their assumptions and experiences of ACP. Data were analysed thematically using the well-established framework method. RESULTS: Participants recognised the importance of ACP but few had ever completed formal ACP documentation. We identified eight key factors, which we suggest comprise three main conditions for avoidance: (1) difficulties being a highly emotive, time-intensive practice requiring the right 'window of opportunity' and (2) presence and availability of others; (3) ambiguities in ACP definition, purpose and practice. Combined, these created a 'culture of shared avoidance'. CONCLUSION: In busy clinical environments, 'shared responsibility' is interpreted as 'others' responsibility' laying the basis for a culture of avoidance. To address this, we suggest a 'generalists and specialists' model of ACP, wherein healthcare professionals undertake particular responsibilities. Healthcare professionals are already adopting this model informally, but without formalised structure it is likely to fail given a tendency for people to assume a generalist role

Expansion of W 3(OH)

A direct measurement of the expansion of W 3(OH) is made by comparing Very Large Array images taken about 10 yr apart. The expansion is anisotropic with a typical speed of 3 to 5 km/s, indicating a dynamical age of only 2300 yr. These observations are inconsistent with either the freely expanding shell model or a simple bow shock model. The most favored model is a slowly expanding shell-like HII region, with either a fast rarefied flow or another less massive diffuse ionized region moving towards the observer. There is also a rapidly evolving source near the projected center of emission, perhaps related to the central star.Comment: LaTeX file, 28 pages, includes 8 figures. To appear in ApJ in December 10 (1998) issue. Also available at http://www.submm.caltech.edu/~kawamura/w3oh_pp.p

(Sub)mm Interferometry Applications in Star Formation Research

This contribution gives an overview about various applications of (sub)mm interferometry in star formation research. The topics covered are molecular outflows, accretion disks, fragmentation and chemical properties of low- and high-mass star-forming regions. A short outlook on the capabilities of ALMA is given as well.Comment: 20 pages, 7 figures, in proceedings to "2nd European School on Jets from Young Star: High Angular Resolution Observations". A high-resolution version of the paper can be found at http://www.mpia.de/homes/beuther/papers.htm

A Census of the High-Density Molecular Gas in M82

We present a three-pointing study of the molecular gas in the starburst nucleus of M82 based on 190 - 307 GHz spectra obtained with Z-Spec at the Caltech Submillimeter Observatory. We present intensity measurements, detections and upper limits, for 20 transitions, including several new detections of CS, HNC, C2H, H2CO, and CH3CCH lines. We combine our measurements with previously-published measurements at other frequencies for HCN, HNC, CS, C34S, and HCO+ in a multi-species likelihood analysis constraining gas mass, density and temperature, and the species' relative abundances. We find some 1.7 - 2.7 x 10^8 M_sun of gas with n_H2 between 1 - 6 x 10^4 cm^-3 and T > 50 K. While the mass and temperature are comparable to values inferred from mid-J CO transitions, the thermal pressure is a factor of 10 - 20 greater. The molecular interstellar medium is largely fragmented and is subject to ultraviolet irradiation from the star clusters. It is also likely subject to cosmic rays and mechanical energy input from the supernovae, and is warmer on average than the molecular gas in the massive star formation regions in the Milky Way. The typical conditions in the dense gas in M82's central kpc appear unfavorable for further star formation; if any appreciable stellar populations are currently forming, they are likely biased against low mass stars, producing a top-heavy initial mass function.Comment: 15 pages (using emulateapj.cls), 6 figures, Astrophysical Journal, in pres

Interaction of Wilson loops in confining vacuum

Nonperturbative and perturbative interaction mechanisms of Wilson loops in gluodynamics are studied within the background field formalism. The first one operates when distance between minimal surfaces of the loops is small and may be important for sea quark effects and strong decay processes. The second mechanism -- perturbative interaction in nonperturbative confining background is found to be physically dominant for all loop configurations characteristic of scattering process. It reduces to perturbative gluon exchanges at small distances, while at larger distances it corresponds to the t-channel exchange of (reggeized) glueball states. Comparison to other approaches is made and possible physical applications are discussed.Comment: LaTeX, 25 pages, 5 EPS-figure

Stochastic Theory of Relativistic Particles Moving in a Quantum Field: II. Scalar Abraham-Lorentz-Dirac-Langevin Equation, Radiation Reaction and Vacuum Fluctuations

