bluuebunny/crossref_metadata_2025 huggingface dataset:
A critique of the NHS ADRT proforma
Authors: Martin J , Sallnow L
Published: May 2011

At St Joseph's Hospice the process of documenting advance decisions to refuse treatment (ADRTs) has been shaped by patient and practitioner experiences. To guide this process the proforma available from the ARDTNHS website (http://www.adrtnhs.co.uk) has historically been used. We present a critique of this document, reflecting broader issues concerning how ADRTs are recorded.

In order for ADRTs to be valid and applicable in the UK they should specify both the refusals and the circumstances in which they come into effect. If these exact circumstances do not occur the ADRT does not hold the legal refusal status it otherwise would, although it still might be used to inform decision making. We contend that a clinician's judgment is usually required to determine whether the ADRT circumstances really apply at the moment of decision. Our view is that refusals, and the circumstances in which they apply, can only be properly understood in the context of information that gives rationale and ‘balance’ to these decisions. In this way the intentions behind the ADRT can be used to interpret the refusals more accurately. This information (which might be found in a separate advance statement) is of such importance that it should be positioned ahead of the refusals in the same ADRT document. Examples will be used to illustrate these points. Successful ADRT documentation is not simple and requires balanced information.
What challenges do CNSs experience when facilitating advance care planning?
Authors: Boot M
Published: May 2011

The findings of a qualitative descriptive study, which sort to gain insight into the challenges that Clinical Nurse Specialists experienced when facilitating advance care planning (ACP) will be presented.

Method

The study used semi-structured interviews, gathering data from purposeful sampling of 8 community palliative care CNSs.

Findings

The findings identified a number of themes, within which were driving and restraining factors in term of ACP facilitation. A characteristic of all of the themes was the need to balance a number of risks, this led to the development of the metaphor ‘walking the tightrope’ to describe the nature of the challenges that the CNSs experienced. This main theme was broken down into three categories which all had a balance of tensions within them. These categories were: opening the discussion; ethical issues; and how the personal attributes of the CNS influence the process. Key challenges were; when and how to open the discussion without harming the patient; dealing with emotional and ethical challenges; working with generalist colleagues. Facilitating factors were: building a relationship with the patient; CNS experience; and working as part of a team.

Contribution to the evidence

This work adds to the evidence on ACPs and the experience of CNSs working in palliative care. Increased understanding of the driving and restraining factors can improve educational preparation, and ensure that organisational issues are addressed.
Using end-of-life care profiles to support advance care planning
Authors: Gandy R , Roe B , Rogers J
Published: May 2011

In 2010, Liverpool PCT pioneered a care profiles approach to commissioning End of Life (EoL) services. This enabled comprehensive service requirements to be set in respect of skill mix, delivery, quality and outcomes for each stage of the EoL pathway.

The project involved a series of action learning-related workshops, each targeting one EoL stage. Consensus was developed among participants with commissioning, provider and service user interests, with outputs evaluated by an external reference group. A number of innovations were introduced, and it was concluded that the basic service requirements for EoL care are the same irrespective of the related disease.

The project was a success, with its recommendations used to commission EoL services across Liverpool. Care profiles are simple and flexible, and complement and augment integrated care pathways. They can support GP commissioning by providing clinically relevant and detailed information to specify and cost services.

Commissioned EoL services will vary between PCTs, to reflect local geography, history, service models and resources. Therefore care profiles serve to clarify exactly what services are available locally. Summary information extracted from the care profiles, would be appropriately tailored and presented, and made available across all professionals and providers to ensure patients and carers receive consistent, detailed information irrespective of which discipline happens to lead on their advanced care planning.

