bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring benefits at end of life for economic evaluation: measure development and a ‘thinkaloud’ study
Authors: Coast J. , Sutton E. , Orlando R. , Armour K.
Published: May 2012

Introduction

NICE uses economic evaluation to determine which interventions (including symptom control) provide most benefit for the resources used. Current health-gain measures for economic analysis may miss important benefits of holistic end of life care and these interventions may not be prioritised.

Aims and Methods

To develop and evaluate a new measure for economic evaluation of end of life care. In-depth interviews with 23 informants at different stages along the dying trajectory (general population, residential care, palliative care) explored what informants felt was important about end of life care, dying and death. Constant comparison was used to develop conceptual attributes; repeat interviews with 12 informants checked these attributes and generated wording for the measure. Interviews with patients (n=35), family members or carers (n=20) and health professionals (n=20) will use the ‘thinkaloud’ technique to study the measure's feasibility and validity.

Results

Seven attributes emerged based on what people felt was important to them: autonomy, love, physical suffering, emotional suffering, dignity, support and preparation. These provide the basis for seven questions in a simple measure expressed in terms of capability, each with four levels. Thinkaloud interviews will provide important information about who could complete the measure, and an understanding of why differences occur when measures are completed by different groups.

Conclusion

Rigorous methods have been used to develop a measure for use in economic evaluation that will more accurately reflect benefits of end of life care. Validation is ongoing.
The Responsive Needs Tool – unlocking communication of end of life care needs.
Authors: Ball B. , Johnson B. , Bake J.
Published: May 2012

Introduction

The Lincolnshire Home Deaths Project Group brought together organisations from across the county to develop new ways of working that were patient focussed and to ensure that end of life services dovetailed. This included a night care pilot which identified the need for an assessment and communication tool endorsed by the health and social care community to enable the needs led prioritisation of resource in end of life care.

Aims and Methods

To enable clear, accurate and effective communication of need across organisations to support the allocation and re-allocation of available night care resources for patients at the end of life based on their clinical need. The ‘responsive need’ tool was devised by members of the group using the work of two organisations, Marie Curie Cancer Care and St Barnabas Lincolnshire Hospice and the Gold Standards prognostic indicators as a resource.

Results

The tool has become the common ‘currency’ of communication countywide and is incorporated into SystmOne palliative care template. It has enabled the provision of end of life care according to need, and stopped unmet need for complex patients in the pilot area. Given clinicians confidence that the care will be there when the patient needs it; releasing care and supporting new ways of working.

Conclusion

The responsive need tool has supported choice at the end of life for patients and would be of interest to both those commissioning and providing end of life care.
Parkinson's Disease Support Workers advise on symptom control
Authors: G. Kernohan W. , Waldron M. , Hasson F. , McLaughlin D. , Cochrane B.
Published: May 2012

Introduction

The symptoms of PD vary but with no cure, people with advanced disease experience distressing symptoms, such as motor complications, dementia, depression, pain and gastro intestinal symptoms which can be difficult to manage. There are many unmet needs such as lack of information, ad hoc delivery of services and a lack of preparation.

Aims & Methods

To investigate the palliative care needs of people with Parkinson's Disease as perceived by support workers. Semi structured interviews were undertaken with seven PDUK support workers. With permission interviews were audio recorded, transcribed and analysed using content analysis. Demographic variables were recorded.

Results

Participants included two information and support workers, an information manager, a branch and voluntary support officer, a manager, a service development officer and an education and training officer who provide advice to people with PD. Seminars with nursing home staff and in-service GP training sessions are held to increase understanding of PD and its symptoms such as ‘freezing’. The participants stressed the importance of clients' PD medication timetable when in a hospital or nursing home settings. They also advocate for more nurse specialists and for early referral to therapists for clients to learn how to deal with symptoms and improve their quality of life.

Conclusion

People with PD can experience distressing symptoms both physically and psychologically. Increasing the knowledge and understanding of their health professionals regarding PD symptom control and medication effects within a palliative care approach would help alleviate their distress and increase their quality of life.
An evaluation of the use of traditional opioids and immediate-release fentanyl in the management of breakthrough cancer pain in an integrated cancer network
Authors: Nwosu A. , Marley K. , Sulaivany E. , Dickman A. , Littlewood C.
Published: May 2012

Introduction

Breakthrough cancer pain (BTcP) is common and is associated with significant morbidity. Immediate release Fentanyl products are licensed for the management of BTcP; however, some practical concerns exist about their safety and routine use in clinical practice.

Aims and Methods

To identify the multi-disciplinary team (MDT) experience in managing BTcP in relation to APM guidance. To identify the MDT experience of using immediate-acting Fentanyl products in the management of breakthrough cancer pain. To develop new regional guidelines to help health professionals manage breakthrough cancer pain. A literature review informed the development of two audit surveys which examined the health professional's experience of: (i) Managing a patient with BTcP. (ii) Using immediate-acting Fentanyl products. Electronic surveys were distributed to multidisciplinary members of four integrated cancer networks during August 2011.

