bluuebunny/crossref_metadata_2025 huggingface dataset:
PERSONAL VALUES PROFILING AND ADVANCE CARE PLANNING
Authors: Corke Charlie
Published: April 2013

Many people find it difficult to think about dying and to refuse medical treatments. This makes Advance Care Planning a challenge. In contrast, thinking about values is much easier. Exploring values can reveal how consistent views are and can also provide a profile of values that can give insight to how the individual thinks about issues relating to death, debility, medical treatment and dependency. People have reacted positively to completing the Personal Values Profile. No negative feedback has been received. Several users have commented that the survey was confronting but important. Many stated that they planned to share the Personal Values Profile report with their family and doctors. This is very encouraging as this may Personal Values Profiling has been tested in a Best-Worst Scoring System involving over 1000 people aged 55 and over. This reveals that only a small minority of people have values that support the medical default position (ie, to do whatever possible to save life, whatever the burden of treatment and however poor the outcome may be). The Personal Values Profile results have been analysed for clustering of values within the individual responses. This reveals 3 distinct groups:

Group 1(7%) believe in extending life no matter what the consequences

Group 2(32%) view quality of life as important but are willing to accept some limitations

Group 3(61%) view quality of life as paramount and would rather die than accept limitations

Sub-analysis of responses by patients aged over 80 reveals that Group 3 are even more highly represented in this group. Group 1 remains at 7% so the increase is due to older individuals ceasing to accept limitations so moving from Group 2 to Group 3.

The finding that the majority opinion (Group 3) takes the view that there are situations that are worse than death is of great import and suggests that the medical default (to save life at any cost) fails a large proportion of patients. This finding also suggests that Advance Care Planning is required for a large proportion of the population. The utility of Personal Values Profile report to directly assist medical decision making, or to facilitate formal Advance Care Planning, remains to be demonstrated.
‘I AM SO ANGRY AND FRIGHTENED TO BE AT THIS STAGE OF MY LIFE’: OBSERVATIONS OF GRIEF AND LOSS IN COMMUNITY ADVANCE CARE PLANNING GROUP EDUCATION
Authors: Crowe L , Boddy J , Chenoweth L
Published: April 2013

Background

The ACP literature has a paucity of information in relation to the loss and grief experiences for people when contemplating engagement in ACP. Without this information engagement of certain populations and resolution of barriers to ACP may be difficult to overcome.

Aim

To explore the incidence and themes of loss and grief that were shared within the context of ACP education workshops.

Methods

A qualitative approach was used with participant observation and reflective journaling to record events within the implementation of ACP workshops. Thematic analysis was then employed to identify the various themes and frequency of loss and grief issues disclosed within the workshops.

Results

There were two to three significant loss and grief statements made or disclosures of personal losses in each workshop. Loss and grief themes included fear of death, loneliness, suffering and vulnerability. Grief experiences included watching loved ones be palliated or die in a way that did not match personal values.

Discussion

Loss and grief for older people outside the context of bereavement is under researched. Despite recognition of depression in the elderly there is scarcity in the literature of general grief and loss experiences and how this may impact the engagement and participation in ACP training. There are both historical and sociological grief and loss issues for this generation which require exploration for successful engagement in ACP planning.

Conclusion

Participants had many fears related to previous loss experiences and misconceptions of the ACP process. Disclosures resulted in increased participation in the group and greater understanding of the benefits of the ACP process.
ADVANCE CARE PLANNING IN PRIMARY CARE IN THE EAST OF ENGLAND: PUTTING GUIDANCE INTO PRACTICE?
Authors: Hayhoe B , Howe A
Published: April 2013

Background

Advance care planning (ACP) continues to gain importance in UK healthcare, with definition in statute in the Mental Capacity Act 2005 and professional guidance advocating its use in primary care. However, the impact on clinical practice is unclear.

Aim

This qualitative study investigates ACP in UK primary care, establishing current experience, ideas and views on ACP, and identifying the extent to which guidance is embedded in practice.

Method

Fifteen General Practitioners and four Old Age Psychiatrists took part in semi-structured interviews. Themes arising were discussed in a lay focus group, before a questionnaire survey of 140 primary care practices tested findings in detail.

Results

Many primary care physicians remain unfamiliar with guidance on ACP and lack experience in its use. However, while they feel a need for support and training, practitioners are well aware of barriers to ACP as well as potential ethical problems, and can provide relevant suggestions for improvement. Agreeing with lay people that primary care has a key role in this process, professionals express strong commitment to make more use of ACP, ensuring patients' wishes are recorded and respected.

Discussion

Primary care is an ideal environment to build on conceptual understanding of ACP, translating evidence, policy and guidance into practice.

Conclusion

Primary care professionals show keen interest and openness to ideas regarding ACP. These findings provide novel insight into understanding and use of ACP in primary care, with potential to facilitate development of practical strategies to enhance implementation of quality, patient centred ACP in this setting.
‘GOING FOR GOLD’: ACHIEVING TOP QUALITY END OF LIFE CARE IN GP PRACTICES AND MAINSTREAMING ADVANCE CARE PLANNING (ACP) DISCUSSIONS: FINDINGS FROM THE FIRST GP PRACTICES TO BE GSF ACCREDITED
Authors: Thomas K , Armstrong-Wilson J
Published: April 2013

Background

Primary care is pivotal to good end-of-life care and the routine introduction of ACP discussions, though uptake is variable. In the UK most GP practices use Foundation Level GSF that is, have a Palliative Care Register and meetings, but only 25% were included on the register and ACP use was low(NPCA 2011). Further training (GSF Going for Gold ) in over 300 practices showed early improvements, but further evaluation was required.

