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The terminal phase of cancer represents a major crisis for the family system. Regardless of the caregiving role they undertake, family members are forced to address multiple impacts when facing the approaching death of their terminally ill loved one. International guidelines recognize the importance of integrating the family into a care plan. However, more needs to be known about how to deliver optimal family support. The purpose of this study is to review the current state of the art in family/caregiver-focused interventions of people with terminal cancer in palliative care.
For this purpose, an overview of the literature's systematic reviews on the topic was conducted to select Randomized Controlled Trials (RCTs) on family/caregiver-focused interventions.
Nine interventions were found in the systematic reviews of literature and meta-analysis. These family/caregiver-focused interventions were then thoroughly and critically analyzed. Despite the heterogeneity with regard to their characteristics, the interventions commonly focused on caregiving matters, were brief in duration, and delivered by non-mental health experts. The efficacy of such interventions was seen as modest.
Significance of results
Family/caregiver-focused interventions in palliative care remain a matter of concern and more research is needed to identify adequate and effective ways of helping families that face the crisis of terminal illness in the system.
We present a study of laser-driven ion acceleration with micrometre and sub-micrometre thick targets, which focuses on the enhancement of the maximum proton energy and the total number of accelerated particles at the PHELIX facility. Using laser pulses with a nanosecond temporal contrast of up to
and an intensity of the order of
, proton energies up to 93 MeV are achieved. Additionally, the conversion efficiency at
incidence angle was increased when changing the laser polarization to p, enabling similar proton energies and particle numbers as in the case of normal incidence and s-polarization, but reducing the debris on the last focusing optic.
We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.
We performed a new series of measurements on samples that were part of early measurements on radiocarbon (14C) dating made in 1948–1949. Our results show generally good agreement to the data published in 1949–1951, despite vast changes in technology, with only two exceptions where there was a discrepancy in the original studies. Our new measurements give calibrated ages that overlap with the known ages. We dated several samples at four different laboratories, and so we were also able to make a small intercomparison at the same time. In addition, new measurements on samples from other Egyptian materials used by Libby and co-workers were made at UC Irvine. Samples of tree rings used in the original studies (from Broken Flute Cave and Centennial Stump) were obtained from the University of Arizona Laboratory of Tree-Ring Research archive and remeasured. New data were compared to the original studies and other records.
The issues surrounding a patient's terminal phase of cancer and the imminent death of the individual represent a major family crisis affecting all its members. The goal of this study was to assess the prevalence of psychological morbidity in family caregivers of persons with terminal cancer in terms of psychological distress, depression, anxiety, somatization, and complicated anticipatory grief, and to determine which factors may influence these responses.
One hundred and twelve family caregivers of individuals with terminal cancer completed an assessment protocol comprising the Brief Symptom Inventory (depression, anxiety, somatization, and a computed score for global distress), the Marwit-Meuser Caregiver Grief Inventory - Short Form (anticipatory grief), the Family Inventory of Needs (importance and satisfaction of needs), and the Systemic Clinical Outcome Routine Evaluation -15 (family functioning). Prevalence of psychological morbidity was determined through descriptive and frequency statistics. Predictors of psychological morbidity were ascertained through structural equation modelling methods.
Regarding the prevalence of psychological morbidity in family caregivers, 66.1% reported high levels of distress, 68.8% showed high risk of depression, 72.3% showed high risk of anxiety, 50.9% reported high levels of somatization, and 25.9% showed high risk of complicated anticipatory grief. It was found that the predictors of age, gender, relationship to the family member with terminal cancer, the caregiving role played (i.e., primary vs. nonprimary), the satisfaction of needs by healthcare professionals, and family functioning play an important role in terms of one's risk of developing psychological morbidity.
Significance of results
This study revealed an alarming prevalence of psychological morbidity in family caregivers of individuals living with terminal cancer, making it crucial to move forward from a patient-centered approach to a family-centrad approach to reduce the risk of family maladjustment when facing the imminent death of a family member and to prevent postdeath unadjusted responses.
