Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria

Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Results Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment – the Dying with Dignity Victoria Advance Healthcare Directive. Conclusions More research is needed to understand how online resources can optimally elicit and record consumers’ individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement

Three-generation neutrino mixing and LSND dark matter neutrinos

The reported signal at the LSND experiment, when interpreted as neutrino mixing with $\delta m^2 = 6 \;\rm{eV}^2$, provides evidence for neutrinos with a cosmologically significant mass. However, attempts to reconcile this interpretation of the experiment with other hints about neutrino properties require a (sterile) fourth neutrino and/or an ``inverted'' neutrino mass hierarchy. An interpretation of the LSND experiment employing $\delta m^2 = 0.3\; \rm{eV}^2$, with three-generation mixing and a ``normal'' neutrino mass hierarchy, can just barely be reconciled with the negative results of other laboratory neutrino oscillation experiments and the positive hints of neutrino oscillation from the solar and atmospheric neutrino problems. Though subject to test by by future experiments, such a solution allows (but does not demand) neutrino masses relevant for dark matter.Comment: To be published in Nucl. Phys. B (Proc. Suppl.), in the proceedings of "Sources and Detection of Dark Matter in the Universe", held in Santa Monica, Feb. 14-16 1996. 5 page

On the Size of the Dark Side of the Solar Neutrino Parameter Space

We present an analysis of the MSW neutrino oscillation solutions of the solar neutrino problem in the framework of two-neutrino mixing in the enlarged parameter space $(\Delta m^2, \tan^2\theta)$ with $\theta \in (0,\frac{\pi}{2})$. Recently, it was pointed out that the allowed region of parameters from a fit to the measured total rates can extend to values $\theta \geq \frac{\pi}{4}$ (the so called ``dark side'') when higher confidence levels are allowed. The purpose of this letter is to reanalize the problem including all the solar neutrino data available, to discuss the dependence on the statistical criteria in the determination of the CL of the ``dark side'' and to extract the corresponding limits on the largest mixing allowed by the data. Our results show that when the Super-Kamiokande data on the zenith angle distribution of events and the spectrum information is included, the regions extend more into the dark side.Comment: 5 pages,latex file using RevTex. Two-layer aproximation for the Earth density replaced by numerical integration with PREM. Latest parametrization of the sun matter density (BP2000) is included. Misprints corrected. Conclusions unchanged. 5 postscript figures (bitmapped for compression). A full version of the paper can be found at http://ific.uv.es/~penya/papers/ To appear in Phys. Rev.

Experiences of women with cardiac disease in pregnancy: A systematic review and metasynthesis

© Author(s) (or their employer(s)) 2018. Objective Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services. Method We conducted a systematic search of peerreviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women's experiences extracted from each publication to inform new healthcare practices and communication. Results Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences. Conclusions There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidencebased guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decisionmaking must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care

Three-Neutrino Mixing and Combined Vacuum Oscillations and MSW Transitions of Solar Neutrinos

Assuming three flavour neutrino mixing takes place in vacuum, we investigate the possibility that the solar nu_e take part in MSW transitions in the Sun due to Delta m^2_{31} from 10^{-7} eV^2 to 10^{-4} eV^2, followed by long wave length vacuum oscillations on the way to the Earth, triggered by Delta m^2_{21} (or Delta m^2_{32}) from 10^{-12} eV^2 to 10^{-10} eV^2, Delta m^2_{31} and Delta m^2_{21} (Delta m^2_{32}) being the corresponding neutrino mass squared differences. The solar nu_e survival probability is shown to be described in this case by a simple analytic expression. Depending on whether the vacuum oscillations are due to Delta m^2_{21} or Delta m^2_{32} there are two very different types of interplay between the MSW transitions and the vacuum oscillations of the solar nu_e. Performing an analysis of the most recently published solar neutrino data we have found several qualitatively new solutions of the solar neutrino problem of the hybrid MSW transitions + vacuum oscillations type. The solutions differ in the way the pp, 7Be and 8B neutrino fluxes are affected by the transitions in the Sun and the oscillations in vacuum. The specific features of the new solutions are discussed.Comment: 37 pages Latex, 16 Postscript Figure

A Study of the Day - Night Effect for the Super - Kamiokande Detector: I. Time Averaged Solar Neutrino Survival Probability