Aim

To evaluate the progress of the first seven GP practices to undertake GSF Going for Gold training and GSF Accreditation with the Quality Hallmark Award, endorsed by the Royal College of GPs.

Methods

Accreditation included 10 key metrics, a portfolio with good practice examples, After Death Analysis Audit and a follow up conference call. Comparative benchmarked analysis was undertaken with the data and the Accreditation panel assessed the findings.

Results

There was significant improvement in numbers included on the register, non-cancer and care home patients, increase in uptake of ACP and DNAR discussions, development of practice protocol for sustainability and other benefits following the Going for Gold training.

Discussion

By earlier identification, use of registers and routinely offering ACP discussions, more were enabled to communicate their views and preferences and early results indicated more dying at home.

Conclusion

Through whole-team involvement, culture change and routine systemisation of end-of-life care, significant improvements were made in these practices, with uptake of ACP discussion increasing. Additional benefits included improved confidence and development of a sustainable plan.
ADVANCE CARE PLANNING FOR COPD PATIENTS: A VIDEO DOES THE TRICK
Authors: Taylor Robin
Published: April 2013

No abstract
‘BUSINESS AS USUAL’: IMPLEMENTATION OF ADVANCE CARE DIRECTIVES IN A RENAL DIALYSIS UNIT
Authors: Larmer A , Battese T , Westgarth F
Published: April 2013

Background

Advance care directives (ACDs) are designed to empower patients and give them a choice in end of life (EOL) care. According to the NSW Health policy established in 2004, ACDs are to be present in patients' medical records for moments when the patients are unable to make decisions for themselves. In 2009, two incidents highlighted the need to implement ACDs as a standard component of the model of care in our unit.

Aim

To normalise the establishment of ACDs for patients in our Unit, and to have at least 80% of our renal dialysis patients with up-to-date and easily accessible ACD in place.

Methods

Project guidance was provided to the Ballina project team via the ACI Haemodialysis Models of Care Program. The project involved staff training, patient education, development of an ACD Form, and process change within the renal unit and the hospital. The process was adaptable, flexible and responsive, and staff developed confidence in addressing this difficult issue with their patients. Furthermore, a system was developed to include ACD alerts on the patient's electronic medical record (eMR), making this information available at all access points throughout the health district.

Results

ACDs have been established as a standard component of the model of dialysis care within our Unit. As a result of the project the proportion of our patients with active ACDs rose from <5% to above 85%. There remain some difficulties broaching this topic with some cultural groups.

Discussion

ACDs have the ability to prevent overuse of medical resources and decrease family burden during EOL care. During education sessions it was found that staff had difficulty approaching their patients on these very sensitive and challenging issues, and required considerable training to empower them to support their patients' during advance care planning (ACP). The successful implementation was due to the patients perceiving it as a normal process that they themselves should drive, in collaboration with their families and with their clinical carers.

Conclusion

ACP policies require considerable staff training and support to enable successful implementation.
HOW WELL ARE ACUTE HOSPITAL STAFF SETTING TREATMENT GOALS AND IDENTIFYING NEED FOR PALLIATIVE CARE FOR IN-PATIENTS?
Authors: Moran J , Jones D
Published: April 2013

Background

Medical teams in acute hospitals often do not set goals of treatment for patients, especially those who are frail or complex. Hospitals have limitation of treatment policies, but compliance is often poor. The need for palliative care is also under-recognised.

Aim

This was an observational audit to determine whether patients in a tertiary Melbourne hospital had goals and limitations of treatment documented by the treating team, and the association with length of stay and outcome.

Method

Over 2 weeks, the records of hospital inpatients were reviewed. Data included demographics, co-morbidities, goals and limitations of treatment (LOT), need for referral to palliative care and outcomes.

Results

290 records were reviewed; 55% were male, average age was 67. 60% of patients had no goals of treatment. Ten patients were asked about advance care plans. Of those who should have had LOT according to hospital policy, 55% had no plans. 23 patients were suitable for Palliative Care, but only 9 had been referred. 18% of patients were confused; 60% of these had no record of discussions with family. 9% of patients died, 76% went home and 8% to residential care.

Discussion

There was a lack of setting goals and limitations of treatment and under-referral to palliative care. Patients were more likely to die or go to residential care the longer they stayed in hospital and the greater their co-morbidities.

Conclusion

There is potential to improve the practice of setting goals and limitations of treatment in this acute hospital.
CARE PLANNING IN ADVANCE: THE PROCESS OF BRINGING AN IMPOSSIBLE MISSION TO AN INSTITUTIONAL REALITY AT ST VINCENT'S HOSPITAL MELBOURNE
Authors: Boughey M , Hickey B , McDonald L
Published: April 2013

Background

The development of a systematised advanced care planning process in Catholic faith based institutions has presented challenges that have seen unsustainable unsupported programme. Increasing clinician need, a changing understanding of the role of advanced care planning in routine health care, changing community expectations of the use of advanced care plans and reform in health care quality standards have necessitated a recommitment to develop a sustainable, workable process.

