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Strobe checklist and survey instrument for a national cross-sectional survey of constipation experienced by patients with cancer in the eight national cancer centres in Ireland.

An exploratory, longitudinal single case study of a novel palliative care rehabilitative service in Ireland. All information here presented refers to the current protocol for the Palliat Rehab service. Affiliations: Mater Misericordiae University Hospital, St. Francis Hospice, Dublin, Trinity College Dublin. Project Lead Investigators: Professor Karen Ryan (St. Francis Hospice, Mater Misericordiae University Hospital) & Dr. Bridget Johnston (Trinity College Dublin).

Additional file 1.

Background Respiratory medicine (RM) and palliative care (PC) physicians’ management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey. Methods A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists. Results 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p p p p χ2 = 13.8; p χ2 = 12.58, p χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018). Conclusions These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled.

Supplemental material, sj-docx-1-pmj-10.1177_0269216321999962 for Mutual support between patients and family caregivers in palliative care: A systematic review and narrative synthesis by Rachel McCauley, Regina McQuillan, Karen Ryan and Geraldine Foley in Palliative Medicine

Supplemental material, sj-docx-1-pmj-10.1177_0269216321999962 for Mutual support between patients and family caregivers in palliative care: A systematic review and narrative synthesis by Rachel McCauley, Regina McQuillan, Karen Ryan and Geraldine Foley in Palliative Medicine

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: To compare health and social care costs, quality and their drivers in the last three months of life for older adults across countries. Null hypothesis: no difference between countries.Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs.Setting: Palliative care services in England (London), Ireland (Dublin), USA (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care. Results: 767 returned questionnaires: 245 England, 282 Ireland, 240 USA. Mean care costs per person with cancer/non-cancer were: USA ($37,250 /$37,376), Ireland ($29,065 /$29,411), England ($15,347 /$16,631), and differed significantly (F=25.79/14.27, p80% of total care costs; community care 6-16%, palliative care 1-15%; 10% of decedents used ~30% of total care cost. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction.Conclusions: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the USA were high and highly variable, suggesting that high cost low value care may be prevalent.

Additional file 3: Supplementary file 3. Round 2 and 3 Questionnaire

Additional file 1: Table S1. Informal care (IC) costs in the last three months of life categorized by the relationship of carers to patients. Figure S1. Distribution of subsequent grief, carer burden and positive aspects of caregiving and by country. Table S2. Subsequent grief, carer burden and positive feeling of care by carers’ relationship to patients. Figure S2. Histogram of costs of informal care (IC) provided for older patients in their last three months of life, with and without ‘Time being on call’ in three countries. Figure S3. Cumulative distribution of costs of informal care (IC) provided for older patients in their last three months of life, with and without ‘Time being on call’ in three countries.

Supplemental material, Revised_PMJ-18-0419_Care_costs_and_quality_Suppl for Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States by Deokhee Yi, Bridget M Johnston, Karen Ryan, Barbara A Daveson, Diane E Meier, Melinda Smith, Regina McQuillan, Lucy Selman, Steven Z Pantilat, Charles Normand, R Sean Morrison and Irene J Higginson in Palliative Medicine

Supplemental material, PMJ-18-0419_Care_costs_and_quality_at_the_end_of_life_Supplements for Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States by Deokhee Yi, Bridget M Johnston, Karen Ryan, Barbara A Daveson, Diane E Meier, Melinda Smith, Regina McQuillan, Lucy Selman, Steven Z Pantilat, Charles Normand, R Sean Morrison and Irene J Higginson in Palliative Medicine

Additional file 2: Supplementary file 2. Round 1 Questionnaire

Additional file 1: Supplemental file 1. Delphi Interview

Delirium is a neurocognitive syndrome that commonly occurs in older populations and people with cancer, particularly in those with advanced disease and in the last hours or days of life. While an underlying malignancy and its complications predispose a person to develop delirium, many of the treatments used in the management of cancer also increase the risk of delirium [1]. In addition to being associated with an increased risk of mortality and causing significant physical morbidity, delirium is often a severely distressing experience, not only for patients, but also for families and professional caregivers [1]. The target population for this European Society for Medical Oncology (ESMO) Clinical Practice Guideline (CPG) is adults with cancer who are at risk of delirium or have been diagnosed with delirium. The intended users for this CPG are healthcare professionals working in the field of oncology, in order to inform both clinical decisions and standards of care.