Background: Planning for neurology training necessitated a reflection on the experience of graduates. We explored practice characteristics, and training experience of recent graduates. Methods: Graduates from 2010-2014 completed a survey. Results: Response rate was 37% of 211. 56% were female. 91% were adult neurologists. 65% practiced in an outpatient setting. 63% worked in academics. 85% completed subspecialty training (median 1 year). 36% work 3 days a week or less. 82% took general call (median 1 night weekly). Role preparation was considered very good or excellent for most; however poor or fair ratings were 17% in advocacy and 8% in leadership. Training feedback was at least “good” for 87%. Burnout a few times a week or more was noted by 5% (6% during residency, particularly PGY1 and 5). 64% felt overly burdened by paperwork. Although most felt training was adequate, it was poor or fair at preparing for practice management (85%) and personal balance (55%). Most conditions were under-observed in training environment. Many noted a need for more independent practice development and community neurology. Conclusions: Although our training was found to be very good, some identified needs included advocacy training, and more training in general neurology in the longitudinal outpatient/community settings.
Background: Sturge Weber Syndrome (SWS) patients at risk of epilepsy are often not identified before their first seizure which leads to unnecessary follow up of many patients with facial angioma. Methods: The medical photography database of our institution has been reviewed to identify SWS patients followed between 1993 and 2013. Patients with isolated glaucoma were compared to patients with epilepsy regarding the location of the facial angioma, the presence of asymmetrical background activity on EEG done prior epilepsy onset and cerebral imaging. Logistical regression tests and a p-value of 0.05 were used. Results: 21 patients with SWS have been identified. No significant difference was noted when patients were compared based on the laterality of the lesion (p=0.169), or the location of the facial angioma (p = 0.314 to 0.999). Only 2 epileptic patients had digital EEG done prior the onset of epilepsy and only 2 patients with glaucoma had digital EEG done during their follow up. No significant difference was noted between EEG background activities in the two groups (p= 0.514). The presence of venous drainage anomalies (VDA) predicted (p = 0.004) the onset of epilepsy. Conclusions: Cerebral VDA increases the risk of epilepsy in SWS patients. Since they can be detected at birth, they might guide the management.
Background: Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome that can present with many disabling neurological symptoms, the most common being seizures. Although it is a chronic systemic syndrome, healthcare utilization and long-term outcome of subjects with TSC are not well defined. The goal of this study was to evaluate the direct cost and long-term outcome of TSC compared to other forms of epilepsy and healthy controls. Methods: Our provincial health care database was interrogated to determine use of medical services by patients with TSC, epilepsy and healthy controls from 1996-2011. Data on demographics, outcomes and health care utilization were analyzed. Results: 1004 TSC, 41,934 with epilepsy and 41,934 controls were identified. The prevalence of TSC was 1/7,872 compared to 1/189 for epilepsy. TSC experienced more hospitalizations, medical visits and prescription drug use, resulting in higher total health care costs. Their most common admission diagnosis was seizures and age at death was significantly lower: 61,3 years old for TSC vs 69,6 and 76,6 years old for epilepsy and controls, (p<0,001). Conclusions: TSC subjects have a significantly higher burden of disease than other subjects with epilepsy. These results stress the need for specialized services in this population through the lifespan.
Background: Debate persists in Canada about the cost and benefit of vagal nerve stimulation in patients with refractory epilepsy. The aim of our study was to evaluate the impact of a vagal nerve stimulator on the seizure frequency and the admission rate of children with refractory epilepsies over five years of follow-up. Methods: 52 patients were implanted between 2000-2013. Of these, 37 were followed at CHU Sainte-Justine and 21 kept seizure diaries. Seizure frequency was compared to the baseline at 6 months, 12 months, 24 months and 60 months of follow up using a multivariate ANOVA analysis. The hospitalization rate was calculated as the mean difference between the number of hospitalizations prior to and after the implantation. Results: Seizure frequency decreased by 58% at 6 months, by 61% at 12 months, by 53% at 24 months and by 63% at 60 months of follow up respectively compared to the baseline (p<0.001). The hospitalization rate decreased by 50.87% after surgery (p<0.001). Conclusion: In our population, vagal nerve stimulation has a sustained impact on seizure frequency and hospitalization rates. This supports previous data from our group and others on cost-effectiveness of the technique in children with refractory epilepsy.
