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This article presents an evaluation of a rapid-response crisis-intervention service, hospice at home (H@H), for patients with advanced cancer. The project took place in Glasgow, UK, between July 1999 and May 2001. An integral part of the (H@H) project was the concurrent evaluation, which attempted to explore a range of service and user outcomes. The service was able to prevent admission to, or facilitate discharge from, institutional care on 62 occasions. The evaluation found significant improvements in some areas of pain and symptom management. High levels of satisfaction were recorded by all service users. A partial cost analysis revealed that the medical and nursing support costs for the (H@H) would have been substantially reduced if throughput had been higher. The (H@H) project team agreed that a valuable lesson learned from the project was the importance of involving all key players from the outset when determining the requirements of a new service initiative. [ABSTRACT FROM AUTHOR]

Background: The Unmind Index is a 26-item, 7-subscale measure of mental health and wellbeing designed for use on the Unmind digital workplace mental health platform. The Unmind Index was developed and validated in the UK but is used internationally. This paper reports further psychometric validation of this measure for use in USA, Australia, and New Zealand (ANZ)., Methods: Participants in four countries completed the Unmind Index and a battery of existing measures. In Study 1 (N = 770), we validated the Unmind Index separately in USA and in ANZ. In Study 2 (N = 600), we used multiple group confirmatory factor analysis to test the measurement invariance of the Unmind Index across the UK, USA, and ANZ., Results: Study 1 establishes the factor structure, reliability, convergent and discriminant validity, and measurement invariance by age and gender of the Unmind Index separately for USA and for ANZ. Study 2 further demonstrates measurement invariance across locations, and establishes benchmark scores by location, age, and gender., Conclusions: We conclude that the Unmind Index is valid and reliable as a measure of mental health and wellbeing in these locations., Competing Interests: Authors ET and HB are employees of and hold stock options in Unmind Ltd. Authors LS and BSL are employees of the University of Cambridge Psychometrics Centre, which received payment from Unmind Ltd for consultancy services delivered by the authors. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Travers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Sixteen cycles of Brentuximab vedotin (BV) after autologous stem cell transplant (ASCT) in high-risk relapsed/refractory classical Hodgkin lymphoma demonstrated an improved 2-year progression-free survival (PFS) over placebo. However, most patients are unable to complete all 16 cycles at full dose due to toxicity. This retrospective, multicenter study investigated the effect of cumulative maintenance BV dose on 2-year PFS. Data were collected from patients who received at least one cycle of BV maintenance after ASCT with one of the following high-risk features: primary refractory disease (PRD), extra-nodal disease (END), or relapse <12 months (RL<12) from the end of frontline therapy. Cohort 1 had patients with >75% of the planned total cumulative dose, cohort 2 with 51-75% of dose, and cohort 3 with ≤50% of dose. The primary outcome was 2-year PFS. A total of 118 patients were included. Fifty percent had PRD, 29% had RL<12, and 39% had END. Forty-four percent of patients had prior exposure to BV and 65% were in complete remission before ASCT. Only 14% of patients received the full planned BV dose. Sixty-one percent of patients discontinued maintenance early and majority of those (72%) were due to toxicity. The 2-year PFS for the entire population was 80.7%. The 2-year PFS was 89.2% for cohort 1 (n=39), 86.2% for cohort 2 (n=33), and 77.9% for cohort 3 (n=46) (P=0.70). These data are reassuring for patients who require dose reductions or discontinuation to manage toxicity.

