bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Radar Wind Observations for Low-Level NWP Wind Forecast Validation
Authors: Salonen Kirsti , Niemelä Sami , Fortelius Carl
Published: January 2011

The Finnish Meteorological Institute has produced a new numerical weather prediction model–based wind atlas of Finland. The wind atlas provides information on local wind conditions in terms of annual and monthly wind speed and direction averages. In the context of the wind atlas project, low-level Applications of Research to Operations at Mesoscale (AROME) model wind forecasts have been validated against radar radial wind observations and, as a comparison, against conventional radiosonde observations to confirm the realism of the wind forecasts. The results indicate that the systematic and random errors in the AROME wind forecasts are relatively small and are of the same order of magnitude independent of the validating observation type. The validation benefits from the high spatial and temporal resolution of the radar observations. There are over 4000 times as many radar observations as radiosonde observations available for the considered validation period of July 2008–May 2009.
Precipitation and Temperature Variations on the Interannual Time Scale: Assessing the Impact of ENSO and Volcanic Eruptions
Authors: Gu Guojun , Adler Robert F.
Published: January 2011

The effects of ENSO and two large tropical volcanic eruptions (El Chichón, March 1982; Mt. Pinatubo, June 1991) are examined for the period of 1979–2008 using various satellite- and station-based observations of precipitation, temperature (surface and atmospheric), and tropospheric water vapor content. By focusing on the responses in the time series of tropical and global means over land, ocean, and land and ocean combined, the authors intend to provide an observational comparison of how these two phenomena, represented by Niño-3.4 and the tropical mean stratospheric aerosol optical thickness (τ), respectively, influence precipitation, temperature, and water vapor variations.

As discovered in past studies, strong same-sign ENSO signals appear in tropical and global mean temperature (surface and tropospheric) over both land and ocean. However, ENSO only has very weak impact on tropical and global mean (land + ocean) precipitation, though intense anomalies are readily seen in the time series of precipitation averaged over either land or ocean. In contrast, the two volcanoes decreased not only tropical and global mean surface and tropospheric temperature but also tropical and global mean (land + ocean) precipitation. The differences between the responses to ENSO and volcanic eruptions are thus further examined by means of lag-correlation analyses. The ENSO-related peak responses in oceanic precipitation and sea surface temperature (SST) have the same time lags with Niño-3.4, 2 (4) months for the tropical (global) means. Tropical and global mean tropospheric water vapor over ocean (and land) generally follows surface temperature. However, land precipitation responds to ENSO much faster than temperature, suggesting a certain time needed for surface energy adjustment there following ENSO-related circulation and precipitation anomalies. Weak ENSO signals in the tropical and global mean mid- to lower-tropospheric atmospheric (dry) static instability are further discovered, which tend to be consistent with weak ENSO responses in the tropical and global mean (land + ocean) precipitation. For volcanic eruptions, tropical and global mean precipitation over either ocean or land responds faster than temperature (surface and atmospheric) and tropospheric water vapor averaged over the same areas, suggesting that precipitation tends to be more sensitive to volcanic-related solar forcing. The volcanic-related precipitation variations are further shown to be related to the changes in the mid- to lower-tropospheric atmospheric (dry) instability.
Eddy-Mean Flow Interactions in the Along-Stream Development of a Western Boundary Current Jet: An Idealized Model Study
Authors: Waterman Stephanie , Jayne Steven R.
Published: January 2011

A theoretical study on the role of eddy-mean flow interactions in the time-mean dynamics of a zonally evolving, unstable, strongly inertial jet in a configuration and parameter regime that is relevant to oceanic western boundary current (WBC) jets is described. Progress is made by diagnosing the eddy effect on the time-mean circulation, examining the mechanism that permits the eddies to drive the time-mean recirculation gyres, and exploring the dependence of the eddy effect on system parameters.

It is found that the nature of the eddy-mean flow interactions in this idealized configuration is critically dependent on along-stream position, in particular relative to the along-stream evolving stability properties of the time-mean jet. Just after separation from the western boundary, eddies act to stabilize the jet through downgradient fluxes of potential vorticity (PV). Downstream of where the time-mean jet has (through the effect of the eddies) been stabilized, eddies act to drive the time-mean recirculations through the mechanism of an upgradient PV flux. This upgradient flux is permitted by an eddy enstrophy convergence downstream of jet stabilization, which results from the generation of eddies in the upstream region where the jet is unstable, the advection of that eddy activity along stream by the jet, and the dissipation of the eddies in the region downstream of jet stabilization. It is in this region of eddy decay that eddies drive the time-mean recirculations through the mechanism of nonlinear eddy rectification, resulting from the radiation of waves from a localized region. It is found that similar mechanisms operate in both barotropic and baroclinic configurations, although differences in the background PV gradient on which the eddies act implies that the recirculation-driving mechanism is more effective in the baroclinic case.