Aim

To present a narrative of the factors, internal and external to the hospital, that have had to be considered and worked through, to develop a programme in care planning for advanced care at St. Vincent's Hospital Melbourne that has gained acceptance and led to implementation to be embarked upon.

Methods

Review of the Advanced care planning working group's meeting minutes actions and document developments taken over 8 month period June 1 to December 2.

Results

The process demonstrates the key steps in the 18 month timeline that has brought significant points of development to create a workable and viable policy and guidelines, acceptable within a Catholic hospital's ethical and clinical framework

Discussion

Sharing the learning's will be helpful for others developing programmes in comparable institutions to see how important the linking together of key people and committees in an organisation is to develop the acceptable shared understanding and language within the institutions ethical and clinical framework.

Conclusion

Setting aside historical challenges, it has been possible to develop a system of advanced care planning processes within a Catholic, faith base, tertiary hospital.
MORE THAN JUST LANGUAGE: OLDER DUTCH AND ITALIAN MIGRANTS' VIEWS ON ADVANCE CARE PLANNING
Authors: Smith J , Sinclair C , Touissant Y , Auret K
Published: April 2013

Background

Western cultural practices and values have largely shaped advance care planning (ACP) policies across the world. In most Western countries utilisation of ACP is typically lower among minority cultural groups (Searight, 2005). Cultural factors may influence attitudes towards ACP (Searight, 2005).

Aim

To explore perceptions of ACP among older, non-hospitalised first-generation Dutch-Australian and Italian-Australian migrants.

Methods

Twenty-nine people participated in individual interviews (N=16) and focus groups (N=13). Average time residing in Australia was 52 years. Most participants were proficient in English; some Italian participants preferred to speak Italian and utilised interpreters. Interviews were recorded, transcribed verbatim and thematically analysed.

Results

Pre-migration experiences, reliance on ethnic community support networks and continued contact with the native country contributed to migrant identity, which influenced attitudes towards ACP. Dutch participants typically adopted an individualist approach to medical decision-making, whereas Italian participants associated more with a familial style. Mistrust towards institutions was often associated with less support for ACP. Discussions about ACP elicited unprompted views on euthanasia, particularly among Dutch participants. Participants with poorer English language skills showed similar openness to considering ACP when supported with appropriate language assistance.

Discussion

An individualistic decision making style was associated with openness to ACP. Familial decision making styles and the presence of ethnic community support networks were associated with a view that ACP was redundant.

Conclusion

Ensuring informed access to ACP for migrant Australians will require appropriate language assistance, understanding the patient's social history and framing benefits of ACP within the broader context of decision-making styles and reliance on ethnic community support networks.
END-OF-LIFE CARE FOR PEOPLE WITH DEMENTIA
Authors: Cartwright C
Published: April 2013

Introduction

A Diagnosis of Dementia—what does this mean? Receiving a diagnosis of dementia raises many challenges for the person themselves and for their carers and other family members and friends. However, it can also provide opportunities, to plan ahead, to put financial and other affairs in order and, for those who are in the early stages of dementia, to travel or do other things with family and friends.

This session will consider some of the issues that need to be addressed at this time. These include: when does a person have capacity to make their own decisions?; the need to undertake Advance Care Planning to appoint a substitute decision-maker and write an Advance Directive; the legally available options that the person may want to include in their Advance Care Plans; an understanding of palliative care; their right to adequate pain relief in terminal illness (and the related issue of what is/is not euthanasia). Issues for Carers of people with dementia will also be covered.

Finally, as there is increasing activity in Australia to introduce euthanasia legislation, the special concerns for people with dementia, should such legislation be introduced, will be discussed.
HAVE WE IMPROVED ADVANCE CARE PLANNING FOR DYING RESIDENTIAL AGED CARE PATIENTS PRESENTING TO AN ACUTE TERTIARY HOSPITAL?
Authors: Wilkinson J , Street M , Brean S , Fullerton S
Published: April 2013

Background

The number of people from Residential Aged Care (RAC) presenting to Emergency Departments (ED) is increasing. The importance of rapid patient-centred decision making highlights the need for Advance Care Plans (ACPs).

Aim

To investigate trends in ACP completion for the RAC population presenting to ED, by comparing data from 2009 to 2011; the proportion of patients with ACPs in place; whether ACPs were acknowledged and complied with by hospital staff; and whether current strategies have improved ACP implementation and compliance.

Methods

A retrospective cohort study of 79 patients from RAC who died during hospital admission in 2011 was compared to a similar group of 90 patients in 2009.

Results

The median age was 87 for both groups. Time from admission to death was shorter in 2011 (median 3.9 days, IQR=1.3–6.4) compared to 2009 (median 4.3 days, IQR=1.7–8.2). The proportion of patients with ACPs in place had doubled from 13% in 2009 to 29% in 2011 (χ2=5.448, df=1, p=0.02). Improvements were seen in the number of patients for whom ACPs were acknowledged or adhered to. The proportion of patients transferred from RAC who died during that admission was lower in 2011 (6.2%) compared to 2009 (7.3%).

