The Flanagan Quality of Life Scale: Evidence of Construct Validity

BACKGROUND: The Quality of Life Scale (QOLS), developed originally by John Flanagan in the 1970's, has been adapted for use in chronic illness groups. Evidence for reliability and validity has been published over the years for both English and translations. This paper presents further evidence of construct validity for persons with chronic conditions as well as across two languages, and gender. METHODS: A sample of 1241 chronically ill and healthy adults from American and Swedish databases was used to generate factor analyses for both the 15-item original QOLS and the 16-item chronic illness adaptation. RESULTS: Analysis of the data suggested that the QOLS has three factors in the healthy sample and across chronic conditions, two languages and gender. Factors that could be labeled (1) Relationships and Material Well-Being, (2) Health and Functioning, and (3) Personal, Social and Community Commitment were identified. CONCLUSIONS: The QOLS is a valid instrument for measuring domains of quality of life across diverse patient groups

Linearizability with Ownership Transfer

Linearizability is a commonly accepted notion of correctness for libraries of concurrent algorithms. Unfortunately, it assumes a complete isolation between a library and its client, with interactions limited to passing values of a given data type. This is inappropriate for common programming languages, where libraries and their clients can communicate via the heap, transferring the ownership of data structures, and can even run in a shared address space without any memory protection. In this paper, we present the first definition of linearizability that lifts this limitation and establish an Abstraction Theorem: while proving a property of a client of a concurrent library, we can soundly replace the library by its abstract implementation related to the original one by our generalisation of linearizability. This allows abstracting from the details of the library implementation while reasoning about the client. We also prove that linearizability with ownership transfer can be derived from the classical one if the library does not access some of data structures transferred to it by the client

Reasoning algebraically about refinement on TSO architectures

The Total Store Order memory model is widely implemented by modern multicore architectures such as x86, where local buffers are used for optimisation, allowing limited forms of instruction reordering. The presence of buffers and hardware-controlled buffer flushes increases the level of non-determinism from the level specified by a program, complicating the already difficult task of concurrent programming. This paper presents a new notion of refinement for weak memory models, based on the observation that pending writes to a process' local variables may be treated as if the effect of the update has already occurred in shared memory. We develop an interval-based model with algebraic rules for various programming constructs. In this framework, several decomposition rules for our new notion of refinement are developed. We apply our approach to verify the spinlock algorithm from the literature

On the Behaviour of General-Purpose Applications on Cloud Storages

Managing data over cloud infrastructures raises novel challenges with respect to existing and well studied approaches such as ACID and long running transactions. One of the main requirements is to provide availability and partition tolerance in a scenario with replicas and distributed control. This comes at the price of a weaker consistency, usually called eventual consistency. These weak memory models have proved to be suitable in a number of scenarios, such as the analysis of large data with Map-Reduce. However, due to the widespread availability of cloud infrastructures, weak storages are used not only by specialised applications but also by general purpose applications. We provide a formal approach, based on process calculi, to reason about the behaviour of programs that rely on cloud stores. For instance, one can check that the composition of a process with a cloud store ensures `strong' properties through a wise usage of asynchronous message-passing

Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery

BACKGROUND: Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain. METHODS: A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered. RESULTS: There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance. CONCLUSION: This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain

Robustness against Power is PSPACE-complete

Power is a RISC architecture developed by IBM, Freescale, and several other companies and implemented in a series of POWER processors. The architecture features a relaxed memory model providing very weak guarantees with respect to the ordering and atomicity of memory accesses. Due to these weaknesses, some programs that are correct under sequential consistency (SC) show undesirable effects when run under Power. We call these programs not robust against the Power memory model. Formally, a program is robust if every computation under Power has the same data and control dependencies as some SC computation. Our contribution is a decision procedure for robustness of concurrent programs against the Power memory model. It is based on three ideas. First, we reformulate robustness in terms of the acyclicity of a happens-before relation. Second, we prove that among the computations with cyclic happens-before relation there is one in a certain normal form. Finally, we reduce the existence of such a normal-form computation to a language emptiness problem. Altogether, this yields a PSPACE algorithm for checking robustness against Power. We complement it by a matching lower bound to show PSPACE-completeness

Timing properties and correctness for structured parallel programs on x86-64 multicores

This paper determines correctness and timing properties for structured parallel programs on x86-64 multicores. Multicore architectures are increasingly common, but real architectures have unpredictable timing properties, and even correctness is not obvious above the relaxed-memory concurrency models that are enforced by commonly-used hardware. This paper takes a rigorous approach to correctness and timing properties, examining common locking protocols from first principles, and extending this through queues to structured parallel constructs. We prove functional correctness and derive simple timing models, and both extend for the first time from low-level primitives to high-level parallel patterns. Our derived high-level timing models for structured parallel programs allow us to accurately predict upper bounds on program execution times on x86-64 multicores.Postprin

