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This paper explores telecare manager and other ‘stakeholder’ perspectives on the nature, extent and impact of family and other unpaid/informal carers’ involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers’ engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals’ engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as ‘resources’ and involvement is largely taken for granted. There are instances in which carers can be seen as ‘co-workers’: this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or ‘supersede’ hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers’ own rights as ‘co-clients’ was little acknowledged.
Chemoradiotherapy followed by monthly temozolomide (TMZ) is the standard of care for patients with glioblastoma multiforme (GBM). Case reports have identified GBM patients who experienced transient radiological deterioration after concurrent chemoradiotherapy which stabilized or resolved after additional cycles of adjuvant TMZ, a phenomenon known as radiographic pseudoprogression. Little is known about the natural history of radiographic pseudoprogression.
We retrospectively evaluated the incidence of radiographic pseudoprogression in a population-based cohort of GBM patients and determined its relationship with outcome and MGMT promoter methylation status.
Out of 43 evaluable patients, 25 (58%) exhibited radiographic progression on the first MRI after concurrent treatment. Twenty of these went on to receive adjuvant TMZ, and subsequent investigation demonstrated radiographic pseudoprogression in 10 cases (50%). Median survival (MS) was better in patients with pseudoprogression (MS 14.5 months) compared to those with true radiologic progression (MS 9.1 months, p=0.025). The MS of patients with pseudoprogression was similar to those who stabilized/responded during concurrent treatment (p=0.31). Neither the extent of the initial resection nor dexamethasone dosing was associated with pseudoprogression.
These data suggest that physicians should continue adjuvant TMZ in GBM patients when early MRI scans show evidence of progression following concurrent chemoradiotherapy, as up to 50% of these patients will experience radiologic stability or improvement in subsequent treatment cycles.
A stringent process of selection of appropriate candidates for liver transplantation is necessary for a number of reasons. This chapter discusses deceased organ transplantation in adults. In liver transplant practice, a distinction needs to be made between the process of selection of appropriate candidates for transplant, which is the main focus of the chapter, and that of organ allocation for those candidates who have been placed on the waiting list for the procedure. Both of these processes are underpinned by similar considerations with respect to the relevant clinical end points and ethical standpoints. The practice of candidate selection and organ allocation is predicated on two fundamental ethical principles: justice (or equity) and utility. Most liver transplant programs have adopted the Milan criteria for selecting patients with hepatocellular carcinoma (HCC) for transplantation. Rarely, patients with heart and liver failure will be considered for combined heart-liver or heart-lung-liver transplant.
The effect of TiN Anti-Reflective Coating (ARC) layer capping of metal, in a multilevel interconnect system, on the reliability of the tungsten (W) plug has been investigated. EM study on Kelvin via showed that the thin TiN ARC Kelvin via lifetime exhibited a reduction of one order of magnitude compared to that of the thicker ARC thickness (1000Å) when they were stressed in a certain direction. A new testing technique, used to investigate the effect of ARC thickness on the W-plug electromigration (EM) performance, is discussed. The simulation results of current distribution confirmed the proposed failure model of EM performance of W-plug via with different ARC thickness.
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