bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication skills for advance care planning at end-of-life
Authors: Campbell H , Lillyman S , Nicholson P , Fisher J
Published: May 2011

A total of 44 one day advance care planning (ACP) communications workshops were developed and delivered across two counties to health and social care practitioners Band 5 and above. This collaborative project between two Hospices and a University aimed to develop knowledge, skills and confidence in ACP discussions underpinned by national and local initiatives and policy and the evidence base.

Satisfaction with the programme was excellent with 98% of participants very satisfied/satisfied that the programme was clinically relevant. There were post programme increases in confidence in exploring patient cues, structuring an ACP discussion and identifying patient & relatives concerns.

The workshops also highlighted areas for further development in more general communication skills including identifying and following through cues and use of questions and silence.

The structure of these workshops has since been used for the development of other local programmes addressing ACP and dementia.

However recommendations from this evaluation would suggest that further communication skills training prior to the application to ACP discussions would facilitate conversations taking place particularly in getting conversations started.
‘We were here – Three persons' journeys of life’
Authors: Laidlaw R
Published: May 2011

Narrative interviewing can be traced in American history as far back as 1920. Its application to Advance Care Planning (ACP) as a research method has yet to be extensively researched but where explored, it is the meaning portrayed and the perspective of the value of the event that assists learning. The methodology being less structured and using conversational interaction provides ACP Facilitators' opportunity to reflect on elements such as culture diversity and aspects of life that have compelling interest.

My curiosity in narrative interviewing began in the 80s when involved in death and dying education and was regenerated when implementing the Respecting Patient Choices Program (RPC) at Ipswich Hospital and the surrounding West Moreton Health Service District in 2009. Through the RPC processes including, training of Facilitators and leading the facilitation of ACP conversations in acute, residential and community settings it contributed to my desire to scribe the experiences and lives of three special people and follow their stories through to death with family members.

Scribing these privileged moments in time has provided me with invaluable lessons in life and living, consolidated my reasons of the importance of sharing their lives and their personal meanings when training and preparing Facilitators. The lives explored in context confront positively the importance of ACP and become the infancy of a library of ‘real experiences' that can be intertwined in models of ACP learning.
Structured advance care planning and its impact on patients at end-of-life: a review
Authors: Renton J , Detering K , Silvester W
Published: May 2011

Introduction

Following the trial conducted by Detering et al (2008), Respecting Patient Choices implemented a formal process for advance care planning (ACP) provided by dedicated ACP staff. The intention was to review the impact of ACP on end of life care 12 months after implementation.

Aim

A systematic evaluation of deaths of patients who underwent ACP.

Methods

We reviewed the end of life care of patients over a 12 month period. The review included ACP documentation, patient acuity, demographics, legal capacity, location at death and medical interventions prior to death.

Results

Of 108 patients 68% had formal ACP while the other 32% were introduced to the concepts of ACP. Median age was 78, 47% Male with both genders comparable in ACP completion; 76% had 2–4 comorbidities, however less ACPs were completed in those with more comorbidities. 73% lived at home with others and were less likely to complete ACP (67%) than those living alone (83%). 70% had legal capacity on admission. Location of death showed that 40% of patients died in a palliative care unit, 32% died in an acute ward, while of patients who died at home 100% had completed ACP. Only 2/73 patients who completed ACP had ICU admissions versus 6/35 who only received a brief introduction to ACP.

Conclusion

(1) Using dedicated staff is an effective way of delivering ACP to patients. (2) A completed ACP process ensures that end of life wishes are known and respected.
Government inquiries: why bother?
Authors: Luxford Y
Published: May 2011

Like many other nations, Australia is seeking to improve both the level of integration of delivery of health care, and better address the health needs of its people through significant health system reform. Invariably the reform process is dotted with consultations, discussion papers and numerous opportunities to respond to semi-developed concepts through the mechanism of written submissions.

Preparing a written submission is a time consuming process for both individual practitioners who have an interest, and small NGOs with limited staff and diverse demands on their time.

Despite competing priorities, Palliative Care Australia has found that the process of carefully preparing written submissions, accompanied by various mechanisms of advocacy, provides considerable opportunity to achieve systemic improvement of access to, and delivery of, end of life care.

The primary example used in this presentation will address the current Productivity Commission inquiry into Caring for Older Australians, although other relevant inquiries, such as the National Health and Hospitals Reform Commission and the Advanced Care Directives inquiry will also be addressed.

In each of these cases, explanation will be provided of successful techniques to ensure that messages supporting improved palliative care are conveyed to key decision makers such as politicians and governmental policy creators. Mechanisms discussed include collaboration with like-minded organisations to both pool resources and boost impact, ensuring that the needs of the membership base are met, the importance of robust and evidence based material and the value of direct lobbying.

All reports from current significant inquiries in Australia are now addressing palliative care. Late 2010 saw the Senate strongly supporting a motion to improve funding and access.

It is definitely worth responding to government inquiries – but just writing a letter is simply not enough.
ACP at Barwon health – a community program in a Victorian regional health service
Authors: Mann J
Published: May 2011

Barwon Health's (BH) community sector has been the focus of the Respecting Patient Choices (RPC) program implementation as it was considered that treatment decisions were best made in the non-acute phase of a person's illness.