This study highlights the important roles that eddies play in the idealized WBC jet dynamics considered here of stabilizing the jet and driving the flanking recirculations. In the absence of eddy terms, the magnitude of the upper-ocean jet transport would be significantly less and the abyssal ocean recirculations (and their significant enhancement to the jet transport) would be missing altogether.
Mixing in a Moderately Sheared Salt-Fingering Layer
Authors: Smyth W. D. , Kimura S.
Published: January 2011

Mixing due to sheared salt fingers is studied by means of direct numerical simulations (DNS) of a double-diffusively unstable shear layer. The focus is on the “moderate shear” case, where shear is strong enough to produce Kelvin–Helmholtz (KH) instability but not strong enough to produce the subharmonic pairing instability. This flow supports both KH and salt-sheet instabilities, and the objective is to see how the two mechanisms work together to flux heat, salt, and momentum across the layer.

For observed values of the bulk Richardson number Ri and the density ratio Rρ, the linear growth rates of KH and salt-sheet instabilities are similar. These mechanisms, as well as their associated secondary instabilities, lead the flow to a fully turbulent state. Depending on the values of Ri and Rρ, the resulting turbulence may be driven mainly by shear or mainly by salt fingering. Turbulent mixing causes the profiles of temperature, salinity, and velocity to spread; however, in salt-sheet-dominated cases, the net density (or buoyancy) layer thins over time. This could be a factor in the maintenance of the staircase and is also an argument in favor of an eventual role for Holmboe instability.

Fluxes are scaled using both laboratory scalings for a thin layer and an effective diffusivity. Fluxes are generally stronger in salt-sheet-dominated cases. Shear instability disrupts salt-sheet fluxes while adding little flux of its own. Shear therefore reduces mixing, despite providing an additional energy source. The dissipation ratio Γ is near 0.2 for shear-dominated cases but is much larger when salt sheets are dominant, supporting the use of Γ in the diagnosis of observed mixing phenomena. The profiler approximation Γz, however, appears to significantly overestimate the true dissipation ratio.
Impacts of Sea Surface Temperature Uncertainty on the Western North Pacific Subtropical High (WNPSH) and Rainfall
Authors: Hong Xiaodong , Bishop Craig H. , Holt Teddy , O’Neill Larry
Published: January 2011

This paper examines the sensitivity of short-term forecasts of the western North Pacific subtropical high (WNPSH) and rainfall to sea surface temperature (SST) uncertainty using the Coupled Ocean–Atmosphere Mesoscale Prediction System (COAMPS). A comparison of analyzed SSTs with satellite observations of SST indicates that SST analysis errors are particularly pronounced on horizontal scales from 100 to 200 km, similar to the mesoscale eddy scales in the Kuroshio region. Since significant oceanic variations occur on these scales, it is of interest to examine the effects of representing this small-scale uncertainty with random, scale-dependent perturbations. An SST ensemble perturbation generation technique is used here that enables temporal and spatial correlations to be controlled and produces initial SST fields comparable to satellite observations. The atmospheric model develops large uncertainty in the Korea and Japan area due to the fluctuation in the horizontal pressure gradient caused by the location of the WNPSH. This, in turn, increases the variance of the low-level jet (LLJ) over southeast China, resulting in large differences in the moist transport flux from the tropical ocean and subsequent rainfall. Validation using bin-mean statistics shows that the ensemble forecast with the perturbed SST better distinguishes large forecast error variance from small forecast error variance. The results suggest that using the SST perturbation as a proxy for the ocean ensemble in a coupled atmosphere and ocean ensemble system is feasible and computationally efficient.
Bias Correction and Forecast Skill of NCEP GFS Ensemble Week-1 and Week-2 Precipitation, 2-m Surface Air Temperature, and Soil Moisture Forecasts
Authors: Fan Yun , van den Dool Huug
Published: January 2011

A simple bias correction method was used to correct daily operational ensemble week-1 and week-2 precipitation and 2-m surface air temperature forecasts from the NCEP Global Forecast System (GFS). The study shows some unexpected and striking features of the forecast errors or biases of both precipitation and 2-m surface air temperature from the GFS. They are dominated by relatively large-scale spatial patterns and low-frequency variations that resemble the annual cycle. A large portion of these forecast errors is removable, but the effectiveness is time and space dependent. The bias-corrected week-1 and week-2 ensemble precipitation and 2-m surface air temperature forecasts indicate some improvements over their raw counterparts. However, the overall levels of week-1 and week-2 forecast skill in terms of spatial anomaly correlation and root-mean-square error are still only modest. The dynamical soil moisture forecasts (i.e., land surface hydrological model forced with bias-corrected precipitation and 2-m surface air temperature integrated forward for up to 2 weeks) have very high skill, but hardly beat persistence over the United States. The inability to outperform persistence mainly relates to the skill of the current GFS week-1 and week-2 precipitation forecasts not being above a threshold (i.e., anomaly correlation > 0.5 is required).
Modeling PM10 Originating from Dust Intrusions in the Southern Iberian Peninsula Using HYSPLIT
Authors: Stein A. F. , Wang Y. , de la Rosa J. D. , Sanchez de la Campa A. M. , Castell Nuria , Draxler R. R.
Published: January 2011