Discussion

More aggressive discharge planning of dying RAC patients by the palliative care team has resulted in fewer than previous deaths of RAC patients in acute beds and shorter length of stay.

Conclusion

Overall improvement in ACP implementation and compliance has resulted in improved patient outcomes.
HOW OFTEN DOES THE MEDICAL EMERGENCY TEAM IMPLEMENT END OF LIFE CARE? A SYSTEMATIC REVIEW
Authors: Tan L H , Delaney A
Published: April 2013

Background

The members of Medical Emergency Teams (METs) teams undergo training to deal with medical emergencies. METs also deal with end of life issues arising in the context of acute illness. It is unknown how often METs implement end of life care relative to other interventions and thus what proportion of time should be allocated to training the MET members to deal with end of life issues.

Aim

To determine the frequency of end of life care relative to other common interventions delivered by METs.

Methods

Two authors independently searched for potentially relevant studies. We included prospective studies that reported activities undertaken by the MET. The suitability of studies for inclusion and validity of studies was assessed independently by two authors. We extracted data on the characteristics of the included studies, the composition of the MET and the activities undertaken by the MET. The primary analysis was descriptive.

Results

Preliminary results are presented. The search identified 2324 abstracts, 99 articles were retrieved for full text review, 32 studies were included. Rates of end of life interventions performed by the MET ranged from 2% to over 20%. These rates are similar to many common interventions performed by METs.

Discussion

End of life care is an important component of the work carried out by the MET and is carried out at a frequency similar to many interventions that are given more weight in MET training.

Conclusion

Training to deal with end of life care should be incorporated into all MET training.
PRACTICALITIES AND SENSITIVITIES AROUND DISCUSSING RESUSCITATION AT THE END OF LIFE: A CLINICAL TOOL
Authors: Herbert A , Irving H
Published: April 2013

Background

The presence of a resuscitation plan as a clinical indicator in paediatric palliative care and the development of an ‘Acute Resuscitation Plan’ for adult patients in Queensland provided impetus for the development of a resuscitation planning form for children and adolescents in Queensland.

Aim

To develop a resuscitation planning tool which would facilitate the process of clinical assessment, encourage communication with children and their families and subsequent documentation of mutually agreed upon resuscitation plans.

Methods

A working group used the adult ‘Adult Resuscitation Plan’ to determine the key components required for a clinical form which related to the care of patients aged less than 18 years.

Results

The ‘Paediatric Acute Resuscitation Plan’ (PARP) included the following sections: clinical assessment, resuscitation management plan, consenting details, and clinical authorisation.

Discussion

The resuscitation management plan acknowledges that patients may still benefit from a range of treatments and therapies that contribute to quality end-of-life care. At the same time, the form clearly documents whether cardio-pulmonary resuscitation will or won't be provided. Consent is usually given by the parents who in usual circumstances act in the best interests of their child. The form also encourages discussion and consideration of the views of the Gillick competent child.

Conclusion

The development of the Paediatric Acute Resuscitation Plan (PARP) is a clinical form and tool which allows consistency of practice on a statewide level but also allows flexibility to document a unique care plan for each child or young person.
PILOT OF AN END-OF-LIFE CARE PATHWAY IN NON-CANCER PALLIATIVE UNIT IN CHINESE POPULATION
Authors: Wong W M , Chen M&G W T
Published: April 2013

Background

The End-of-life Care Pathway (ECP) based on the concept used in Liverpool Care Pathway (LCP V.12), was developed, with modification to suit the local needs. It was first applied to non-cancer palliative unit (MPM) in Hong Kong.

Table 1

ECPNCDAH 2009SettingWard baseHospital baseAudit period1/8/2010–31/12/2010 (4 months)1/10/08–31/12/08 (3 months)Total number of hospitals1155Total Number ECP/LCP applied423893Median number of wards (IQR)2323(15–32)Median number of all deaths occurring in data gathering period (IQR)117227 (180–366)Total percentage of deaths on an ECP/LCP in data gathering period (N)34% (N=40)21%Median age (IQR)80 (75–85)81 (73–87)Female %55% (N=23)55% (N=2141)Median hours in LCP/ECP (IQR)62 (18–103)33 (12–74)Non Cancer79%61%Patient is able to communicate95.4%59%Carer is able to communicate95.2%73%Patient is aware of dying88.9%40%Carer is aware of the patient is dying90.5%76%Carer's contact information updated90.5%73%Carer had a full explanation of the facilities available to them with leaflets88.1%53%Patient's spiritual needs assessed77.3%30%Carer's spiritual needs assessed78.6%50%Anticipated symptom control PRN medications prescribed71.4%90%Patient's current intervention reviewed and unnecessary medications discontinued100%/Artificial nutrition assessed97.6%/Artificial hydration assessed95.2%/Skin integrity assessed92.9%/Full explanation of the pathway to patient83.3%30%Full explanation of the pathway to carer54.8%72%

Objective

To identify the quality of care for dying patients as documented in ECP and benchmark our performance with the National Care of the Dying Audit—Hospital (NCDAH) 2009 in UK.

Methods

A retrospective audit design was used to gather ECP data from Tuen Mun Hospital from 1st August to 31st December 2010.