The initial aim was to provide advance care planning (ACP) for patients with chronic illness participating in formal programs including the Hospital Admission Risk Program (CHF & COPD clients), Renal Services, Palliative Care Services and Aged Care. The acute site wards where these patients were likely to be admitted were also included in the initial phase of implementation.

It became evident that as partners of patients and others in the community heard about the program, there were more individuals wanting to complete ACP's. This group of relatively well, ‘non-patients’ had a high completion rate of ACP documents (80%).

As a result, strong links have been established with the local General Practice Association, General Practices, private hospitals and other health service providers. A public launch was held to raise awareness and the service was extended to provide access to ACP for all BH patients and the wider community.

Process and systems are in place to provide follow up of patients post introduction, consultation, audit, electronic alerts and review. ACP documents are accessible to provide information to family and health care providers.

Data collection and IT capabilities at BH have been useful for both reporting requirements and to identify potential patients and areas requiring ongoing focus.
It's my life: influences on advance care planning conversations
Authors: Russell S
Published: May 2011

As part of a doctoral research study 20 hospice patients responded to an invitation to participate in a video interview to discuss their influences on discussing end of life wishes and preferences. 15 participants were interviewed.

▶

2 withdrew after reading the information sheet.

▶

1 retrospectively withdrew consent.

▶

1 died before participation.

▶

1 did not meet the sample criteria.

The findings indicate participants:

(a)

Can feel processed through an end of life check list to make decisions where they are given the decisions and then asked to think rather than think and decide.

(b)

Do not always discuss issues with those closest to them because of a desire to protect them.

(c)

Are not always willing to make advance care planning decisions not because they are unaware of their illness but because they do not feel resilient to face the emotional impact of their choices as well as being within the advance care planning process of; (1) consideration of wishes and preferences, (2) discussion, (3) discussion and decision making, (4) decision making and documentation, (5) communication and implementation.

(d)

Are willing to discuss end of life wishes and preferences when conversations are empathetic, at their pace and as part of an ongoing process.

Conclusion

Health care professionals should value the consideration and discussion part of advance care planning as the vehicle and support mechanism for decision making outcomes. A reductionist, tick box approach to advance care planning can enable participants to feel processed through rather than participating in advance care planning discussions.
Advance care planning for GLBTI people: results of a state-wide survey
Authors: Cartwright C
Published: May 2011

Background

Increasing evidence suggests that many gay, lesbian, bisexual, transgender and intersex (GLBTI) people are being denied their legal rights at the end-of-life. A 2009 study in Northern NSW (presented 2010 ACPEL Conference) found evidence of active discrimination and abuse of GLBTI people.

Methods

A State-wide hard copy and on-line survey and in-depth interviews were undertaken.

Results

305 useable questionnaires were returned; questionnaire distribution was via Newsletter & websites so a response rate could not be determined.

The majority of respondents were open to all significant others; just over half were in a relationship; 77% had been in their relationship for 4 years or more.

Most respondents had high levels of education and income above that of the general population. Only 21% rated their health as Fair or Poor, while 53% said it was excellent or very good.

Knowledge of/Experience with advance care planning (ACP) options was variable; most respondents did not understand the law relating to ACP. Few had discussed their end-of-life wishes with their doctor or significant others.

Those who were not out to significant others, had lower education and income and poorer health, are at greatest risk of inadequate care and not having their end of life wishes respected.

Conclusions

As many GLBTI people are ageing, there is an urgent need for focussed education for GLBTI people about legally available ACP options and resources. Findings from this study and the pilot have resulted in a new GLBTI-specific ACP resource booklet.

Funding

Study funded by Law and Justice Foundation of NSW.
Can advance care planing offer an alternative to people contemplating euthanasia?
Authors: Fullam R , Hancock A , Detering K , Davies J , Silvester W
Published: May 2011

Background

Many patients with terminal illness and progressive loss of control over their bodies explore the option of euthanasia as a means to regain control. Some of these patients are referred by health professionals for advance care planning (ACP). This case study illustrates the difficulties involved.

Case summary

MH had advanced Multi System Atrophy, a terminal disease involving progressive paralysis and pain and was being cared for at a nursing home. At the time of referral to the Respecting Patient Choices (RPC) Program, she was actively seeking advice from voluntary euthanasia organisations, and was exhibiting increasingly severe symptoms of depression as her disease progressed. The psychiatric liaison service viewed the initiation of involuntary treatment as inappropriate in this context. At this point a referral to the RPC program was made. ACP was conducted with MH, and she and her family completed an ACP including the appointment of a substitute decision maker, and the completion of a refusal of treatment certificate. MH was subsequently admitted to a specialist palliative care unit, where she died shortly after admission.

Discussion

This case touches on a number of issues around requests for hastened death, demonstrates a failure of terminal care provision and highlights the need for ACP at the time of diagnosis or early in the course of a terminal illness. Even at a late stage, ACP provided MH with information regarding her treatment options and allowed her to gain a sense of control over aspects of her treatment.