Copy of the questionnaire. Questionnaire used in the study for IARE project. Note this is British version of the questionnaire. There were minor amendments to some introductory text in USA and Dublin (e.g. opening explanation), to comply with local requirements, but the questions remained the same. (PDF 477Â kb)

Determinants choices appendices tables and figures. Appendices tables and figures in numerical order. Appendices tables and figures referred to in the main manuscript text. (DOC 185Â kb)

Informed consent materials. (DOCX 26Â kb)

Details of biological studies. (DOCX 25Â kb)

Hybrid literature has flourished in the Russian diaspora in the last decade and much of it is semi-autobiographical, concerned with the reconfiguration of identity in emigration. It dwells productively on the translation of the self and (more broadly) on the relationship between center and margin in the post-Soviet, transnational world. Gender roles are subject to contestation, as writers interrogate and reconsider expectations inherited from traditional Russian culture. This article situates Russian hybrid literature vis-à-vis Western feminism, taking into account Russian women’s particular experience of feminism. Four female writers of contemporary Russian-American literature – Lara Vapnyar, Sana Krasikov, Anya Ulinich, and Irina Reyn – inscribe failures of domesticity into their prose. Their female characters who cannot or do not cook or clean problematize woman’s role as nurturer. Home (geographic or imaginary) carries a semantic load of limitation and restriction, so failure as a homemaker may be paradoxically liberating. For female characters working in the West to support their families in Russia, domesticity is sometimes even more darkly cast as servitude. Rejection of traditional Russian definitions of women’s gender roles may signal successful renogotiation of identity in the diaspora. Although these writers may express nostalgia for the Russian culture of their early childhood, their critique of the tyranny of home is a powerful narrative gesture. Failures of domesticity represent successful steps in the redefinition of the self and they support these writers’ claim to transnational status.

BACKGROUND:\ud People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs.\ud AIM:\ud To define consensus norms for palliative care of people with intellectual disabilities in Europe.\ud DESIGN:\ud Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version.\ud SETTING AND PARTICIPANTS:\ud Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members' networks.\ud RESULTS:\ud A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents' comments, several items were modified and one item was deleted.\ud CONCLUSION:\ud This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice.

ObjectiveBile acids (BA) are elevated after vertical sleeve gastrectomy (VSG) and farnesoid-X-receptor (FXR) is critical to the success of murine VSG. BA downregulate hepatic lipogenesis by activating the FXR-small heterodimer partner (SHP) pathway. The role of SHP in fatty liver disease improvement after VSG was tested.MethodsWild type (WT), SHP liver transgenic (SHP-Tg), and SHP knockout (SHP-KO) high-fat diet (HFD) fed mice underwent either VSG or Sham surgery. Body weight, BA level and composition, steatosis, and BA metabolism gene expression were evaluated.ResultsObese WT mice post-VSG lost weight, reduced steatosis, decreased plasma alanine aminotransferase (ALT), had more BA absorptive ileal area, and elevated serum BA. Obese SHP-Tg mice post-VSG also lost weight and had decreased steatosis. SHP-KO mice were however resistant to steatosis despite weight gain on a HFD. Further SHP-KO mice that underwent VSG lost weight, but developed hepatic inflammation and had increased ALT.ConclusionsVSG produces weight loss independent of SHP status. SHP ablation creates a proinflammatory phenotype which is exacerbated after VSG despite weight loss. These inflammatory alterations are possibly related to factors extrinsic to a direct manifestation of NASH.

Bariatric surgical procedures, such as vertical sleeve gastrectomy (VSG), are at present the most effective therapy for the treatment of obesity, and are associated with considerable improvements in co-morbidities, including type-2 diabetes mellitus. The underlying molecular mechanisms contributing to these benefits remain largely undetermined, despite offering the potential to reveal new targets for therapeutic intervention. Substantial changes in circulating total bile acids are known to occur after VSG. Moreover, bile acids are known to regulate metabolism by binding to the nuclear receptor FXR (farsenoid-X receptor, also known as NR1H4). We therefore examined the results of VSG surgery applied to mice with diet-induced obesity and targeted genetic disruption of FXR. Here we demonstrate that the therapeutic value of VSG does not result from mechanical restriction imposed by a smaller stomach. Rather, VSG is associated with increased circulating bile acids, and associated changes to gut microbial communities. Moreover, in the absence of FXR, the ability of VSG to reduce body weight and improve glucose tolerance is substantially reduced. These results point to bile acids and FXR signalling as an important molecular underpinning for the beneficial effects of this weight-loss surgery.