Results

Twenty-eight BTcP surveys and 29 Fentanyl products survey proformas were completed. BTcP was identified correctly in most instances (80.8% of individuals had their background cancer pain controlled). Oxynorm was the most popular short-acting opioid (32% of occasions); Abstral was the most popular immediate-release Fentanyl preparation across hospice, hospital and community settings. Most episodes of BTcP were relieved in 30 minutes (56%). Concerns about storage and disposal (45%), delay in accessing medicines (45%), prescribing issues (62%) and education of generalists (62%) were highlighted by respondents.

Conclusion

Most episodes of BTcP were correctly identified and in 56% of cases resolved within 30 minutes of receiving analgesia. Concerns around prescribing of immediate-acting Fentanyl products and the education of generalists were highlighted.
‘Battling on’ and ‘blinkered’: carer experiences of home based care at the end of life
Authors: Harrop E. , Byrne A. , Nelson A.
Published: May 2012

Introduction

The physical care needs of patients approaching the end of life are considerable and require specialist knowledge and skills amongst those who care for them. However, when hospice patients are discharged back home families often express concern as they receive no formal guidance on practicalities of physical care and instead adopt a ‘trial and error approach’ to palliative care. This is not only problematic for the patient but also impacts upon carer wellbeing.

Aims and Methods

To explore the experiences of carers and health professionals of end of life care provided in the home setting by informal carers. To explore views on the information and training needs of carers and how these might feasibly be addressed via interventions. Two focus groups with hospice based nurses and two groups with carers/former carers of patients at the hospice. Discussions explored experiences of, and views on, the challenges of providing care in the home setting, the information and training needs of carers, and possible interventions. Results: Thematic analysis of the data has indicated knowledge gaps and concerns amongst carers relating to practical care tasks and uncertainty over what support services are available and when and where to get help. The data also provides examples of how such concerns impact upon carer wellbeing and adaptation, and how carer and patient identities influence service use.

Conclusion

Carers experience a complex set of challenges, needs and barriers when providing end of life care, with implications for patient care, carer wellbeing and interventions which provide support to carers.
Palliative radiotherapy in addition to self-expanding metal stent for improving outcomes of dysphagia and survival in advanced oesophageal cancer: ROCS (Radiotherapy after Oesophageal Cancer Stenting) Study
Authors: Byrne A. , Adamson D. , Sivell S. , Griffiths G. , Crosby T. , Staffurth J. , Cohen D. , Blazeby J. , Fitzgibbon J. , Nelson A.
Published: May 2012

Introduction

Oesophageal cancer patients often experience dysphagia due to the blockage of the gullet by the tumour, resulting in severe restrictions on food intake, physical activity, social functioning and quality of life. One of the more effective treatments to improve swallowing is the insertion of a metal stent (SEMS), which then self expands to open up the gullet. The addition of radiotherapy may also help to improve the problems causes by dysphagia and provide an additional survival benefit.

Aims and Methods

To add radiotherapy to SEMS and examine the impact on: i) duration of improvement of swallow; ii) quality of life; iii) survival. A pragmatic, randomised controlled trial of external beam radiotherapy plus SEMS versus SEMS alone in 396 patients with oesophageal cancer. Radiotherapy will be given as an outpatient either as five treatments over one week, or ten treatments over two weeks. Questionnaires assessing quality of life and cost effectiveness will be completed at weeks two, four, eight and twelve and then monthly for up to one year. Semi-structured interviews will be held with: i) trial participants to explore their experiences while on the trial; ii) patients who decide not to take part in the trial to explore reasons for non-consent.

Results

This trial will provide data on the time to progression of dysphagia, quality of life, morbidity and re-intervention rates, survival, patient attitude to treatment and cost-effectiveness of the treatment.

Conclusion

Achieving funding for large scale trials capable of answering important symptom control questions is feasible using a pragmatic approach.
Clinical Care Tracker: a new member of community Specialist Palliative Care team
Authors: Hayes J. , Nelson A. , Harry K. , Hayles L. , Byrne A. , Stephens K.
Published: May 2012

Introduction

The Clinical Care Tracker (CT) role has been established to enhance the quality and efficiency of services provided by the Community Specialist Palliative Care Team (CSPCT) at Marie Curie Hospice, Penarth. The CT is a Registered Nurse who works exclusively on the telephone, providing a point of contact for any patient or family on the CNS caseload and for clinicians and services involved in their care. The team implemented a traffic light system for stratifying the community specialist palliative care caseload and the ‘green’ patients are monitored by the CT.