The Hybrid Single-Particle Lagrangian Integrated Trajectories (HYSPLIT) model has been applied to calculate the spatial and temporal distributions of dust originating from North Africa. The model has been configured to forecast hourly particulate matter ≤10 μm (PM10) dust concentrations focusing on the impacts over the southern Iberian Peninsula. Two full years (2008 and 2009) have been simulated and compared against surface background measurement sites. A statistical analysis using discrete and categorical evaluations is presented. The model is capable of simulating the occurrence of Saharan dust episodes as observed at the measurement stations and captures the generally higher levels observed in eastern Andalusia, Spain, with respect to the western Andalusia station. But the simulation tends to underpredict the magnitude of the dust concentration peaks. The model has also been qualitatively compared with satellite data, showing generally good agreement in the spatial distribution of the dust column.
Determinants of Daily Happiness on Vacation
Authors: Nawijn Jeroen
Published: January 2011

How happy are tourists during a day of their holiday and what makes them happy? These questions were addressed in a study of 466 international tourists in the Netherlands. While on vacation, tourists are generally high on hedonic level of affect, with positive affect exceeding negative affect almost fourfold. Affect balance is higher than generally observed in everyday life, whereas tourists’ life satisfaction is not significantly different compared with life satisfaction in their everyday life. Vacationers’ socioeconomic backgrounds and life satisfaction only partially explain their affective state of the day. Most of the variance is explained by factors associated with the holiday trip itself. During a holiday, holiday stress and attitude toward the travel party are the most important determinants of daily affect balance. These findings imply that on the whole, the tourism industry is doing a good job. The industry could probably do better with more research on experiences during the holiday.
Structure of Travel Planning Processes and Information Use Patterns
Authors: Choi Soojin , Lehto Xinran Y. , Morrison Alastair M. , Jang SooCheong (Shawn)
Published: January 2011

Based on an empirical data set collected from Chinese tourists visiting Macau SAR, this study attempts to decompose the travel decision-making process into a multistage sequence (before purchase, at time of purchase, after purchase, after arriving at destination) with multiple decision choices for a vacation trip. The study results demonstrate that travel decision making follows a multidimensional, ongoing sequence and is a hierarchical process. This study further attempts to expand the framework for describing the travel decision-making structure by incorporating information use patterns across the overall course of the travel planning process. The contingent nature of decision making is partially validated by tracing the sequence of decision making and information use along the travel planning horizon. Furthermore, given the lack of studies based on Chinese tourists’ decision-making behavior, the study results provide new insights for many tourism destinations and businesses eyeing the burgeoning Chinese tourists’ market.
Raising Awareness
Authors: Napierski-Prancl Michelle
Published: January 2011

This article provides a model for incorporating a student-run campus awareness week into the course objectives of a sociology class. It reflects on four semesters in which students in a sociology course on eating disorders create social change by developing and implementing a campus-based awareness week. Although the article focuses specifically on a course about eating disorders, the method may be generalized to any course in which students have the potential to educate the college community with the knowledge they have learned over the course of a semester. This article describes the course and addresses the design of the project, including student responsibilities and expectations, the specific contributions of students, and previous week themes, and it offers an evaluation of the effectiveness of this assignment.
Exploring the Benefits of Community-based Research in a Sociology of Sexualities Course
Authors: Bach Rebecca , Weinzimmer Julianne
Published: January 2011

The benefits of community-based research (CBR) in the sociology classroom go beyond those associated with traditional service learning. Here, students use their sociological skills to examine and propose solutions to local social problems addressed by community organizations. Through analyzing students’ course reflection journals and the results of pre- and posttests, the authors demonstrate how CBR can help students gain a better command of the research process and enhance student attitudes toward community service. After participating in CBR, the authors find that students indicate greater proficiency in undertaking the entire research process, from creating and implementing a research plan to making data-derived client recommendations. In addition, by showing how CBR can be incorporated into a less obviously applicable course, such as Sociology of Sexualities, the authors hope to encourage its further expansion in sociology.
The Empty Shops Project
Authors: Willis Evan , Burns Edgar
Published: January 2011

An informal research project with high local relevance was developed for a first-year sociology course at an Australian rural university campus. The project developed students’ sociological insight by challenging them to investigate “truths” about their own region, rather than immediately pushing them to comprehend new and different societyscapes. Classroom sessions elicited debate over the adequacy of social theories about rural and urban life, centering on the question, “How do you know?” This morphed into debate about “How can you find out, sociologically?” With interest piqued, many students volunteered to participate in investigating the proportion of empty shops in their own or nearby towns, as one measure of rural well-being. Classroom analysis and reflection on the results—what they meant and limits in how well this measured rural districts and rural town existence—greatly enhanced the introductory sociology learning experience for the core group and, to a lesser extent, the “audience” members of class.
Making the Undergraduate Classroom into a Policy Think Tank
Authors: Broughton Chad
Published: January 2011