Episodic autobiographical memories are characterized by a spatial context and an affective component. But how do affective and spatial aspects interact? Does affect modulate the way we encode the spatial context of events? We investigated how one element of affect, namely aesthetic liking, modulates memory for location, in three online experiments ( n = 124, 79, and 80). Participants visited a professionally curated virtual art exhibition. They then relocated previously viewed artworks on the museum map and reported how much they liked them. Across all experiments, liking an artwork was associated with increased ability to recall the wall on which it was hung. The effect was not explained by viewing time and appeared to modulate recognition speed. The liking-wall memory effect remained when participants attended to abstractness, rather than liking, and when testing occurred 24 h after the museum visit. Liking also modulated memory for the room where a work of art was hung, but this effect primarily involved reduced room memory for disliked artworks. Further, the liking-wall memory effect remained after controlling for effects of room memory. Recalling the wall requires recalling one's facing direction, so our findings suggest that positive aesthetic experiences enhance first-person spatial representations. More generally, a first-person component of positive affect transfers to wider spatial representation and facilitates the encoding of locations in a subject-centered reference frame. Affect and spatial representations are therefore important, and linked, elements of sentience and subjectivity. Memories of aesthetic experiences are also spatial memories of how we encountered a work of art. This linkage may have implications for museum design.

Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce., Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being., Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations., Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales., Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs., (©Anika Sierk, Eoin Travers, Marcos Economides, Bao Sheng Loe, Luning Sun, Heather Bolton. Originally published in JMIR Mental Health (https://mental.jmir.org), 17.01.2022.)

To interact meaningfully with its environment, an agent must integrate external information with its own internal states. However, information about the environment is often noisy. In this study, we identify a neural correlate that tracks how asymmetries between competing alternatives evolve over the course of a decision. In our task participants had to monitor a stream of discrete visual stimuli over time and decide whether or not to act, on the basis of either strong or ambiguous evidence. We found that the classic P3 event-related potential evoked by sequential evidence items tracked decision-making processes and predicted participants' categorical choices on a single trial level, both when evidence was strong and when it was ambiguous. The P3 amplitudes in response to evidence supporting the eventually selected option increased over trial time as decisions evolved, being maximally different from the P3 amplitudes evoked by competing evidence at the time of decision. Computational modelling showed that both the neural dynamics and behavioural primacy and recency effects can be explained by a combination of (a) competition between mutually inhibiting accumulators for the two categorical choice outcomes, and (b) a context-dependant urgency signal. In conditions where evidence was presented at a low rate, urgency increased faster than in conditions when evidence was very frequent. We also found that the readiness potential, a classic marker of endogenously initiated actions, was observed preceding movements in all conditions - even when those were strongly driven by external evidence., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

In marching bands, sports, dance and virtually all human group behaviour, we coordinate our actions with others. Coordinating actions in time and space can act as a social glue, facilitating bonding among people. However, much of our understanding about coordination dynamics is based on research into dyadic interactions. Little is known about the nature of the sensorimotor underpinnings and social bonding outcomes of coordination in medium-sized groups-the type of groups, in which most everyday teamwork takes place. In this study, we explored how the presence of a leader and an unexpected perturbation influence coordination and cohesion in a naturalistic setting. In groups of seven, participants were instructed to walk in time to an auditory pacing signal. We found that the presence of a reliable leader enhanced coordination with the target tempo, which was disrupted when the leader abruptly changed their movement tempo. This effect was not observed on coordination with the group members. Moreover, participants' perceptions of being a follower and group cooperativeness increased in the presence of a leader. This study extends our knowledge about coordination beyond previous work on dyads. We discuss our results in light of sensorimotor coupling and social cohesion theories of coordination in groups.