Aims & Methods

To provide stable patients and their carers with regular contact, support or self-care information. To monitor for change in clinical status or indication of likely deterioration, prompting immediate increased input from CSPCT. For patients who are in crisis, the CT enables a rapid assessment of their needs and escalation to the relevant care to ensure the patients' needs are met. To supplement the face to face support provided by the CSPCT team. This is an innovative approach based on the Croydon model of a virtual ward in the community (Lewis, 2006) and the Department of Health model of a care tracker for chronic conditions (Player, 2007). Evaluation has been undertaken using a variety of sources including focus groups, observation, semi-structured interviews, impromptu interviews, attendance at weekly multi-disciplinary meeting and analysis of activity data.

Results

The evaluation highlighted a risk that palliative care patients who are not receiving regular input from the Specialist Palliative Care CNS can get lost in the complex system of care. This is of particular relevance when they have a lower level of need, but are likely to deteriorate in the future. The Care Tracker offers a more appropriate way of stepping down the intensity of the support and giving the patient more choice about how much they engage with the service.

Conclusion

The care tracker provides a way to monitor patients and enable the CNS team to intervene in a timely way if the patient deteriorates and their needs become more complex.
The prevalence of neurological disorders, including those of a palliative nature, in people aged 70 years and over in the Hai district of northern Tanzania
Authors: Dewhurst F. , Dewhurst M. J. , K. Gray W. , Howlett W. , Warren N. , Orega G. , Walker R. W.
Published: May 2012

Introduction

There are few data on neurological disorder prevalence from developing countries, particularly sub-Saharan Africa (SSA), and none specific to the elderly despite a need highlighted by the World Health Organisation.

Aims and Methods

We determined the prevalence of neurological disorders in those aged 70 years and over in a rural African community, described their sub-groups including those of a palliative nature, level of diagnosis and treatment and associated disability. We carried out an epidemiological survey in the Hai district demographic surveillance site (DSS) in northern Tanzania (n=161,119). 2232 participants (1/4 of the DSS 70+ population) were screened with a validated screening questionnaire with high sensitivity (87.8%) and specificity (94.9%). Positive responders underwent full neurological assessment to confirm or refute the presence of a neurological diagnosis.

Results

In 2232 participants, there were 384 neurological diagnoses amongst 349 people. The age adjusted prevalence (cases/1000 population) of neurological diagnoses (95% confidence intervals (CI)) was 168.9/1000 (153.4 to 184.5). Palliative neurological disorders included Parkinson's disease, progressive supra-nuclear palsy and motor neuron disease. 14.6% had been correctly diagnosed and 10.6% were on appropriate treatment. Neurological disorders were associated with disability.

Conclusion

This is the first community-based neurological disorder prevalence study specifically in the elderly in SSA. It reveals a high prevalence of neurological morbidity, low diagnosis and treatment levels and high associated disability and demonstrates the contribution neurological morbidity makes to the non-communicable disease epidemic.
How many people need expert symptom assessment but are not in the last year of life?
Authors: Maher J. , McConnel H.
Published: May 2012

Introduction

Earlier palliative assessment and support for symptom self management may reduce distress and health resource use in incurable illness. The end of life tariff includes assessment of unstable symptoms, even if not in the last year of life. Current hospital recording systems do not allow timely identification of these individuals. Understanding how many people have palliative needs but are not in the last year of life will be increasingly important.

Aims and Methods

To identify people living with cancer at different phases across the care pathway including those at risk of developing complex symptoms, with progressive illness or at end of life. Using available data and clinically led assumptions we make indicative estimates of the number of people in different health states – particularly those with palliative care needs and not in the last year of life.

Results

We estimate pathway phases for breast, prostate, colorectal and lung cancers. For example, we estimate that in one year 48,000 women develop breast cancer in the UK and 12,000 are in the last year of life 24,000 have progressive illness and are not in the last year of life.

Conclusion

We provide ‘good enough’ estimates of the number of patients with different health needs and transition points in the cancer care pathway to stimulate debate and inform commissioners about areas of need. While cancer is seen to have the most predictable pattern of deterioration, as more incurable cancers become treatable, illness trajectories will become more comparable to other chronic illness. A similar approach might be taken with other illnesses.
Mortality and medical care after bereavement: a general practice cohort study
Authors: King M. , Varagunam M. , Petersen I. , Jones L. , Marston L. , Nareth I.
Published: May 2012

Introduction

Bereaved spouses or partners are thought to be at increased risk of morbidity and mortality. However, there are few large prospective studies and results are inconsistent. We estimated the relative mortality, prescription of psychotropic medication and use of primary medical care services in adults whose cohabitee died of cancer.

Aims and Methods

Cohort study using The Health Improvement Network (THIN) UK primary care database. Participants were (1) people aged over 40, who were registered with general practices and had been exposed to the death of a cohabitee from cancer; and (2) a comparison cohort frequency matched on five year age bands and sex who were cohabiting with a living partner. The baseline was chosen as six months before the date of the cancer death for the exposed group and a random date for the unexposed group. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were estimated using random effects Poisson regression to account for clustering within general practices and adjusting for other key variables.