It follows that EoL care profiles can be used to support advanced care planning, by assuring the range, quality and consistency of information given to patients and carers, with any potential choices highlighted.
‘I know I should, but I haven't’: advance care directive decision-making by baby boomers in South Australia
Authors: Bradley S
Published: May 2011

Aim

To describe the results of a grounded theory study on what influences advance directive decision-making by Baby Boomers in South Australia

As longevity increases and chronic illness becomes the leading cause of death, the demands boomers will make on healthcare is of paramount importance to governments around the world. The literature speculates about these demands, yet there is little evidence to guide policy makers, academics and others interested in advance care planning. By understanding boomer use of advance directives, evidence can be provided of healthcare lifestyles important to this generation. Thus, a grounded theory study of seven South Australians aged 43–61 years was undertaken to identify the factors that influenced these boomers' advance directive decision-making. In analysis of the data, elements of their decision-making reflected critical areas of concern similar to those cited by persons already engaged in advance directive or advance care planning through terminal illness or frail age. The difference for participants in this study was that they were still ‘young’, in good health and had experienced the healthcare environment through relationships with others. These experiences presented a process of contemplation for developing a long-term plan for future healthcare needs. Contemplation was found to be a significant element of the decision-making process for the participants, which evolved as additional social and psychological influences impacted on them – ultimately leading them to create, reject or further contemplate their own advance directives.
Introducing advance care planning in patients with advanced COPD
Authors: Sives D , McKeown A , Raeside D
Published: May 2011

Background

Advance care planning has become government policy in Scotland and England, and many health professionals are being trained to do it for all patients with advanced life-limiting disease. However there is little evidence of its feasibility and effectiveness.

Aim

To design and introduce for all patients with advanced COPD who attend an out-patient clinic an intervention that facilitates ACP, and to evaluate the feasibility and utility of this innovation.

Design

piloting of the implementation of structured ACP we introduced an aide memoire (to facilitate ACP) and structured recording sheet into the out-patient clinic for patients with advanced COPD.

Findings

We introduced structured ACP into routine out-patient practice and the use of an aide memoire was positively received by health professionals working in the clinic. However ACP conversations were rarely initiated, despite the ACP prompts, unless first raised by the patients themselves. Patients with advanced COPD focused on planning to remain well and rarely had considered end of life planning. In those patients in whom ACP was facilitated hospital admission and interventions such as ventilation were perceived to be to be acceptable particularly when patients had previous experience. Most patients perceived that their eolc would be delivered in hospital.

Conclusions

Facilitated ACP proved less useful for initiating conversation for patients with advanced COPD in an out-patient clinic. Patients with advanced COPD rarely consider eolc planning preferring instead to focus on living with and managing their illness and this may prove to be a significant barrier to the facilitation of ACP.
Facilitating the public discussions of advance care planning with audio-visual media in taiwan – a action research
Authors: Yang W , Chao C S , Chiu G , Lin P C , Weng Yih-Chyang , Kuo Y M , Shih Ya Lan , Lai Wei-Shu
Published: May 2011

With the action research method, the senior physicians and nurses became involved with the community: they interviewed 32 seniors, ages 50 to 80, through a focus group to understand their needs and suggestions regarding issues related to terminal medical decisions. The following five points regarding the presentation are summarized: (1) be easy to understand, not boring; (2) be realistic and accurate; (3) clearly guide the thinking of the important issues; (4) narrative; (5) present with actual images. The physicians and nurses further worked with the IT professionals. After five panel meetings and three times modified according to the experts and audiences' suggestions, a 10-min video that combines flash design and real images was created. Total 291 valid questionnaires were collected in a university, a church and a nursing home; the participants included elementary school students as well as 80+ years old seniors. A discussion about the terminal medical decision was guided after each play of the video. 97.6% expressed interest in the issue related to terminal medical decision and the willingness of sharing and discussing it with their families. 98.3% indicated that when they or their illness reached the final stage, they wanted no more CPR and wished to receive hospice care. The results show the effect to use audio-visual media to guide the public to understand what is actually happening in terminal emergency treatment, to think about their own terminal medical decisions and to stand up and defend their own medical autonomies.
Advocacy of advance care planning by social ecological model in Taiwan
Authors: Chen Y R , Wang N , Wang Y W
Published: May 2011

The National Health Insurance in Taiwan started to reimburse for non-cancer diagnoses like congestive heart failure, COPD, end stage renal disease since 1st September 2009, the driving of advance care planning not only can encourage terminal patients to think about the meaning of life, but also help chronic illness patients to understand the mode of palliative care treatment at the early stage, so that we can improve the quality of care and the dignity of patients in final stage.

