Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings

Background: Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods: We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results: Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion: The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation

Constraining the Distribution of L- & T-Dwarfs in the Galaxy

We estimate the thin disk scale height of the Galactic population of L- & T-dwarfs based on star counts from 15 deep parallel fields from the Hubble Space Telescope. From these observations, we have identified 28 candidate L- & T- dwarfs based on their (i'-z') color and morphology. By comparing these star counts to a simple Galactic model, we estimate the scale height to be 350+-50 pc that is consistent with the increase in vertical scale with decreasing stellar mass and is independent of reddening, color-magnitude limits, and other Galactic parameters. With this refined measure, we predict that less than 10^9 M_{sol} of the Milky Way can be in the form L- & T- dwarfs, and confirm that high-latitude, z~6 galaxy surveys which use the i'-band dropout technique are 97-100% free of L- & T- dwarf interlopers.Comment: 4 pages, 4 figures, accepted to ApJ

Combination Treatment of Withalongolide a Triacetate with Cisplatin Induces Apoptosis by Targeting Translational Initiation, Migration, and Epithelial to Mesenchymal Transition in Head and Neck Squamous Cell Carcinoma

Treatment regimens for head and neck squamous cell carcinoma (HNSCC) typically include cisplatin and radiotherapy and are limited by toxicities. We have identified naturally derived withalongolide A triacetate (WGA-TA) from Physalis longifolia as a lead compound for targeting HNSCC. We hypothesized that combining WGA-TA with cisplatin may allow for lower, less toxic cisplatin doses. HNSCC cell lines were treated with WGA-TA and cisplatin. After treatment with the drugs, the cell viability was determined by MTS assay. The combination index was calculated using CompuSyn. The expression of proteins involved in the targeting of translational initiation complex, epithelial to mesenchymal transition (EMT), and apoptosis were measured by western blot. Invasion and migration were measured using the Boyden-chamber assay. Treatment of MDA-1986 and UMSCC-22B cell lines with either WGA-TA or cisplatin alone for 72 h resulted in a dose dependent decrease in cell viability. Cisplatin in combination with WGA-TA resulted in significant synergistic cell death starting from 1.25 μM cisplatin. Combination treatment with WGA-TA resulted in lower cisplatin dosing while maintaining the downregulation of translational initiation complex proteins, the induction of apoptosis, and the blockade of migration, invasion, and EMT transition. These results suggest that combining a low concentration of cisplatin with WGA-TA may provide a safer, more effective therapeutic option for HNSCC that warrants translational validation

CS 30322-023: an ultra metal-poor TP-AGB star?

With [Fe/H] = -3.5, CS 30322-023 is the most metal-poor star to exhibit a clear s-process signature and the most metal-poor ``lead star'' known. CS 30322-023 is also remarkable in having the lowest surface gravity (log g <= -0.3) among the metal-poor stars studied to date. The available evidence indicates that this star is presently a thermally-pulsing asymptotic giant branch (TP-AGB) star, with no strong indication of binarity thus far (although a signal of period 192 d is clearly present in the radial-velocity data, this is likely due to pulsation of the stellar envelope). We show that low-mass TP-AGB stars are not expected to be exceedingly rare in a magnitude-limited sample such as the HK survey, because their high luminosities make it possible to sample them over a very large volume. The strong N overabundance and the low 12C/13C ratio (4) in this star is typical of the operation of the CN cycle. Coupled with a Na overabundance and the absence of a strong C overabundance, this pattern seems to imply that hot-bottom burning operated in this star, which should then have a mass of at least 2 Msun. However, the luminosity associated with this mass would put the star at a distance of about 50 kpc, in the outskirts of the galactic halo. We explore alternative scenarios in which the observed abundance pattern results from some mixing mechanism yet to be identified occurring in a single low-metallicity 0.8 Msun AGB star, or from pollution by matter from an intermediate-mass AGB companion which has undergone hot-bottom burning. We stress, however, that our abundances may be subject to uncertainties due to NLTE or 3D granulation effects which were not taken into consideration.Comment: 17 pages, Astronomy & Astrophysics, in press; also available at http://www.astro.ulb.ac.be/Html/ps.html#PR

An updated survey of globular clusters in M31. II Newly discovered bright and remote clusters