Case summary

MH had been diagnosed with Multi System Atrophy, a terminal disease involving progressive paralysis and pain, 6 years prior to referral and was being cared for at a nursing home. At the time of referral to the RPC Program, Austin Health, Melbourne, she was suicidal, was actively seeking advice from voluntary euthanasia organisations, and had been assessed by the psychiatric liaison service as meeting the diagnostic criteria for major depression. The psychiatric consensus was against initiating involuntary treatment. At this point a referral to the RPC program was made. An ACP Clinician met with MH and her family to assist her to complete an advance care plan including the appointment of a substitute decision maker and the completion of a refusal of treatment certificate. She was also informed of her right to refuse further medical treatment. MH was subsequently referred, and admitted, to a specialist palliative care unit, where she died within 24 h of admission.

Discussion

This case demonstrates a failure of terminal care provision and highlights the need for ACP at the time of diagnosis. Even at a late stage ACP offered an alternative to euthanasia in a situation where she and her family felt that they had no other options.
Core principles and guidance in relation to CPR status
Authors: George R , Sherwen E , Regnard C
Published: May 2011

The End of Life Care Strategy (DH 2008) highlights the importance, within Care Planning, of clear and appropriate discussion and decisions about CPR. These decisions may change over time with clinical deterioration and/or therapeutic reversibility. One point at which this becomes critical is when a patient moves between care settings for example, with some clinical crisis or when care is delivered better elsewhere.

Currently, while organisations have crafted their own policies, small but critical variations exist, together with the assumption that ‘our policy ends at our front door’. This has profound implications for transport and receiving services because this hiatus, for anyone in transit who does not want CPR, will inevitably make them vulnerable to inappropriate intervention. This can be overcome by harmonising CPR policies between partner organisations or across localities to ensure that there are clear ways in which people are managed when being moved.

There are excellent examples of work nationally including the Unified Policy being implemented across South Central SHA, DNACPR Principles from South East Coast SHA, and the unified policy being developed within the East of England SHA.

The National End of Life Care programme has scoped current work with key partners to produce a set of Core Principles and guidance for managing the intersection of policies where unification has not or cannot yet be achieved. This is aimed at organisations wishing to work together to ensure that policies connect to achieve smooth transition for the individual that safeguards choice, reduces unwanted and unnecessary attempts at resuscitation and promotes a dignified death.
New insights into place of death for people with Alzheimer's disease, dementia and senility
Authors: Verne J , Harris S , Ho D
Published: May 2011

Between 2001 and 2009, 15% of all deaths in England had a mention (ie, either an underlying or contributory mortality coding) of Alzheimer's disease, dementia or senility. Over this period there was a 57% increase in the number of mentions from these conditions.

This analysis specifically examined the age and sex distributions and places of death for each of these conditions, by whether they were coded as underlying or contributory causes of death. Major differences were found in age distribution, gender balance and place of death across these conditions, and there was also marked variations across these factors according to whether the conditions were recorded as underlying or contributory.

The analysis then went on to examine patterns and effects of contributory codings of Alzheimer's disease, dementia and senility for major underlying cause of death groupings (circulatory diseases, malignant cancers, respiratory diseases) and found large differences across these groups. Place of death of each of these major groups was also examined according to whether contributory codings of Alzheimer's disease, dementia or senility were present and radical differences observed between populations with and without contributory codings.

As the number of people with Alzheimer's disease, dementia and senility is projected to increase by over 70% in England between 2010 and 2030, these conditions are set to become increasingly important, both in terms of numbers of persons affected and resources consumed. Greater insight into the patterns and trends of these conditions is therefore essential to plan the provision of appropriate levels and patterns of care.
Who makes use of the enduring guardianship provisions in Tasmania (Australia) and what do they write on the forms?
Authors: Thomas R , Ashby M , Thornton R
Published: May 2011

Under the provisions of the Guardianship and Administration Act 1995 in the state of Tasmania (Australia), the document of appointment has to be registered with the Guardianship and Administration Board. This study therefore provides an unusual opportunity to learn what people write in their Enduring Guardianship (EG) forms, who they appoint as enduring guardians, and also gives other valuable demographic information about the appointment of substitute decision-makers, the making of advance care directives in Tasmania. It also gives a rare opportunity to obtain ‘denominator’ data about the uptake of these provisions in a defined jurisdiction.

A total of 502 EG forms were analysed, out of a total of 10 040 forms lodged at the time of the study, since 1995. This represents a 2% uptake by a population of approximately 500 000 over a 15-year period. In total there were 298 females and 176 males, with 28 forms where gender was not recorded.

The majority of the sample consisted of forms completed by retired persons aged over 60. Despite the fact that legal assistance is not necessary to complete an EG form, 197/502 (39%) showed evidence of some qualified legal input.

238/502 (47%) of the forms contained some kind of statement about care at the end of life, and indicated a preference for the deployment of timely and appropriate palliative care.