Objectives

(1) To encourage public to think about the issues of live and death earlier through the driving of advance care of planning. (2) Palliative care can intervention every medical treatment in early stage, so we can efficiently improve and implement the quality of care for terminal patients.

Methods

(1) This program is driven by the social ecological model. (2) Methods of implementation include:

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Design ACP promotion flyers for hospitals and public promotion activities.

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Make an ACP advertisement and the official website of Hospice Foundation of Taiwan

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To host the public promotion activities.

Conclusion

In 2010, the goals of this program are to make an advertisement, to design the promotion flyers for Advance Care Planning, and to host 41 public promotion activities for over 2400 people. To respect the medical autonomy of terminal patients and reduce the medical futility, we will not only hosting public promotion activities and clinical training courses, but also will drive this plan on related medical policy.
Bringing in care planning conversations for patients whose recovery is uncertain: learning from the AMBER care bundle
Authors: Morris M , Briant L , Chidgey-Clark J , Shouls S , Carey I , Hopper A , Robinson C
Published: May 2011

60 per cent of people in our inner city area die in an acute hospital. The hospital provides good care to patients known to be dying through the Liverpool Care Pathway. Delays in recognising that a patient may be end of life prevents timely patient and family involvement in planning care. Some of these delays relate to hospital staff having difficulties in managing uncertainty, as patients receive full active treatment. This can result in distress and preferences not being met.

The team designed and develop the AMBER care bundle for patients who may be receiving active treatment but whose recovery is uncertain. The care bundle comprises four elements:

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Clear medical plan

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Clear escalation plan

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Nurses agree with medical plan

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Patient/family meeting.

The care bundle complements, but does not replace existing care pathways. Staff make key decisions around ceilings of treatment and care and treatment preferences involving patients and their families. Patients are identified via ward rounds, nursing handover, multi-disciplinary meetings and by the patient safety team.

To date 122 patients have received the AMBER care bundle. 48% were transferred to the community from hospital. 78% died in their preferred place of care.

Staff often needed initial training or support to hold the family meetings. Expert facilitation helped to overcome barriers. Patients and family feedback has been positive. There have been benefits to team working and within team communication around this important patient group.
Using former carers in training staff
Authors: Burleigh S , Thompsell Amanda , Prior Norma
Published: May 2011

There are major problems in end-of-life care for people with dementia.

Staff and relatives, particularly in care home settings (where often a significant majority of residents with dementia lack capacity), can find discussion about end of life care especially difficult to bring up. Difficulties relating to mental capacity and the often unpredictable decline with dementia in the last few months mean that dementia-specific approaches need to be developed to meet the needs of people with dementia and their families.

This project recruited former carers, who had looked after a relative with dementia until they died, to aid staff and relatives in discussing advance care planning.

This presentation discusses the recruitment process and the training needs identified by the carers themselves. A detailed description of their work in the care homes and also in staff training will be discussed.
Advance directive (Living Will) completion and intention of completion rates in Alberta
Authors: Wilson D , Cohen J , Aliyar S
Published: May 2011

Canadian provinces have had laws for 10 years to guide developing and use of advance directives (living wills). Although laws reflect public preferences, living will completion rates have been identified as low. A public survey in Alberta Canada was done for information on current living will completion or intention rates. The University of Alberta's Population Research Laboratory was asked to add questions to their annual telephone survey. This survey is carefully conducted for correct population proportions and results highly (95%) representative of all persons aged 18+. In May-July 2010, 1203 were surveyed and 43.6% reported having a current living will and 42.1% reported thinking about or planning one; 14.3% said they did not need or want one. Significant differences across population sub-groups were found, with higher completion rates among persons who had been involved in a decision to stop or not start life support, had cared for a dying person, had a close family member or friend who died, had been involved in a decision to put a pet or another animal down, described themselves as religious, were over age 64 and were married or divorced/widowed. Albertans have a relatively high rate of completion and intention of completion, with factors having lead to this state of interest. With the number of deaths expected to double in the future, and with public experience of death and dying increasing, living will completion rates could increase. This information should be taken into consideration for future developments in advanced care planning and end-of-life care.
Redefining the temporal framework for end-of-life planning: the planful self-advocacy model
Authors: Kahana E , Kahana B , Lovegreen L , Kahana J , Brown J
Published: May 2011