Teflon amorphous fluoropolymer (TAF) multi-walled carbon nanotube (MWCNT) suspensions have the potential for creating conductive coatings on insulating films for numerous applications. However, there are few studies on polymer MWCNT suspension properties and even fewer that use Teflon. To define mechanical and electrical property relationships, bilayer films of TAF-MWCNT were created with differing concentrations of MWCNTs. Nanoindentation revealed that addition of 8 wt% MWCNTs to TAF increased the elastic modulus by about 25% and hardness by about 15%. Conducting indentation showed 8 wt% MWCNT films exhibit uniform stable conductance once indentation depth exceeds several hundred nanometers. Films with lower concentrations of CNTs were insulating. The two techniques provide a unique description of structure property relationships in this suspension film system.
Localized heating of metals and alloys using a focused laser beam in ambient atmosphere produces dielectric oxide layers that have characteristic optical appearances including different colors. Nanoindentation probed the deformation and fracture of laser-fabricated oxides on 304L stainless steel. Conductive nanoindentation measured electrical contact resistance (ECR) of the same colored oxides indicating a correlation between laser exposure, conductance during loading, current-voltage (I-V) behavior at constant load, and indentation response. Microscopy and X-ray diffraction examined the microstructure and chemical composition of the oxides. Combining techniques provides a unique approach for correlating mechanical behavior and the resulting performance of the films in conditions that cause wear.
We have developed a prototype spectroscopic ellipsometer for imaging/mapping purposes requiring only one measurement cycle (one rotation period of a polarizer or analyzer) for the acquisition of a two-dimensional array of data points. Our new measurement technique serves as a novel form of imaging ellipsometry, using a divergent (uncollimated, diffuse) source system and a detection system consisting of an angle-of-incidence-sensitive pinhole camera. By incorporating broad-band sources and wavelength dispersion optics, the instrument provides continuous high-resolution spectra along a line image of the sample surface. As a result, information on multilayer photovoltaics stacks can be obtained over large areas (several dm2) at high speed. The technique can be expanded to even larger areas by scaling-up the optical geometry. The spatial resolution of the line image is limited by the minimum resolved-angle as determined by the detection system. Small-aperture polarizers (25 mm diameter) are incorporated into the instrument, which reduces its cost. Demonstration mapping measurements have been performed ex situ on a multilayer sample deposited on a polymer substrate, including an intentionally graded 80-350 nm thick hydrogenated amorphous silicon (a-Si:H) layer and an intended uniform 400-500 nm thick transparent conducting ZnO:Al layer, both on opaque silver. Alternative commercial instruments for ex situ SE mapping must translate the sample in two dimensions. Even a 15 x 15 cm2 sample requires > 200 measurements with cm-resolution and at least 15 min. By collecting ex situ data in parallel along one dimension through imaging, the divergent-beam system can measure with similar spatial resolution in < 2 min. In situ measurements on both roll-to-roll polymer and rigid glass will be possible in the future.
A prototype expanded-beam spectroscopic ellipsometer has been developed that uses uncollimated (non-parallel, diffuse) illumination with a detection system consisting of an angle-of-incidence-sensitive pinhole camera for high-speed, large-area imaging/mapping applications. The performance of this novel instrument is being tested for imaging/mapping of mixed-phase hydrogenated silicon films having graded amorphous (a-Si:H) and nanocrystalline (nc-Si:H) components throughout the film depth. The speed of the measurement system makes the instrument suitable for use on production lines. The precision enables detection of subnanometer thicknesses, and refractive index and extinction coefficient changes of 0.01. Angle-of-incidence and mirror calibrations are made via well-known sample structures. Alternative commercial instrumentation for mapping by spectroscopic ellipsometry must translate the sample or ellipsometer in two dimensions. For this instrumentation, even a 15 × 15 cm2 sample with cm2 resolution requires > 200 measurements and at least 15 min. By imaging along one dimension in parallel, the expanded-beam system can measure with similar resolution in < 2 min. The focus of recent instrumentation efforts is on improving the overall system spectral range and its performance.