This article examines the opportunities and limitations presented by organizing an undergraduate field research methods class as a policy think tank working for a government client. Organized as such, the course had both the learning objectives of a traditional undergraduate methods class and the corporate objectives of a policy think tank (i.e., to produce a high-quality presentation and report for its client). This article finds that the learning and corporate objectives were largely aligned rather than conflicting, leading to anticipated and some unanticipated pedagogical benefits for learning sociological research methods, substantive sociological and policy areas, how to work effectively in goal-directed group work, and public policy generally. Finally, this article considers the pedagogical and ethical concerns with the course-based production of “policy-relevant” knowledge in the context of stark social divisions between student and research subject.
Judging Books by Their Covers
Authors: Kwan Samantha , Trautner Mary Nell
Published: January 2011

Sociologists have developed a wide range of pedagogical strategies to facilitate student learning about racial/ethnic, class, and gender inequalities. Despite the growing subdiscipline of the sociology of the body and evidence pointing to the prevalence of inequalities based on physical attractiveness, the pedagogical literature has yet to develop strategies for teaching students about biases based on physical attractiveness. In this article, the authors report on a pedagogical module that involves student evaluations of photographs (depicting individuals ranging in levels of physical attractiveness) using semantic differential scales, and discuss the results of this evaluation. The authors test for student learning outcomes through (1) a one-group pretest-posttest design and (2) an assessment survey with both qualitative and quantitative components. Because this photograph evaluation typically illustrates students’ beauty biases, a discussion of these results, paired with relevant readings, provides a powerful tool for the exchange of ideas about physical attractiveness biases.
Elites and Death in Vietnam and Other U.S. Wars: A Research Note
Authors: Campbell Alec
Published: January 2011

Research on class bias in military service has focused on service and death among the economically disadvantaged during the Vietnam War. This study uses the war records of elite colleges to examine elite participation in five major wars. Significant differences in elite participation across wars are found, with lower rates during the Civil, Korean, and Vietnam Wars and higher rates during the World Wars. The similarities between Korea and Vietnam indicate that political unrest related to the Vietnam War was not the sole cause of low levels of elite participation. Changes in the size and structure of the post–World War II military are hypothesized as alternative causal factors.
Dictating Justice
Authors: Kyle Brett J. , Reiter Andrew G.
Published: January 2011

Militaries throughout the world operate their own courts to prosecute military crimes, such as insubordination, that are not part of civilian legal codes. Latin American militaries traditionally have extended this hermetic justice system to cover all crimes committed by their personnel, allowing the institution to sit in judgment of its own actions and escape punishment for human rights violations. This parallel legal system erodes the principle of equality before the law, threatens civilian control of the military, and nurtures a culture of impunity. This article develops a theoretical model to explain the state of military court jurisdiction over military personnel for human rights violations in democracies. It then empirically tests this model on seventeen cases in Latin America. The article concludes that the variation in reform of military courts is a result of the relative balance between the extent of military autonomy and the strength of the civilian reform movement.
An investigational study of minimum rotational pump speed to avoid retrograde flow in three centrifugal blood pumps in a pediatric extracorporeal life support model
Authors: Clark Joseph B , Yulong Guan  , McCoach Robert , Kunselman Allen R , Myers John L , Ündar Akif
Published: January 2011

During extracorporeal life support with centrifugal blood pumps, retrograde pump flow may occur when the pump revolutions decrease below a critical value determined by the circuit resistance and the characteristics of the pump. We created a laboratory model to evaluate the occurrence of retrograde flow in each of three centrifugal blood pumps: the Rotaflow, the CentriMag, and the Bio-Medicus BP-50. At simulated patient pressures of 60, 80, and 100 mmHg, each pump was evaluated at speeds from 1000 to 2200 rpm and flow rates were measured. Retrograde flow occurred at low revolution speeds in all three centrifugal pumps. The Bio-Medicus pump was the least likely to demonstrate retrograde flow at low speeds, followed by the Rotaflow pump. The CentriMag pump showed the earliest transition to retrograde flow, as well as the highest degree of retrograde flow. At every pump speed evaluated, the Bio-Medicus pump delivered the highest antegrade flow and the CentriMag pump delivered the least.
Extracorporeal life support systems: alternative vs. conventional circuits
Authors: Khan Sameer , Vasavada Rahul , Feng Qiu  , Kunselman Allan , Ündar Akif
Published: January 2011