This paper offers a conceptual framework to help contextualize end of life planning and expand its temporal dimensions. Traditional orientations to plan for end of life are focused on advance directives, primarily dealing with removal of invasive life sustaining interventions during the weeks, days or hours prior to death. Such planning has not been successful in achieving its intended goals. The ascendance of the palliative care movement in many regions of the world allows for recognizing the importance of maximizing comfort, offering social support and respecting spiritual and existential needs for meaningfulness close to the end of life. Our framework of ‘Planful Self-Advocacy’ is focused on the value and promotion of proactive patient self-advocacy for eliciting responsive health care long before the patient reaches the end of life. Consideration of options for planful action as people reach old age, or as they are diagnosed with life limiting chronic illness, are presented. These options include organizing informal supports for times of need, planning environmental modifications, establishing long term relationships with health care professionals who are willing to serve as patient advocates, learning about desirable long term care options and using technology to help counteract shrinking life space near the end of life. Data from our ongoing study of elders nearing the final years of life will be used to explore the relationships between model elements.
A gift to your family
Authors: McGregor D , Porterfield P , Tolson M
Published: May 2011

This workshop will describe an initiative within a Canadian health authority (Vancouver Coastal Health, referred to as VCH), in which the Community Engagement Team and the Advance Care Planning (ACP) project leadership partnered to seek this public engagement. To better understand the public's perspectives, and to facilitate greater public acceptance of ACP in our health region, a public forum was held in March 2010. The workshop will outline the forum participants, the program including discussion topics and the outcomes. Themes discussed at the forum included key aspects of public messaging, countering public fear by ‘normalising’ ACP conversations, and supporting patients and families to have these conversations. It was acknowledged that some members of the public might be mistrustful or worried about the intent and outcomes of ACP and thus the need to emphasize the benefits of ACP, ‘a gift to your family’. The forum influenced the emphasis of the ACP project on the importance of communication, the language used for public information, and the ways in which the public are involved in education. At the forum, a number of public participants expressed interest in assisting with public education; subsequently, a group of volunteers has been trained and will present ACP workshops to public groups in our region. The experience of these volunteers will continue to inform our VCH approach to ACP.
Ethical and Moral Dilemmas in End-of-Life Decision Making: Is Advanced Care Planning the answer?
Authors: Sneesby L
Published: May 2011

Advanced Care Planning (ACP) in end-of-life decision making is a fairly new concept in Australia. The greater use of ACP may assist the community in recognising the limits of modern medicine and technology and acknowledge palliative care as a life enhancement philosophy of care. As health care professionals gain knowledge and skills in ACP they are confronted with issues and difficulties which may impact on moral and ethical values.

Disagreements and dilemmas have arisen regarding the interpretation and application of Advanced Care Directives (ACD). The intentions of the substitute decision makers, at the time when the patient has lost capacity can also be complicated. Problem solving, strategies implemented and the resolving of disputes are investigated and analysed.

Discourse Analysis of conversations and interviews with the major stakeholders (patients, families, doctors and nurses) within the case studies reveal power relations within social interaction and social structure. This influences end of life decision making. The case studies were set in residential aged care facilities, where ACP is now routinely offered (but not necessarily accepted).

ACP promotes autonomy and ensures that the person's values and preferences are respected and known for a future time, when capacity may be reduced. For various reasons, ACP has been slow in progress, as Australians have been hesitant in embracing this concept. By analysing these case studies, some of the dilemmas and barriers to ACP are identified through the views of the family, friends, carers, health care professionals and the person themselves.
Advance care planning in general practice
Authors: Mann J , Neale D
Published: May 2011

Barwon Health's (BH) Respecting Patient Choices (RPC) program together with the local General Practitioner's (GP) Association and two GP developed a project plan to implement a model of advance care planning (ACP) into General Practice over a 6-month period.

The aims of the project were to increase the awareness and uptake of ACP by GP patients. Also, to demonstrate an increased participation in ACP whereby there is an established rapport and confidence with the doctor and provide a sustainable ACP model for general practice.