Persons who appoint enduring guardians in Tasmania are predominantly older retired citizens, whose single most frequently expressed concern is for palliative care at the end of life.
Singapore nursing students' perceptions about spirituality and spiritual care: a qualitative study
Authors: Tiew L H , Drury V , Creedy D
Published: May 2011

Background

Spiritual care is a central element of holistic and multidisciplinary care, but is not often integrated into practice. Some nurses may confuse spirituality with religion and refer this aspect of care to other professionals. There is little exploration of student nurses' perceptions and attitudes towards spirituality and spiritual care. Identifying student nurses' perceptions may inform educational content and practice development activities.

Purpose

This exploratory study investigated nursing students' perceptions and attitudes about spirituality and spiritual care in practice.

Method

In-depth interviews were conducted with 16 final year pre-registration nursing students from three different educational institutions offering a degree or diploma programme in Singapore. Data were analysed using the Miles and Huberman (1994) research method.

Results

Three themes emerged in regards to the construct of spirituality: (1) being human, (2) spiritual well-being and (3) spiritual awareness. The construct of spiritual care revealed three themes: (1) antecedents for spiritual care, (2) role of nurses in spiritual care, and (3) nurses' spirituality. Themes relating to the construct of factors influencing spiritual care were: (1) personal factors; (2) system factors and (3) patient factors.

Conclusions

Students perceived spirituality as an innate characteristic of individuals. Spiritual awareness was perceived to develop across the lifespan and was essential for spiritual well-being. Spiritual care required nurses to engage patients in meaningful ways. Cursory attention to spiritual care was considered ineffective and students perceived that a comprehensive spiritual assessment was important for care. Participants identified that nurses need to connect with patients in a unique spiritual care-giving relationship. Students also identified that nurses with certain attributes and spiritual awareness were more likely to provide spiritual care. However, students recognised that some nurses may not be equipped to address deeper levels of spiritual care. Education and professional development for effective spiritual care needs to be offered to nurses.
Novel Teaching of Advance Care Planning Conversations for Family Doctors
Authors: Corke C , Milnes S
Published: May 2011

Though most doctors recognize the value of Advance Care Planning (ACP) only a minority of doctors feel comfortable raising the topic with patients. This results in many patients being denied the opportunity to plan.

The literature suggests approaches that are effective and some doctors represent excellent role models. We have reviewed published approaches and have recorded the conversations of doctors who appear to have highly effective strategies for the communication of the ACP message (and others who feel that their discussions are ineffective and uncomfortable).

Using this information we have designed and implemented a teaching program that clearly teaches an approach that is acceptable to patients and which encourages patients to engage in ACP.

Family Doctors require teaching that is easily accessible and flexible so this program includes multimodal educational components including DVD examples of good and bad approaches (with critical commentary) and an eSim component where doctors are able to conduct an on-line simulated dialogue with a simulated patient. In the case of the eSim there is ability to record and to score performance.

This project demonstrates a novel education system to explain effective language to those family doctors who recognize the benefit of ACP but lack the skills to introduce the topic without upsetting their patients.
Patient-Centered Worksheets for Advance Care Planning: Education for Patients and Guidance for Clinician Communication
Authors: Pearlman R
Published: May 2011

In the 1990s the Veterans Health Administration (VHA) developed worksheets to help patients think about and discuss aspects of advance care planning (ACP). The content of the worksheets was based on input from patients, family members, physicians, and religious leaders. Research demonstrated that the worksheets improved clinician understanding of patient values and preferences. The worksheets were updated in 2008–2009 with input from experts, including clinicians, religious leaders, ethicists, and attorneys. This was followed by an iterative content review involving subject matter experts and senior VHA leaders, and editing by experts in patient education and communication.

The worksheets elicit a patient's values and/or preferences, such as hopes and fears (eg, ‘If I have a condition that will make me die very soon, even with life-sustaining treatments …, what would be your biggest fears … ? What would you most want to avoid?’), strongly held beliefs (eg, ‘I gain strength from other things like family, prayer, inspirational literature, or music. I want the following things included [in] my care: … ‘), contacts for taking care of important things, mental health care, conditions in which life-sustaining treatment would be wanted (versus not wanted), and care during one's last days.

Workshop participants will assign priorities to aspects of ACP they wish to discuss, discuss their approaches to a priority aspect of ACP, complete a worksheet on the same subject, and then discuss the strengths and weakness of the worksheet for their practice. This will be repeated for several worksheets to demonstrate their applications and value in ACP.
Making health choices; Part 1. Advance Care planning in aged care project. Setting the scene
Authors: Jackson L , Sjanta R , Fullam R , Silvester W
Published: May 2011

Introduction

The (2009) Australian National Health & Hospital Reform Commission Report highlighted the need for advance care planning (ACP) for older persons in residential aged care facilities (RACFs). Using knowledge gained from a previous RACF Project Implementation in 2004-5, Respecting Patient Choices has developed a sustainability based model for the effective training of residential aged care service staff to deliver ACP to their residents. This presentation will provide a unique insight into the complexities of ACP implementation within Australian residential aged care.