Emerging technologies and practices for pediatric and neonatal extracorporeal life support (ECLS) are promising. This experiment sought to compare the Medtronic 0800 silicon rubber membrane oxygenator to the Quadrox-iD Pediatric oxygenator in the conventional roller pump circuit, as well as comparing the conventional circuit to an alternative circuit. Three circuits were set up in the experiment. Two conventional roller pump circuits were used to compare the two oxygenators and an alternative circuit consisting of the Quadrox-iD Pediatric oxygenator and Maquet Rotaflow centrifugal pump system was used to identify differences between circuits. All three circuits were primed with Lactated Ringers’ solution and human blood, with an hematocrit of 40%. Testing occurred at flow rates of 250, 500, and 750 ml/ min at 37°C for mean arterial line pressures of 60, 80, and 100 mmHg. The results of the experiment showed lower pressure drops and greater retention of total hemodynamic energy (THE) across the Quadrox-iD Pediatric oxygenator compared to the Medtronic 0800 oxygenator. Furthermore, the centrifugal pump used in the alternative circuit showed no back flow at flow rates as low as 250 ml/min while, on the other hand, rpm levels were kept below 2200 for flow rates as high as 750 ml/min. Findings support the usage of the Quadrox-iD Pediatric oxygenator in a circuit utilizing the Maquet Rotaflow centrifugal pump system due to lower pressure drops and greater percentage of THE retained across the circuit. Additional advantages of the alternative circuit include rapid set-up time, easy transport, lower priming volumes, and no gravity-dependent venous drainage system so that it can be situated in close proximity to and at the level of the patient.
Caring for families with a family history of cancer: Why concerns about genetic predisposition are missing from the palliative agenda
Authors: Lillie Alison Kate , Clifford Collette , Metcalfe Alison
Published: January 2011

Care of the family is integral to palliative care, but little attention has been paid to the way nurses, or other healthcare professionals, are responding to the needs of families who are concerned about whether their family history of cancer is associated with an inherited genetic predisposition. This paper discusses how palliative care nurses perceive the care needs of patients with a family history of cancer. Data were collected through recorded, semi-structured interviews with 10 nurses who had worked in specialist palliative care. The findings show that there are cogent arguments and concerns about raising the issue of an inherited genetic predisposition at the end of life (especially when the patient is close to death and there is a lack of knowledge about genetics). Nevertheless, exemplar cases are used to illustrate the reasons why it is important that nurses working in specialist palliative care settings are aware of the needs of this patient group. The paper highlights that nurses not only need an appropriate knowledge base but also an insight of what can be achieved when supporting patients with a family history of cancer.
Integrating palliative care in public health: The Colombian experience following an International Pain Policy Fellowship
Authors: Leon Marta , Florez Sandra , De Lima Liliana , Ryan Karen
Published: January 2011

Access to palliative care is insufficient in many countries around the world. In an effort to improve access to palliative care services and treatments, a public health approach as suggested by the World Health Organization was implemented in Colombia to improve opioid availability, increase awareness and competences about palliative care for healthcare workers, and to include palliative care as a component of care in legislation. As a result, opioid availability has improved, a mandatory palliative care course for medical undergraduate students has been implemented and a palliative care law is being discussed in the Senate. This article describes the strategy, main achievements and suggestions for implementing similar initiatives in developing countries.
The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: Cross-sectional survey with four-week follow-up
Authors: Rayner Lauren , Lee William , Price Annabel , Monroe Barbara , Sykes Nigel , Hansford Penny , Higginson Irene J , Hotopf Matthew
Published: January 2011

This cross-sectional survey aimed to determine the prevalence and remission of depression in patients receiving palliative care and to ascertain the predictive value of somatic symptoms in making the diagnosis. Three hundred consecutive patients were interviewed within one week of their initial assessment by a specialist nurse at a palliative care service with in-patient and homecare facilities in south London, UK. Depression was assessed using the PRIME-MD PHQ-9. Presence of somatic symptoms (fatigue, sleep disturbance, poor appetite) was determined using the EORTC-QLQ-C30 quality of life questionnaire. Fifty-eight (19.3% [15.3 to 23.3]) patients met criteria for Major Depressive Disorder; 109 (36.3% [32.3 to 40.3]) met criteria for ‘Any depressive syndrome’. Patients with Major Depressive Disorder were more likely to be male, and to have non-malignant disease, pain, poor performance status and desire for an early death. Of those patients with Major Depressive Disorder at baseline, 69% (27/39) had remitted four weeks later. Of those not depressed at baseline, 11% (19/174) met criteria for depression at follow-up. The positive predictive values of sleep disturbance, poor appetite and fatigue were low (<24%), whereas the negative predictive values of these symptoms were high (>89%). The high prevalence of depression in palliative care attests to the need for psychological assessment and support. Depression in patients receiving palliative care is unstable, suggesting that symptoms should be carefully monitored.
Case report: Maintaining and withdrawing long-term invasive ventilation in a patient with MND/ALS in a home setting
Authors: LeBon B , Fisher S
Published: January 2011