State and federal governments supports the accessibility of ACP for all Australians, yet there is no specific funding item number to support ACP in a cost effective manner in general practice. However, the provision of appropriate care for patients and the ripple effect for future savings in the acute sector has the potential to demonstrate overall benefits.

Patients tend to expect their GP's, with whom they trust and have an established rapport, to initiate ACP or end of life discussions. Project outcomes reflect this notion and demonstrate that, by utilising staff from a funded RPC® program, a cost effective ACP model for General Practice is viable, with patients having a high rate of acceptance, participation and satisfaction.

It is a recommendation that specialty services provided by ACP staff (RPC program), who would otherwise facilitate ACP for those referred into the service from GPs, should be expanded and resourced to provide outreach ACP Facilitators to General Practice in order for the continuation of a highly effective, viable model.
A Gift to Your Family
Authors: McGregor D , Porterfield P , Tolson M
Published: May 2011

This workshop will describe an initiative within a Canadian health authority (Vancouver Coastal Health (VCH)), in which the Community Engagement Team and the Advance Care Planning (ACP) project leadership partnered to seek this public engagement. To better understand the public's perspectives, and to facilitate greater public acceptance of ACP in our health region, a public forum was held in March 2010. The workshop will outline the forum participants, the program including discussion topics and the outcomes. Themes discussed at the forum included key aspects of public messaging, countering public fear by ‘normalising’ ACP conversations and supporting patients and families to have these conversations. It was acknowledged that some members of the public might be mistrustful or worried about the intent and outcomes of ACP and thus the need to emphasize the benefits of ACP, ‘a gift to your family’. The forum influenced the emphasis of the ACP project on the importance of communication, the language used for public information and the ways in which the public are involved in education. At the forum, a number of public participants expressed interest in assisting with public education; subsequently, a group of volunteers has been trained and will present ACP workshops to public groups in our region. The experience of these volunteers will continue to inform our VCH approach to ACP.
A self-evaluation tool for advance care planning programs
Authors: Blackford J , Street A
Published: May 2011

Internationally a number of advance care planning (ACP) programs have been established. Measurement of a program's success is usually focused on the completion rate of advance directives or plans. As a quality measure though it provides little information about the organisational processes that either contribute to or hinder a program's success. A study was conducted to develop an evaluation tool for an ACP model (ACP) implemented in community palliative care services. A multi-site action research approach was used to work with three community palliative care services located in Victoria, Australia. Qualitative and quantitative data collection strategies were used to develop the ACP evaluation tool. The tool was used as both a peer-assessment and self-assessment tool. It identifies a 3-staged organisational implementation process for the ACP model. These were: establishment, consolidation and sustainability. This occurred across the previously established ACP model domains of governance, ACP documentation processes, ACP practice, ACP education, quality processes and community engagement. The evaluation tool enabled community palliative care services to monitor, evaluate and plan quality improvement of their ACP model and thereby improve end of life care. As the tool describes generic processes common to all health services there is potential transferability of the tool to other types of health services.
Hear the right story and finish up in country: learning lessons from Aboriginal Australians implementing Advance Care Planning
Authors: Ray R , Street A , Blackford J
Published: May 2011

As part of a national study evaluating a model of advance care planning (ACP) in community palliative care we conducted interviews and focus groups with health and social care workers providing chronic illness and palliative care services in Aboriginal communities. Many of these communities are in remote areas with limited access to health care facilities. Patients and support people have to leave their country (community land) and travel long distances to receive treatment for cancer, chronic kidney disease or other illnesses.

Data analysis indicated the need for conversations and planning for both clinical and the social care. Three major themes arose from the data.

The right story: including the use of language, correct information, avoiding unwanted treatment, and knowing the patient's wishes.

Right people: identifying the decision makers, who should be involved in conversations and who should be told, wider dissemination of the story. Finishing up: importance of spiritual well being, ceremony and ritual, familial ties to country, and people present.