Results

92,129 patients were studied for a median follow up of 4 years. Cohabitees of patients who died of cancer were less likely to die of any cause (IRR 0.71, 96% CI 0.68-0.74) after adjustment for age, gender, number of non-psychotropic prescriptions 6 months before the cancer death/index date, use of psychotropic medication 6 months before the cancer death/index date, smoking, alcohol and area deprivation score. Exposed patients were more likely to receive a prescription for antidepressant or hypnotic medication and to attend their GP both before and after the death of the cohabitee.

Conclusion

We did not confirm increased mortality after bereavement of a cohabitee. Our finding may reflect the high quality of care that partners of people dying from cancer in the UK receive from palliative care and primary care services.
Patients' experiences and understandings of taking part in clinical trials for advanced cancer: a metasynthesis of findings
Authors: Nelson A. , Edwards M. , Byrne A.
Published: May 2012

Introduction

Advanced cancer patients have difficult decisions to make when offered further treatments in clinical trials. It is essential that such decisions are made with a full understanding of the potential impact of further treatment side effects and the trade off against this added symptom burden, and quality of life.

Aims and Methods

To present a metasynthesis of findings from three qualitative studies linked to clinical trials exploring patients' motivations, and understandings of the trials. Data from three qualitative studies were synthesised to explore themes associated with participants' motivations when joining a trial and their experiences and understandings of trial processes. The data set comprised interview transcripts from 60+ advanced cancer patients.

Results

In retrospect, control arm patients were altruistic and accepting of their allocation, whereas intervention arm patients were more focussed on the potential treatment benefits. Some patients expressed a sense of pressure to do the right thing for family and clinicians. Joining a trial was sometimes seen as the only remaining treatment option. Both groups were pleased to be receiving enhanced care and attention as part of a clinical trial. Patients frequently misunderstood the potential effect of the treatment intervention; some wrongly thought that their treatment was anti cancer, some thought that they may be receiving a placebo when in fact they were on the treatment arm of the trial.

Conclusion

The results raise concerns about equipoise in trials, truly informed consent, patients' expectations and experiences of participating trials and the potential impact on their symptom burden and quality of life.
Hypovitaminosis D in Hospice patients in a Caucasian West Midlands Population
Authors: McCarron N.M. , Meystre C. , Wells S. , Jones A.F. , Gittoes N. , Armour K. , Hodson J. , Webster C.
Published: May 2012

Introduction

Our hospice multi-disciplinary team was challenged by failing to deliver adequate pain relief to an elderly anicteric woman with locally advanced cholangiocarcinoma but with no known bone metastases. She was immobilised by severe knee pain resistant to optimal pain pathway prescribing and Allied Health Professional support. The patient was placed in a nursing home due to her immobility. Subsequently her serum vitamin D (VitD) was reported undetectable, and symptoms were explained by osteomalacia.

Aims and Methods

To test patients with clinical symptoms and susceptible disease profiles for VitD deficiency. Serum VitD levels of 16 caucasian hospice patients (6 female; 10 male) with symptoms suggestive deficiency were compared to 10,474 caucasian hospital patients (7,140 female; 3,334 male) in the same 10 month period.

Results

Hospice median VitD was 11.65 µg/L (Interquartile Range = 6.66 - 15.25) (sufficient >20 µg/l; insufficient 6-20 µg/L; severe deficiency <6µg/L) This differed significantly from the hospital median VitD of 16.50 µg/L (Interquartile Range = 9.70 - 33.40;) Mann-Whitney p=0.016. Age and gender distribution differed between the two groups but controlling for this with a general linear model the difference in VitD remained significant (p value=0.011).

Conclusion

Hospice patients had lower VitD levels than hospital patients, despite the differences in age and gender. Resistant pain is a common problem in hospice patients and may lead to unnecessary morbidity and institutionalisation. As part of holistic care VitD deficiency requires exclusion as a cause of morbidity in patients with pain and susceptible disease profiles. Its incidence in hospice patients warrants further investigation.
Developing Patient Controlled Analgesia (PCA) in the home for children and young people (CYP)
Authors: Boggs T. , Rajapske D. , Kelly P. , R. Hollowell D. , Howard R. , Craig F. , Bluebond-Langner M.
Published: May 2012

Introduction

Pain management for CYP in advanced disease is sub-optimal and, of concern to parents and palliative care professionals. PCA provides the patient, with a mechanism to rapidly and safely self-administer a bolus dose of analgesia in response to their experiences of pain. There is limited evidence on its use for CYP receiving palliative care.

