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Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals’ quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care.
We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY).
PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries.
Educational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.
The x-ray energy emitted from laser-produced plasmas has been measured under various experimental conditions. Two Nd-glass lasers were used in separate experiments to focus pulsed laser light on planar targets. X-ray fluences were measured with newly developed silicon detector calorimeters. Results for various experimental conditions are reported in terms of the efficiency with which the laser light was converted to x-ray energy by plasma production.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
We report on eight years of spectropolarimetric monitoring of the WR140 binary. The broad-band linear polarization decreased systematically after the 1985 periastron passage. By 1991, it settled to a constant value at which it has remained through the 1993 periastron passage. We do not detect, in data taken after 1989, a line-effect in He II Λ4686. This suggests either that the continuum and the line emission scatter at the same region, or that any intrinsic polarization has been below our detection limit. We conclude that the presently observed polarization of WR140 is consistent with interstellar foreground polarization.
Background: Intracranial mycotic aneurysms are rare forms of vascular abnormalities. They are typically fragile and have high tendency to bleed. Even when they are successfully secured upon intervention, the medical management can be challenging in presence of other non-ruptured aneurysms and concomitant cerebral vasospasm. Methods: A 31 year old female was admitted with right sided large intracerebral hemorrhage due to ruptured mycotic MCA aneurysm. She was also known with severe tricuspid regurgitation from drug abuse. Others aneurysms were also located intracranially and extracranially, including subclavian and renal arteries. Results: The MCA aneurysm was successfully clipped during decompressive craniectomy. The non-ruptured left ACA aneurysm was occluded through endovascular intervention. Due to cardiac condition and presence of other non-secured extarcranial aneurysms, we followed the MNI protocol for treating cerebral vasospsam by milrinone infusion. The treatment was successful for over three weeks until another micro-aneurysm had ruptured which had lead to severe and rapid clinical deterioration, that had lead eventually to death. Conclusions: Intracranial mycotic aneurysms remain challenging. Patients should be selected for surgical clipping versus endovascular intervention based on clinical state and radiological features. We suggest using milrinone over induced hypertension therapy for post-intervention cerebral vasospasm in order to lower the risk for rupturing non-secured aneurysms.
By applying a display ecology to the Deeper, Wider, Faster proactive, simultaneous telescope observing campaign, we have shown a dramatic reduction in the time taken to inspect DECam CCD images for potential transient candidates and to produce time-critical triggers to standby telescopes. We also show how facilitating rapid corroboration of potential candidates and the exclusion of non-candidates improves the accuracy of detection; and establish that a practical and enjoyable workspace can improve the experience of an otherwise taxing task for astronomers. We provide a critical road test of two advanced displays in a research context—a rare opportunity to demonstrate how they can be used rather than simply discuss how they might be used to accelerate discovery.
We summarize the results of the Far-Ultraviolet Spectroscopic Explorer (FUSE) program to study O VI in the Milky Way halo. Spectra of 100 extragalactic objects and two distant halo stars are analyzed to obtain measures of O VI absorption along paths through the Milky Way thick disk/halo and beyond. Strong O VI absorption over the velocity range from −100 to 100 km s−1 reveals a widespread but highly irregular distribution of O VI, implying the existence of substantial amounts of hot gas with T~3×105 K in the Milky Way thick disk/halo. The overall distribution of O VI can be described by a plane-parallel patchy absorbing layer with an average O VI mid-plane density of no(O VI) = 1.7×10−8 cm−3, an exponential scale height of ~2.3 kpc, and a ~0.25 dex excess of O VI in the northern Galactic polar region. Approximately 60 percent of the sky is covered by high velocity O VI with |vLSR|>100 km s−1. This high velocity O VI traces a variety of phenomena in and near the Milky Way including outflowing material from the Milky Way, tidal interactions with the Magellanic Clouds, accretion of gas onto the Milky Way, and warm/hot gas interactions in a highly extended (>70 kpc) Galactic corona or with hot intergalactic gas in the Local Group.
We used the Wisconsin Ultraviolet Photo-Polarimeter Experiment during the Astro-2 mission aboard the Space Shuttle Endeavour, to obtain ultraviolet spectropolarimetry of three classical novae that had recently gone into outburst. All three novae appear to have intrinsic polarization, with polarization changes across emission lines. This result indicates that, geometrically, the ejecta were quite aspherical.
Many catalogues of astronomical data appear in book form as well as in a machine-readable format. The latter form is popular because of the convenience of handling large bodies of data by machine and because it is an efficient way in which to transmit and make accessible data in books which are now out of print or very difficult to obtain. Some new catalogues are prepared entirely in a machine-readable form and the book form, if it exists at all, is of secondary importance for the preservation of the data.
In this paper comments are given about the importance of prefaces for transmitting the results of a critical evaluation of a body of data and it is noted that it is essential that this type of documentation be transferred with any machine-readable catalogue. The types of error sometimes encountered in handling machine-readable catalogues are noted. The procedures followed in developing the Goddard Cross Index of eleven star catalogues are outlined as one example of how star catalogues can be compared using computers. The classical approach to evaluating data critically is reviewed and the types of question one should ask and answer for particular types of data are listed. Finally, a specific application of these precepts to the problem of line identifications is given.