Results

117 deaths occurred in the audit period and 42 ECP was applied. Median Age is 80 (IQR=75–85); 55% are female; 79% are non-cancer patients. The most common diagnosis is end-stage renal failure. The median duration in ECP is 62 h (IQR=18–103). A high percentage of patients and carers can participate in the communication (95.4%, 95.2%), aware the dying status (88.9%, 90.5%), have the current interventions reviewed (100%), and symptoms controlled (range from 85.1% to 90.5%).

Relatively low percentage of the patients and cares could discuss about their spiritual needs (77.3%, 78.6%), have the anticipated symptoms control medications prescribed and received (71.4%, 36.7%), pathway explained (83.3%, 54.8%) and physically adjusted environment received (76.2%). The comparison of the results with the NCDAH 2009 was shown in table 1.

Conclusion

This audit point out different aspects for improvement of the ECP first applied in non-cancer medical unit in Hong Kong
ADVANCE CARE DIRECTIVES FOR PERSONS WITH MENTAL ILLNESS
Authors: Swartz M , Swanson Jeffrey
Published: April 2013

The movement toward patient-centred care has fueled considerable interest in Psychiatric Advance Directives (PADs), analogous to medical advance directives and health care proxies, as a possible remedy for loss of patient autonomy in mental healthcare decisions, patient alienation from the treatment process, and associated poor clinical outcomes. Based on the hope for these benefits, 25 US legislatures have adopted PAD statutes and are encouraging the appointment of healthcare proxies, through durable power of attorney, for persons with mental illness. PADs may include three types of anticipatory decision-making: (1) informed consent to future treatment; (2) a forecast of personal values; (3) and the entrusting of someone to act as a proxy decision maker. The role of a healthcare agent (HCA), or proxy decision maker, is to help ensure that the patient's previously expressed wishes are fulfilled; to further interpret what treatment the patient would wish to receive (or not receive); or to act in the patient's best interest and protect the patient's welfare. A recently conducted study in five US communities found that patients have great interest in PADs and supports the idea that people with mental illnesses should write down the type of treatment they would like to receive if they become very ill at some point in the future; 70–83% across sites wished a PAD, but only 4–13% had any form of PAD. In this presentation we will discuss current interest in, barriers to implementing and efforts underway to foster large scale use of PADs.

Testimonial

The APCEL conference is an important venue for dissemination of critical information and emerging research on advance care planning. A focus on advance care planning for persons with mental illness will place psychiatric advance directives in the broader context of other types of mechanisms to foster patient-centred healthcare.
Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer: a framework for developing an objective pathological diagnostic system using the Delphi method, from the Pathology Working Group of the Japanese Society for Cancer of the Colon and Rectum
Authors: Kojima Motohiro , Shimazaki Hideyuki , Iwaya Keiichi , Kage Masayoshi , Akiba Jun , Ohkura Yasuo , Horiguchi Shinichiro , Shomori Kohei , Kushima Ryoji , Ajioka Yoichi , Nomura Shogo , Ochiai Atsushi
Published: April 2013

Aims

The goal of this study is to create an objective pathological diagnostic system for blood and lymphatic vessel invasion (BLI).

Methods

1450 surgically resected colorectal cancer specimens from eight hospitals were reviewed. Our first step was to compare the current practice of pathology assessment among eight hospitals. Then, H&E stained slides with or without histochemical/immunohistochemical staining were assessed by eight pathologists and concordance of BLI diagnosis was checked. In addition, histological findings associated with BLI having good concordance were reviewed. Based on these results, framework for developing diagnostic criterion was developed, using the Delphi method. The new criterion was evaluated using 40 colorectal cancer specimens.

Results

Frequency of BLI diagnoses, number of blocks obtained and stained for assessment of BLI varied among eight hospitals. Concordance was low for BLI diagnosis and was not any better when histochemical/immunohistochemical staining was provided. All histological findings associated with BLI from H&E staining were poor in agreement. However, observation of elastica-stained internal elastic membrane covering more than half of the circumference surrounding the tumour cluster as well as the presence of D2-40-stained endothelial cells covering more than half of the circumference surrounding the tumour cluster showed high concordance. Based on this observation, we developed a framework for pathological diagnostic criterion, using the Delphi method. This criterion was found to be useful in improving concordance of BLI diagnosis.

Conclusions

A framework for pathological diagnostic criterion was developed by reviewing concordance and using the Delphi method. The criterion developed may serve as the basis for creating a standardised procedure for pathological diagnosis.
NUMERICAL STUDY OF TRANSPORT PROPERTIES IN TOPOLOGICAL INSULATOR QUANTUM DOTS UNDER MAGNETIC FIELD
Authors: ZHANG SHENG-NAN , JIANG HUA , LIU HAIWEN
Published: April 2013