Implementing ACP enabled a cultural group that is often underserved, to be able to make choices about their treatment options and to finish up – to die in country. We conclude that while Aboriginal practices are specific to their culture, many of the subthemes are relevant to patients and families across cultures. Understanding the deeper social issues that underlie ACP conversations and decision making will enhance health and social care workers ability to implement ACP enabling patients and their families to experience appropriate care.
The use of audience response system to promote advance care planning in community and veterans care home
Authors: Wang Y , Hsieh J G
Published: May 2011

Introduction

The concept of advance care planning (ACP) is new for residents in community and those living in Veterans Care Home (VCH). To increase their interest and understanding of ACP, an interactive audience response system (ARS) was introduced to facilitate the discussion of ACP.

Method and results

Most participants can live independently. They watch TV every day and can easily handle the remote control device. The device of ARS is similar to the remote control and can be easily managed by community elderly. A video clip about ACP was presented and followed by multiple choice questions about the concept of ACP. ACP introductory sessions were delivered in the community and VCH. A total of 2596 habitants participated in the program from September to November 2010. 704 used ARS to finished the session. The satisfaction was higher for those using ARS in the session (69∼92%) than those using the traditional deductive method (38∼69%).

Conclusion

ARS is an effective method to promote the discussion of ACP in the community and care home. There are high interactions between the speaker and residents. It can be used effectively even with the elderly people.
A study to explore the experience of advanced care planning among family caregivers and relatives of people with advanced dementia
Authors: Ashton S , Roe B , Jack B , McClelland B
Published: May 2011

Background

The North West NHS End of Life Care Initiative aims to improve the quality of care received by older people with dementia in care settings at the end of their lives. The implementation of advance care planning (ACP) by use of Gold Standards Framework was studied in one care home specialising in the care of people with advanced dementia.

Aim

The purpose of this study was to gain an understanding of the experiences of family caregivers as proxy decision makers for a relative with advanced dementia at the end of life.

Methods

Data were recorded using semi structured interviews from a self selecting convenience sample of 12 family relatives of residents with advanced dementia in a long term care setting. All respondents had been involved in proxy decision making relating to the care and treatment of their relative with advanced dementia.

Results

Study participants describe ACP as a distressing but necessary activity. Knowledge of the person and the family dynamics was identified as an important factor before staff approach relatives about ACP. Study participants were able to give a good explanation of what was discussed during the completion of the ACP. This included management of pain, medical interventions and treatments and also nutrition and hydration needs.

Conclusion

ACP is a relevant and useful activity to undertake with family carers. However the ethical burden ‘to do the right thing’ can contribute to the already distressed family carer and should therefore be supported by experienced and educated health professionals.
ACP in the New Zealand medicolegal context
Authors: Moore M , Grundy K
Published: May 2011

Advance Care Planning (ACP) in New Zealand (NZ) is being implemented into a unique medicolegal environment. This has practical implications as well as providing an opportunity for critical analysis of the place of legally recognised advance decisions within the overall process and philosophy of ACP.

NZ has no specific statute in relation to ACP or the use Advance Directives (AD) although it is acknowledged in the Code of Rights that ADs may be used in accordance with the common law. In addition legally authorised proxy and or substitute decision makers are uncommon and have limited powers. In the overwhelming majority of cases authority to make decisions on behalf of incompetent patients resides with clinicians. Implementation of ACP in this context provides a valuable opportunity to carefully consider the advantages and disadvantages of the NZ medicolegal framework compared with that in other countries and to share insights gained.

ACP is intended to give greater ‘voice’ to individuals (patients). There are however risks to over-emphasising ACP as a mechanism primarily intended to give patients' ‘voice’ through legal mechanisms for advance decisions which come in to effect once the individual is incompetent The greater benefit from ACP comes from hearing patients while they are still able to speak to us and including them in shared-planning within clinician-patient relationships based in mutual respect and trust. Effective ACP reduces occasions on which clinicians are required to make decisions on behalf of incompetent patients, but where they still are, should also result in better decision-making.
Collaborative patient care model: comprehensive care coordination for geriatric population
Authors: Mohanty A
Published: May 2011

Evolutionary changes in the health care delivery system and reimbursement of health care services in current healthcare scenario has dramatically changed the resource assessment and health care utilization. Not only that, it has also placed a greater emphasis on quality of services provided through different post acute care settings. Kissito Healthcare has designed and implemented a unique collaborative model named as Collaborative Patient Care (CPC) Model. Compared to standard care, CPC Model aims to address the organization's mission to deliver quality patient-centred care and demonstrate greater continuity of care, a shorter duration of stay and improved patient outcomes.