We apply the open systems concept and the influence functional formalism introduced in Paper I to establish a stochastic theory of relativistic moving spinless particles in a quantum scalar field. The stochastic regime resting between the quantum and semi-classical captures the statistical mechanical attributes of the full theory. Applying the particle-centric world-line quantization formulation to the quantum field theory of scalar QED we derive a time-dependent (scalar) Abraham-Lorentz-Dirac (ALD) equation and show that it is the correct semiclassical limit for nonlinear particle-field systems without the need of making the dipole or non-relativistic approximations. Progressing to the stochastic regime, we derive multiparticle ALD-Langevin equations for nonlinearly coupled particle-field systems. With these equations we show how to address time-dependent dissipation/noise/renormalization in the semiclassical and stochastic limits of QED. We clarify the the relation of radiation reaction, quantum dissipation and vacuum fluctuations and the role that initial conditions may play in producing non-Lorentz invariant noise. We emphasize the fundamental role of decoherence in reaching the semiclassical limit, which also suggests the correct way to think about the issues of runaway solutions and preacceleration from the presence of third derivative terms in the ALD equation. We show that the semiclassical self-consistent solutions obtained in this way are ``paradox'' and pathology free both technically and conceptually. This self-consistent treatment serves as a new platform for investigations into problems related to relativistic moving charges.Comment: RevTex; 20 pages, 3 figures, Replaced version has corrected typos, slightly modified derivation, improved discussion including new section with comparisons to related work, and expanded reference

Bispectrum speckle interferometry observations and radiative transfer modelling of the red supergiant NML Cyg: Multiple dust-shell structures evidencing previous superwind phases

(abridged) NML Cyg is a highly evolved OH/IR supergiant and supposed to be among the most luminous supergiants in the galaxy. We present the first diffraction limited 2.13micron observations of NML Cyg with 73mas resolution. The speckle interferograms were obtained with the SAO 6m telescope, image reconstruction is based on the bispectrum speckle interferometry method. Radiative transfer calculations have been carried out to model the spectral energy distribution, our 2.13micron visibility function, and mid-infrared visibility functions. The observed dust shell properties do not appear to be in accordance with single-shell models but seem to require multiple components. Considering previous periods of enhanced mass-loss, various density enhancements in the dust shell were taken into account. An extensive grid of models was calculated for different locations and strenghts of such superwind regions in the dust shell. To match the observations from the optical to the sub-mm domain requires at least two superwind regions embedded in the shell. The best model includes a dust shell with a temperature of 1000K at its inner radius of 6.2Rstar, a close embedded superwind shell extending from 15.5Rstar to 21.7Rstar with amplitude 10 (factor of density enhancement), and a far-out density enhancement at 186Rstar with amplitude 5. The angular diameter of the inner dust-shell rim amounts to 105mas. Within the various parts of the dust shell, 1/r^2 density distributions could be maintained differing only in their amplitude A. The present-day mass-loss rate was determined to be 1.2 10^-4 Msol/yr. The inner embedded superwind shell corresponds to a phase of enhanced mass-loss which began ~59yr ago and lasted for ~18yr, and the outer superwind region to a high mass-loss period which terminated 529yr ago.Comment: 12 pages including 13 PostScript figures, also available from http://www.mpifr-bonn.mpg.de/div/ir-interferometry/publications.html; accepted for publication in Astronomy & Astrophysic

Rheumatoid Arthritis is an Autoimmune Disease Triggered by Proteus Urinary Tract Infection

Rheumatoid arthritis (RA) is a chronic and disabling polyarthritic disease, which affects mainly women in middle and old age

Decomposition of the QCD String into Dipoles and Unintegrated Gluon Distributions

We present the perturbative and non-perturbative QCD structure of the dipole-dipole scattering amplitude in momentum space. The perturbative contribution is described by two-gluon exchange and the non-perturbative contribution by the stochastic vacuum model which leads to confinement of the quark and antiquark in the dipole via a string of color fields. This QCD string gives important non-perturbative contributions to high-energy reactions. A new structure different from the perturbative dipole factors is found in the string-string scattering amplitude. The string can be represented as an integral over stringless dipoles with a given dipole number density. This decomposition of the QCD string into dipoles allows us to calculate the unintegrated gluon distribution of hadrons and photons from the dipole-hadron and dipole-photon cross section via kT-factorization.Comment: 43 pages, 14 figure