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Families facing end-stage nonmalignant chronic diseases (NMCDs) are presented with similar symptom burdens and need for psycho-social–spiritual support as their counterparts with advanced cancers. However, NMCD patients tend to face more variable disease trajectories, and thus may require different anticipatory supports, delivered in familiar environments. The Life Rainbow Programme (LRP) provides holistic, transdisciplinary, community-based end-of-life care for patients with NMCDs and their caregivers. This paper reports on the 3-month outcomes using a single-group, pre–post comparison.
Patients with end-stage NMCDs were screened for eligibility by a medical team before being referred to the LRP. Patients were assessed at baseline (T0), 1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale (IPOS). Their hospital use in the previous month was also measured by presentations at accident and emergency services, admissions to intensive care units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 using the Chinese version of the Modified Caregiver Strain Index, and self-reported health, psychological, spiritual, and overall well-being. Over-time changes in outcomes for patients, and caregivers, were tested using paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests.
Seventy-four patients and 36 caregivers participated in this research study. Patients reported significant improvements in all IPOS domains at both 1 and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and information needs fulfilled)]. Average hospital bed-days in the previous month fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, caregiver strain was significantly reduced (r = 0.332), while spiritual well-being was enhanced (r = 0.333).
After receiving 3 month's LRP services, patients with end-stage NMCDs and their caregivers experienced significant improvements in the quality of life and well-being, and their hospital bed-days were reduced.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Hair cortisol concentration (HCC) can be used to periodically assess hypothalamic–pituitary–adrenal (HPA) axis function, and appears correlated with prolonged exposure to stress.
Serial assessment (at Baseline, Week 6 and Week 12) of participants (n = 35) with anxiety disorders by psychopathological rating scales, with assays of HCC and levels of peripheral anti- and pro-inflammatory cytokines. Patients underwent antidepressant treatment for an initial 6 weeks, followed by cyclo-oxygenase inhibitor-2 (COX-2) inhibitor (celecoxib) augmentation or ‘treatment as usual’ for a further 6 weeks.
At Baseline (n = 35), HCC was elevated in patients with single-episode but not recurrent-episode anxiety disorders, mean IL-12p70 levels were low, and mean TNF-α levels were elevated. Following 6 weeks of antidepressant treatment (n = 33), mean HCC was within the normal range but mean IL-2 level was low. Celecoxib augmentation (n = 18) was associated with a reduction in anxiety symptoms and normalisation of mean IL-2 levels.
Small sample size. Not all participants were assessed at all time points.
Serial assessment of HCC is practicable in patients with anxiety disorders. These preliminary findings warrant further investigation in larger samples.
The magnetic resonance imaging (MRI) appearance of the brain and spinal cord in humans with neuroangiostrongyliasis (NA) due to Angiostrongylus cantonensis infection has been well reported. Equivalent studies in animals are lacking. This case series describes clinical and MRI findings in 11 dogs with presumptively or definitively diagnosed NA. MRI of the brain and/or spinal cord was performed using high-field (1.5 T) or low-field (0.25 T) scanners using various combinations of transverse, sagittal, dorsal and three-dimensional (3D) T1-weighted (T1W), transverse, sagittal and dorsal T2-weighted (T2W), T2W fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*W) gradient echo (GRE), dorsal T2W short tau inversion recovery (STIR) and post-gadolinium transverse, sagittal, dorsal and 3D T1W and transverse T2W FLAIR sequences. In 4/6 cases where the brain was imaged, changes consistent with diffuse meningoencephalitis were observed. Evidence of meningeal involvement was evident even when not clinically apparent. The spinal cord was imaged in 9 dogs, with evidence of meningitis and myelitis detected in regions consistent with the observed neuroanatomical localization. Pathognomonic changes of neural larva migrans, as described in some human patients with NA, were not detected. NA should be considered in the differential diagnosis of dogs with MRI evidence of focal or diffuse meningitis, myelitis and/or encephalitis, especially in areas where A. cantonensis is endemic. If not precluded by imaging findings suggestive of brain herniation, cerebrospinal fluid (CSF) collection for cytology, fluid analysis, real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) testing should be considered mandatory in such cases after the MRI studies.
To compare soft-tissue complications following implantation of different bone conduction hearing devices.
Adults who underwent implantation of different bone conduction hearing devices, between January 2008 and December 2016, were included in the study. Five groups were identified depending on the soft-tissue approach: (1) split-thickness skin flap with use of dermatome; (2) Sheffield ‘S’-shaped incision with skin thinning; (3) linear incision without skin thinning (hydroxyapatite-coated abutment); (4) ‘C’-shaped full-thickness incision for passive transcutaneous bone conduction hearing devices; and (5) post-aural incision for active transcutaneous bone conduction hearing devices. The main outcome measures were different soft-tissue complications.