The CPC Model is based on four tenets: process, quality, cost and outcome with the patient considered as the centre for the tenets. Evidence-based best practices and medicine are embedded in the care processes. Care is coordinated and integrated across all elements and in a culturally and linguistically appropriate manner. The intended outcomes of the CPC Model include reduction in preventable rehospitalization, reduction in mortality and readmission rates, continuity of care across all post acute settings, patient driven shorter rehabilitation and recuperation periods as opposed to Payment Setting.

The model is theory-based, collaborative and multidisciplinary primarily focusing on patient-centred care. But evidence of the CPC Model's effectiveness remains inconclusive although there are positive outcomes based on intermediary results. Empiric evidence is needed to validate the effectiveness of the model. If proven effective, model can be widely implemented and translated to a national standard based on evidences.
Perceptions of clients and veterinarians on what attributes constitute ‘a good vet’
Authors: Mellanby R. J. , Rhind S. M. , Bell C. , Shaw D. J. , Gifford J. , Fennell D. , Manser C. , Spratt D. P. , Wright M. J. H. , Zago S. , Hudson N. P. H.
Published: June 2011

The perceptions of veterinarians and small animal (SA) clients on what attributes constitute ‘a good veterinarian’ were examined by a questionnaire survey. The respondents were asked to record how important they considered 20 attributes for a veterinary surgeon to have on a five‐point scale from ‘not at all important’ to ‘very important’. In addition, they were asked to list which attributes they considered to be the three most important attributes in a veterinary surgeon; finally, they were asked whether there were any additional attributes that they considered to be highly desirable in a veterinary surgeon. In total, 407 SA clients, 243 SA veterinarians and 61 non‐SA veterinarians completed the questionnaire. There were significant differences in the proportion of clients who considered an attribute to be ‘very important’ compared with SA veterinarians for 12 of the 20 attributes (P<0.005). A larger proportion of clients considered ‘confidence’, ‘knowledge about veterinary medicine and surgery’, ‘cleanliness’, ‘good at explaining technical terms’, ‘patience’, ‘clear about cost of treatment’, ‘ability to work in a team’, ‘honesty’, ‘politeness’, ‘decisiveness’, ‘good with animals’ and ‘good practical skills’ to be ‘very important’ attributes than the SA veterinarians; a larger proportion of SA veterinarians considered ‘good communication skills’ to be a ‘very important’ attribute than the clients.
Purification to homogeneity and characterization of nonproteolyzed potato (Solanum tuberosum) tuber hexokinase 1
Authors: Moisan Marie-Claude , Rivoal Jean
Published: May 2011

We have developed an extraction procedure that improves the stability of potato ( Solanum tuberosum L.) tuber hexokinase (HK) after extraction. Using this protocol, we showed that at least four HK isoforms are present in this tissue, and they can be separated by hydrophobic-interaction chromatography on a butyl-Sepharose™ 4 Fast Flow column. One of the main HK isoforms was purified to homogeneity using further chromatographic separations on red dye, DEAE Fractogel, hydroxyapatite, cibacron blue, and MonoQ matrices. HK-specific activity of this fraction (10.2 U·mg protein–1) corresponds to an enrichment of more than 5500-fold, with a yield of 0.9%. This is the highest reported HK-specific activity from a plant source. The purified enzyme consisted of a monomer with a subunit apparent Mr of 51 kDa when analyzed by SDS–PAGE. This polypeptide was recognized by affinity-purified anti- Solanum chacoense Bitt. recombinant HK IgGs. The protein was digested with trypsin and its digestion products were subjected to MS – MS sequencing after HPLC separation. The sequences of these tryptic peptides matched the predicted coding sequence of the S. tuberosum HK1 gene with a coverage of 57%. Examination of the kinetic properties of the purified protein HK1 indicates that it may be regulated by the internal O2 concentration of the tuber because of its sensitivity to acidic pHs and inhibition by ADP.
Characterization of an alien source of resistance to Fusarium head blight transferred to Chinese Spring wheat1ECORC contribution #10-151.
Authors: Miller S.S. , Watson E.M. , Lazebnik J. , Gulden S. , Balcerzak M. , Fedak G. , Ouellet T.
Published: May 2011