Aims and Methods

To identify the salient issues and challenges in developing a home PCA service for CYP patients of a tertiary palliative care (PC) service. A mixed methods processual evaluation including: (a) longitudinal systematic participant observations of multidisciplinary project team planning meetings, PC team rounds and PCA training sessions, (b) interviews with community and tertiary based staff providing palliative care, (c) prospective pain data from CYP and carers (d) retrospective case review of parenteral analgesia utilisation, (e) survey of affiliated community services.

Results

We identified the following issues to consider when developing this service: (1) only small numbers of CYP require PCA, limiting the potential for developing and sustaining clinical expertise, (2) introduction of PCA is time sensitive requiring rapid and flexible responses from a range of services, (3) normalisation of PCA as a symptom management technique reduced safety concerns and increased professional, parent and CYP confidence.

Conclusion

Preliminary analysis suggests provision of PCA in the home is feasible although resource intensive. Further research is now required to address the efficacy of this symptom management technique, in this patient population.
Nurses' decisions to use anticipatory prescriptions in end of life care: study overview
Authors: Wilson E. , Brown J. , Seymour J.
Published: May 2012

Introduction

Community nurses working in primary care and in care homes registered to provide nursing care for older people have a key role in activating prescriptions written in advance of symptoms and distress that patients may have at the end of life (anticipatory prescribing). However, little is known about the decision-making processes employed by nurses or their experiences in this area of practice.

Aims and Methods

To determine the roles and experiences of community nurses in end of life medication decisions, using sedation in end of life care as an exemplar. A mixed method case study design involving four community nursing teams and four nursing homes in three Cancer Networks. The study takes place in two phases. Phase one is an ethnography using participant observation of nurses involved in decision making about the use of anticipatory prescriptions for sedation in end of life care. In addition, up to 15 interviews will be conducted at each study site (n=120) with healthcare professionals who have played a part in prescribing, dispensing or administration of sedation medication. In phase two a questionnaire survey, informed by existing literature and findings from the ethnography, will be used to access views from district nurses, specialist palliative care nurses, and nursing home nurses across the three Cancer Networks.

Results

Phase one of this study is due to commence in October 2011 and results are expected in May 2013.
The future of gastroenterology: patient choice, patient voice
Authors: Driscoll Richard , Canham Peter
Published: May 2012

The policy context for patient choice and public and patient involvement (PPI) in the NHS is set out. Both have become increasingly prominent since 2000. A series of NHS systems and policies have been put in place to enable greater patient choice in the belief that the exercise of choice by patients will influence providers to improve quality. This has had some success in elective surgery. One focus has been the publication of outcome data and this may have led to quality improvement through the inherent competitiveness of professionals and institutions. PPI has suffered from a series of unsuccessful reorganisations of patient involvement organisations but has ensured that most health bodies include patient representatives. Capturing patient experience and providing information to enable patient choice have been constantly developed over this time. A particular framework developed by Angela Coulter is used to review current levels of patient engagement in Inflammatory Bowel Disease (IBD), exploring the extent to which patient choice and patient voice are supported and enhanced within current IBD services locally and in national IBD strategy.1 A 2017 vision of the way in which IBD services might maximise patient choice and patient voice is put forward, based on the adoption of present good practice and current service developments, followed by a few rather more radical thoughts about possibilities for after 2017.
Takotsubo cardiomyopathy: pathophysiology and treatment
Authors: Milinis Kristijonas , Fisher Michael
Published: May 2012

Since it was first described 20 years ago in Japan, takotsubo cardiomyopathy has received considerable interest from the medical community around the world, particularly in recent years. Although takotsubo cardiomyopathy was originally described as a transient, stress-induced dysfunction of the left ventricular apex, other morphological subtypes have now been described. The pathogenesis of this disorder is likely to be catecholamine mediated myocyte damage and microvascular dysfunction; however, a number of possible alternative theories have been suggested. These include oxidative stress, transient coronary obstruction and oestrogen deficiency, the last explaining the high prevalence of takotsubo cardiomyopathy in women. The treatment remains largely supportive; however, a number of agents have been implicated in the acute stage and long term. Although most of the patients show complete recovery, there is a high risk of complications at the initial presentation requiring intense support.
Transferring chromosome DNA fragments from multiple donor cells into a host strain for yeast strain improvement
Authors: Shi Xian’ai , Wang Hang , Wang Hao , Wang Zhiming , Meng Chun
Published: May 2012

Based on a common biological phenomenon — homologous recombination — a novel method was developed by transferring chromosome DNA fragments extracted from multiple donor cells into a host strain. Through this method of transferring DNA fragments, foreign DNA fragments are introduced into one host cell and multiple positive traits from multiple strains may be integrated into the host strain. We first confirmed its feasibility in both prokaryotic and eukaryotic cells by selecting reverse mutants to prototrophy from auxotrophic strains through receiving chromosomal DNA fragments of wild-type parental strains. We then applied this method to Saccharomyces cerevisiae to improve its ethanol and temperature tolerance. We introduced donor chromosome DNA fragments from different S. cerevisiae strains with improvements in ethanol or temperature tolerance into a common strain S. cerevisiae and obtained a strain with much superior ethanol and temperature tolerance. The results showed that the Transferring DNA Fragments method provides a new way for strain breeding.
A COMPARATIVE STUDY OF ABSENT FEATURES AND UNOBSERVED VALUES IN SOFTWARE EFFORT DATA
Authors: ZHANG WEN , YANG YE , WANG QING
Published: May 2012