Voluntary actions are preceded by a Readiness Potential (RP), a slow EEG (electroencephalogram) component generated in medial frontal cortical areas. The RP is classically thought to be specific to internally-driven decisions to act, and to reflect post-decision motor preparation. Recent work suggests instead that it may reflect noise or conflict during the decision itself, with internally driven decisions tending to be more random, more conflicted and thus more uncertain than externally driven actions. To contrast accounts based on endogenicity with accounts based on uncertainty, we recorded EEG in a task where participants decided to act or withhold action to accept or reject visually presented gambles, and used multivariate methods to extract an RP-like component. We found no difference in amplitude of this component between actions driven by strong versus weak evidence, suggesting that the RP may not reflect uncertainty. In contrast, the same RP-like component showed higher amplitudes prior to actions performed without any external evidence (guesses) than for actions performed in response to equivocal, conflicting evidence. This supports the view that the RP reflects the internal source of action, rather than decision uncertainty., (© 2020 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Actions are guided by a combination of external cues, internal intentions, and stored knowledge. Self-initiated voluntary actions,  produced without immediate external cues, may be preceded by a slow EEG Readiness Potential (RP) that progressively increases prior to action. The cognitive significance of this neural event is controversial. Some accounts link the RP to the fact that timing of voluntary actions is generated endogenously, without external constraints. Others link it to the unique role of a planning process, and therefore of temporal expectation, in voluntary actions. In many previous experiments, actions are unconstrained by external cues, but also potentially involve preplanning and anticipation. To separate these factors, we developed a reinforcement learning paradigm where participants learned, through trial and error, the optimal time to act. If the RP reflects freedom from external constraint, its amplitude should be greater early in learning, when participants do not yet know when to act. Conversely, if the RP reflects planning, it should be greater later on, when participants have learned, and plan in advance, the time of action. We found that RP amplitudes grew with learning, suggesting that this neural activity reflects planning and anticipation for the forthcoming action, rather than freedom from external constraint.

Faces with typically African features are perceived as darker than they really are. We investigated how early in processing the bias emerges, whether participants are aware of it, and whether it can be altered by explicit instructions. We presented pairs of faces sequentially, manipulated the luminance and morphological features of each, and asked participants which was lighter, and how confident they were in their responses. In Experiment 1, pre-response mouse cursor trajectories showed that morphology affected motor output just as early as luminance did. Furthermore, participants were not slower to respond or less confident when morphological cues drove them to give a response that conflicted with the actual luminance of the faces. However, Experiment 2 showed that participants could be instructed to reduce their reliance on morphology, even at early stages of processing. All stimuli used, code to run the experiments reported, raw data, and analyses scripts and their outputs can be found at https://osf.io/brssn., Competing Interests: Declaration of Competing Interest None. The authors declare no competing financial interests., (Copyright © 2020. Published by Elsevier Inc.)

The Readiness Potential (RP) is a slow negative EEG potential found in the seconds preceding voluntary actions. Here, we explore whether the RP is found only at this time, or if it also occurs when no action is produced. Recent theories suggest the RP reflects the average of accumulated stochastic fluctuations in neural activity, rather than a specific signal related to self-initiated action: RP-like events should then be widely present, even in the absence of actions. We investigated this hypothesis by searching for RP-like events in background EEG of an appropriate dataset for which the action-locked EEG had previously been analysed to test other hypotheses [Khalighinejad, N., Brann, E., Dorgham, A., Haggard, P. Dissociating cognitive and motoric precursors of human self-initiated action. Journal of Cognitive Neuroscience. 2019, 1-14]. We used the actual mean RP as a template, and searched the entire epoch for similar neural signals, using similarity metrics that capture the temporal or spatial properties of the RP. Most EEG epochs contained a number of events that were similar to the true RP, but did not lead directly to any voluntary action. However, these RP-like events were equally common in epochs that eventually terminated in voluntary actions as in those where voluntary actions were not permitted. Events matching the temporal profile of the RP were also a poor match for the spatial profile, and vice versa. We conclude that these events are false positives, and do not reflect the same mechanism as the RP itself. Finally, applying the same template-search algorithm to simulated EEG data synthesized from different noise distributions showed that RP-like events will occur in any dataset containing the 1⁄f noise ubiquitous in EEG recordings. To summarise, we found no evidence of genuinely RP-like events at any time other than immediately prior to self-initiated actions. Our findings do not support a purely stochastic model of RP generation, and suggest that the RP may be a specific precursor of self-initiated voluntary actions., (Copyright © 2019. Published by Elsevier Inc.)

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day., (Copyright © 2019. Published by Elsevier Inc.)

