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Importance: An evidence-practice gap exists for cancer pain management, and cancer pain remains prevalent and disabling. Objectives: To evaluate the capacity of 3 cancer pain guideline implementation strategies to improve pain-related outcomes for patients attending oncology and palliative care outpatient services. Design, Setting, and Participants: A pragmatic, stepped wedge, cluster-randomized, nonblinded, clinical trial was conducted between 2014 and 2019. The clusters were cancer centers in Australia providing oncology and palliative care outpatient clinics. Participants included a consecutive cohort of adult outpatients with advanced cancer and a worst pain severity score of 2 or more out of 10 on a numeric rating scale (NRS). Data were collected between August 2015 and May 2019. Data were analyzed July to October 2019 and reanalyzed November to December 2021. Interventions: Guideline implementation strategies at the cluster, health professional, and patient levels introduced with the support of a clinical champion. Main Outcomes and Measures: The primary measure of effect was the percentage of participants initially screened as having moderate to severe worst pain (NRS ≥ 5) who experienced a clinically important improvement of 30% or more 1 week later. Secondary outcomes included mean average pain, patient empowerment, fidelity to the intervention, and quality of life and were measured in all participants with a pain score of 2 or more 10 at weeks 1, 2, and 4. Results: Of 8099 patients screened at 6 clusters, 1564 were eligible, and 359 were recruited during the control phase (mean [SD] age, 64.2 [12.1] years; 196 men [55%]) and 329 during the intervention phase (mean [SD] age, 63.6 [12.7] years; 155 men [47%]), with no significant differences between phases on baseline measures. The mean (SD) baseline worst pain scores were 5.0 (2.6) and 4.9 (2.6) for control and intervention phases, respectively. The mean (SD) baseline average pain scores were 3.5 (2.1) for both groups. For the primary outcome, the proportions of participants with a 30% or greater reduction in a pain score of 5 or more of 10 at baseline were similar in the control and intervention phases (31 of 280 participants [11.9%] vs 30 of 264 participants [11.8%]; OR, 1.12; 95% CI, 0.79-1.60; P = .51). No significant differences were found in secondary outcomes between phases. Fidelity to the intervention was low. Conclusions and Relevance: A suite of implementation strategies was insufficient to improve pain-related outcomes for outpatients with cancer-related pain. Further evaluation is needed to determine the required clinical resources needed to enable wide-scale uptake of the fundamental elements of cancer pain care. Ongoing quality improvement activities should be supported to improve sustainability.

Infantile colic is a common self-limiting condition that causes significant distress to parents and caregivers. There is no clear cause, gold standard remedy or preventative action. The role of the family physician is to rule out sinister causes while providing counselling and reassurance for parents. The mainstay of management is parental support and reassurance while looking out for red flags in the baby such as fever, lethargy, distended abdomen and failure to thrive. This article provides a framework to approaching infantile colic and practical pointers to share with parents.

For long-distance migratory songbirds, morphological traits such as longer wings and a smaller body size are predicted to increase migration efficiency. Due to previous limitations in our ability to track the long-distance journeys of small-bodied birds, the relationship between morphology and start-to-finish migration performance has never been fully tested in free-living songbirds. Using direct-tracking data obtained from light-level geolocators, we examined the effects of morphological factors (wing and body size) on spring and fall migration performance (flight speed, duration of stopovers, total stopovers taken) of a widely distributed, trans-hemispheric migratory songbird, the purple martin (Progne subis) (n = 120). We found that smaller-bodied birds spent fewer days at stopovers along fall migration, but larger-bodied birds spent fewer days at stopover and took fewer stopovers during spring migration. More of the variation in fall migration performance was explained by morphology, as compared to spring migration, possibly indicating a larger influence of environmental conditions on spring performance. Overall, our results partially support long-standing and previously untested predictions regarding the influence of intrinsic factors on migration performance. Future research should examine the influence of environmental variation on migration performance as well as additional morphological traits that may contribute to migration performance.