Software effort data contains a large amount of missing values of project attributes. The problem of absent features, which occurred recently in machine learning, is often neglected by researchers of software engineering when handling the missingness in software effort data. In essence, absent features (structural missingness) and unobserved values (unstructured missingness) are different cases of missingness although their appearance in the data set are the same. This paper attempts to clarify the root cause of missingness of software effort data. When regarding missingness as absent features, we develop Max-margin regression to predict real effort of software projects. When regarding missingness as unobserved values, we use existing imputation techniques to impute missing values. Then, ε – SVR is used to predict real effort of software projects with the input data sets. Experiments on ISBSG (International Software Benchmarking Standard Group) and CSBSG (Chinese Software Benchmarking Standard Group) data sets demonstrate that, with the tasks of effort prediction, the treatment regarding missingness in software effort data set as unobserved values can produce more desirable performance than that of regarding missingness as absent features. This paper is the first to introduce the concept of absent features to deal with missingness of software effort data.
RESAMPLING METHODS IN SOFTWARE QUALITY CLASSIFICATION
Authors: AFZAL WASIF , TORKAR RICHARD , FELDT ROBERT
Published: May 2012

In the presence of a number of algorithms for classification and prediction in software engineering, there is a need to have a systematic way of assessing their performances. The performance assessment is typically done by some form of partitioning or resampling of the original data to alleviate biased estimation. For predictive and classification studies in software engineering, there is a lack of a definitive advice on the most appropriate resampling method to use. This is seen as one of the contributing factors for not being able to draw general conclusions on what modeling technique or set of predictor variables are the most appropriate. Furthermore, the use of a variety of resampling methods make it impossible to perform any formal meta-analysis of the primary study results. Therefore, it is desirable to examine the influence of various resampling methods and to quantify possible differences. Objective and method: This study empirically compares five common resampling methods (hold-out validation, repeated random sub-sampling, 10-fold cross-validation, leave-one-out cross-validation and non-parametric bootstrapping) using 8 publicly available data sets with genetic programming (GP) and multiple linear regression (MLR) as software quality classification approaches. Location of (PF, PD) pairs in the ROC (receiver operating characteristics) space and area under an ROC curve (AUC) are used as accuracy indicators. Results: The results show that in terms of the location of (PF, PD) pairs in the ROC space, bootstrapping results are in the preferred region for 3 of the 8 data sets for GP and for 4 of the 8 data sets for MLR. Based on the AUC measure, there are no significant differences between the different resampling methods using GP and MLR. Conclusion: There can be certain data set properties responsible for insignificant differences between the resampling methods based on AUC. These include imbalanced data sets, insignificant predictor variables and high-dimensional data sets. With the current selection of data sets and classification techniques, bootstrapping is a preferred method based on the location of (PF, PD) pair data in the ROC space. Hold-out validation is not a good choice for comparatively smaller data sets, where leave-one-out cross-validation (LOOCV) performs better. For comparatively larger data sets, 10-fold cross-validation performs better than LOOCV.
EQUIVALENCE CHECKING OF COMMUNICATING UML STATECHART DIAGRAMS
Authors: LAM VITUS S. W. , PADGET JULIAN
Published: May 2012

We demonstrate how a subset of UML statechart diagrams (SCDs) as distinct from statecharts is encoded in the π-calculus as a number of processes which communicate via a channel-passing interaction paradigm. An extension to the original UML semantics for communicating statechart diagrams is presented. Different sorts of equivalences of UML SCDs encompassing isomorphism, strong behavioural equivalence and weak behavioural equivalence are defined. Determining equivalence of any two UML SCDs is transformed to a problem of checking whether their respective π-calculus process expressions are equivalent. The practicality of the approach is exemplified using an industry level case study.
MASSIVE GRAVITY ON CURVED BACKGROUND
Authors: ALBERTE LASMA
Published: May 2012

We investigate generally covariant theories which admit a Fierz–Pauli mass term for metric perturbations around an arbitrary curved background. For this we restore the general covariance of the Fierz–Pauli mass term by introducing four scalar fields which preserve a certain internal symmetry in their configuration space. It is then apparent that for each given spacetime metric this construction corresponds to a completely different generally covariant massive gravity theory with different symmetries. The proposed approach is verified by explicit analysis of the physical degrees of freedom of massive graviton on de Sitter space.
CONSERVATIVE SELF-ORGANIZED EXTREMAL MODEL FOR WEALTH DISTRIBUTION
Authors: CHAKRABORTY ABHIJIT , MUKHERJEE G. , MANNA S. S.
Published: May 2012

