Quality indicators for Palliative Day Services: A modified Delphi study

BACKGROUND: The goal of Palliative Day Services is to provide holistic care that contributes to the quality of life of people with life threatening-illness and their families. Quality indicators provide a means by which to describe, monitor and evaluate the quality of Palliative Day Services provision, and act as a starting point for quality improvement. However, currently, there are no published quality indicators for Palliative Day Services. AIM: To develop and provide the first set of quality indicators that describe and evaluate the quality of Palliative Day Services. DESIGN AND SETTING: A modified Delphi technique was used to combine best available research evidence derived from a systematic scoping review with multi-disciplinary expert appraisal of the appropriateness and feasibility of candidate indicators. The resulting indicators were compiled into ‘toolkit’, and tested in five UK Palliative Day Service settings. RESULTS: A panel of experts independently reviewed evidence summaries for 182 candidate indicators and provided ratings on appropriateness, followed by a panel discussion and further independent ratings of appropriateness, feasibility, and necessity. This exercise resulted in the identification of 30 indicators which were used in practice testing. The final indicator set comprised 7 structural indicators, 21 process indicators, and 2 outcome indicators. CONCLUSIONS: The indicators fulfil a previously unmet need among Palliative Day Service providers by delivering an appropriate and feasible means to assess, review, and communicate the quality of care, and to identify areas for quality improvement

Environmental noise reduces predation rate in an aquatic invertebrate

Noise is one of a wide range of disturbances associated with human activities that have been shown to have detrimental impacts on a wide range of species, from montane regions to the deep marine environment. Noise may also have community-level impacts via predator–prey interactions, thus jeopardising the stability of trophic networks. However, the impact of noise on freshwater ecosystems is largely unknown. Even more so is the case of insects, despite their crucial role in trophic networks. Here, we study the impact of underwater noise on the predatory functional response of damselfly larvae. We compared the feeding rates of larvae under anthropogenic noise, natural noise, and silent conditions. Our results suggest that underwater noise (pooling the effects of anthropogenic noise and natural noise) decreases the feeding rate of damselflies significantly compared to relatively silent conditions. In particular, natural noise increased the handling time significantly compared to the silent treatment, thus reducing the feeding rate. Unexpectedly, feeding rates under anthropogenic noise were not reduced significantly compared to silent conditions. This study suggests that noise per se may not necessarily have negative impacts on trophic interactions. Instead, the impact of noise on feeding rates may be explained by the presence of nonlinearities in acoustic signals, which may be more abundant in natural compared to anthropogenic noise. We conclude by highlighting the importance of studying a diversity of types of acoustic pollution, and encourage further work regarding trophic interactions with insects using a functional response approach

Performance of wide-area power system stabilizers during major system upsets: investigation and proposal of solutions

© 2021 Springer Nature Switzerland AG. This is a post-peer-review, pre-copyedit version of Benasla, M., Denaï, M., Liang, J. et al. Performance of wide-area power system stabilizers during major system upsets: investigation and proposal of solutions. Electr Eng (2021). The final authenticated version is available online https://doi.org/10.1007/s00202-020-01168-3Wide-area damping controllers (WADCs) are effective means of improving the damping of inter-area oscillations and thereby ensuring a secure operation of modern highly stressed interconnected power systems; however, their implementation costs are high. Therefore, the controller must be well configured and designed to ensure its cost-effectiveness. Several techniques have been proposed in the literature to design effective controllers and good results have been achieved. However, some important practical aspects that could potentially impact the performance of the designed controller have not been addressed or studied in sufficient detail in these previous works. One such aspect is assessing the performance of the designed controllers under major system upsets resulting in large deviations in the frequency and fluctuations in the power. These may lead to controller saturation which could negatively impact its damping performance or even cause instability. In this paper, the impact of such large upsets is investigated on several test systems via extensive small- and large-signal analyses and it is shown that, during severe transients, controller saturation may occur and persist over a long period of time, posing a potential threat to the power system stability. This paper presents a very effective solution to alleviate this problem and help design more robust WADCs. The simulation results show that the proposed solution works well and leads to improved power system stabilisers performance during transient upsets.Peer reviewedFinal Accepted Versio

Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso

BACKGROUND: Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. METHODS: Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. RESULTS: Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. CONCLUSIONS: Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication

CHOP Potentially Co-Operates with FOXO3a in Neuronal Cells to Regulate PUMA and BIM Expression in Response to ER Stress

Endoplasmic reticulum (ER) stress-induced apoptosis has been implicated in various neurodegenerative diseases including Parkinson Disease, Alzheimer Disease and Huntington Disease. PUMA (p53 upregulated modulator of apoptosis) and BIM (BCL2 interacting mediator of cell death), pro-apoptotic BH3 domain-only, BCL2 family members, have previously been shown to regulate ER stress-induced cell death, but the upstream signaling pathways that regulate this response in neuronal cells are incompletely defined. Consistent with previous studies, we show that both PUMA and BIM are induced in response to ER stress in neuronal cells and that transcriptional induction of PUMA regulates ER stress-induced cell death, independent of p53. CHOP (C/EBP homologous protein also known as GADD153; gene name Ddit3), a critical initiator of ER stress-induced apoptosis, was found to regulate both PUMA and BIM expression in response to ER stress. We further show that CHOP knockdown prevents perturbations in the AKT (protein kinase B)/FOXO3a (forkhead box, class O, 3a) pathway in response to ER stress. CHOP co-immunoprecipitated with FOXO3a in tunicamycin treated cells, suggesting that CHOP may also regulate other pro-apoptotic signaling cascades culminating in PUMA and BIM activation and cell death. In summary, CHOP regulates the expression of multiple pro-apoptotic BH3-only molecules through multiple mechanisms, making CHOP an important therapeutic target relevant to a number of neurodegenerative conditions

Increasing Potential Risk of a Global Aquatic Invader in Europe in Contrast to Other Continents under Future Climate Change

BACKGROUND: Anthropogenically-induced climate change can alter the current climatic habitat of non-native species and can have complex effects on potentially invasive species. Predictions of the potential distributions of invasive species under climate change will provide critical information for future conservation and management strategies. Aquatic ecosystems are particularly vulnerable to invasive species and climate change, but the effect of climate change on invasive species distributions has been rather neglected, especially for notorious global invaders. METHODOLOGY/PRINCIPAL FINDINGS: We used ecological niche models (ENMs) to assess the risks and opportunities that climate change presents for the red swamp crayfish (Procambarus clarkii), which is a worldwide aquatic invasive species. Linking the factors of climate, topography, habitat and human influence, we developed predictive models incorporating both native and non-native distribution data of the crayfish to identify present areas of potential distribution and project the effects of future climate change based on a consensus-forecast approach combining the CCCMA and HADCM3 climate models under two emission scenarios (A2a and B2a) by 2050. The minimum temperature from the coldest month, the human footprint and precipitation of the driest quarter contributed most to the species distribution models. Under both the A2a and B2a scenarios, P. clarkii shifted to higher latitudes in continents of both the northern and southern hemispheres. However, the effect of climate change varied considerately among continents with an expanding potential in Europe and contracting changes in others. CONCLUSIONS/SIGNIFICANCE: Our findings are the first to predict the impact of climate change on the future distribution of a globally invasive aquatic species. We confirmed the complexities of the likely effects of climate change on the potential distribution of globally invasive species, and it is extremely important to develop wide-ranging and effective control measures according to predicted geographical shifts and changes