Long-term home-based invasive ventilation in patients with motor neurone disease / amyotrophic lateral sclerosis (MND/ALS) remains rare in the UK. We describe a case of an MND/ALS patient who was treated with long-term invasive ventilation at home but subsequently requested its withdrawal despite a seemingly stable period of his illness. We also discuss the impact of the delivery of this treatment and its withdrawal on his carers, primary healthcare team, community trust managers and specialist palliative care team.
Former palliative caregivers who identify that additional spiritual support would have been helpful in a population survey
Authors: Hegarty Meg M , Abernethy Amy P , Olver Ian , Currow David C
Published: January 2011

Background: Palliative care encompasses physical, psychosocial and spiritual care for patients and caregivers. No population data are available on bereaved people who subsequently report that additional spiritual support would have been helpful.

Methods: In a population survey, a respondent-defined question was asked regarding ‘additional spiritual support’ that would have been helpful if someone ‘close to them had died’ an expected death in the previous five years. Data (socio-demographic [respondent]); clinical [deceased]) directly standardized to the whole population were analysed.

Results: There were 14,902 participants in this study (71.6% participation rate), of whom 31% (4665) experienced such a death and 1084 (23.2%) provided active hands-on (day-to-day or intermittent) care. Fifty-one of the 1084 (4.7%) active caregivers identified that additional spiritual support would have been helpful. The predictors in a regression analysis were: other domains where additional support would have been helpful (OR 1.69; 95% CI 1.46–1.94; p < 0.001); and being female (OR 3.23; 95% CI 1.23 to 8.33; p = 0.017). ‘Additional spiritual support being helpful’ was strongly associated with higher rates where additional support in other domains would also have been helpful in: all bereaved people (2.7 vs 0.6; p < 0.0001); and in active caregivers (3.7 vs 0.8; p < 0.0001).

Conclusion: People who identify that additional spiritual support would have been helpful have specific demographic characteristics. There is also a strong association with the likelihood of identifying that a number of other additional supports would have been helpful. Clinically, the need for additional spiritual support should open a conversation about other areas where the need for further support may be identified.
Challenging symptom profiles of life-limiting conditions in children: a survey of care professionals and families
Authors: Malcolm Cari , Forbat Liz , Anderson Gillian , Gibson Faith , Hain Richard
Published: January 2011

This paper reports on data from the initial phase of a UK-wide study exploring life-limiting conditions (LLCs) in children where, because of their rarity, little is understood regarding the significant symptom challenges of families and care professionals who support them. In this initial phase, care professionals ( n = 43) and families ( n = 16) completed a survey to identify which rare LLCs present symptom challenges and which individual symptoms prove difficult to manage. Findings led to the prioritization of mucopolysaccharidoses, Batten Disease and leukodystrophy. Care professionals’ rationales for selecting these conditions included the presence of symptoms that are very difficult to manage, a requirement for additional clinical evidence to support symptom management, and the progressive nature of these diseases where symptoms frequently change and are difficult to predict. Families identified symptoms such as behavioural difficulties, visual impairments and communication impairments as those being most difficult to manage and having most impact on quality of life for children and families.
Palliative assessment and advance care planning in severe dementia: An exploratory randomized controlled trial of a complex intervention
Authors: Sampson Elizabeth L , Jones Louise , Thuné-Boyle Ingela CV , Kukkastenvehmas Riitta , King Michael , Leurent Baptiste , Tookman Adrian , Blanchard Martin R
Published: January 2011

Patients with advanced dementia often receive poor end-of-life care. We aimed to design and pilot a palliative care and advance care plan (ACP) intervention. Patients had undergone emergency hospital admission and had severe dementia. The intervention consisted of a palliative care patient assessment which informed an ACP discussion with the carer, who was offered the opportunity to write an ACP for the person with dementia. Carer–patient dyads were randomized to ‘usual care’ or the intervention. Carer-related outcome measures included the Kessler Distress Scale, Decision Satisfaction Inventory, Client Satisfaction Questionnaire and the Euroqol-5D, measured at baseline, six weeks, six months and three months after bereavement. The Satisfaction with End of Life Care in Dementia Scale was completed if the patient died. The 32 patient participants were physically frail and in the advanced stages of dementia: 62% had pressure damage to the skin, all needed feeding assistance and 95% were in pain. Nearly 50% died during the six-month follow-up period. Carers were difficult to recruit during acute admission; 33 patients and carers entered the study (22 intervention arm; 11 control arm). Only seven carers made ACPs. The care planning discussion was well received, but few carers wrote an ACP, despite intensive support from an experienced nurse specialist. Advance care planning is, in theory, a necessary intervention for people with severe dementia; the reluctance of carers to write plans needs to be explored further.
Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data
Authors: Howell Debra A , Shellens Rhiannon , Roman Eve , Garry Anne C , Patmore Russell , Howard Martin R
Published: January 2011

