The philosophy of palliative care: a critique

Palliative care is unusual as a specialty within health care in that it has its own philosophy, which is summarised in the WHO definition of palliative care. This philosophy has influenced clinical practice so that specialist palliative care differs significantly from other aspects of health care. The thesis is a critique of that philosophy. It examines the moral problems inherent in implementing the philosophy in clinical practice. It concludes with suggestions for improvements which could be made to the philosophy statement so as to influence clinical care for the better. Thesis 1 is that decisions regarding the use of treatment to control symptoms or prolong life did not need to depend on complex doctrines such as double effect, but instead ought to be based on weighing up the benefits, harms and risks of treatment. Thesis 2 is that the relatives should not be an equal part of the remit of care. It is argued that whilst there is a special relationship, founded on an implicit promise and associated with specific obligations, between patients and health care professionals, this special relationship should not be extended to relatives of the patient. Thesis 3 is that quality of life as a global concept should not be used. Since quality of life depends on many incommensurable factors, and it is not possible to construct a coherent account of quality of life from our everyday notions of what it means, it is not possible to construct a quality of life scale. Thesis 4 is that there are constraints of expertise and propriety on attempts to influence the patient’s psychological, social and spiritual well-being. Thesis 5 is that within health care there ought to be a just distribution of resources to specialist palliative care, and then among terminally ill patients regardless of their illness

ACA Implementation Monitoring and Tracking Site Visit Report: Colorado

Assesses Colorado's progress in implementing federal healthcare reform legislation, including ongoing planning for the health insurance exchange, enrollment and subsidy determination, and Medicaid expansion, as well as work remaining on insurance reforms

The Corticostriatal System in Dissociated Cell Culture

The sparse connectivity within the striatum in vivo makes the investigation of individual corticostriatal synapses very difficult. Most studies of the corticostriatal input have been done using electrical stimulation under conditions where it is hard to identify the precise origin of the cortical input. We have employed an in vitro dissociated cell culture system that allows the identification of individual corticostriatal pairs and have been developing methods to study individual neuron inputs to striatal neurons. In mixed corticostriatal cultures, neurons had resting activity similar to the system in vivo. Up/down states were obvious and seemed to encompass the entire culture. Mixed cultures of cortical neurons from transgenic mice expressing green fluorescent protein with striatal neurons from wild-type mice of the same developmental stage allowed visual identification of individual candidate corticostriatal pairs. Recordings were performed between 12 and 37 days in vitro (DIV). To investigate synaptic connections we recorded from 69 corticostriatal pairs of which 44 were connected in one direction and 25 reciprocally. Of these connections 41 were corticostriatal (nine inhibitory) and 53 striatocortical (all inhibitory). The observed excitatory responses were of variable amplitude (−10 to −370 pA, n = 32). We found the connections very secure – with negligible failures on repeated stimulation (approximately 1 Hz) of the cortical neuron. Inhibitory corticostriatal responses were also observed (−13 to −314 pA, n = 9). Possibly due to the mixed type of culture we found an inhibitory striatocortical response (−14 to −598 pA, n = 53). We are now recording from neurons in separate compartments to more closely emulate neuroanatomical conditions but still with the possibility of the easier identification of the connectivity

An Assessment of Climate Induced Increase in Soil Water Availability for Soil Bacterial Communities Exposed to Long-Term Differential Phosphorus Fertilization

The fate of future food productivity depends primarily upon the health of soil used for cultivation. For Atlantic Europe, increased precipitation is predicted during both winter and summer months. Interactions between climate change and the fertilization of land used for agriculture are therefore vital to understand. This is particularly relevant for inorganic phosphorus (P) fertilization, which already suffers from resource and sustainability issues. The soil microbiota are a key indicator of soil health and their functioning is critical to plant productivity, playing an important role in nutrient acquisition, particularly when plant available nutrients are limited. A multifactorial, mesocosm study was established to assess the effects of increased soil water availability and inorganic P fertilization, on spring wheat biomass, soil enzymatic activity (dehydrogenase and acid phosphomonoesterase) and soil bacterial community assemblages. Our results highlight the significance of the spring wheat rhizosphere in shaping soil bacterial community assemblages and specific taxa under a moderate soil water content (60%), which was diminished under a higher level of soil water availability (80%). In addition, an interaction between soil water availability and plant presence overrode a long-term bacterial sensitivity to inorganic P fertilization. Together this may have implications for developing sustainable P mobilization through the use of the soil microbiota in future. Spring wheat biomass grown under the higher soil water regime (80%) was reduced compared to the constant water regime (60%) and a reduction in yield could be exacerbated in the future when grown in cultivated soil that have been fertilized with inorganic P. The potential feedback mechanisms for this need now need exploration to understand how future management of crop productivity may be impacted.</p

