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Background: Addressing timely community palliative care integration is prioritized due to the increased burden of noncommunicable diseases. Objectives: To compare referral-to-death duration among palliative cancer and noncancer patients and to determine its associated factors in a Malaysian community palliative care center. Methods: This retrospective cohort study included decedents referred to a Malaysian community palliative care center between January 2017 and December 2019. Referral-to-death is the interval between the date of community palliative care referral and to date of death. Besides descriptive analyses, negative binomial regression analyses were conducted to identify factors associated with referral-to-death among both groups. Results: Of 4346 patients referred, 86.7% ( n = 3766) and 13.3% ( n = 580) had primary diagnoses of cancer and noncancer respectively. Median referral-to-death was 32 days (interquartile range [IQR]: 12–81) among cancer patients and 19 days (IQR: 7–78) among noncancer patients. The shortest referral-to-death among cancer patients was for liver cancer (median: 22 days; IQR: 8–58.5). Noncancer patients with dementia, heart failure, and multisystem organ failure had the shortest referral-to-death at 14 days. Among cancer patients, longer referral-to-death was associated with women compared to men (IRR: 1.26; 95% CI: 1.16–1.36) and patients 80 to 94 years old compared to those below 50 years old (IRR: 1.19; 95% CI: 1.02–1.38). Cancer patients with analgesics prescribed before or upon referral had 29% fewer palliative care days compared to no prescribing analgesics. In contrast, noncancer patients 50 to 64 years old had shorter referral-to-death compared to those below 50 years old (IRR: 0.51; 95% CI: 0.28–0.91). Conclusion: Shorter referral-to-death among noncancer patients indicated possible access inequities with delayed community palliative care integration. Factors associated with referral-to-death are considered in developing targeted approaches ensuring timely and equitable community palliative care.

ObjectivesTo compare the referral-to-death duration among palliative cancer and non-cancer patients and to determine its influencing factors in a Malaysian community hospice.MethodsThis retrospective cohort study included decedents referred to palliative care in a community hospice between January 2017 to December 2019. Referral-to-death is the interval between first referral date to date of death. Besides descriptive analyses, negative binomial regression analyses were conducted to identify factors associated with referral-to-death duration among both groups.ResultsOf 4346 patients referred, 86.7% (n=3766) and 13.3% (n=580) had primary diagnoses of cancer and non-cancer respectively. Median referral-to-death was 32 days (IQR:12-81) among cancer patients and 19 days (IQR:7-78) among non-cancer patients. The shortest referral-to-death duration among cancer patients were for liver cancer (Median:22 days,IQR:8-58.5). Non-cancer patients with dementia, heart failure and multisystem failure had the shortest referral-to-death duration at 14 days. Among cancer patients, longer referral-to-death duration was associated with women compared to men (IRR:1.26,95%CI:1.16-1.36) and patients aged 80 to 94 years old compared to below 50 years old (IRR:1.19,95%CI:1.02-1.38). Cancer patients with analgesics prescribed before palliative care had 29% fewer palliative care days compared to those with no analgesics prescribed before referral. Non-cancer patients aged 50 to 64 years old had shorter referral-to-death duration compared to below 50 years old (IRR:0.51,95%CI:0.28-0.91).ConclusionShorter referral-to-death duration among non-cancer patients indicated possible access inequities with delayed palliative care integration. Factors influencing referral-to-death duration should be accounted for in developing targeted approaches to ensure timely and equitable access to all patients requiring palliative care.KEY MESSAGESWhat is already known on this topic⍰Addressing the need for timely integration of palliative care in low- and middle-income countries (LMIC) is a priority, considering its increasing burden of non-communicable diseases with limited data available in this region.What this study adds⍰Findings from our study have shown an underrepresentation of non-cancer patients amongst community palliative care referrals with a shorter referral-to-death duration among these patients as compared to cancer patients.⍰Age, sex, and use of analgesia prior to referrals were factors significantly associated with referral-to-death duration among cancer patients whereas for non-cancer patients, older aged patients had a shorter referral-to-death duration..How this study might affect research, practice or policy⍰The underrepresentation of non-cancer referrals for palliative care indicates the need to determine reasons for the disparity in referrals between cancer and non-cancer patients in clinical practice and to evaluate feasible and effective approaches to narrow this gap in settings similar to that of ours.⍰At a policy level, plans to develop interventions to allow timely integration of community palliative care should target specific groups of patients.