Haematological malignancies are complex diseases, affecting the entire age spectrum, and having marked differences in presentation, treatment, progression and outcome. Patients have a significant symptom burden and despite treatment improvements for some sub-types, many patients die from their disease. We carried out a systematic review and meta-analysis to examine the proportion of patients with haematological malignancies that received any form of specialist palliative or hospice care. Twenty-four studies were identified, nine of which were suitable for inclusion in the meta-analysis. Our review showed that patients with haematological malignancies were far less likely to receive care from specialist palliative or hospice services compared to other cancers (Risk Ratio 0.46, [95% confidence intervals 0.42–0.50]). There are several possible explanations for this finding, including: ongoing management by the haematology team and consequent strong bonds between staff and patients; uncertain transitions to a palliative approach to care; and sudden transitions, leaving little time for palliative input. Further research is needed to explore: transitions to palliative care; potential unmet patient needs; where patients want to be cared for and die; existing practices in the delivery of palliative and end-of-life care; and barriers to specialist palliative care and hospice referral and how these might be overcome.
Hope Over Experience
Authors: Massey Cade , Simmons Joseph P. , Armor David A.
Published: January 2011

Many important decisions hinge on expectations of future outcomes. Decisions about health, investments, and relationships all depend on predictions of the future. These expectations are often optimistic: People frequently believe that their preferred outcomes are more likely than is merited. Yet it is unclear whether optimism persists with experience and, surprisingly, whether optimism is truly caused by desire. These are important questions because life’s most consequential decisions often feature both strong preferences and the opportunity to learn. We investigated these questions by collecting football predictions from National Football League fans during each week of the 2008 season. Despite accuracy incentives and extensive feedback, predictions about preferred teams remained optimistically biased through the entire season. Optimism was as strong after 4 months as it was after 4 weeks. We exploited variation in preferences and matchups to show that desirability fueled this optimistic bias.
How Incidental Values From the Environment Affect Decisions About Money, Risk, and Delay
Authors: Ungemach Christoph , Stewart Neil , Reimers Stian
Published: January 2011

How different are £0.50 and £1.50, “a small chance” and “a good chance,” or “three months” and “nine months”? Our studies show that people behave as if the differences between these values are altered by incidental everyday experiences. Preference for a £1.50 lottery rather than a £0.50 lottery was stronger among individuals exposed to intermediate supermarket prices than among those exposed to lower or higher prices. Preference for “a good chance” rather than “a small chance” of winning a lottery was stronger among participants who predicted intermediate probabilities of rain than among those who predicted lower or higher chances of rain. Preference for consumption in “three months” rather than “nine months” was stronger among participants who planned for an intermediate birthday than among participants who planned for a sooner or later birthday. These fluctuations directly challenge economic accounts that translate monies, risks, and delays into subjective equivalents with stable functions. The decision-by-sampling model—in which subjective values are rank positions constructed from comparisons with samples—predicts these effects and indicates a primary role for sampling in decision making.
Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study
Authors: Vogel A , Bhattacharya S , Larsen JL , Jacobsen S
Published: January 2011

This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms ( r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.
SLEDAI-2K 10 days versus SLEDAI-2K 30 days in a longitudinal evaluation
Authors: Touma Z , Urowitz MB , Ibañez D , Gladman DD
Published: January 2011

The objective of the study was to evaluate SLEDAI-2K 30 days over time and to compare with the original SLEDAI-2K 10 days. Forty-one patients seen at The University of Toronto Lupus Clinic were followed at monthly intervals for 12 months. The SLEDAI-2K score was completed twice, once for a 10-day window and again for a 30-day window using the same definitions for the descriptors. Four hundred and nineteen patient-visits in 41 patients were recorded for both SLEDAI-2K for a 10-day and a 30-day window. One hundred and fifty-one patient-visits had a SLEDAI-2K activity score of 0 and 268 patient-visits had varying levels of disease activity in the range 1–15. In all but one patient-visit there was an agreement between the SLEDAI-2K 10 days and 30 days. SLEDAI-2K 30 days scores were concordant with SLEDAI-2K 10 days scores, both in patients in remission and in patients with a spectrum of disease activity levels followed monthly over 1 year. SLEDAI-2K 30 days was validated against SLEDAI-2K 10 days in a longitudinal evaluation over 1 year. We recommend the use of SLEDAI-2K 30 days in clinical studies and clinical trials.
Once daily busulfan cyclophosphamide is well tolerated and effective as a preparative regimen for allogeneic hematopoietic stem cell transplant
Authors: LeMaistre Julia A , Bachier Carlos , Smith Bradley , LeMaistre CF , Shaughnessy Paul J
Published: January 2011