We propose a strategy for real time multicolour detection of light emitting particles under flow conditions, using the diffracted orders of a grating. The method relies on the fact that the spatial (angular/linear) separation between the orders of a diffraction grating is a wavelength dependent quantity. Thus, the difference in arrival times at a fixed detector for neighbouring orders produced by a moving, light-emitting particle can be used as a wavelength sensing mechanism. We demonstrate this functionality using a prototype PDMS microfluidic device that incorporates a focusing transmission grating. A key attribute of this approach is that it requires only a single sensitive detector, such as a photomultiplier tube, in contrast to many conventional approaches which require multiple sensitive detectors or a detector array.

Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches.An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future.A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79).Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.

We describe the monolithic integration of microfluidic channels, optical waveguides, a collimating lens and a curved focusing transmission grating in a single PDMS-based microsystem. All optical and fluidic components of the device were simultaneously formed in a single layer of high refractive index (n∼1.43) PDMS by soft lithography. Outer layers of lower-index (n∼1.41) PDMS were subsequently added to provide optical and fluidic confinement. Here, we focus on the design and characterization of the microspectrometer part, which employs a novel self-focusing strategy based on cylindrical facets, and exhibits resolution

The design, fabrication, and quasi-static testing of a high fill factor electrostatically actuated MEMS mirror array with application to spectrometry are presented. Mirror inclination with applied voltage is demonstrated by optical profilometry.

It is essential to determine the optimal treatment of intertrochanteric fractures due to their high incidence and related public health burden. Debate remains as to whether dynamic hip screws (DHS) or proximal femoral nails (PFNs) are best practice, and this pilot study seeks to collect information relevant to this query.We undertook a retrospective audit of 144 patients who received a dynamic hip screw or a proximal femoral nail in order to compare age, sex, duration of surgery, duration of hospitalization, time of first mobilization, and rate anaemia, sepsis, avascular necrosis, prosthesis failure, revision, deep vein thrombosis, pulmonary embolus, non-ST elevation myocardial infarction, common peroneal nerve palsy and death between implantation of a DHS and a PFN.No differences were found between groups in age, duration of surgery, duration of hospitalization, time of first mobilization and rate of complications. Statistically significant differences were found in sex distributions, operation time and length of stay. However, analysis of median operation time and length of stay when adjusted for sex revealed no significant differences.This study demonstrated no statistically significant differences in peri- and post-operative measures between patients undergoing intertrochanteric fracture fixation via PFN or DHS. This is the only data from Australian hospitals, and further national research is needed.

INTRODUCTIONThis paper presents the results of a case study of twenty working class Italian immigrant couples residing in Toronto. The investigation focuses on the subjective experiences of wives and husbands who have migrated from one socio-economic and socio-cultural environment to another. Specifically, its aims are to determine the impact of these changes, especially as highlighted by wives' employment, on the gendered division of labour and power dynamics between the couples.There is a growing body of literature documenting the problems experienced by immigrants and their families as a result of migration to a new social and cultural setting and the concommitent stresses and strains of assimilation and adaptation processes. One of the greatest of these changes is the economic disempowerment of the male breadwinner, and the realization of many husbands and wives that breadwinning must be shared between them (and often, other family members) if the family is to maintain economic solvency. For example, research undertaken by Lanphier (1980) and Lam and Richmond (1987) have produced evidence that immigrants generally have a lower occupaitonal status than their educational attainment would predict and must often "adapt" to this situation by sharing economic roles between spouses. A number of studies have provided consistent evidence indicating immigrant women (Richmond, 1990; Boyd, 1990; Grinstaff, 1990; Basavarajappa and Verma, 1990) and men (Breton et al, 1990) are systematically disadvantaged in employment status and income. For the Italians, Breton et al found that while the majority Canadian male has a mean occupational status score of roughly 50 points, Italian males are 12 points below and their income is 5% to 15% less than that of the majority Canadian male. Similar patterns have been observed for Italian females.For many, especially those from the less industrialised regions of the world, this is a major and often traumatic change in their way of life. For example, in the report entitled After the Door Has Been Opened, Beiser (1988) reports that among immigrant families in which husbands and wives must both engage in paid work, the consequences are a loss of self-esteem by husbands, extreme stress by wives, and other strains on wives, husbands and other family members, which result in psychological and social problems. These problems include family violence, mental health problems and marital breakdown. On the positive side, Haddad and Lam (1988) found evidence that many immigrant families also confront their new socio-economic realities by realizing the need and urency of pooling the familial resources, an important consequence of which is a greater contribution to housework and child care tasks by husbands.Theorizing on the immigrant individual and family adaptation processes, D. Herberg (1989) advances a conceptual and analytic model which integrates the adaptation framework with E.T. Hall's concept of contexting. For Herberg, adaptation and contexting serve to "conceptualize the flow and transitions that highlight the ethnocultural structure of social life" (D. Herberg, 1989:258). D. Herberg argues that ethnic groups from non-western and less industrialized societies come from "high context" cultures, characterized, among other things, by social structures which revolve around the extended family, a sex-segregated division of labour and hierarchical power relations. On the other hand, western industrial societies, such as Canada, are characterized by the nuclear family, individualism, sex integration and egalitarian power relations, at least in the family. D. Herber explains that for ethnic groups who come from less industrialized "high context" cultures migration to an industrialized, "low context" culture (such as that of Canada), leads to a more flexible and less sex-segregated division of domestic labour, and egalitarian power dynamics within their families. Reminiscent of Blood and Wolfe's (1960) Conjugal Power theory, which is based within liberal functionalist assumptions, D. …