Mapping the cosmic web with the Sloan Digital Sky Survey

Paper presented at The Proceedings IAU Colloquium No. 195, 2004.Wide-angle, moderately deep redshift surveys such as that conducted as part of the Sloan Digital Sky Survey (SDSS) allow study of the relationship between the structural elements of the large-scale distribution of galaxies – including groups, cluster, superclusters, and voids – and the dependence of galaxy formation and evolution on these enviroments. We present a progress report on mapping efforts with the SDSS and discuss recently constructed catalogs of clusters, voids, and void galaxies, and evidence for a 420h−1Mpc supercluster or “Great Wall.” Analysis of multi-band photometry and moderate-resolution spectroscopy from the SDSS reveals environmental dependence of the star formation history of galaxies that extends over more than a factor of 100 in density, from clusters all the way to the deep interiors of voids. On average, galaxies in the rarified environments of voids exhibit bluer colors, higher specific star formation rates, lower dust content, and more disk-like morphology than objects in denser regions. This trend persists in comparisons of samples in low vs. high-density regions with similar luminosity and morphology, thus this dependence is not simply an extension of the morphology-density relation. Large-scale modulation of the halo mass function and the temperature of the intergalactic medium might explain this dependence of galaxy evolution on the large-scale environment

Understanding Psychophysiological Correlates of User Experience using Electroencephalogram (EEG)

The objective of this research is to understand psychophysiological correlates of user experience using electroencephalogram (EEG). We will conduct an experimental study to assess the psychophysiological differences across three states of user experience -- flow, boredom, and anxiety -- and compare them with the neutral state as a baseline. EEG measurement provides a plethora of data that can be decomposed using different analytical procedures. We will utilize one type of analysis, time-frequency decomposition, to examine changes in frequency (e.g., alpha/beta/theta band) over time. These frequency bands correlate with different cognitive states. In this study, we will use Event Related Spectral Perturbation (ERSP), a type of time-frequency decomposition, for its ability to model both time and frequency changes occurring in a frequency band. We expect the findings to not only contribute to a better understanding of psychophysiological means of assessing user experience, but also provide implications for future research in brain-computer interface

THE LUMINOSITY FUNCTION OF VOID GALAXIES IN THE SLOAN DIGITAL SKY SURVEY

ABSTRACT We measure the r-band luminosity function ( LF ) of a sample of 10 3 void galaxies over a large range of magnitude, À21:5 &lt; M r &lt; À14:5. These objects were identified by Rojas et al. from the Sloan Digital Sky Survey as residing in regions with local galaxy density = &lt; À0:6 on a scale of 7 h À1 Mpc. We compare the void galaxy LF with that of galaxies in denser regions (so-called &apos;&apos;wall&apos;&apos; galaxies). 07. Thus, we find that void galaxies are characteristically fainter than wall galaxies, but we do not find a significant dependence of the slope of the LF at the faint end on environment alone. The latter result suggests that there is no excess of dwarfs in voids, in contrast to predictions of cold dark matter (CDM ) models. We split both the void and wall samples in half by density and find that the LFs of both the higher and lower density void galaxies and the lower density wall galaxies are similar in shape. However, the LF of wall galaxies in the highest density regions has a shallower faint-end slope, i.e., there are relatively fewer faint galaxies in the highest density regions. The LF of void galaxies is most similar to that of late-type galaxies in denser regions. The LFs of subsamples of wall galaxies that have blue g À r color, spiral-like surface brightness profiles (Sérsic index n &lt; 2), or relatively high star formation rates [EW( H) &gt; 5 8], have brighter M Ã r but faint-end slopes similar to those of void galaxies. In contrast, the LFs of wall galaxies with red g À r color, elliptical-like profiles, or low star formation rates have significantly shallower faint-end slopes and brighter values of M Ã r than we find for void galaxies. We conclude that the void galaxy population is dominated by faint, late-type galaxies. The shift in M Ã between the void and wall galaxy LFs is consistent with the shift of the mass function in voids predicted by extended Press-Schechter theory