Decision-making with children, young people, and parents

The origin and importance of support in decision-making in paediatric palliative care (PPC) is rooted in its primary goal: to reduce suffering and maintain and even improve the quality of life of seriously ill children and their families. Decisions take place throughout the trajectory of a child’s illness and many are straight forward and barely noticed. However, often at pivotal points such as changes in treatment plans and the focus of care, the outcomes of the decisions assume much more importance and how they are made becomes a significant task for the family and clinicians involved

Bias of Maximum-Likelihood estimates in logistic and Cox regression models: A comparative simulation study

Parameter estimates of logistic and Cox regression models are biased for finite samples. In a simulation study we investigated for both models the behaviour of the bias in relation to sample size and further parameters. In the case of a dichotomous explanatory variable x the magnitude of the bias is strongly influenced by the baseline risk defined by the constants of the models and the risk resulting for the high risk group. To conduct a direct comparison of the bias of the two models analyses were based on the same simulated data. Overall, the bias of the two models appear to be similar, however, the Cox model has less bias in situations where the baseline risk is high

'I have to live with the decisions I make': laying a foundation for decision making for children with life-limiting conditions and life-threatening illnesses.

The relationship between parents and clinician is critical to the care and treatment of children with life-limiting conditions (LLCs) and life-threatening illnesses (LTIs). This relationship is built and maintained largely in consultations. In this article we lay out factors that bear on the success of clinical consultations and the maintenance of the essential clinician-parent relationship at progression or deterioration of LLCs or LTIs. We suggest an approach to engaging parents in conversations about care and treatment that recognises and appreciates the dilemmas which clinicians and parents face and in so doing provides a way for everyone to live with the decisions that are made. A close analysis of a consultation at progression and excerpts of encounters among parents, clinician and researcher are used to illustrate our approach to research, analysis and development of recommendations for clinical practice

Current understanding of decision-making in adolescents with cancer: A narrative systematic review

BACKGROUND: Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. AIMS: To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. DESIGN: A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. DATA SOURCES: The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13-19 years) with cancer. RESULTS: Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. CONCLUSION: Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory

Abrupt transition in quasiparticle dynamics at optimal doping in a cuprate superconductor system

We report time-resolved measurements of the photoinduced change in reflectivity, Delta R, in the Bi2Sr2Ca(1-y)Dy(y)Cu2O(8+delta) (BSCCO) system of cuprate superconductors as a function of hole concentration. We find that the kinetics of quasiparticle decay and the sign of Delta R both change abruptly where the superconducting transition temperature Tc is maximal. These coincident changes suggest that a sharp transition in quasiparticle dynamics takes place precisely at optimal doping in the BSCCO system.Comment: 10 pages, 4 figure

High quality superconducting niobium films produced by Ultra High Vacuum Cathodic Arc

The vacuum arc is a well-known technique to produce coating with enhanced adhesion and film density. Many cathodic arc deposition systems are actually in use in industry and research. They all work under (high) vacuum conditions in which water vapor pressure is an important source of film contamination, especially in the pulsed arc mode of operation. Here we present a Cathodic Arc system working under Ultra High Vacuum conditions (UHVCA). UHVCA has been used to produce ultra-pure niobium films with excellent structural and electrical properties at a deposition temperature lower than 100oC. The UHVCA technique therefore opens new perspectives for all applications requiring ultra-pure films or, as in the case of Plasma Immersion Ion Implantation, ultra-pure plasmas.Comment: submitted to AP

A Map of Periodicity Orthogonal to Frequency Representation in the Cat Auditory Cortex

Harmonic sounds, such as voiced speech sounds and many animal communication signals, are characterized by a pitch related to the periodicity of their envelopes. While frequency information is extracted by mechanical filtering of the cochlea, periodicity information is analyzed by temporal filter mechanisms in the brainstem. In the mammalian auditory midbrain envelope periodicity is represented in maps orthogonal to the representation of sound frequency. However, how periodicity is represented across the cortical surface of primary auditory cortex (AI) remains controversial. Using optical recording of intrinsic signals, we here demonstrate that a periodicity map exists in primary AI of the cat. While pure tone stimulation confirmed the well-known frequency gradient along the rostro-caudal axis of AI, stimulation with harmonic sounds revealed segregated bands of activation, indicating spatially localized preferences to specific periodicities along a dorso-ventral axis, nearly orthogonal to the tonotopic gradient. Analysis of the response locations revealed an average gradient of − 100° ± 10° for the periodotopic, and −12° ± 18° for the tonotopic map resulting in a mean angle difference of 88°. The gradients were 0.65 ± 0.08 mm/octave for periodotopy and 1.07 ± 0.16 mm/octave for tonotopy indicating that more cortical territory is devoted to the representation of an octave along the tonotopic than along the periodotopic gradient. Our results suggest that the fundamental importance of pitch, as evident in human perception, is also reflected in the layout of cortical maps and that the orthogonal spatial organization of frequency and periodicity might be a more general cortical organization principle

Indoor heat stress: An assessment of human bioclimate using the UTCI in different buildings in Berlin

Because humans spend most of their time indoors and can be negatively affected by unfavourable thermal environ­ments, the assessment of indoor heat stress is an important issue for public health care. To characterise indoor human bioclimate, the Universal Thermal Climate Index (UTCI) was used. UTCI values were calculated from meas­urements of air temperature and air humidity in 16 rooms in Berlin during the summer months of 2011 and 2012. A constant air velocity of approximately 0.3 m/s and a metabolic heat production of 135 W/m2 were assumed. The mean radiant temperature was set to the air temperature. Because the mean air humidity was below or slightly above 50 %, the calculated UTCI values were mostly lower than the air temperatures. In summer 2012, the mean UTCI values ranged from 22.2 °C to 27.1 °C, and the maximum UTCI values ranged from 24.7 °C to 35.6 °C. Whereas only minor differences were found between rooms located within comparable buildings in different districts of Berlin, pronounced variations of the UTCI values were detected in two adjoining buildings, with differences up to 8.6 K for the daily minimum, 9.8 K for the daily mean and 12.2 K for the daily maximum UTCI between differ­ent rooms. These variations can be explained by differences in the structures of the two buildings, floor level and aspect. The UTCI values were also used to determine the occurrence of moderate and strong heat stress. Only two rooms showed no thermal stress, while strong heat stress was detected in three rooms