Sufficient conditions are developed for solutions to certain classes of nonlinear continuous-time systems to be located within certain a priori specified sets over a given time interval. Analogous results are obtained for discrete-time systems, and in both cases such conditions are shown to be necessary under mild additional hypotheses.

The study presents empirical data, based on interviews with 117 immigrant fathers/husbands, about their involvement in family work. We found that their pattern of behaviour and participation in family work can be grouped into three types: (1) "Traditionalists" who refused to do more in compensation for their spouses' decrease in time availability for family chores due to employment; (2) "Situationalists' who did a minimal amount of domestic labour and believed that they had limited choice in the matter due to "situational constraints"; and (3) "Adaptors" or "prioritizors" who because of the presence of preschoolers and/or their wives being employed fulltime did a fair number of domestic chores as a necessary strategy to maximize their family's well-being. The involvement of these husbands/fathers did not support the theoretical underpinnings of the Exchange/Resource Theory in explaining the family relation/interaction between husband and wife within the context of family work. The analysis points to the need for a critical re-assessment of this theory. However, the findings suggest that changes in sex role attitudes and in the socio-economic and socio-cultural milieu as a result of their migration to Canada, and importantly, how they cope with these changes are important factors in explaining the division of labour in family work.

Converse theorems for Liapunov stability of non-linear difference equations are presented, which improve upon past results in this area. The main improvement consists in not assuming that solutions can be extended backward in time. When such assumptions are made, however, it is shown that necessary conditions for finite-time stability of non-linear difference equations can be readily derived.

This paper proposes an LFG constraint-based approach to binding in Mandarin Chinese and Cantonese. We illustrate the power of LFG’s f-structure in developing a formal model which is, in essence, a unifying proposal integrating syntactic anaphoric binding with pragmatically-rooted but grammaticised logophoric binding. The anaphoric-binding component of our model resolves the local binding of complex reflexives and that of simplex reflexives, whereas the logophoric-binding component handles the long-distance binding of simplex reflexives. Our view that Chinese binding is best explained by a dual system encompassing syntactic (anaphoric) and pragmatic (logophoric) aspects is in line with Huang and Liu (2001). While it is not easy for a syntactic theory to accommodate logophoric binding, the LFG formalism has a high degree of flexibility, allowing it to model both types of binding while maintaining its formal, mathematical rigour. Our constraint-based proposal offers an alternative binding theory in response to recent Minimalist proposals on Chinese binding (e.g., Giblin, 2016; Reuland, Wong & Everaert, 2020), opening up a cross-theoretical dialogue. We establish the notion of grammaticised logophoricity in Chinese binding in connection with crosslinguistic studies. Empirically, we examine a range of data to clarify properties of Chinese reflexives and settle past debates, in particular, the animacy debate in relation to typological research on adnominal possession. The comparison between Mandarin Chinese and Cantonese contributes to the comparative study of binding phenomena in Sinitic languages.