Verifying linearizability on TSO architectures

Linearizability is the standard correctness criterion for fine-grained, non-atomic concurrent algorithms, and a variety of methods for verifying linearizability have been developed. However, most approaches assume a sequentially consistent memory model, which is not always realised in practice. In this paper we define linearizability on a weak memory model: the TSO (Total Store Order) memory model, which is implemented in the x86 multicore architecture. We also show how a simulation-based proof method can be adapted to verify linearizability for algorithms running on TSO architectures. We demonstrate our approach on a typical concurrent algorithm, spinlock, and prove it linearizable using our simulation-based approach. Previous approaches to proving linearizabilty on TSO architectures have required a modification to the algorithm's natural abstract specification. Our proof method is the first, to our knowledge, for proving correctness without the need for such modification

Intravenous iron preparations transiently generate non-transferrin-bound iron from two proposed pathways

Intravenous iron-carbohydrate complex preparations (IVIPs) are non-interchangeable pro-drugs: their pharmacokinetics (PK) varies determined by semi-crystalline iron core and carbohydrate shell structures, influences pharmacodynamics (PD) and thus efficacy and safety. Examining PK/PD relationships of 3 IVIPs we identify a two-pathway model of transient NTBI generation following single dose administration. 28 hypoferremic non-anemic patients randomized to 200mg iron as ferric carboxymaltose (Fe-carboxymaltose), iron sucrose (Fe-sucrose), iron isomaltoside 1000 (Fe-isomaltoside-1000), n=8/arm, or placebo, n=4, on a 2-week PK/PD study, had samples analysed for total serum iron, IVIP-iron, transferrin-bound iron (TBI) by HPLC-ICP-MS, transferrin saturation (TSAT), serum ferritin (s-Ferritin) by standard methods, non-TBI (NTBI) and hepcidin as published before. IVIP-dependent increases in these parameters returned to baseline in 48-150h, except for s-Ferritin and TSAT. NTBI was low with Fe-isomaltoside-1000 (0.13µM at 8h), rapidly increased with Fe-sucrose (0.8µM at 2h, 1.25µM at 4h), and delayed for Fe-carboxymaltose (0.57µM at 24h). NTBI AUCs were 7-fold greater for Fe-carboxymaltose and Fe-sucrose than for Fe-isomaltoside-1000. Hepcidin peak time varied, but not AUC or mean levels. s-Ferritin levels and AUC were highest for Fe-carboxymaltose and greater than placebo for all IVIPs. We propose 2 mechanisms for the observed NTBI kinetics: rapid and delayed NTBI appearance consistent with direct (circulating IVIP-to-plasma) and indirect (IVIP-to-macrophage-to-plasma) iron release based on IVIP plasma half-life and s-Ferritin dynamics. IVIPs generate different, broadly stability- and PK-dependent, NTBI and s-Ferritin signatures, which may influence iron bioavailability, efficacy and safety. Longer-term studies should link NTBI exposure to subsequent safety and efficacy parameters and potential clinical consequences

Postgraduate Symposium Positive influence of nutritional alkalinity on bone health: Conference on ‘Over- and undernutrition: challenges and approaches'

There is growing evidence that consumption of a Western diet is a risk factor for osteoporosis through excess acid supply, while fruits and vegetables balance the excess acidity, mostly by providing K-rich bicarbonate-rich foods. Western diets consumed by adults generate approximately 50-100 mEq acid/d; therefore, healthy adults consuming such a diet are at risk of chronic low-grade metabolic acidosis, which worsens with age as a result of declining kidney function. Bone buffers the excess acid by delivering cations and it is considered that with time an overstimulation of this process will lead to the dissolution of the bone mineral content and hence to reduced bone mass. Intakes of K, Mg and fruit and vegetables have been associated with a higher alkaline status and a subsequent beneficial effect on bone health. In healthy male volunteers an acid-forming diet increases urinary Ca excretion by 74% and urinary C-terminal telopeptide of type I collagen (C-telopeptide) excretion by 19% when compared with an alkali (base-forming) diet. Cross-sectional studies have shown that there is a correlation between the nutritional acid load and bone health measured by bone ultrasound or dual-energy X-ray absorptiometry. Few studies have been undertaken in very elderly women (>75 years), whose osteoporosis risk is very pertinent. The EVAluation of Nutrients Intakes and Bone Ultra Sound Study has developed and validated (n 51) an FFQ for use in a very elderly Swiss population (mean age 80·4 (sd 2·99) years), which has shown intakes of key nutrients (energy, fat, carbohydrate, Ca, Mg, vitamin C, D and E) to be low in 401 subjects. A subsequent study to assess net endogenous acid production (NEAP) and bone ultrasound results in 256 women aged ≥75 years has shown that lower NEAP (P=0·023) and higher K intake (P=0·033) are correlated with higher bone ultrasound results. High acid load may be an important additional risk factor that may be particularly relevant in very elderly patients with an already-high fracture risk. The latter study adds to knowledge by confirming a positive link between dietary alkalinity and bone health indices in the very elderly. In a further study to complement these findings it has also been shown in a group of thirty young women that in Ca sufficiency an acid Ca-rich water has no effect on bone resorption, while an alkaline bicarbonate-rich water leads to a decrease in both serum parathyroid hormone and serum C-telopeptide. Further investigations need to be undertaken to study whether these positive effects on bone loss are maintained over long-term treatment. Mineral-water consumption could be an easy and inexpensive way of helping to prevent osteoporosis and could be of major interest for long-term prevention of bone los