In this paper, we investigate the transport properties of HgTe / CdTe -based topological insulator quantum dots (TIQDs) under magnetic field. Both disk and square shaped TIQDs are considered and the magneto-conductance are calculated numerically for various magnetic field strength. The magnetic field lifts the spin degeneracy, leading to spin polarized current at given Fermi energy. Meanwhile, the magneto-conductance demonstrates the Aharonov–Bohm (AB) oscillation with a period of one flux quantum [Formula: see text]. Numerical results for AB oscillation features indicate the mismatch between electron (e) and hole (h) doping conditions, which can be attributed to the e–h asymmetry in the full band Hamiltonian. Further, interference effect emerges around bulk and edge energy degenerate points, subsequently suppressing the magneto-conductance in both shaped systems. All these physical characteristics are qualitatively consistent for disk and square shaped TIQDs due to the topological nature of edge modes.
DYNAMICS OF DISCRETE OPINIONS WITHOUT COMPROMISE
Authors: ÖZTÜRK M. KAAN
Published: April 2013

A new agent-based, bounded-confidence model for discrete one-dimensional opinion dynamics is presented. The agents interact if their opinions do not differ by more than a tolerance parameter. In pairwise interactions, one of the pair, randomly selected, converts to the opinion of the other. The model can be used to simulate cases where no compromise is possible, such as choices of substitute goods, or other exclusive choices. The homogeneous case with maximum tolerance is equivalent to the Gambler's Ruin problem. A homogeneous system always ends up in an absorbing state, which can have one or more surviving opinions. An upper bound for the final number of opinions is given. The distribution of absorption times fits the generalized extreme value distribution. The diffusion coefficient of an opinion increases linearly with the number of opinions within the tolerance parameter. A general master equation and specific Markov matrices are given. The software code developed for this study is provided as a supplement.
Circulating Prostate Cells Found in Men with Benign Prostate Disease Are P504S Negative: Clinical Implications
Authors: Murray Nigel P. , Reyes Eduardo , Badínez Leonardo , Orellana Nelson , Fuentealba Cynthia , Olivares Ruben , Porcell José , Dueñas Ricardo
Published: April 2013

Introduction. Developments in immunological and quantitative real-time PCR-based analysis have enabled the detection, enumeration, and characterization of circulating tumor cells (CTCs). It is assumed that the detection of CTCs is associated with cancer, based on the finding that CTCs can be detected in all major cancer and not in healthy subjects or those with benign disease.Methods and Patients. Consecutive men, with suspicion of prostate cancer, had blood samples taken before prostate biopsy; mononuclear cells were obtained using differential gel centrifugation and CPCs detecting using anti-PSA immunocytochemistry. Positive samples underwent further classification with anti-P504S.Results. 329 men underwent prostate biopsy; of these men 83 underwent a second biopsy and 44 a third one. Of those with a biopsy negative for cancer, 19/226 (8.4%) had CPCs PSA (+) P504S (−) detected at first biopsy, 6/74 (8.1%) at second biopsy, and 5/33 (15.2%) at third biopsy. Men with cancer-positive biopsies did not have PSA (+) P504S (−) CPCs detected. These benign cells were associated with chronic prostatitis.Conclusions. Patients with chronic prostatitis may have circulating prostate cells detected in blood, which do not express the enzyme P504S and should be thought of as benign in nature.
Effects of Growth Hormone Replacement Therapy on Bone Mineral Density in Growth Hormone Deficient Adults: A Meta-Analysis
Authors: Xue Peng , Wang Yan , Yang Jie , Li Yukun
Published: April 2013

Objectives. Growth hormone deficiency patients exhibited reduced bone mineral density compared with healthy controls, but previous researches demonstrated uncertainty about the effect of growth hormone replacement therapy on bone in growth hormone deficient adults. The aim of this study was to determine whether the growth hormone replacement therapy could elevate bone mineral density in growth hormone deficient adults.Methods. In this meta-analysis, searches of Medline, Embase, and The Cochrane Library were undertaken to identify studies in humans of the association between growth hormone treatment and bone mineral density in growth hormone deficient adults. Random effects model was used for this meta-analysis.Results. A total of 20 studies (including one outlier study) with 936 subjects were included in our research. We detected significant overall association of growth hormone treatment with increased bone mineral density of spine, femoral neck, and total body, but some results of subgroup analyses were not consistent with the overall analyses.Conclusions. Our meta-analysis suggested that growth hormone replacement therapy could have beneficial influence on bone mineral density in growth hormone deficient adults, but, in some subject populations, the influence was not evident.
Molecular Cochaperones: Tumor Growth and Cancer Treatment
Authors: Calderwood Stuart K.
Published: April 2013

Molecular chaperones play important roles in all cellular organisms by maintaining the proteome in an optimally folded state. They appear to be at a premium in cancer cells whose evolution along the malignant pathways requires the fostering of cohorts of mutant proteins that are employed to overcome tumor suppressive regulation. To function at significant rates in cells, HSPs interact with cochaperones, proteins that assist in catalyzing individual steps in molecular chaperoning as well as in posttranslational modification and intracellular localization. We review current knowledge regarding the roles of chaperones such as heat shock protein 90 (Hsp90) and Hsp70 and their cochaperones in cancer. Cochaperones are potential targets for cancer therapy in themselves and can be used to assess the likely prognosis of individual malignancies. Hsp70 cochaperones Bag1, Bag3, and Hop play significant roles in the etiology of some cancers as do Hsp90 cochaperones Aha1, p23, Cdc37, and FKBP1. Others such as the J domain protein family, HspBP1, TTC4, and FKBPL appear to be associated with more benign tumor phenotypes. The key importance of cochaperones for many pathways of protein folding in cancer suggests high promise for the future development of novel pharmaceutical agents.
Assessing the Risks of Airport Airside through the Fuzzy Logic-Based Failure Modes, Effect, and Criticality Analysis
Authors: Feng Cheng-Min , Chung Chi-Chun
Published: April 2013