The inclination to touch objects that we can see is a surprising behaviour, given that vision often supplies relevant and sufficiently accurate sensory evidence. Here we suggest that this 'fact-checking' phenomenon could be explained if touch provides a higher level of perceptual certainty than vision. Testing this hypothesis, observers explored inverted T-shaped stimuli eliciting the Vertical-horizontal illusion in vision and touch, which included clear-cut and ambiguous cases. In separate blocks, observers judged whether the vertical bar was shorter or longer than the horizontal bar and rated the confidence in their judgments. Decisions reached by vision were objectively more accurate than those reached by touch with higher overall confidence ratings. However, while confidence was higher for vision rather than for touch in clear-cut cases, observers were more confident in touch when the stimuli were ambiguous. This relative bias as a function of ambiguity qualifies the view that confidence tracks objective accuracy and uses a comparable mapping across sensory modalities. Employing a perceptual illusion, our method disentangles objective and subjective accuracy showing how the latter is tracked by confidence and point towards possible origins for 'fact checking' by touch.

Humans have been shown to be capable of performing many cognitive tasks using information of which they are not consciously aware. This raises questions about what role consciousness actually plays in cognition. Here, we explored whether participants can learn cue-target contingencies in an attentional learning task when the cues were presented below the level of conscious awareness and how this differs from learning about conscious cues. Participants' manual (Experiment 1) and saccadic (Experiment 2) response speeds were influenced by both conscious and unconscious cues. However, participants were only able to adapt to reversals of the cue-target contingencies (Experiment 1) or changes in the reliability of the cues (Experiment 2) when consciously aware of the cues. Therefore, although visual cues can be processed unconsciously, learning about cues over a few trials requires conscious awareness of them. Finally, we discuss implications for cognitive theories of consciousness.

Purpose Constipation in hospitalised older adults leads to adverse events and prolonged stay. The purpose of this paper, therefore, is to effectively prevent and manage constipation in older adults undergoing inpatient rehabilitation using a multidisciplinary war on constipation (WOC) algorithm. Design/methodology/approach A quality improvement project in older adults undergoing rehabilitation for prevention and constipation management was conducted. Quality improvement "plan-do-study-act" cycles included an initial constipation audit in the wards and meetings with the multidisciplinary team (MDT) to develop an algorithm for the preventing, detecting and effectively treating constipation. Findings The project resulted in a 14 per cent reduction in constipation incidence after the newly developed WOC algorithm was introduced. The project also improved communication between patients and the MDT around patients' bowel habits. Practical implications The project shows that using quality improvement methods in rehabilitation settings, earlier detection, earlier intervention and overall reduction in constipation in older adults can be achieved. Originality/value The WOC algorithm has been developed and institutionalised in the current setting. This algorithm may also be applicable in other inpatient settings.

Regret over missed opportunities leads adults to take more risks. Given recent evidence that the ability to experience regret impacts decisions made by 6-year-olds, and pronounced interest in the antecedents to risk taking in adolescence, we investigated the age at which a relationship between missed opportunities and risky decision-making emerges, and whether that relationship changes at different points in development. Six- and 8-year-olds, adolescents and adults completed a sequential risky decision-making task on which information about missed opportunities was available. Children also completed a task designed to measure their ability to report regret when explicitly prompted to do so. The relationship between missed opportunities and risky decision-making did not emerge until 8 years, at which age it was associated with the ability to explicitly report regret, and was stronger in adults than in adolescents. These novel results highlight the potential importance of the ability to experience regret in children and adolescents' risky decision-making.