We report a retrospective review of our institutional data using once daily intravenous (IV) busulfan (Bu) and cyclophosphamide (Cy) and total body irradiation (TBI)/Cy in patients who received allogeneic hematopoietic stem cell transplant (HCT) from January 2000 to December 2006. Bu 3.2 mg/kg IV once daily × 4 days followed by Cy 60 mg/kg IV daily × 2 days was given to 42 patients. Cy 60 mg/kg IV daily for 2 days and fractionated TBI 1200 cGy delivered over 3 days was given to 60 patients. Veno-occlusive disease developed in two patients in the once daily BuCy group and no patients in the TBI/Cy group. The once daily BuCy group had significantly less transplant-related mortality (TRM) than the TBI/Cy group at 100 days ( p = 0.047) and better overall survival at 1 year ( p = 0.01). This review demonstrates once daily IV BuCy and allogeneic HCT is well tolerated with no unexpected TRM or differences in clinical outcomes.
Safety and tolerability of cladribine tablets in multiple sclerosis: the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study
Authors: Cook S , Vermersch P , Comi G , Giovannoni G , Rammohan K , Rieckmann P , Sørensen P Soelberg , Hamlett A , Miret M , Weiner J , Viglietta V , Musch B , Greenberg SJ
Published: January 2011

Background: Cladribine is a synthetic deoxyadenosine analogue in development as an oral multiple sclerosis (MS) therapy.

Objective: To report in detail the safety findings from the 96-week, phase III, double-blind CLARITY study, which evaluated treatment with cladribine tablets in relapsing–remitting MS.

Methods: A total of 1,326 patients were randomized 1 : 1 : 1 to two short-course regimens of cladribine tablets (3.5 or 5.25 mg/kg cumulative dose over 96 weeks) or placebo. Safety assessments included monitoring for adverse events (AEs), routine physical and neurologic examinations and frequent laboratory parameter assessments.

Results: Of the randomized patients, 88.6% completed treatment with cladribine tablets versus 86.3% with placebo. Lymphopenia was the most commonly reported AE in patients treated with cladribine tablets and was anticipated based on the mechanism of action. The incidence of infections was 48.3% with cladribine tablets and 42.5% with placebo, with 99.1% and 99.0% rated mild-to-moderate by investigators. Herpes zoster infections developed in 20 (2.3%) cladribine-treated patients; all cases were dermatomal. There were no herpes zoster infections in the placebo group. Nine (1.0%) patients experienced events related to uterine leiomyomas in the cladribine tablets groups versus one (0.2%) with placebo. Three isolated cases of malignancy were reported in cladribine-treated patients during the study; a fourth was reported during post-study surveillance. A pre-malignant cervical carcinoma in situ was also reported. The incidence of malignancies during the study did not exceed the expected rate in a population standardized for country, gender and age.

Conclusion: The safety and tolerability profile observed in the CLARITY study together with the reported efficacy support the potential for cladribine tablets as an MS therapy.
Effect of disease-modifying drugs on cortical lesions and atrophy in relapsing–remitting multiple sclerosis
Authors: Calabrese M , Bernardi V , Atzori M , Mattisi I , Favaretto A , Rinaldi F , Perini P , Gallo P
Published: January 2011

Objective: To measure the effects of disease-modifying drugs (DMDs) on the development of cortical lesions (CL) and cortical atrophy in patients with relapsing–remitting multiple sclerosis (RRMS).

Methods: RRMS patients ( n = 165) were randomized to subcutaneous (sc) interferon (IFN) beta-1a (44 mcg three times weekly), intramuscular (im) IFN beta-1a (30 mcg weekly) or glatiramer acetate (GA; 20 mg daily). The reference population comprised 50 untreated patients. Clinical and MRI examinations were performed at baseline, 12 months and 24 months.

Results: One hundred and forty-one treated patients completed the study. After 12 months, 37/50 (74%) of untreated patients developed ≥1 new CL (mean 1.6), compared with 30/47 (64%) of im IFN beta-1a-treated patients (mean 1.2, p = 0.021), 24/48 (50%) of GA-treated patients (mean 0.8, p = 0.001) and 12/46 (26%) of sc IFN beta-1a-treated patients (mean 0.4, p < 0.001). After 24 months, ≥1 new CL was observed in 41/50 (82%) of untreated (mean 3.0), 34/47 (72%) of im IFN beta-1a-treated (mean 1.6, p < 0.001), 30/48 (62%) of GA-treated (mean 1.3, p < 0.001) and 24/46 (52%) of sc IFN beta-1a-treated patients (mean 0.8, p < 0.001). Mean grey matter fraction decrease in DMD-treated patients at 24 months ranged from 0.7 to 0.8 versus 1.0 in untreated patients ( p = 0.023).

Conclusions: Disease-modifying drugs significantly decreased new CL development and cortical atrophy progression compared with untreated patients, with faster and more pronounced effects seen with sc IFN beta-1a than with im IFN beta-1a or GA.