General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required

Software systems for operation, control, and monitoring of the EBEX instrument

We present the hardware and software systems implementing autonomous operation, distributed real-time monitoring, and control for the EBEX instrument. EBEX is a NASA-funded balloon-borne microwave polarimeter designed for a 14 day Antarctic flight that circumnavigates the pole. To meet its science goals the EBEX instrument autonomously executes several tasks in parallel: it collects attitude data and maintains pointing control in order to adhere to an observing schedule; tunes and operates up to 1920 TES bolometers and 120 SQUID amplifiers controlled by as many as 30 embedded computers; coordinates and dispatches jobs across an onboard computer network to manage this detector readout system; logs over 3~GiB/hour of science and housekeeping data to an onboard disk storage array; responds to a variety of commands and exogenous events; and downlinks multiple heterogeneous data streams representing a selected subset of the total logged data. Most of the systems implementing these functions have been tested during a recent engineering flight of the payload, and have proven to meet the target requirements. The EBEX ground segment couples uplink and downlink hardware to a client-server software stack, enabling real-time monitoring and command responsibility to be distributed across the public internet or other standard computer networks. Using the emerging dirfile standard as a uniform intermediate data format, a variety of front end programs provide access to different components and views of the downlinked data products. This distributed architecture was demonstrated operating across multiple widely dispersed sites prior to and during the EBEX engineering flight.Comment: 11 pages, to appear in Proceedings of SPIE Astronomical Telescopes and Instrumentation 2010; adjusted metadata for arXiv submissio

EBEX: A balloon-borne CMB polarization experiment

EBEX is a NASA-funded balloon-borne experiment designed to measure the polarization of the cosmic microwave background (CMB). Observations will be made using 1432 transition edge sensor (TES) bolometric detectors read out with frequency multiplexed SQuIDs. EBEX will observe in three frequency bands centered at 150, 250, and 410 GHz, with 768, 384, and 280 detectors in each band, respectively. This broad frequency coverage is designed to provide valuable information about polarized foreground signals from dust. The polarized sky signals will be modulated with an achromatic half wave plate (AHWP) rotating on a superconducting magnetic bearing (SMB) and analyzed with a fixed wire grid polarizer. EBEX will observe a patch covering ~1% of the sky with 8' resolution, allowing for observation of the angular power spectrum from \ell = 20 to 1000. This will allow EBEX to search for both the primordial B-mode signal predicted by inflation and the anticipated lensing B-mode signal. Calculations to predict EBEX constraints on r using expected noise levels show that, for a likelihood centered around zero and with negligible foregrounds, 99% of the area falls below r = 0.035. This value increases by a factor of 1.6 after a process of foreground subtraction. This estimate does not include systematic uncertainties. An engineering flight was launched in June, 2009, from Ft. Sumner, NM, and the long duration science flight in Antarctica is planned for 2011. These proceedings describe the EBEX instrument and the North American engineering flight.Comment: 12 pages, 9 figures, Conference proceedings for SPIE Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy V (2010

How the COVID-19 infection tsunami revolutionized the work of respiratory physiotherapists: an experience from Northern Italy.

Due to COVID-19 outbreak, to lighten the burden of acute and critical care hospitals, some respiratory rehabilitation departments have been used to host patients with COVID-19 in the post-acute phase. This new and unexpected situation required a change of roles and scheduling of the rehabilitation teams. In this manuscript we describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) service during the COVID-19 emergency in a Northern Italian rehabilitation hospital, focusing on the Respiratory Physiotherapists' (RPTs) role. A quick three-days complete reorganization of the entire hospital was needed. A COVID-19 care team including a multidisciplinary panel of physicians, nurses, and RPTs was quickly performed to manage 90 beds for post acute patients with COVID-19. Within the team, the RPTs changed their shifts, so as to be available 16h per day, 7 days out of 7. Remodelled tasks in charge of RPTs were: oxygen therapy daily monitoring, non invasive ventilation (NIV) and continuous positive airways pressure (CPAP) delivery, pronation and postural changes to improve oxygenation, reconditioning with leg/arm cranking and exercises, initial and final patients' functional assessment by short-physical performance battery (SPPB) and 1-minute sit-to-stand test (1-STS) to evaluate motor conditions and exercise-induced oxygen desaturation. Three "what-to-do" algorithms were developed to guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity. One-hundred seventy patients were treated in one month. As main topics, RPTs have been involved in oxygen therapy management in almost a third of the admitted patients, reconditioning exercises in 60% of the cases, and initial and final functional motor capacity assessment in all patients. Details of activities performed by the RPT in one typical working day are also shown. Our reorganization has exploited the professional skills and clinical expertise of the RPTs. This re-organization can provide practical insights to other facilities that are facing this crisis, and may be a starting point for implementing post-COVID-19 rehabilitation. Future studies will have to improve and review this organization