The study comprised 120 patients (group 1 = 20 patients, group 2 = 35, group 3 = 35, group 4 = 20, and group 5 = 10). Soft tissue related problems were encountered in 55 per cent of patients from group 1, 26 per cent in group 2, 3 per cent in group 3, and 0 per cent in groups 4 and 5.
There was a reduction in soft tissue related complications with reduced soft-tissue handling. In addition, there was a shift from an initial skin-penetrating (percutaneous) approach to a non-skin-penetrating (transcutaneous) approach.
Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
Yui-Yip Lau, Division of Business and Hospitality Management, Hong Kong Community College, The Hong Kong Polytechnic University,
Adolf K. Y. Ng, Asper School of Business, University of Manitoba, Canada,
Jorge Acevedo Alarid, president of the Mexican Logistics Institute (Instituto Mexicano de Logística, IML).
Absorb what is useful, discard what is useless and add what is specifically your own.
Knowing is not enough, we must apply. Willing is not enough, we must do.
— Bruce Lee, martial artist (1940– 73)
When we were designing and planning for this book, a few quick questions came to our mind: how could we transform new knowledge into practice? How important were infrastructural issues in supply chains? Were there any key research topics that have been seriously neglected in previous books publication? Were active scholars participating in research dedicated to industrial practitioners? Indeed, these are core objectives of applied research that can contribute to academic, industry and community in an ever- changing world.
This book addresses the role of supply chain in the global economy and organizations. Although global supply chain management is critical with different stakeholders within policymakers, students, researchers, logistics associations, participators, even for governmental actors who need to make strategic decisions in sustaining economic competitiveness for their countries and citizens, the core topics are often overlooked. Understanding such deficiency, we strive to include interesting, innovative, and timely topics. The contents may be similar, but different readers may have diversified expectations. Industrial practitioners may look for insight to generate appropriate strategic decisions; students and researchers may look for new ideas to develop new research areas and secure research grants; policymakers may look for best practices that will help them to develop appropriate public policies; logistics associations may look for new knowledge to review their professional training programs that align with international academic/ professional standards. Taking three years to complete this book (from writing the proposal to its final publication), we based it on four main principles, namely, “clarity” (which makes it simple for readers to comprehend), “richness” (which identifies questions from various academic experiences and disciplines to encourage readers to find out possible unexplored research or key issues), “innovations” (which stimulates readers to reflect on changing traditional, day- to- day operations for enhancement) and “practicality” (which equips learners with the skills and knowledge to work in the real world).
This book offers fundamental knowledge with many practical cases that can fulfill the needs and expectations of different parties. Readers can get invaluable insight on the future direction of supply chain development.
The conventional dependency ratio based on cohort-invariant cutoff points could overstate the true burden of population aging. Using optimal cohort-varying years of schooling and retirement age in a life-cycle model, we propose a modified definition of dependency ratio. We compare the proposed economic-demographic dependency ratio (EDDR) with the conventional definition and find that the conventional dependency ratio of the USA is projected to increase by 0.105 from 2010 to 2060, which is an over-projection of 86% when compared with the projected increase of 0.015 in the EDDR over the same period. Sensitivity analysis suggests that our finding is quite robust to reasonable changes in parameter values (except for one parameter), and the magnitude of over-projection ranges mainly from 0.079 to 0.102 (i.e., 75% to 97%). We follow the well-established Lee–Carter model to forecast stochastic mortality and employ the method of expanding duration to decompose the sources of over-projection.
Pharyngeal pouch surgical treatments can be carried out via an endoscopic or open approach. Injection of botulinum toxin into the cricopharyngeus was first described as an alternative treatment to the more invasive surgical procedures performed for cricopharyngeal dysfunction. It has not been previously described as a treatment option for pharyngeal pouch.
To compare operative time, average stay, complication rates and symptom control between endoscopic laser diverticulotomy, botulinum toxin injection and open procedures for pharyngeal pouch patients.
The medical records for 66 pharyngeal pouch procedures, carried out on 47 patients treated between 2011 and 2017, were identified and reviewed.
The mean operative time was 21 minutes for botulinum toxin injection, 38 for endoscopic laser diverticulotomy and 104 for open surgery. The mean hospital stay was 0.6 days for botulinum toxin injection, 4.7 for endoscopic laser diverticulotomy and 4 for open surgery. The improvement in Reflux Symptom Index scores was statistically significant for both endoscopic laser diverticulotomy and botulinum toxin injection. Botulinum toxin injection had a 0 per cent complication rate.
Botulinum toxin injection is a safe and effective treatment for pharyngeal pouch.
Discrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates.
We constructed a retrospective cohort (1997–2015) of incident cases of non-affective psychosis aged 16–50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach.
Our case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4–35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4–20.3).
Case ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.