Project methods

19 individual RACFs, representing 12 Aged Care organisations were selected from regional and metropolitan areas of Victoria. Three full-day workshops were delivered over a 6 month period, with RACFs expected to complete sustainability oriented tasks in between each workshop in order to meet the project deliverables. As part of the project an aged care specific ACP document was developed by an expert working party.

Pre-implementation over-view

A number of contextual factors have impacted the present project including; Australian geography, RACF funding issues, and provision of medical support to RACF residents.

Results

from a pre-implementation policy and practice survey demonstrated a wide variation of the quality of existing ACP knowledge and practices. An audit of pre-existing ACP documents revealed that all documents were missing key elements of a best practice ACP document. 11 of the 12 organisations in the project have adopted the specially developed document.
Advance care planning – out goes paternalism, in comes consultative conversation
Authors: Finlay I
Published: May 2011

We all know what we want – or do we? Patients cannot ‘choose’ to not be ill or avoid dying of their disease, but deserve be involved in decisions about their care.

UK Mental Capacity legislation heralded a long-overdue change, encapsulated in the NHS slogan ‘no decision about me without me’; everyone must to do everything to maximise patients' decision-making ability. Impediment of brain function cannot be assumed to render decisions invalid; if decision-making capacity for a particular decision is lacking, then previously expressed wishes must be considered when making a decision in aperson's best-interest.

Personhood is a function of being alive; after death one is a corpse. So, best interest to relieve suffering may necessitate risk-taking, but does not include deliberately killing the person.

Advance Decisions to refuse treatment (aka Advance Directives/Living Wills) if competently drawn up and relevant to the specific situation are legally binding, signalling the person hasalreadywithheld consent to a particular intervention; they cannot direct in advance that something is done, neither drug treatment nor surgery nor lethal overdose.

In ethical equipoise is an advance statement of wishes – to be considered if lack of capacity requires a best-interest decision.

Advance care planning (ACP) maintains this equipoise; calm timely discussions can ‘plan for the worst and hope for the best’. Open, realistic conversations address concerns, avoid false reassurance, and honestly discuss options.

Honest ACP can reveal service deficits that militate against excellent care, galvanising action to improvements in care.
Allergy among veterinary medicine students in The Netherlands
Authors: Samadi Sadegh , Spithoven Jack , Jamshidifard Ali-Reza , Berends Boyd R , Lipman Len , Heederik Dick J J , Wouters Inge M
Published: June 2011

Background

Veterinary medicine students who practice with animals are potentially exposed to many occupational agents, yet sensitisation and allergic symptoms among this group have not been studied extensively.

Objective

The objective of this study was to estimate the prevalence of sensitisation and allergic symptoms in veterinary medicine students in association with study specialisation over time.

Methods

A questionnaire-based cross-sectional study was conducted. Blood was collected and tested for total and specific serum IgE for 16 different common and study-specific allergens using enzyme immunoassay.

Results

New development of self-reported allergic symptoms to various allergens occurred in 8.7%, of which 44% was deducted against animals. Handling farm animals was strongly associated with self-reported allergies to various allergens (OR=6.9, 95% CI 1.9 to 25) and animal allergens (OR=12, 95% CI 1.4 to 103). Sensitisation to at least one allergen occurred in 33.1%. Sensitisation prevalence tended to be elevated in later years of the equine study program. In contrast to self-reported allergies, the prevalence of sensitisation to any allergen decreased with prolonged study duration for those specialising in farm animal health (years 3–5: OR=0.5, 95% CI 0.3 to 1.1; year 6: OR=0.2, 95% CI 0.1 to 0.5). This was independent of whether people were raised on a farm, which is in itself a protective factor for allergy and sensitisation.

Conclusion

This study provides evidence of an elevated prevalence of allergic symptoms with increasing years of veterinary study, suggesting that contact with animals, more specifically contact to farm animals, is a risk factor for the development of symptoms.
GAUGE MEDIATION OF SUPERSYMMETRY BREAKING AND THE FROGGATT–NIELSEN MECHANISM
Authors: ZHANG ZHONG-HUA , ZHANG DA-XIN
Published: June 2011

In the model of gauge mediation of SUSY breaking in the presence of tree-level mediation, the Froggatt–Nielsen mechanism provides a different hierarchy of sparticle masses. We study the spectra and show the results to be like those in an effective supersymmetric model.
SELF-DUAL FORMULATIONS OF d = 3 GRAVITY THEORIES IN THE PATH-INTEGRAL FRAMEWORK
Authors: ARIAS P. J. , SCHAPOSNIK F. A.
Published: June 2011

We study the connection, at the quantum level, between (d = 2+1)-dimensional self-dual models with actions of growing (from first to fourth) order, governing the dynamics of helicity ±2 massive excitations. We obtain identities between generating functionals of the different models using the path-integral framework, this allowing us to establish dual maps among relevant vacuum expectation values. We check consistency of these vacuum expectation values with the gauge invariance gained in each mapping.
MIXING OF FERMION FIELDS OF OPPOSITE PARITIES AND BARYON RESONANCES
Authors: KALOSHIN A. E. , KOBELEVA E. A. , LOMOV V. P.
Published: June 2011