We present an extensive numerical study of the modified version of a conservative self-organized extremal model introduced by Pianegonda et al. (Physica A322 (2003) 667–675) in the context of wealth distribution of the people in a society. Here the trading process has been modified by the stochastic bipartite trading rule. More specifically in a trade one of the agents is necessarily the one with the globally minimal value of wealth, the other one being selected randomly from the neighbors of the first agent. The pair of agents then randomly re-shuffle their entire amount of wealth without saving. This model has most of the characteristics similar to the self-organized critical Bak-Sneppen model of evolutionary dynamics. Numerical estimates of a number of critical exponents indicate this model is likely to belong to a new universality class different from the well known models in the literature. In addition the persistence time, which is the time interval between two successive updates of wealth of an agent has been observed to have a non-trivial power law distribution. An opposite version of the model has also been studied where the agent with maximal wealth is selected instead of the one with minimal wealth, which however, exhibits similar behavior as the Minimal Wealth model.
TREATMENT WITH OR WITHOUT INTERNAL FIXATION FOR ULNAR STYLOID BASE FRACTURES ACCOMPANIED BY DISTAL RADIUS FRACTURES FIXED WITH VOLAR LOCKING PLATE
Authors: Zenke Yukichi , Sakai Akinori , Oshige Toshihisa , Moritani Shiro , Nakamura Toshitaka
Published: May 2012

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.
PYOGENIC FLEXOR TENOSYNOVITIS: ONE YEAR'S EXPERIENCE AT A UK HAND UNIT AND A REVIEW OF THE CURRENT LITERATURE
Authors: Nikkhah Dariush , Rodrigues Jeremy , Osman Khabab , DeJager Lodewikus
Published: May 2012

We report outcomes and learning points from flexor sheath infection (FSI) cases presenting over one year to a United Kingdom (UK) hand unit.

Between August 2009 and August 2010, 16 FSIs were confirmed from operation note findings. Patient age ranged from 12 to 82 years. All patients were posted a quickDASH questionnaire. In all cases, surgery was performed within 24 hours, via distal and palmar incisions, with 0.9% saline irrigation. Seven patients (44%) responded to questionnaires. Of these, most achieved a good functional outcome, with a mean quickDASH of 7.14. Four cases (25%) had no triggering event. Beta-haemolytic streptococcus was cultured in three cases (18%). Its presence was significantly associated with a requirement for multiple operations (p < 0.032), and with prolonged admission of up to nine days (p < 0.009). We suggest that close liaison with microbiology services and early identification of beta-haemolytic streptococcus may predict the need for multiple washouts in FSI.
OPEN WEDGE FLEXION OSTEOTOMY OF THE METACARPAL NECK FOR THE AVASCULAR NECROSIS OF THE THIRD METACARPAL HEAD: CASE REPORT
Authors: Ohta Souichi , Kakinoki Ryousuke , Fujita Satoshi , Noguchi Takashi
Published: May 2012

The avascular necrosis of the metacarpal head is a rare disease. Therefore, although a variety of surgical treatments were performed in the sporadically published case reports, the optimal surgical treatment is still controversial. Open wedge osteotomy of the metacarpal neck was first reported in 2002. However, no other reports using the same procedure have been published. We presented 13-year-old girl case of the third metacarpal head necrosis having been treated by the open wedge osteotomy of the metacarpal neck. Four years later, she had no pain and gained full range of motion of the metacarpophalangeal (MP) joint. The plain X-rays and magnetic resonance images demonstrated sufficient bone remodeling of the metacarpal head. The open wedge osteotomy of the metacarpal neck is a useful option for the metacarpal head necrosis, especially when the dorsal articular surface of the head remains intact.
PARADOXICAL EXTENSION PHENOMENON OF THE LITTLE FINGER DUE TO REPETITIVE TRAUMA TO THE PALM
Authors: Abe Yukio , Tominaga Yasuhiro
Published: May 2012

We report a case of paradoxical extension phenomenon of the little finger, so called "lumbrical plus deformity" due to repetitive trauma to the ulnar side of the palm. The adhesion between the flexor digitorum profundus tendon and the lumbrical muscle was the cause of this phenomenon. The lumbrical muscle release was sufficient to solve this rare problem.
Acute supplementation of amino acids increases net protein accretion in IUGR fetal sheep
Authors: Brown Laura D. , Rozance Paul J. , Thorn Stephanie R. , Friedman Jacob E. , Hay William W.
Published: May 2012

