Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Genetic and Phenotypic Variability for Constitutive Oleoresin Flow in Loblolly Pine

Papers and abstracts from the 27th Southern Forest Tree Improvement Conference held at Oklahoma State University in Stillwater, Oklahoma on June 24-27, 2003

Fluorodeoxyglucose positron emission tomography in the evaluation of germ cell tumours at relapse

Differentiation of active disease from fibrosis/mature teratoma in patients with residual masses or identifying of sites of recurrence in patients with raised markers following treatment of their testicular cancer remains a problem.18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has the potential to identify active disease and thereby influence further management in these patients. We performed a retrospective study of the use of FDG-PET in detecting residual/recurrent testicular carcinoma in 55 patients (seventy FDG-PET scans). Forty-seven scans were for the assessment of residual masses (18 had raised markers) and 23 scans were for the investigation of raised markers in the presence of normal CT scans. True positive results were based on positive histology or clinical follow-up. FDG-PET had a positive predictive value (PPV) of 96% and a negative predictive value (NPV) of 90% in patients with residual masses. This PPV was equivalent to that of markers (94%) but FDG-PET had the advantage of identifying the site of that recurrence. The NPV was higher than that of markers. In patients with raised markers alone the PPV of FDG-PET was 92% but the NPV was only 50%. However, subsequent FDG-PET imaging was frequently the first imaging modality to identify the site of disease. FDG-PET effected a management change in 57% of cases. FDG-PET scanning detected viable tumour in residual masses and identified sites of disease in suspected recurrence. © 2000 Cancer Research Campaig

Sharpening ECOSTRESS and VIIRS Land Surface Temperature Using Harmonized Landsat-Sentinel Surface Reflectances

Land surface temperature (LST) is a key diagnostic indicator of agricultural water use and crop stress. LST data retrieved from thermal infrared (TIR) band imagery, however, tend to have a coarser spatial resolution (e.g., 100 m for Landsat 8) than surface reflectance (SR) data collected from shortwave bands on the same instrument (e.g., 30 m for Landsat). Spatial sharpening of LST data using the higher resolution multi-band SR data provides an important path for improved agricultural monitoring at sub-field scales. A previously developed Data Mining Sharpener (DMS) approach has shown great potential in the sharpening of Landsat LST using Landsat SR data co-collected over various landscapes. This work evaluates DMS performance for sharpening ECOsystem Spaceborne Thermal Radiometer Experiment on Space Station (ECOSTRESS) LST (~70 m native resolution) and Visible Infrared Imaging Radiometer Suite (VIIRS) LST (375 m) data using Harmonized Landsat and Sentinel-2 (HLS) SR data, providing the basis for generating 30-m LST data at a higher temporal frequency than afforded by Landsat alone. To account for the misalignment between ECOSTRESS/VIIRS and Landsat/HLS caused by errors in registration and orthorectification, we propose a modified version of the DMS approach that employs a relaxed box size for energy conservation (EC). Sharpening experiments were conducted over three study sites in California, and results were evaluated visually and quantitatively against LST data from unmanned aerial vehicles (UAV) flights and from Landsat 8. Over the three sites, the modified DMS technique showed improved sharpening accuracy over the standard DMS for both ECOSTRESS and VIIRS, suggesting the effectiveness of relaxing EC box in relieving misalignment-induced errors. To achieve reasonable accuracy while minimizing loss of spatial detail due to the EC box size increase, an optimal EC box size of 180–270 m was identified for ECOSTRESS and about 780 m for VIIRS data based on experiments from the three sites. Results from this work will facilitate the development of a prototype system that generates high spatiotemporal resolution LST products for improved agricultural water use monitoring by synthesizing multi-source remote sensing data

Measurement of the stellar Ni 58 (n,γ) Ni 59 cross section with accelerator mass spectrometry

The Ni58(n,γ)Ni59 cross section was measured with a combination of the activation technique and accelerator mass spectrometry (AMS). The neutron activations were performed at the Karlsruhe 3.7 MV Van de Graaff accelerator using the quasistellar neutron spectrum at kT=25 keV produced by the Li7(p,n)Be7 reaction. The subsequent AMS measurements were carried out at the 14 MV tandem accelerator of the Maier-Leibnitz Laboratory in Garching using the gas-filled analyzing magnet system (GAMS). Three individual samples were measured, yielding a Maxwellian-averaged cross section at kT=30 keV of (σ)30keV = 30.4 (23)syst(9)stat mbarn. This value is slightly lower than two recently published measurements using the time-of-flight (TOF) method, but agrees within the uncertainties. Our new results also resolve the large discrepancy between older TOF measurements and our previous value

Hamiltonian magnetohydrodynamics: symmetric formulation, Casimir invariants, and equilibrium variational principles

The noncanonical Hamiltonian formulation of magnetohydrodynamics (MHD) is used to construct variational principles for symmetric equilibrium configurations of magnetized plasma including flow. In particular, helical symmetry is considered and results on axial and translational symmetries are retrieved as special cases of the helical configurations. The symmetry condition, which allows the description in terms of a magnetic flux function, is exploited to deduce a symmetric form of the noncanonical Poisson bracket of MHD. Casimir invariants are then obtained directly from the Poisson bracket. Equilibria are obtained from an energy-Casimir principle and reduced forms of this variational principle are obtained by the elimination of algebraic constraints.Comment: submitted to Physics of Plasmas, 16 page

FDG–PET. A possible prognostic factor in head and neck cancer

Previous studies have shown that high uptake of 18F-fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value on positron emission tomography scan, was associated with poor survival. The aim of this study was to confirm the association and to establish whether a high standardized uptake value had prognostic significance. Seventy-three consecutive patients with newly diagnosed squamous cell carcinoma of the head and neck underwent a positron emission tomography study before treatment. Age, gender, performance status tumour grade, stage, maximal tumour diameter and standardized uptake value were analyzed for their possible association with survival. The median standardized uptake value for all primary tumours was 7.16 (90% range 2.30 to 18.60). In univariate survival analysis the cumulative survival was decreased as the stage, tumour diameter and standardized uptake value increased. An standardized uptake value of 10 was taken as a cut-off for high and low uptake tumours. When these two groups were compared, an standardized uptake value >10 predicted for significantly worse outcome (P=0.003). Multivariate analysis demonstrated that an standardized uptake value >10 provided prognostic information independent of the tumour stage and diameter (P=0.002). We conclude that high FDG uptake (standardized uptake value>10) on positron emission tomography is an important marker for poor outcome in primary squamous cell carcinoma of the head and neck. Standardized uptake value may be useful in distinguishing those tumours with a more aggressive biological nature and hence identifying patients that require intensive treatment protocols including hyperfractionated radiotherapy and/or chemotherapy