We consider a loop mixing of two fermion fields of opposite parities whereas the parity is conserved in Lagrangian. Such kind of mixing is specific for fermions and has no analogy in boson case. Possible applications of this effect may be related with physics of baryon resonances. The obtained matrix propagator defines a pair of unitary partial amplitudes which describe the production of resonances of spin J and different parity 1/2± or 3/2±. The use of our amplitudes for joint description of πN partial waves P13 and D13 shows that the discussed effect is clearly seen in these partial waves as the specific form of interference between resonance and background. Another interesting application of this effect may be related with partial waves S11 and P11, where the picture is more complicated due to presence of several resonance states.
MSSM-LIKE AdS FLUX VACUA WITH FROZEN OPEN-STRING MODULI
Authors: CHEN CHING-MING , LI TIANJUN , MAYES VAN ERIC , NANOPOULOS D. V.
Published: June 2011

We construct supersymmetric Pati–Salam flux vacua in AdS from intersecting D6-branes on T6/(ℤ2 × ℤ′2). The models constructed have three generations of MSSM matter plus right-handed neutrinos. Because the cycles wrapped by the D-branes are rigid there are no extra massless fields in the adjoint representation, arising as open-string moduli. However, we find that it is problematic to break the Pati–Salam gauge symmetry to the Standard Model (SM) while keeping the SM hypercharge massless.
DL-LINK: A CONCEPTUAL CLUSTERING ALGORITHM FOR INDEXING DESCRIPTION LOGICS KNOWLEDGE BASES
Authors: D'AMATO CLAUDIA , STAAB STEFFEN , FANIZZI NICOLA , ESPOSITO FLORIANA
Published: June 2011

Efficient resource retrieval is a crucial issue, particularly when semantic resource descriptions are considered which enable the exploitation of reasoning services during the retrieval process. In this context, resources are commonly retrieved by checking if each available resource description satisfies the given query. This approach becomes inefficient with the increase of available resources. We propose a method for improving the retrieval process by constructing a tree index through a new conceptual clustering method for resources expressed as class definitions or as instances of classes in ontology languages. The available resource descriptions are located at the leaf nodes of the index, while inner nodes represent intensional descriptions (generalizations) of their child nodes. The retrieval is performed by following the tree branches whose nodes satisfy the query. Query answering time may be improved as the number of retrieval steps may be O(log n) in the best case.
SYNCHRONIZATION OF SPIN-TORQUE NANO-OSCILLATORS FROM AN INDUCED CORRUGATED ATTRACTOR
Authors: CHEN HAOHSUAN , CHANG JUIHANG , CHANG CHINGRAY
Published: June 2011

Due to the demagnetization field of the free layer, an approximate theory was introduced to analyze the synchronization mechanism of coupled nano-oscillators. The necessary conditions of synchronization for a coupled spin-transfer-torque system are derived and dipolar interaction generates synchronization within an induced corrugated attractor. The theory of corrugated attractor also shows that the current feedback effect from Giant Magnetoresistance (GMR) cannot synchronize the second type of spin-torque nano-oscillators. Our theory is consistent with the numerical results from the Landau–Lifshitz–Gilbert equation with a spin-transfer-torque.
Identification and functional characterization in vivo of a novel splice variant of LDLR in rhesus macaques
Authors: Kassim Sadik H. , Vandenberghe Luk H. , Hovhannisyan Ruben , Wilson James M. , Rader Daniel J.
Published: June 2011

In the course of developing a low-density lipoprotein receptor (LDLR) gene therapy treatment for homozygous familial hypercholesterolemia (HoFH), we planned to examine the efficacy in a nonhuman primate model, the rhesus macaque heterozygous for an LDL receptor mutation fed a high-fat diet. Unexpectedly, our initial cDNA sequencing studies led to the identification of a heretofore unidentified splicing isoform of the rhesus LDLR gene. Compared with the publicly available GenBank reference sequence of rhesus LDLR, the novel isoform contains a 21 bp in frame insertion. This sequence coincides with part of exon 5 and creates a site for the restriction enzyme MscI. Using this site as a marker for the 21 bp in-frame insertion, we conducted a restriction enzyme screen to examine for the prevalence of the novel isoform in rhesus liver tissue cDNA and its homolog in human liver tissue cDNA. We found that the novel isoform is the predominant LDLR cDNA found in rhesus liver and the sole LDLR cDNA found in human liver. Finally, we compared the in vivo functionality of the novel and previously identified rhesus LDLR splicing isoforms in a mouse model of HoFH.
The Rare Malignancy of the Hepatobiliary System: Ampullary Carcinoid Tumor
Authors: Ozsoy Mustafa , Ozsoy Yucel , Canda Aras Emre , Nalbant Olcay Ak , Haskaraca Fatih
Published: May 2011