How well are school library media programs realizing the mission, objectives and challenges set by Information Power? Teacher-librarians are struggling to realize its ideals in less than ideal circumstances. To gain a broader understanding of their work and success, this paper studies 48 good library media programs in New England Region, U.S. using a combination of qualitative and quantitative methods to ensure the perceived success of participating programs in conforming to the national guidelines.

Freshwater bacteria play key roles in biogeochemical cycling and contribute significantly to biomass and energy fluxes. However, studies of Great Lakes ecosystem dynamics often omit bacteria. Here, we used high throughput sequencing to analyze how bacterial diversity and community composition (BCC) vary seasonally along the long-term Muskegon estuary to pelagic research transect. Diversity was higher in the estuary than Lake Michigan, in spring compared to summer, and for particle-associated (PA) relative to free-living (FL) fractions. PA communities were distinct from and more variable than FL communities. For both fractions, spring BCC was more similar between estuary and nearshore Lake Michigan compared to offshore waters. In summer and fall, nearshore and offshore BCC were more similar compared to estuary BCC. Most abundant taxa were inferred to be chemoorganoheterotrophs. While, as a whole, this functional group only showed habitat preference for the PA fraction, we observed phylum- and class-level seasonal and spatial preferences. Chemoorganoheterotrophs that also perform bacteriorhodopsin-mediated phototrophy, such as acI Actinobacteria and LD12, strongly preferred FL fractions. Photoautotrophs (Cyanobacteria) were least abundant in spring, when mixotrophic methylotrophs were more abundant, particularly in the estuary. Organisms with chemolithotrophic capabilities, including a mixotrophic, highly abundant Limnohabitans (Lhab-A1) OTU, showed limited spatiotemporal patterns. One exception was Nitrosospira, an autotrophic ammonium oxidizer, which peaked in deep offshore waters in fall. Nitrosospira co-occurred with Chloroflexi CL500-11, which likely mineralizes nitrogen-rich organic matter in deep waters. These spatiotemporal BCC shifts suggest differences in bacterially mediated elemental cycling along estuary to pelagic gradients in Lake Michigan.

Background: Patients with life-limiting illnesses are dependent on their families and healthcare providers for care. In Malaysia, there is a lack of data exploring the experiences and needs of patients and carers. It is not known whether these needs are being identified accurately by the palliative care providers.Aim: The aim of this study was to explore the experiences and needs of patients with life-limiting illnesses receiving community palliative care and the experiences of their formal and informal carers when providing care for the patients.Design: A qualitative study involving individual semi-structured in-depth interviews and focus groups. The interviews and focus group discussion were audio-recorded, transcribed verbatim, and the transcripts and fields notes were used as data for thematic analysis.Setting/participants: The participants were patients, carers, and healthcare professionals from Hospis Malaysia, an urban community palliative care service in Malaysia.Results: Four main themes emerged:...

Background: The purpose of this study was to examine the relationship between critical thinking and the use of concept mapping (CM) and problem-based learning (PBL) during care plan development. Method: A quasi-experimental study with a pretest–posttest design was conducted using a convenience sample ( n = 49) of first-semester undergraduate baccalaureate nursing students. Critical thinking was measured using the Holistic Critical Thinking Scoring Rubric. Data analysis consisted of a repeated measures analysis of variance with post hoc mean comparison tests using the Bonferroni method. Results: Findings indicated that mean critical thinking at phase 4 (CM and PBL) was significantly higher, compared with phase 1 (baseline), phase 2 (PBL), and phase 3 (CM [ p < 0.001]). Conclusion: The results support the utilization of nontraditional instructional (CM and PBL) methodologies in undergraduate nursing curricula. [ J Nurs Educ. 2015;54(8):455–459.]