Reasoning that is deliberative and reflective often requires the inhibition of intuitive responses. The Cognitive Reflection Test (CRT) is designed to assess people's ability to suppress incorrect heuristic responses in favour of deliberation. Correct responding on the CRT predicts performance on a range of tasks in which intuitive processes lead to incorrect responses, suggesting indirectly that CRT performance is related to cognitive control. Yet little is known about the cognitive processes underlying performance on the CRT. In the current research, we employed a novel mouse tracking methodology to capture the time-course of reasoning on the CRT. Analysis of mouse cursor trajectories revealed that participants were initially drawn towards the incorrect (i.e., intuitive) option even when the correct (deliberative) option was ultimately chosen. Conversely, participants were not attracted to the correct option when they ultimately chose the incorrect intuitive one. We conclude that intuitive processes are activated automatically on the CRT and must be inhibited in order to respond correctly. When participants responded intuitively, there was no evidence that deliberative reasoning had become engaged., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Over the past few years the issue of child marriage has received growing political and programmatic attention. In spite of some progress in a number of countries, global rates have not declined over the past decade. Knowledge gaps remain in understanding trends, drivers and approaches to ending child marriage, especially to understand what is needed to achieve results on a large scale. This commentary summarizes the outcomes of an Expert Group Meeting organized by World Health Organization to discuss research priorities on Ending Child Marriage and Supporting Married Girls. It presents research gaps and recommends priorities for research in five key areas; (i) prevalence and trends of child marriage; (ii) causes of child marriage (iii) consequences of child marriage; (iv) efforts to prevent child marriage; (v) efforts to support married girls.

Background: There is lack of consensus on the incidence of appendiceal carcinoids in recent times. The influence of number of appendicectomies performed has been postulated to play a role in this. To determine the incidence and clinico-pathological profile of appendiceal carcinoids in a cohort of patients undergoing emergency appendicectomies for clinically suspected acute appendicitis, and examine the influence of the trend (if any) of the number of appendicectomies performed on the overall incidence of appendiceal carcinoids., Methods: A retrospective analysis of patients diagnosed with appendiceal carcinoids following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011. The patient cohort was divided into Group 1 (March 2007 - March 2009) and group 2 (April 2009 - April 2011) to study the influence of time trends on incidence of appendiceal carcinoids. Statistical analyses were performed using the Statistical Product and Service Solutions, SPSS 14.0 for Windows., Results: Of 506 patients who underwent emergency appendicectomy for acute appendicitis, 8 patients (1.6%) were found to have appendiceal carcinoids. The median age was 23 years with 7 patients being female. There was no difference in the incidence of appendiceal carcinoids over the two time periods (P < 0.12)., Conclusions: Appendiceal carcinoids were found in 1.6% of patients undergoing emergency appendicectomy for acute appendicitis. These tumors are found more commonly in young females with a predilection for the tip of the appendix. The perceived increased incidence appendiceal carcinoids appear to be unrelated to the increase in the number of appendicectomies being performed., Competing Interests: None declared.

Introduction: Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity., Objective: To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients., Materials and Methods: A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2., Results and Discussion: 506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20%) patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001). Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05)., Conclusions: Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.

There is currently much interest regarding the needs of people affected by non-malignant disease and whether or not these are being met by palliative care services. The evidence available appears to support the conclusion that while there is a general inequality of access, some individuals with non-malignant conditions such as cardiac disease and motor neurone disease are able to access palliative care services more readily than others. Huntington's disease (HD) is a devastating neurological condition of long duration and as such may have a lengthy palliative phase. Consequently, a diagnosis of HD will have a major impact on the quality of life of the affected individual and their family. For carers, an understanding of this challenging disease and its prognosis is essential for the provision of appropriate and effective care. This article reviews the links between HD and palliative care and discusses some of the challenges facing patients, families and health care professionals in adopting a palliative approach in the management of the disease.