To identify risk items, measure risk value objectively, and establish risk assessment matrix of airports is the major task of airport safety. This paper first extracts 14 risk items of airports from the International Civil Aviation Organization (ICAO) aviation accidents database and then applies Failure Modes, Effect and Criticality Analysis (FMECA) to define the decision factors of probability, severity and detectability of airport risks. This paper also designs a questionnaire and applies fuzzy logic to discover the importance of decision factors, to find out the threshold value of Risk Assessment Matrix, and to prioritize the airport risks. This paper uses Taiwan Taoyuan International Airport as a case study to demonstrate the modeling process and analyze the results.
Association between Physical Activity and Neighborhood Environment among Middle-Aged Adults in Shanghai
Authors: Zhou Rena , Li Yang , Umezaki Masahiro , Ding Yongming , Jiang Hongwei , Comber Alexis , Fu Hua
Published: April 2013

Objective. To determine the perceived neighborhood environment (NE) variables that are associated with physical activity (PA) in urban areas in China.Methods. Parents of students at two junior high schools in Shanghai, one downtown and the other in the suburbs, were recruited to participate in the study. They completed an International Physical Activity Questionnaire (IPAQ) and Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A) survey. Participant physical activity was also objectively measured using accelerometers.Results. Participants from downtown areas were more positively associated with transportation PA and leisure-time PA than respondents living in the suburbs. Residential density was found to be a significant positive predictor of recreational or leisure-based PA. Street connectivity was negatively associated with leisure time PA for respondents. Moderate-vigorous PA was found to be negatively associated with traffic safety. There were no significant associations between environmental factors and transportation PA. Women had higher levels of moderate-vigorous PA than men.Conclusions. The results of this study demonstrate that residential density, street connectivity, and traffic safety have a significant impact on Chinese middle-aged adults' PA, suggesting urban planning strategies for promoting positive public health outcomes.
The Spectrum of the OperatorD(r,0,s,0,t)over the Sequence Spacesc0andc
Authors: Tripathy Binod Chandra , Paul Avinoy
Published: April 2013

We have examined the spectra of the operatorD(r,0,s,0,t)on the sequence spacesc0andc.
Production of Pectinolytic Enzymes by the Yeast Wickerhanomyces anomalus Isolated from Citrus Fruits Peels
Authors: Martos María A. , Zubreski Emilce R. , Garro Oscar A. , Hours Roque A.
Published: April 2013

Wickerhamomyces anomalus is pectinolytic yeast isolated from citrus fruits peels in the province of Misiones, Argentine. In the present work, enzymes produced by this yeast strain were characterized, and polygalacturonase physicochemical properties were determined in order to evaluate the application of the supernatant in the maceration of potato tissues.
W. anomalus was able to produce PG in liquid medium containing glucose and citrus pectin, whose mode of action was mainly of endo type. The supernatant did not exhibit esterase or lyase activity. No others enzymes, capable of hydrolyzing cell wall polymers, such as cellulases and xylanases, were detected. PG showed maximal activity at pH 4.5 and at temperature range between 40°C and 50°C. It was stable in the pH range from 3.0 to 6.0 and up to 50°C at optimum pH. The enzymatic extract macerated potato tissues efficiently. Volume of single cells increased with the agitation speed.
The results observed make the enzymatic extract produced by W. anomalus appropriate for future application in food industry, mainly for the production of fruit nectars or mashed of vegetables such as potato or cassava, of regional interest in the province of Misiones, Argentine.
Numerical Simulation on the Food Package Temperature in Refrigerated Display Cabinet Influenced by Indoor Environment
Authors: Zhijuan Chang , Xuehong Wu , Yanli Lu , Qiuyang Ma , Wenhui Zhang
Published: April 2013

In order to study the relation between the food package temperature and ambient environment, the food package temperature is investigated by numerical simulation under the different conditions, such as evaporator outlet velocities, ambient temperatures, and relative humidity. In the present computation, the influence of mass transfer and radiation is considered. The computational results show that the front and top food package temperature rises to 0.1 ~ 1.2°C due to the effect of light. At the investigated range of this paper, the food package temperature decreases when the air curtain velocity increases, but the food package temperature also increases with increase of ambient temperature and humidity. At the same time, the food package temperature decreases 0.2 ~ 1.1°C when air curtain outlet velocity increased by 0.15 m/s. The food package temperature rises about 0.6°C when ambient temperature increases by 2°C. The food package temperature rises about 0.9°C when ambient humidity increases by 20%. Therefore, the study can provide the reference for the design of refrigerated display cabinet.
Hopf Bifurcation Analysis for the Model of the Chemostat with One Species of Organism
Authors: Bai Haiyun , Zhai Yanhui
Published: April 2013