This randomized, double-blind, placebo-controlled study was conducted to compare the effect of a 15-week weight-reducing programme ( − 2900 kJ/d) coupled with a calcium plus vitamin D (calcium+D) supplementation (600 mg elemental calcium and 5 μg vitamin D, consumed twice a day) or with a placebo, on body fat and on spontaneous energy/macronutrient intake. Sixty-three overweight or obese women (mean age 43 years, mean BMI 32 kg/m2) reporting a daily calcium intake < 800 mg participated in present study. Anthropometric variables, resting energy expenditure and spontaneous energy intake were measured before and after the 15-week programme. The calcium+D supplementation induced no statistically significant increase in fat mass loss in response to the programme. However, when analyses were limited to very low-calcium consumers only (initial calcium intake ≤ 600 mg/d, n 7 for calcium+D, n 6 for placebo), a significant decrease in body weight and fat mass (P < 0·01) and in spontaneous dietary lipid intake (P < 0·05) was observed in the calcium+D but not in the placebo group. In very low-calcium consumers, change in fat mass was positively correlated with change in lipid intake. During the weight-reducing programme, a calcium+D supplementation was necessary in female overweight/obese very low-calcium consumers to reach significant fat mass loss that seemed to be partly explained by a decrease in lipid intake. We propose that this change in lipid intake could be influenced by a calcium-specific appetite control.
A long cropmark enclosure at Springfield, Essex, interpreted as a Neolithic cursus, was investigated betwee 1979–85 to confirm its date and establish a site sequence. The enclosure was c. 690 m long and 37–49 m wide the ditch being uninterrupted in all areas examined, features within the interior at the eastern end included a incomplete ring of substantial post-pits which it is suggested originally formed a complete circle. Peterborou pottery, predominately Mortlake style, Grooved Ware, a small amount of Beaker pottery, earlier Bronze Age urn sherds, and flint artefacts of the late 3rd-early 2nd millennium were recovered from the cursus ditch an other features. Collectively the evidence indicates a prolonged period of use. The results of the excavations a described, the site is discussed in its local and regional context and the implications of the excavation for our understanding of cursus monuments are considered.
Mesostructured titanium-oxo/polymer hybrids were obtained by using Ti16O16(OEt)32 (TS) clusters or by aging solutions of Ti alkoxides as precursors. Dendrimers or PEO-based surfactants were used as templating agents. Solids were characterised by XRD, TEM, FTIR and multinuclear liquid and solid (MAS) NMR spectroscopy. Two synthetic approaches are described. In the alkoxide-based systems, the control of the high reactivities of the Ti (IV) metal centers, is essential to obtain ordered mesophases. The assembly of nanobuilding blocks (ANBB) permits to circumvent this high reactivity by using pre-formed Ti-oxo entities. The use of versatile functionalised dendrimers permits to control the reactivity at the surface of the cluster, giving birth to novel ordered architectures.
Several mechanisms have been proposed for the growth of silica spheres by the controlled hydrolysis of silicon alkoxides, the limiting cases of which are the conventional and aggregative growth models. The evolution of surface area predicted from the two models is substantially different at early times into the reaction. In order to probe the change in surface area during growth, 1H NMR measurements of the solvent were made during the growth process. It has been demonstrated that the spin-spin relaxation time.(T2) for an absorbed phase is less than that of the bulk solvent. Using this principal, the change in surface area can be followed in situ during the reaction. The experimental results were compared to the predictions of the conventional model and found not to be in agreement.
A double-ditched sub-rectangular enclosure measuring c.42 by 48 m was excavated. It was shown to have been a Late Bronze Age settlement, with a single central roundhouse opposite the only entrance, and with a rectangular structure in one corner. The site produced a typical range of Late Bronze Age artefacts. The site is low-lying, and environmental data from the waterlogged fills of a well indicate an open landscape of damp grassland. These factors together with the absence of waste from the earliest stages of crop-cleaning among carbonized plant remains from the enclosure, point to a primarily pastoral economy.
A few Neolithic features and artefacts were also found but these are not considered to represent permanent settlement.