Introduction. Carcinoid tumors are low-grade tumors originating from endoderm and mostly involving the gastrointestinal system. However; they may be seen in any site within the gastrointestinal system.Case Presentation. A 69-year-old female patient. The results of blood tests were observed to be consistent with obstructive jaundice. A mass appearance was not encountered on tomographic examination. Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in diagnostic endoscopy. Pylorus—preserving pancreaticoduodenectomy surgical procedure was applied. On pathological examination of the mass, a tumoral mass was detected in ampulla vateri localization, 1.5 × 1 × 0.8 cm in size, which, in immunohistochemical staining, was evaluated as a neuroendocrine tumor. Also, Metastasis was observed.Conclusion. The rarest type of carcinoid tumor is ampullary located carcinoid tumor, and tumor size is not a reliable indicator for tumor aggressivity in ampullary carcinoid tumors.
Almost Surely Asymptotic Stability of Numerical Solutions for Neutral Stochastic Delay Differential Equations
Authors: Yu Zhanhua , Liu Mingzhu
Published: June 2011

We investigate the almost surely asymptotic stability of Euler‐type
methods for neutral stochastic delay differential equations (NSDDEs) using the discrete semimartingale
convergence theorem. It is shown that the Euler method and the backward Euler method can reproduce the almost surely asymptotic stability of exact solutions to NSDDEs under additional conditions. Numerical examples are demonstrated to illustrate the effectiveness of our theoretical results.
Immersion Pulmonary Edema in Female Triathletes
Authors: Carter Eric A. , Koehle Michael S.
Published: June 2011

Pulmonary edema has been reported in SCUBA divers, apnea divers, and long-distance swimmers however, no instances of pulmonary edema in triathletes exist in the scientific literature. Pulmonary edema may cause seizures and loss of consciousness which in a water environment may become life threatening. This paper describes pulmonary edema in three female triathletes. Signs and symptoms including cough, fatigue, dyspnea, haemoptysis, and rales may occur within minutes of immersion. Contributing factors include hemodynamic changes due to water immersion, cold exposure, and exertion which elevate cardiac output, causing pulmonary capillary stress failure, resulting in extravasation of fluid into the airspace of the lung. Previous history is a major risk factor. Treatment involves immediate removal from immersion and in more serious cases, hospitalization, and oxygen administration. Immersion pulmonary edema is a critical environmental illness of which triathletes, race organizers, and medical staff, should be made aware.
Nonstandard FDTD Simulation-Based Design of CROW Wavelength Splitters
Authors: Okada Naoki , Cole James B. , Yamada Shigeki , Ogawa Kensuke , Katayama Yoshifumi
Published: June 2011

The finite-difference time-domain (FDTD) algorithm has been used in simulation-based designs of many optical devices, but it fails to reproduce high-Q whispering gallery modes (WGMs). On the other hand, the nonstandard (NS) FDTD algorithm can accurately compute WGMs and can be used to make simulation-based designs of WGM devices. Wavelength splitters using the coupled resonator optical waveguides (CROWs) based on WGM couplings have recently attracted attention because they are potentially ultracompact. In this paper, we design a CROW wavelength splitter using NS FDTD simulations and demonstrate high interchannel extinction ratios of over 20 dB.
Potential of Stable Carbon and Oxygen Isotope Variations of Speleothems from Andaman Islands, India, for Paleomonsoon Reconstruction
Authors: Laskar Amzad H. , Raghav S. , Yadava M. G. , Jani R. A. , Narayana A. C. , Ramesh R.
Published: May 2011

The Indian monsoon activity, coinciding with the Inter-Tropical Convective Zone (ITCZ), progresses from the southern Indian Ocean during the boreal summer and withdraws towards the south in winter. Islands situated to the south of India receive, therefore, the first and last showers of the monsoon; speleothems in such islands have not yet been explored for their potential to reconstruct past monsoon rainfall. Here, we present the first measurements of stable carbon and oxygen isotopic compositions (δ13C andδ18O) of a stalagmite collected from the Baratang Island of Andamans, along with new data onδ18O of modern monsoon precipitation (May to July 2010). The aim was to detect (i) whether these samples are amenable to dating using14C, (ii) whether their oxygen isotopes indicate precipitation under isotopic equilibrium, and (iii) if (i) and (ii) above are true, can we reconstruct monsoon activity during the past few millennia? Our results indicate that whileδ18O of speleothem does show evidence for precipitation under isotopic equilibrium; dating by14C shows inversions due to varying contributions from dead carbon. The present work highlights the problems and prospects of speleothem paleomonsoon research in these islands.
A Penalization‐Gradient Algorithm for Variational Inequalities
Authors: Moudafi Abdellatif , Al-Shemas Eman
Published: May 2011

This paper is concerned with the study of a penalization‐gradient algorithm for solving variational inequalities, namely, find such that for all y ∈ C, where A : H → H is a single‐valued operator, C is a closed convex set of a real Hilbert space H. Given Ψ : H → ℝ   ∪   {+∞} which acts as a penalization function with respect to the constraint , and a penalization parameter βk, we consider an algorithm which alternates a proximal step with respect to ∂Ψ and a gradient step with respect to A and reads as xk = (I + λkβk∂Ψ) −1(xk−1 − λkAxk−1). Under mild hypotheses, we obtain weak convergence for an inverse strongly monotone operator and strong convergence for a Lipschitz continuous and strongly monotone operator. Applications to hierarchical minimization and fixed‐point problems are also given and the multivalued case is reached by replacing the multivalued operator by its Yosida approximate which is always Lipschitz continuous.
Potential Role of NK Cells in the Pathogenesis of Inflammatory Bowel Disease
Authors: Yadav Praveen K. , Chen Chi , Liu Zhanju
Published: June 2011