We present the first results of a large spectroscopic survey of candidate globular clusters located in the extreme outskirts of the nearby M31 galaxy. We obtained low resolution spectra of 48 targets selected from the XSC of 2MASS, as in Galleti et al. (2005). The observed candidates have been robustly classified according to their radial velocity and by verifying their extended/point-source nature from ground-based optical images. Among the 48 observed candidates clusters we found 5 genuine remote globular clusters. One of them has been already identified independently by Mackey et al. (2007), their GC1; the other four are completely new discoveries: B516, B517, B518, B519. The newly discovered clusters lie at projected distance 40 kpc<~R_p<~100 kpc from the center of M31, and have absolute integrated magnitude -9.5<M_V<-7.5. For all the observed clusters we have measured the strongest Lick indices and we have obtained spectroscopic metallicity estimates. Mackey-GC1, Martin-GC1, B517 and B518 have spectra typical of old and metal poor globular clusters ([Fe/H]<~ -1.3); B519 appears old but quite metal-rich ([Fe/H]~-0.5); B516 presents very strong Balmer absorption lines: if this is indeed a cluster it should have a relatively young age (likely <2 Gyr). The present analysis nearly doubles the number of M31 globulars at R_p> 40 kpc. At odds with the Milky Way, M31 appears to have a significant population of very bright globular clusters in its extreme outskirts.Comment: 16 pages including 6 pages published only in the electronic edition of the Journal. Accepted for publication in A&

Brief report:An evaluation of the AQ-10 as a brief screening instrument for ASD in adults

There is a need for brief screening instruments for autistic spectrum disorders (ASD) that can be used by frontline healthcare professionals to aid in the decision as to whether an individual should be referred for a full diagnostic assessment. In this study we evaluated the ability of a short form of the autism spectrum quotient (AQ) questionnaire, the 10 item AQ-10, to correctly classify individuals as having or not having ASD. In a sample of 149 individuals with ASD and 134 controls without an ASD diagnosis, we found that the full AQ (AQ-50) abridged AQ (AQ-S) and AQ-10 all performed well as a screen for ASD. ROC analysis indicated that sensitivity, specificity and area under the curve were very similar at suggested cut-off's for ASD across measures, with little difference in performance between the AQ-10 and full AQ-50. Results indicate the potential usefulness of the AQ-10 as a brief screen for ASD

ESO Imaging Survey. The Stellar Catalogue in the Chandra Deep Field South

(abridged) Stellar catalogues in five passbands (UBVRI) over an area of approximately 0.3 deg^2, comprising about 1200 objects, and in seven passbands (UBVRIJK) over approximately 0.1 deg^2, comprising about 400 objects, in the direction of the Chandra Deep Field South are presented. The 90% completeness level of the number counts is reached at approximately U = 23.8, B = 24.0, V = 23.5, R = 23.0, I = 21.0, J = 20.5, K = 19.0. A scheme is presented to select point sources from these catalogues, by combining the SExtractor parameter CLASS_STAR from all available passbands. Probable QSOs and unresolved galaxies are identified by using the previously developed \chi^2-technique (Hatziminaoglou et al 2002), that fits the overall spectral energy distributions to template spectra and determines the best fitting template. The observed number counts, colour-magnitude diagrams, colour-colour diagrams and colour distributions are presented and, to judge the quality of the data, compared to simulations based on the predictions of a Galactic Model convolved with the estimated completeness functions and the error model used to describe the photometric errors of the data. The resulting stellar catalogues and the objects identified as likely QSOs and unresolved galaxies with coordinates, observed magnitudes with errors and assigned spectral types by the $\chi^2$-technique are presented and are publicly available.Comment: Paper as it will appear in print. Complete figures and tables can be obtained from: http://www.eso.org/science/eis/eis_pub/eis_pub.html. Astronomy & Astrophysics, accepted for publicatio

Na-O Anticorrelation and HB. IV. Detection of He-rich and He-poor stellar populations in the globular cluster NGC 6218

We used the multifiber spectrograph FLAMES on the ESO Very Large Telescope UT2 to derive atmospheric parameters, metallicities and abundances of O and Na for 79 red giant stars in the Galactic globular cluster NGC 6218 (M 12). We analyzed stars in the magnitude range from about 1 mag below the bump to the tip of the Red Giant Branch. The average metallicity we derive is [Fe/H]=-1.31+/-0.004+/-0.028 dex (random and systematic errors, respectively), with a very small star-to-star scatter (rms=0.033 dex), from moderately high-resolution Giraffe spectra. This is the first extensive spectroscopic abundance analysis in this cluster. Our results indicate that NGC 6218 is very homogeneous as far as heavy elements are concerned. On the other hand, light elements involved in the well known proton-capture reactions of H-burning at high temperature, such as O and Na, show large variations, anticorrelated with each other, at all luminosities along the red giant branch. The conclusion is that the Na-O anticorrelation must be established in early times at the cluster formation. We interpret the variation of Na found near the RGB-bump as the effect of two distinct populations having different bump luminosities, as predicted for different He content. To our knowledge, NGC 6218 is the first GC where such a signature has been spectroscopically detected, when combined with consistent and homogeneous data obtained for NGC 6752 to gain in statistical significance.Comment: 15 pages, 10 figures; fig.5 degraded in resolution; tables 2,3,5 available at CDS. Accepted for publication on A&