More than 250 machine-readable catalogs of stars and extended celestial objects are now available at the NASA/Goddard Space Flight Center (GSFC) as the result of over a decade of catalog acquisition , verification and documentation. Retrieval programs are described which permit the user to obtain from a remote terminal bibliographical listings for stars; to find all celestial objects from a given list that are within a defined angular separation from each object in another list; to plot celestial objects on overlays for sky survey plate areas; and to search selected catalogs for objects by criteria of position , identification number, magnitude or spectral type.
A computer data base of infrared astronomical observations has been established at NASA/Goddard Space Flight Center. It contains a summary of all infrared (1µm-1000µm) observations of celestial sources outside the solar system, published in the major scientific journals since 1960, as well as the contents of infrared surveys and catalogs. A Catalog of Infrared Observations (CIO) has been developed from the data base in printed and magnetic tape versions. A bibliographic Guide to the Infrared Astronomical Literature, and an Atlas of Infrared Source Names and Positions will be published in conjunction with the catalog. Future plans include development of an interactive data system at Goddard which will give a user direct access to the computerized data.
The operation of an astronomical data center requires that many decisions be made concerning the handling of the astronomical catalogs and data distributed. Should a data center be, as Wilkins (1977) described it, passive, in that catalogs and data are collected and distributed blackbox-wise upon request, or should a data center be active and have experts in various fields to scrutinize, correct, reformat, and document data where necessary? These questions will be addressed and illustrated by describing the current operations and future goals of the Astronomical Data Center at NASA/GSFC.
The Edinburgh Town Council minutes for 6 June 1767 record that: ‘On Wednesday last the Magistrates of Edinburgh conferred on Mr James Craig, Architect, a gold medal with the freedom of the city in a silver box, as a reward of his merit for having designed the best plan of the New Town.’
Despite the importance of this plan (Fig. 33a) unfortunately little is known of its architect’s background. Born c. 1740, James Craig’s father was an Edinburgh merchant, his mother a sister of the poet James Thomson, best remembered as the author of Rule Britannia and The Seasons. No record survives of his early education and though he is supposed to have received his architectural training under Sir Robert Taylor, this would appear to be a confusion with a namesake. An obscure young man then, the New Town Competition of 1766–67, was to bring him sudden fame.
When considering the archiving of space astronomy data, one has only to look at the current and projected astrophysics missions to be aware of the enormity of the archival requirements and the urgent need for careful planning in order to properly manage all the data which is and will be acquired. The current list of astrophysics missions for which NASA supports observing/archival phases during the next ten years numbers 23! Even when a mission’s observing period was less than a year, as for the Infrared Astronomy Satellite (IRAS), or only a week, as for Astro-1, the archival phases last for many years, especially if the archives are user-friendly and easily accessible.
Mie scattering calculations have been made for atmospheric aerosols having various indices of refraction to determine their possible contribution to a Martian opposition effect, such as that reported by O'Leary in 1967. Neither substances with a real index between 1.20 and 1.50, such as ice, water, or solid CO2, nor highly absorbing materials, such as limonite, can produce the observed effect. Submicron-sized spherical particles with refractive indices of 1.55 to 2.00 do, on the other hand, exhibit a marked increase in reflectivity at small phase angles and might be responsible for the enhanced brightness at the shorter wavelengths.
Reports of attitudes to aging from older people themselves are scarce. Which life course factors predict differences in these attitudes is unknown.
We investigated life course influences on attitudes to aging in healthy, community-dwelling people in the UK. Participants in the Lothian Birth Cohort 1936 completed a self-report questionnaire (Attitudes to Aging Questionnaire, AAQ) at around age 75 (n = 792, 51.4% male). Demographic, social, physical, cognitive, and personality/mood predictors were assessed, around age 70. Cognitive ability data were available at age 11.
Generally positive attitudes were reported in all three domains: low Psychosocial Loss, high Physical Change, and high Psychological Growth. Hierarchical multiple regression found that demographic, cognitive, and physical variables each explained a relatively small proportion of the variance in attitudes to aging, with the addition of personality/mood variables contributing most significantly. Predictors of attitudes to Psychosocial Loss were high neuroticism; low extraversion, openness, agreeableness, and conscientiousness; high anxiety and depression; and more physical disability. Predictors of attitudes to Physical Change were: high extraversion, openness, agreeableness, and conscientiousness; female sex; social class; and less physical disability. Personality predictors of attitudes to Psychological Growth were similar. In contrast, less affluent environment, living alone, lower vocabulary scores, and slower walking speed predicted more positive attitudes in this domain.
Older people's attitudes to aging are generally positive. The main predictors of attitude are personality traits. Influencing social circumstances, physical well-being, or mood may result in more positive attitudes. Alternatively, interventions to influence attitudes may have a positive impact on associated physical and affective changes.
The excavation of an oval crop mark close to the Abingdon causewayed enclosure showed a complex sequence of development, starting with a rectangular ditched enclosure and most probably ending with an oval barrow of a type with parallels elsewhere in lowland England. The site included the grave of two individuals associated with a polished knife, a belt slider and most probably a leaf shaped arrowhead, and produced a series of radiocarbon dates extending from the Earlier to the Later Neolithic. A number of formal deposits around one end of the site are matched by similar material from the inner ditch of the causewayed enclosure, suggesting a direct link between the two monuments.
Depression is a common and important cause of morbidity and mortality worldwide. It is commonly treated with antidepressants and/or psychological therapy, but some people prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression. This is an update of a review first published in 2009.