Background Although regular factor replacement can reduce the incidence of joint bleeds and slow down the development of haemophilic arthropathy, the ankle joint remains particularly vulnerable even in children with haemophilia on primary or secondary prophylaxis and is now the primary joint affected. The heterogeneity in the pathoaetiology of haemophilic ankle arthropathy means that the functional consequences of early stage of ankle arthropathy are difficult to define as early morphological and structural changes can be observed in clinically asymptomatic ankles. In this context, understanding biomechanics of the normal and arthritic foot is complex and difficult to quantify unless considering the foot as multiple functional segments using more sophisticated assessment tools such as multisegment foot models. However, this understanding can undoubtedly aid in the analysis of an underlying clinical problem and provide a strategic basis for a more optimal management. Aims The purpose of this narrative review was firstly to revise information on the anatomy and biomechanics of the foot and ankle. Finally, related biomechanical markers of human motor performance, which are potentially implicated in the development of haemophilic ankle arthropathy, will be discussed based on published literature and expert opinion. Materials and methods Searches in published literature were limited to the year 2000 onwards. Results Although the ankle (tibiotalar joint) is the most commonly affected joint, associated subtalar joint (SJT) involvement is often seen. This would therefore imply that an alternative phraseology might be better. Discussion and conclusion In this context, the authors propose the use of ‘haemophilic tarsal pan-arthropathy’ (HTPA) which encompasses both tibiotalar and subtalar joints.

Accurately predicting NCLEX-RN ® success has a positive impact on all nursing education stakeholders. This study focused on the ability to predict NCLEX-RN pass rates on the basis of prenursing academic aptitude variables and the Assessment Technologies Institute (ATI) nursing aptitude program. The ATI predictors were the Test of Essential Academic Skills (TEAS) and five ATI subject tests: Fundamentals, Medical Surgical, Nursing Care of Children, Mental Health, and Maternal Newborn. The prenursing variables comprised the prenursing grade point average, a prerequisite communication course, and the ATI TEAS composite subscores of TEAS Reading, TEAS Math, TEAS Science, and TEAS English. This study included participants from four baccalaureate nursing programs in the California State University system. Results of canonical correlation, multiple linear regression, and logistic regression revealed a significant correlation among prenursing, ATI scores, and NCLEX-RN first-try pass rates. Prediction of NCLEX-RN success rate using standardized testing data was supported, with the strongest predictors being the ATI Medical Surgical and ATI Mental Health tests. [ J Nurs Educ. 2014;53(3):151–159.]

article i nfo Article history: Received 6 December 2012 Accepted 20 May 2013 Background: The ankle continuestobeoneofthemostaffectedjoints inthe haemophiliapatient,andascartilage damage progresses, the joint can feel unstable, painful and stiff. Anecdotally, patients often report that sports trainers can improve their pain and daily function, however the actual mechanism for this remains unclear. Methods: Nine patients with ankle haemarthropathy and three controls were examined using 'CODAmotion' analysis and a force plate. Kinematic and kinetic variables of the hip, knee and ankle were recorded. Data was imported from CODA to Excel, where a programme using 2D modelling of the ankle joint forces was employed. This calculated intra-articular force from heel strike to toe-off. Findings: The haemophilia group at midstance showed an increase in intra-articular force in the ankle when wearing the trainer compared to the shoe (P = b 0.05). Overall the haemophilia cohort had an increased joint force in both the trainers and shoes, compared to controls. Interpretation: The type of footwear worn by individuals with ankle arthropathy has a significant effect on the amount of force acting at the joint surface. Sports shoes, in providing better comfort and foot support, may facilitate an increased muscular activity around the ankle and therefore improved dynamic joint stability, accountingforwhysomepatientswithanklearthropathyreportlesspain.Furtherresearchisneededtoestablish levels of acceptable force and the combined effects of orthotics and footwear.

A series of 2-(1H-pyrazol-1-yl)pyridines are described as inhibitors of ALK5 (TGFβ receptor I kinase). Modeling compounds in the ALK5 kinase domain enabled some optimization of potency via substitutions on the pyrazole core. One of these compounds PF-03671148 gave a dose dependent reduction in TGFβ induced fibrotic gene expression in human fibroblasts. A similar reduction in fibrotic gene expression was observed when PF-03671148 was applied topically in a rat wound repair model. Thus these compounds have potential utility for the prevention of dermal scarring.