This is the first of two articles aimed at providing comprehensive predictions for the day-night (D-N) effect for the Super-Kamiokande detector in the case of the MSW \nu_e \to \numt transition solution of the solar neutrino problem. The one-year averaged probability of survival of the solar \nue crossing the Earth mantle, the core, the inner 2/3 of the core, and the (core + mantle) is calculated with high precision (better than 1%) using the elliptical orbit approximation (EOA) to describe the Earth motion around the Sun. Results for the survival probability in the indicated cases are obtained for a large set of values of the MSW transition parameters $\Delta m^2$ and $sin^22\theta_{V}$ from the ``conservative'' regions of the MSW solution, derived by taking into account possible relatively large uncertainties in the values of the $^{8}$B and $^{7}$Be neutrino fluxes. Our results show that the one-year averaged D-N asymmetry in the $\nu_e$ survival probability for neutrinos crossing the Earth core can be, in the case of $sin^22 \theta_{V} \leq 0.13$, larger than the asymmetry in the probability for (only mantle crossing + core crossing) neutrinos by a factor of up to six. The enhancement is larger in the case of neutrinos crossing the inner 2/3 of the core. This indicates that the Super-Kamiokande experiment might be able to test the $sin^22\theta_{V} \leq 0.01$ region of the MSW solution of the solar neutrino problem by performing selective D-N asymmetry measurements.Comment: LaTeX2e - 18 Text Pages + 21 figures = 39 Pages. - Figures in PS + text file sk1b14.tex requires two auxiliary files (included

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care

Background: Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods. An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). Results: The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n=45), episodic care (n=19), and chronic disease management (n=11). They were undertaken in a number of countries including Australia (n=25), USA (n=25), and UK (n=15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n=46 studies) or as a combination of two (n=20) or more strategies (n=9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n=43 studies), patient support (n=29), provision of new services (n=19), workforce development (n=11), and financial incentives (n=9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. Conclusions: This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these. © 2012 Comino et al.; licensee BioMed Central Ltd

An SU(2)L×U(1)Y×S3×DSU(2)_{L}\times U(1)_{Y} \times S_{3} \times D model for atmospheric and solar neutrino deficits

Motivated by the recent Super-Kamiokande experiment on atmospheric and solar neutrino oscillation we propose a see-saw model of three generations of neutrinos based on the gauge group $SU(2)_{L}\times U(1)_{Y}$ with discrete symmetries $(S_{3} \times D)$ and three right handed singlet neutrinos so that this model can accommodate the recent Super-Kamiokande data on atmospheric and solar neutrino oscillations. The model predicts maximal mixing between $\nu_{\mu}$ and $\nu_{\tau}$ with $sin^{2}2{\theta_{\mu\tau}}$ = 1 as required by the atmospheric neutrino data and small mixing between $\nu_{e}$ and $\nu_{\mu}$ with $sin^{2}2{\theta_{e\mu}} \sim (10^{-2}-10^{-3})$ as a possible explanation of the solar neutrino deficit through the MSW mechanism. The model admits two mass scales of which one breaks the electroweak symmetry and the other is responsible for the breaking of the lepton number symmetry at GUT scale leading to small Majorana mass of the left handed doublet neutrinos

Correlations of Solar Neutrino Observables for SNO

Neutrino oscillation scenarios predict correlations, and zones of avoidance, among measurable quantities such as spectral energy distortions, total fluxes, time dependences, and flavor content. The comparison of observed and predicted correlations will enhance the diagnostic power of solar neutrino experiments. A general test of all presently-allowed (two neutrino) oscillation solutions is that future measurements must yield values outside the predicted zones of avoidance. To illustrate the discriminatory power of the simultaneous analysis of multiple observables, we map currently allowed regions of neutrino masses and mixing angles onto planes of quantities measurable with the Sudbury Neutrino Observatory (SNO). We calculate the correlations that are predicted by vacuum and MSW (active and sterile) neutrino oscillation solutions that are globally consistent with all available neutrino data. We derive approximate analytic expressions for the dependence of individual observables and specific correlations upon neutrino oscillations parameters. We also discuss the prospects for identifying the correct oscillation solution using multiple SNO observables.Comment: Accepted Phys Rev D. Included new figure. Related material http://www.sns.ias.edu/~jn

Neutrino Oscillations and Moments of Electron Spectra

We show that the effects of neutrino oscillations on 8B solar neutrinos are described well by the first two moments (the average and the variance) of the energy distribution of scattered or recoil electrons. For the SuperKamiokande and the Sudbury Neutrino Observatory experiments, the differences between the moments calculated with oscillations and the standard, no-oscillation moments are greater than 3 standard deviations for a significant fraction of the neutrino mass-mixing (Delta m^2, sin^2 2 theta) parameter space.Comment: 16 pages, Latex, text+figures. To be published in Physical Review C, January 199