NK cells are a major component of the innate immune system and play an important role in the tissue inflammation associated with autoimmune diseases such as inflammatory bowel disease (IBD). NK cells are unique in bearing both stimulatory and inhibitory receptors specific for MHC class I molecules, and their function is regulated by a series of inhibiting or activating signals. The delicate balance between activation and inhibition that decides NK cell final action provides an opportunity for their possible modulatory effect on specific therapeutic settings. Intestinal NK cells are phenotypically distinct from their counterparts in the blood and resemble “helper” NK cells, which have potentially important functions both in promoting antipathogen responses and in the maintenance of intestinal epithelial homeostasis. NK cell activities have been found to be significantly below normal levels in both remissive and active stages of IBD patients. However, some proinflammatory cytokines (e.g., IL‐15, IL‐21, and IL‐23) could potently induce NK cell activation to secret high levels of proinflammatory cytokines (e.g., IFN‐γ and TNF) and promote the cytolytic activities against the target cells. This paper provides the characteristics of intestinal NK cells and their potential role in the pathogenesis of IBD.
Real‐Time Monitoring of Neural Differentiation of Human Mesenchymal Stem Cells by Electric Cell‐Substrate Impedance Sensing
Authors: Park Hyo Eun , Kim Donghee , Koh Hyun Sook , Cho Sungbo , Sung Jung-Suk , Kim Jae Young
Published: May 2011

Stem cells are useful for cell replacement therapy. Stem cell differentiation must be monitored thoroughly and precisely prior to transplantation. In this study we evaluated the usefulness of electric cell‐substrate impedance sensing (ECIS) for in vitro real‐time monitoring of neural differentiation of human mesenchymal stem cells (hMSCs). We cultured hMSCs in neural
differentiation media (NDM) for 6 days and examined the time‐course of impedance changes with an ECIS array. We also
monitored the expression of markers for neural differentiation, total cell count, and cell cycle profiles. Cellular expression of
neuron and oligodendrocyte markers increased. The resistance value of cells cultured in NDM was automatically measured in real‐time
and found to increase much more slowly over time compared to cells cultured in non‐differentiation media. The relatively slow
resistance changes observed in differentiating MSCs were determined to be due to their lower growth capacity achieved by
induction of cell cycle arrest in G0/G1. Overall results suggest that the relatively slow change in resistance values measured by
ECIS method can be used as a parameter for slowly growing neural‐differentiating cells. However, to enhance the competence
of ECIS for in vitro real‐time monitoring of neural differentiation of MSCs, more elaborate studies are needed.
Nearly Jordan ∗‐Homomorphisms between Unital C∗‐Algebras
Authors: Ebadian A. , Gharetapeh S. Kaboli , Gordji M. Eshaghi
Published: June 2011

Let A, B be two unital C∗‐algebras. We prove that every almost unital almost
linear mapping h : A → B which satisfies h(3nuy + 3nyu) = h(3nu)h(y) + h(y)h(3nu) for all u ∈ U(A), all y ∈ A, and all n = 0,1, 2, …, is a Jordan homomorphism. Also, for a unital
C∗‐algebra A of real rank zero, every almost unital almost linear continuous mapping h : A → B is a Jordan homomorphism when h(3nuy + 3nyu) = h(3nu)h(y) + h(y)h(3nu)
holds
for all u ∈ I1
(Asa), all y ∈ A, and all n = 0,1, 2, …. Furthermore, we investigate the Hyers‐
Ulam‐Aoki‐Rassias stability of Jordan ∗‐homomorphisms between unital C∗‐algebras by using the fixed points methods.
Formation of a Molecular Wire Using the Chemically Adsorbed Monomolecular Layer Having Pyrrolyl Groups
Authors: Ogawa Kazufumi , Mino Norihisa , Yamamoto Shin-ichi , Ohtake Tadashi
Published: May 2011

A molecular wire containing polypyrrolyl conjugate bonds has been prepared by a chemical adsorption technique using 1,1,1-trichloro-12-pyrrolyl-1-siladodecane (PNN) and an electrooxidative polymerization technique, and the conductivity of the molecular wire without any dopant has been measured by using AFM/STM at room temperature. When sample dimension measured was about 0.3 nm (thickness of the conductive portion in the PNN monomolecular layer) ×100 μm (the average width of an electric path) ×2 mm (the distance between Pt positive electrode and the AFM tip covered with Au), the conductivity of the polymerized PNN molecular wire at room temperature was larger than 1.6 × 105 S/cm both in an atmosphere and in a vacuum chamber of 10−5 Torr. The activation energy obtained by Arrhenius' plots was almost zero in the temperature range between 320 and 450 K.