Problem statement: Recent research has shown a relationship between olfaction and episodic/autobiographical memory. The mnemonic theory of odor asserts that odor representation and storage is tied to memory. The Proust phenomenon suggests that specifically episodic memory is the memory component behind the mnemonic theory of olfaction. Neurological evidence demonstrates that neural structures related to emotion have connections between olfactory receptors and the episodic memory center. Approach: This study examined the role of emotion and olfaction in memory for vignettes. Participants were presented with a series of vignettes that varied by emotional content. Olfactory cues were paired with vignettes. Participants were questioned over recall of the vignettes. Results: Two experiments demonstrated a significant effect for emotion in memory performance for vignettes. The role of olfaction was not as prominent. Conclusion/Recommendations: This confirms the Proust phenomenon olfaction, namely that olfaction plays a greater role in autobiographical memory than memory for vignettes. The generalization of the Proust phenomenon to nonautobiographical memory is not supported by the results of these two studies. The authors suggest future research examining the interaction between olfaction and emotion should be directed towards autobiographical memory.

We conducted a neuropsychological and cognitive assessment study to determine whether time of day affects cognitive performance. We measured executive control (fluency), processing speed, semantic memory, and episodic memory performance. We followed 56 students across 3 different times of day, testing performance on vocabulary, fluency, processing speed, and episodic memory. Results showed an advantage for fluency and digit symbol task performance in the afternoon and evening testing times relative to morning testing (regardless of testing order), but that time of day did not affect semantic or episodic memory performance. These results suggest that optimal executive functioning and processing speed may occur for typical college students in the afternoon and evening regardless of time-of-day preference.

This report documents the economic impact of heavy truck traffic related to energy development on the nation’s roads and bridges. Strategies used by transportation agencies to minimize and pay for the damage caused by heavy loads are also documented. Information used in this study was acquired through a review of the literature, a survey of state transportation agencies, and interviews with selected federal and tribal agencies. Follow-up interviews with multiple agencies in five states selected for further study provided additional information. Chapter 1 provides an introduction to the report. Chapter 2 presents a literature review of energy development activities in the United States, highlighting energy development industries in the U.S., costs and revenue sources for public agencies, impacts on public roads and bridges as a result of energy development, strategies used by federal agencies and states, practices reported by federal agencies, and practices reported by tribal nations. Chapter 3 summarizes a survey on energy development impact on state and local roads and bridges, highlighting impact on infrastructure, engineering tools and design standards, economic impacts of energy development on roads and bridges, tools used to assess costs, impacts on roadway safety and operations, and defining the challenges to agencies. Chapter 4 presents case examples of state and local practices used to address energy development impacts in Colorado, Iowa, North Dakota, Pennsylvania and Texas. Chapter 5 presents a conclusion and identifies knowledge gaps.

Health Impact Assessment (HIA) is a relatively new, but increasingly important, contributor to both local and national decision-making processes. Adopting a multi-method approach, it incorporates qualitative and quantitative analyses to determine the various health impacts of policies and projects. HIA thus reflects recent developments in sociological theory, which have promoted qualitative techniques and challenged the dominance of quantitative methods. HIA embodies a particular renegotiation of the qualitative/quantitative opposition; each individual HIA represents an empirical instance of this renegotiation. As such, HIA can be conceptualized as a kind of ‘political space’, in which the opposition in question is structured by various social forces and plays out in concrete ways. Moreover, and notwithstanding the supposed methodological rapprochement, an analysis of a number of HIAs claims to expose a continuing, but perhaps unsurprising, privilege in favour of quantitative methods. In the first place, ...

The construction industry has long been regarded as a high-risk industry in relation to health and safety issues. The purpose of this research was to investigate the extent of occupational health and safety provision within the residential development sector of the construction industry in Britain. An additional aim was to gauge the sectors' attitudes toward health promotion. Data were collected using a self-completed questionnaire that was sent to 200 residential developers; a 46% response rate was achieved. The results revealed a high level of knowledge of health and safety legislation; occupational health provision in the sector is low, but a strong appreciation was demonstrated of the value of such services. There was a low level of health promotion policy development in relation to the areas of alcohol, smoking, and skin cancer.

This report compiles and documents public agency practices used in federal-aid project development and management. A primary objective of this study is to explore what performance measures, delivery practices, strategies, and tools are currently used in relation to federally-funded local public agency (LPA) highway project development and delivery, and how they are used to measure success in project administration. The report also provides information on the definition and elements of state department of transportation (DOT)-sponsored LPA certification processes. Information used in this study was acquired through a review of the literature, a survey of DOT local program representatives in all states, and a survey of local program agency representatives identified by DOTs. Follow-up interviews with multiple state and local agency representatives provided additional information.