We research the dynamics of the chemostat model with time delay. The conclusion confirms that a Hopf bifurcation occurs due to the existence of stability switches when the delay varies. By using the normal form theory and center manifold method, we derive the explicit formulas determining the stability and direction of bifurcating periodic solutions. Finally, some numerical simulations are given to illustrate the effectiveness of our results.
Perturbation of Stochastic Boussinesq Equations with Multiplicative White Noise
Authors: Yang Chunde , Zhao Xin
Published: April 2013

This paper studies the Boussinesq equations perturbed by multiplicative white noise and shows the existence and uniqueness of the global solution. It also gets some regularity results for the unique solution.
Reinforcement of Recycled Foamed Asphalt Using Short Polypropylene Fibers
Authors: Kim Yongjoo , Park Tae-Soon
Published: April 2013

This paper presents the reinforcing effects of the inclusion of short polypropylene fibers on recycled foamed asphalt (RFA) mixture. Short polypropylene fibers of 10 mm length with a 0.15% by weight mixing ratio of the fiber to the asphalt binder were used. The Marshall stability test, the indirect tensile strength test, the resilient modulus test, and wheel tracking test of the RFA mixtures were conducted. The test results were compared to find out the reinforcing effects of the inclusion of the fiber and the other mixtures, which included the conventional recycled foamed asphalt (RFA) mixtures; the cement reinforced recycled foamed asphalt (CRFA) mixtures; the semihot recycled foamed asphalt (SRFA) mixtures; and recycled hot-mix asphalt (RHMA) mixtures. It is found that the FRFA mixture shows higher Marshall stability than the RFA and SRFA mixtures, higher indirect tensile strength than the RFA mixture, and higher rut resistance than the RFA, SRFA, and RHMA mixtures as seen from the wheel tracking test.
A Linked-Registry Study of Gestational Factors and Subsequent Breast Cancer Risk in the Mother
Authors: Troisi Rebecca , Doody David R. , Mueller Beth A.
Published: April 2013

Background: Women who were younger at their first live birth have a reduced breast cancer risk. Other pregnancy characteristics, including complications, also may affect risk but because they are rare, require large datasets to study.

Methods: The association of pregnancy history and breast cancer risk was assessed in a population-based study including 22,646 cases diagnosed in Washington State 1974 to 2009, and 224,721 controls, frequency matched on parity, age, calendar year of delivery, and race/ethnicity. Information on prediagnosis pregnancies derived from linked birth certificate and hospital discharge databases. Adjusted odd ratios (ORs) and 95% confidence intervals (CI) were calculated.

Results: Multiple gestation pregnancies were associated with decreased breast cancer risk (OR, 0.65; 95% CI, 0.57–0.74) as was prepregnancy obesity (OR, 0.76; 95% CI, 0.65–0.90). Infant birth weight was positively associated (6% per 1,000 g; 95% CI, 3%–9%). The ORs for first trimester bleeding (OR, 3.35; 95% CI, 1.48–7.55) and placental abnormality/insufficiency (OR, 2.24; 95% CI, 1.08–4.67) were increased in women diagnosed at age 50+ years and 15+ years after the index pregnancy. Results were similar in analyses restricted to first pregnancies, those closest to diagnosis, and when excluding in situ disease.

Conclusion: These data suggest that multiple gestation pregnancies are protective, whereas delivering larger infants increases risk for later development of maternal breast cancer. Placental abnormalities that result in bleeding in pregnancy also may reverse the long-term protection in postmenopausal women associated with parity.

Impact: Certain pregnancy characteristics seem to be associated with later maternal breast cancer risk. Cancer Epidemiol Biomarkers Prev; 22(5); 835–47. ©2013 AACR.
The Interactions of Dietary Tomato Powder and Soy Germ on Prostate Carcinogenesis in the TRAMP Model
Authors: Zuniga Krystle E. , Clinton Steven K. , Erdman John W.
Published: April 2013

The interactions between bioactive-rich food components within a complex human diet for the inhibition of prostate carcinogenesis are largely unknown and difficult to quantify in humans. Tomato and soy products have each shown anti-prostate cancer (PCa) activity in laboratory studies. The objective of this study was to determine the efficacy of dietary tomato and soy germ, alone and in combination, for the inhibition of PCa in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. At 4 weeks of age, male C57BL/6 × FVB TRAMP mice (n = 119) were randomized to consume: AIN-93G control, 10% whole tomato powder (TP), 2% soy germ powder (SG), or 10% tomato powder with 2% soy germ powder (TP+SG) for 14 weeks. One hundred percent of mice fed the control diet had PCa, whereas PCa incidence was significantly lower in mice consuming TP (61%, P < 0.001), SG (66%, P < 0.001), and TP+SG (45%, P < 0.001). Although the protection offered by the combination of TP and SG was not synergistic, it was the most effective intervention. TP, SG, and TP+SG increased apoptotic index (AI) and modestly reduced the proliferative index (PI) in the prostate epithelium of TRAMP mice exhibiting primarily prostatic intraepithelial neoplasia. The dramatic reduction in the PI/AI ratio by the dietary interventions suggests that the control mice experience a stronger stimulus for malignant progression in the prostate microenvironment. Maximally effective and safe strategies for PCa prevention may result from optimizing combinations of nutrients and bioactives through an orchestration of dietary patterns. Cancer Prev Res; 6(6); 548–57. ©2013 AACR.