Placental insufficiency decreases fetal amino acid uptake from the placenta, plasma insulin concentrations, and protein accretion, thus compromising normal fetal growth trajectory. We tested whether acute supplementation of amino acids or insulin into the fetus with intrauterine growth restriction (IUGR) would increase net fetal protein accretion rates. Late-gestation IUGR and control (CON) fetal sheep received acute, 3-h infusions of amino acids (with euinsulinemia), insulin (with euglycemia and euaminoacidemia), or saline. Fetal leucine metabolism was measured under steady-state conditions followed by a fetal muscle biopsy to quantify insulin signaling. In CON, increasing amino acid delivery rates to the fetus by 100% increased leucine oxidation rates by 100%. In IUGR, amino acid infusion completely suppressed fetal protein breakdown rates but increased leucine oxidation rate by only 25%, resulting in increased protein accretion rates by 150%. Acute insulin infusion, however, had very little effect on amino acid delivery rates, fetal leucine disposal rates, or fetal protein accretion rates in CON or IUGR fetuses despite robust signaling of the fetal skeletal muscle insulin-signaling cascade. These results indicate that, when amino acids are given directly into the fetal circulation independently of changes in insulin concentrations, IUGR fetal sheep have suppressed protein breakdown rates, thus increasing net fetal protein accretion.
Gene regulation of UDP-galactose synthesis and transport: potential rate-limiting processes in initiation of milk production in humans
Authors: Mohammad Mahmoud A. , Hadsell Darryl L. , Haymond Morey W.
Published: May 2012

Lactose synthesis is believed to be rate limiting for milk production. However, understanding the molecular events controlling lactose synthesis in humans is still rudimentary. We have utilized our established model of the RNA isolated from breast milk fat globule from seven healthy, exclusively breastfeeding women from 6 h to 42 days following delivery to determine the temporal coordination of changes in gene expression in the carbohydrate metabolic processes emphasizing the lactose synthesis pathway in human mammary epithelial cell. We showed that milk lactose concentrations increased from 75 to 200 mM from 6 to 96 h. Milk progesterone concentrations fell by 65% at 24 h and were undetectable by day 3. Milk prolactin peaked at 36 h and then declined progressively afterward. In concordance with lactose synthesis, gene expression of galactose kinase 2, UDP-glucose pyrophosphorylase 2 (UGP2), and phosphoglucomutase 1 increased 18-, 10-, and threefold, respectively, between 6 and 72 h. Between 6 and 96 h, gene expression of UDP-galactose transporter 2 (SLC35A2) increased threefold, whereas glucose transporter 1 was unchanged. Gene expression of lactose synthase no. 3 increased 1.7-fold by 96 h, whereas α-lactalbumin did not change over the entire study duration. Gene expression of prolactin receptor (PRLR) and its downstream signal transducer and activator of transcription complex 5 (STAT5) were increased 10- and 2.5-fold, respectively, by 72 h. In summary, lactose synthesis paralleled the induction of gene expression of proteins involved in UDP-galactose synthesis and transport, suggesting that they are potentially rate limiting in lactose synthesis and thus milk production. Progesterone withdrawal may be the signal that triggers PRLR signaling via STAT5, which may in turn induce UGP2 and SLC35A2 expression.
Assessment of body cell mass at bedside in critically ill patients
Authors: Savalle Magali , Gillaizeau Florence , Maruani Gérard , Puymirat Etienne , Bellenfant Florence , Houillier Pascal , Fagon Jean-Yves , Faisy Christophe
Published: May 2012

Critical illness affects body composition profoundly, especially body cell mass (BCM). BCM loss reflects lean tissue wasting and could be a nutritional marker in critically ill patients. However, BCM assessment with usual isotopic or tracer methods is impractical in intensive care units (ICUs). We aimed to modelize the BCM of critically ill patients using variables available at bedside. Fat-free mass (FFM), bone mineral (Mo), and extracellular water (ECW) of 49 critically ill patients were measured prospectively by dual-energy X-ray absorptiometry and multifrequency bioimpedance. BCM was estimated according to the four-compartment cellular level: BCM = FFM − (ECW/0.98) − (0.73 × Mo). Variables that might influence the BCM were assessed, and multivariable analysis using fractional polynomials was conducted to determine the relations between BCM and these data. Bootstrap resampling was then used to estimate the most stable model predicting BCM. BCM was 22.7 ± 5.4 kg. The most frequent model included height (cm), leg circumference (cm), weight shift (Δ) between ICU admission and body composition assessment (kg), and trunk length (cm) as a linear function: BCM (kg) = 0.266 × height + 0.287 × leg circumference + 0.305 × Δweight − 0.406 × trunk length − 13.52. The fraction of variance explained by this model (adjusted r2) was 46%. Including bioelectrical impedance analysis variables in the model did not improve BCM prediction. In summary, our results suggest that BCM can be estimated at bedside, with an error lower than ±20% in 90% subjects, on the basis of static (height, trunk length), less stable (leg circumference), and dynamic biometric variables (Δweight) for critically ill patients.