School libraries in the United States have existed since the founding of private schools and academies in New England, such as Phillips-Andover and Phillips-Exeter in the late 18th century. The development of public secondary school libraries, however, did not occur until early in the 20th century. While New England's academies were national leaders in secondary school education, New England's public schools lagged behind their counterparts in the Central region of the United States in the development of school libraries. The first national standards for secondary school libraries was adopted by and published by the National Education Association (NEA) in 1918 from a study and report by the Committee on Library Organization and Equipment (CLOE), chaired by Charles C. Certain. The 1918 standards were entitled, “Standard Library Organization and Equipment for Secondary Schools of Different Size.” (NEA, 1918) This was the first attempt to quantify high school library facilities by identifying standards for a good high school library. In 1920, the American Library Association (ALA) endorsed and published these standards, which have become known as the “Certain Standards,” in honor of the committee chair. The “Certain Standards” addressed the need for high school libraries to become an integral part of the school by setting goals, planning, and establishing quantified collections, seating, and equipment. These standards also called for creating a library classroom and for hiring a qualified librarian (with 1 year of postgraduate study and one year of internship) (NEA, 1918; ALA, 1920). Most importantly, this document identified the role of the librarian as a professional who was not expected to do clerical work, but who “… should have the ability to work for and with teachers” (NEA, 1918; ALA, 1920, p. 12). Therefore, the standards movement began as an effort to quantify library facilities and to provide qualified librarians in secondary schools which became the focus for improving school libraries throughout the 20th century (Roscello, 2004).

No período de junho a julho de 1974, houve um surto de doença em 2 (duas) granjas distintamente localizadas, com um índice de mortalidade em média de 30%, Sintomas e necrópsias indicaram Salmonelose em ambos os casos. Testes de Coccidiose realizados apresentaram resultado negativo. Pintainhos de faixa etária 2-5 semanas foram sacrificados e necropsiados, obtendo-se amostras de pulmões sangue, conteúdo intestinal, uratos e fezes. Subseqüentemente foram utilizadas coletas de rações, água de beber e detritos da cama aviária. Das análises bacteriológicas feitas em todo o material coletado, foi demonstrado a presença de Salmonella enteritidis biosorotipo Pullorum em pulmões, sangue, conteúdo intestinal e fezes. Esta bactéria é o agente etiológico da doença em pintainhos, denominada Pulorose ou Diarréia bacilar branca. Foi constatado que os lotes de pintainhos infectados vieram da mesma chocadeira. Diagnose seguinte, tratamento e controles foram medidas aplicadas com resultados satisfatórios. Só recentemente, é que estão sendo instaladas granjas de larga escala nesta região e estão se expandindo. Então, as tentativas para controle desta doença devem ser vigorosas, por razões sanitárias e econômicas, em virtude da fatalidade em galinhas e sérias infecções que podem ocasionar no homem. Bacteriological and aviculturological evidence is presented which demonstrates the presence of anaerogenic Salmonella enteritidis bioserotype Pullorum in chickens in the vicinity of Manaus, Amazonas, Brazil. This bacterium is the etiological agent of pullorum disease (bacillary white diarrhea) in chickens and salmonellosis in humans.

Between April 4 and May 10, 1982, fifty-four individuals developed a poison ivy-like dermatitis 1 to 8 days after eating imported cashew nuts. The patients had a very pruritic, erythematous, maculopapular eruption that was accentuated in the flexural areas of the body. Three had blistering of the mouth and four had rectal itching. Nineteen volunteers (eleven ill and eight well) were patch-tested with 2.5 gg of poison ivy urushiol and an acetone extract of cashew nut shells. Patch testing did not predict illness since positive tests to both materials occurred in those who had been ill as well as in those who had been well. Absence of cashew nut shells from two thirds of the bags probably accounted for the lack of correlation between patch testing and illness. All nine who reacted to the cashew extract also reacted to poison ivy urushiol. The three who were not sensitive to poison ivy had no reaction to cashew extract. Mass spectrometry of the cashew shell extract suggested the presence of cardol, one of the allergens in cashew shell oil. (J AM ACAD DERMATOI. 10:627–631, 1984.)