Phase 1 Trial of Antibody NI006 for Depletion of Cardiac Transthyretin Amyloid

BACKGROUND Transthyretin amyloid (ATTR) cardiomyopathy is a progressive and fatal disease caused by misfolded transthyretin. Despite advances in slowing disease progression, there is no available treatment that depletes ATTR from the heart for the amelioration of cardiac dysfunction. NI006 is a recombinant human anti-ATTR antibody that was developed for the removal of ATTR by phagocytic immune cells. METHODS In this phase 1, double-blind trial, we randomly assigned (in a 2:1 ratio) 40 patients with wild-type or variant ATTR cardiomyopathy and chronic heart failure to receive intravenous infusions of either NI006 or placebo every 4 weeks for 4 months. Patients were sequentially enrolled in six cohorts that received ascending doses (ranging from 0.3 to 60 mg per kilogram of body weight). After four infusions, patients were enrolled in an open-label extension phase in which they received eight infusions of NI006 with stepwise increases in the dose. The safety and pharmacokinetic profiles of NI006 were assessed, and cardiac imaging studies were performed. RESULTS The use of NI006 was associated with no apparent drug-related serious adverse events. The pharmacokinetic profile of NI006 was consistent with that of an IgG antibody, and no antidrug antibodies were detected. At doses of at least 10 mg per kilogram, cardiac tracer uptake on scintigraphy and extracellular volume on cardiac magnetic resonance imaging, both of which are imaging-based surrogate markers of cardiac amyloid load, appeared to be reduced over a period of 12 months. The median N-terminal pro-B-type natriuretic peptide and troponin T levels also seemed to be reduced. CONCLUSIONS In this phase 1 trial of the recombinant human antibody NI006 for the treatment of patients with ATTR cardiomyopathy and heart failure, the use of NI006 was associated with no apparent drug-related serious adverse events. (Funded by Neurimmune; NI006-101 ClinicalTrials.gov number, NCT04360434.)

Composition variations in Cu(In,Ga)(S,Se)2 solar cells: Not a gradient, but an interlaced network of two phases

peer reviewedRecord efficiency in chalcopyrite-based solar cells Cu(In,Ga)(S,Se)2 is achieved using a gallium gradient to increase the bandgap of the absorber toward the back side. Although this structure has successfully reduced recombination at the back contact, we demonstrate that in industrial absorbers grown in the pilot line of Avancis, the back part is a source of non-radiative recombination. Depth-resolved photoluminescence (PL) measurements reveal two main radiative recombination paths at 1.04 eV and 1.5–1.6 eV, attributed to two phases of low and high bandgap material, respectively. Instead of a continuous change in the bandgap throughout the thickness of the absorber, we propose a model where discrete bandgap phases interlace, creating an apparent gradient. Cathodoluminescence and Raman scattering spectroscopy confirm this result. Additionally, deep defects associated with the high gap phase reduce the absorber's performance. Etching away the back part of the absorber leads to an increase of one order of magnitude in the PL intensity, i.e., 60 meV in quasi-Fermi level splitting. Non-radiative voltage losses correlate linearly with the relative contribution of the high energy PL peak, suggesting that reducing the high gap phase could increase the open circuit voltage by up to 180 mV.POLC

Forces exerted during exercises by patients with adolescent idiopathic scoliosis wearing fiberglass braces

OBJECTIVE: To quantify and compare the forces exerted by scoliosis patients in fiberglass braces during exercises usually prescribed in departments where casts are made. The exercises are intended to increase corrective forces, activate muscles, stimulate ventilation and help the patient psychologically. SETTING: Outpatient care. PATIENTS: 17 consecutive adolescent patients wearing fiberglass brace for idiopathic scoliosis. INTERVENTIONS: Exercises (kyphotization, rotation, "escape from the pad") in different positions (sitting, supine, on all fours). MAIN OUTCOME MEASURE: Pressure detected by the F-Socket System between the rib hump and the pad of the brace. RESULTS: In static and dynamic conditions, the position adopted did not alter the total pressure exerted by the brace, although the part of the sensor stimulated did vary. Kyphotization and rotation exercises produced a significant increase of pressure (+ 58.9% and +29.8%, respectively); however, the "escape from the pad" exercise, despite its name, did not produce any significant variation of pressure. CONCLUSION: Exercises in the brace allow adjunctive forces to be applied on soft tissues and through them, presumably on the spine. Different exercises can be chosen to obtain different actions. Physical exercises and sporting activities are useful in mechanical terms, although other important actions should not be overlooked