ObjectiveOur objective was to investigate the role of bile acids in hepatic steatosis reduction after vertical sleeve gastrectomy (VSG).Design and methodsHigh fat diet (HFD)-induced obese C57Bl/6 mice were randomized to VSG, Sham operation (Sham), Sham operation with pair feeding to VSG (Sham-PF), or nonsurgical controls (Naïve). All mice were on HFD until sacrifice. Mice were observed postsurgery and data for body weight, body composition, metabolic parameters, serum bile acid level and composition were collected. Further hepatic gene expression by mRNA-seq and RT-PCR analysis was assessed.ResultsVSG and Sham-PF mice lost equal weight postsurgery while VSG mice had the lowest hepatic triglyceride content at sacrifice. The VSG mice had elevated serum bile acid levels that positively correlated with maximal weight loss. Serum bile composition in the VSG group had increased cholic and tauroursodeoxycholic acid. These bile acid composition changes in VSG mice explained observed downregulation of hepatic lipogenic and bile acid synthetic genes.ConclusionVSG in obese mice results in greater hepatic steatosis reduction than seen with caloric restriction alone. VSG surgery increases serum bile acids that correlate with weight lost postsurgery and changes serum bile composition that could explain suppression of hepatic genes responsible for lipogenesis.

By the end of the 1960s research in the Eastern North American Arctic had defined a single widespread Early Palaeoeskimo culture, dubbed Pre-Dorset since it preceded Late Palaeoeskimo Dorset culture. Subsequent investigations in Greenland resulted in the recognition of two other occupations, Independence I and Saqqaq, that, while different, were considered part of the Pre-Dorset manifestation. However, in the mid-1970s it was proposed that Independence I and Pre-Dorset should be considered culturally and temporally distinct. This classification system clearly divided the period and did not allow for interactions between the groups. While this proposal was initially questioned, it has come to dominate interpretation of the Early Palaeoeskimo period. At the same time as this framework was being promoted, a small number of Early Pre-Dorset sites were excavated in Labrador. Classified as Pre-Dorset, these sites nonetheless exhibited Independence I and Saqqaq influences. The reasons for this could not be fully explained, though a relationship between Labrador and the High Arctic was proposed. This thesis reevaluates the place of Labrador Early Pre-Dorset within the sphere of the Eastern Arctic following upon almost thirty years of archaeological work, both in Labrador and elsewhere in the Eastern Arctic. Recent evidence suggests that researchers must rethink their view of the Early Palaeoeskimo period and the vision of Independence I and Saqqaq relations. Only by viewing Independence I and early Saqqaq as part of the same cultural unit can the cultural sequence be reconciled with the archaeological data. Master of Arts (MA)

The objective of this Masters degree is to produce a body of work that looks at the effect of man’s intervention on the environment, resulting in countless extinct species with many more hovering on the brink. My constructed realities are a consequence of human impositions on the natural environment. The interruption of natural habitats has occurred on a monumental scale. To presume that we can continue to produce more and more waste is to be disconnected with the reality of the environment; there are no innocent bystanders. Five major installations have been created as part of my research, ‘Expose’, ‘Capture’, ‘Bleach’, ‘Bloom’ and ‘Choke’. These installations engage in dialogues that surround consumption and production. In constructing these installations I am not attempting to coerce the viewer into dramatically changing their habits, but merely suggesting that we should rethink our actions so that the consequences become positive rather than negative. The use of detritus has become a conversation about who we are and the impact we are having on our aquatic environment. Humans need to consider nature as a fundamental part of the human value system and believe that the future of our environment will be created by the quality of the present. Environmental ethics has become a strong consideration in my work, as my practice is centred on the critical paradigm of the interaction between humans their environment and the resulting annihilation of species. I hope that through my installations viewers may gain an insight into the form and history of human impact on the environment. My work remains tied to the idea of non-reusable discarded materials, translating the transient to the timeless as a testament to the complexity of assessing and valuing objects. It is not possible to reverse the damage already done, to bring back extinct species , but there are many more species hovering on the brink that can be saved.