A 2-year trial of a single Nestorone (NES) rod implant was conducted at three Latin American centers, each enrolling 100 women. We studied the safety, effectiveness and acceptability of this progestin-releasing contraceptive implant. Three pregnancies occurred, the last at 18 months of use. Because no pregnancies were expected in the first 18 months, the trial was halted. At that time, 224 women had completed at least 18 months of use, and 99 women had used the implant for more than 24 months. Few participants used adjunctive contraception between the time the study was halted and the time they had their implant removed. No additional pregnancies occurred before the removal of the last implant. The 2-year cumulative pregnancy rate was 1.7 per 100 with a Pearl index of 0.6 per 100 for the 2-year period. The 1-year and 2-year continuation rates were 80.5 and 66.7 per 100, respectively. Menstrual and medical disturbances were the principal reasons for discontinuation, followed by planned pregnancy. Headache and weight gain frequently led to discontinuation. The NES implant had little important effect on most clinical chemistry and lipid parameters. Over the study course, the mean change in hemoglobin was <1%. Slight modification of the design of this single 2-year implant, restoring features previously examined in clinical trials, is likely to improve its effectiveness. A single NES implant appears to provide acceptable contraception for women.

This article presents an evaluation of a rapid-response crisis-intervention service, hospice at home (H@H), for patients with advanced cancer. The project took place in Glasgow, UK, between July 1999 and May 2001. An integral part of the (H@H) project was the concurrent evaluation, which attempted to explore a range of service and user outcomes. The service was able to prevent admission to, or facilitate discharge from, institutional care on 62 occasions. The evaluation found significant improvements in some areas of pain and symptom management. High levels of satisfaction were recorded by all service users. A partial cost analysis revealed that the medical and nursing support costs for the (H@H) would have been substantially reduced if throughput had been higher. The (H@H) project team agreed that a valuable lesson learned from the project was the importance of involving all key players from the outset when determining the requirements of a new service initiative.

This article is the first in a series of two which report on the development and evaluation of a rapid response crisis intervention service for patients in the advanced stages of cancer. A number of recent studies have identified the need for rapid response teams who are able to provide palliative and specialist palliative care in the home setting (King et al, 2000; Mantz, 2000; Thomas, 2001). By providing an overview of the relevant literature and describing the experience of developing this scheme the authors' aim is to share good practice with interested professionals who may be contemplating setting up similar schemes. This article outlines the development of a 'hospice at home' scheme until its launch and identifies the strategies used to ensure the early success of the project.

Cost accounting is the basic "tool" for identifying the expenses associated with laboratory operations. A budget is a planning tool that allows the director and manager to visualize the evolution of expenses, assets, liabilities, and revenues over a period of time. It is a quantitative annual plan of activities and programs that helps an organization measure the progress toward its financial goals on a periodic basis. A knowledge of how to develop and understand a budget is essential for every director and manager.

Cost accounting is the most basic element of the laboratory's financial management structure. Historically, cost accounting in the nonmedical world referred to accumulating and assigning costs to units of production and departments, primarily for inventory valuation and income determination. In the health industry, microcost accounting is distinguishable from macrocost (management/internal) accounting and serves multiple purposes. Microcost accounting pertains to gathering and providing information for decision making. The range of decisions include managing recurring operations, making nonrecurring strategic decisions, and formulating major organizational policies. Macrocost accounting fulfills the legal requirements of reporting to stockholders, auditors, governmental agencies, and other external parties.

From a financial standpoint, one of the most valuable assets in the survival of a health-care organization is the clinical laboratory. Laboratory directors, managers, and supervisors have indicated their overwhelming need to understand finance, especially cost management, to CLMA and to the author at national meetings and workshops, Tremendous financial pressures are being applied in health-care organizations across the country. Two strategic factors in their successful move into the 21st century are more appropriate test utilization and cost control in the laboratory.

The establishment of mobile or portable laboratories as one strategy for delivery of laboratory services at alternative sites is evaluated. The mobile laboratory may be used to replace centralized laboratory testing in areas of critical need, such as critical care areas of the hospital in which relatively large numbers of tests are needed quickly. Other possible areas of use include outpatient clinics and other outreach settings in which care of the patient may be hastened by the availability of laboratory data on a real-time basis. In such areas where a need is established, mobile laboratory testing may be performed economically and may enhance the position of the medical technologist as a hands-on clinical caregiver.