Very few sources of resistance to Fusarium head blight (FHB) of wheat have been identified. Thinopyrum elongatum (Host) D.R. Dewey (2n = 14, EE genome), a wild relative of wheat, carries resistance to FHB on the long arm of its chromosome 7E (7EL). In this report, a strain of Fusarium graminearum Schwabe, the principal causal agent of FHB, transformed to produce green fluorescent protein (GFP), was used to characterize the resistance carried by 7EL when expressed in the susceptible background of 'Chinese Spring' (CS) wheat. Inoculated spikelets of the addition line CS-7EL showed less infection than those of the parental line, CS. This was associated in CS-7EL with upregulation of many genes predicted to be involved in plant defence and downregulation of genes associated with salicylic-acid-induced defence. The difference between CS and CS-7EL in the progression of infection was striking; the fungus spread easily and extensively from the inoculated spikelet into the node and adjacent spikelets in CS, but was effectively blocked from spreading in CS-7EL. Microscopic data showed that fungal growth was inhibited within the inoculated spikelet in CS-7EL, and spread was completely blocked by the node tissue. The blocking of fungal growth through the node into the rachis correlates with the deposition of an unidentified substance in CS-7EL. Additionally, longer internode segments in CS-7EL versus CS may contribute to limiting fungal spread. Our results suggest that the resistance displayed by CS-7EL is multifaceted, involving both physical and chemical factors.
LOCALIZED ENDOMORPHISMS IN KITAEV'S TORIC CODE ON THE PLANE
Authors: NAAIJKENS PIETER
Published: May 2011

We consider various aspects of Kitaev's toric code model on a plane in the C*-algebraic approach to quantum spin systems on a lattice. In particular, we show that elementary excitations of the ground state can be described by localized endomorphisms of the observable algebra. The structure of these endomorphisms is analyzed in the spirit of the Doplicher–Haag–Roberts program (specifically, through its generalization to infinite regions as considered by Buchholz and Fredenhagen). Most notably, the statistics of excitations can be calculated in this way. The excitations can equivalently be described by the representation theory of [Formula: see text], i.e. Drinfel'd's quantum double of the group algebra of ℤ2.
FAST SOLITONS ON STAR GRAPHS
Authors: ADAMI RICCARDO , CACCIAPUOTI CLAUDIO , FINCO DOMENICO , NOJA DIEGO
Published: May 2011

We define the Schrödinger equation with focusing, cubic nonlinearity on one-vertex graphs. We prove global well-posedness in the energy domain and conservation laws for some self-adjoint boundary conditions at the vertex, i.e. Kirchhoff boundary condition and the so-called δ and δ′ boundary conditions. Moreover, in the same setting, we study the collision of a fast solitary wave with the vertex and we show that it splits in reflected and transmitted components. The outgoing waves preserve a soliton character over a time which depends on the logarithm of the velocity of the ingoing solitary wave. Over the same timescale, the reflection and transmission coefficients of the outgoing waves coincide with the corresponding coefficients of the linear problem. In the analysis of the problem, we follow ideas borrowed from the seminal paper [17] about scattering of fast solitons by a delta interaction on the line, by Holmer, Marzuola and Zworski. The present paper represents an extension of their work to the case of graphs and, as a byproduct, it shows how to extend the analysis of soliton scattering by other point interactions on the line, interpreted as a degenerate graph.
INTEGRATION BY PARTS: AN INTRODUCTION
Authors: GROZIN A. G.
Published: May 2011

Integration by parts is used to reduce scalar Feynman integrals to master integrals.
INFLUENCE OF THE SUBSTRATE BIAS VOLTAGE ON FRETTING FATIGUE BEHAVIOR OF CrN FILM DEPOSITED ON Ti-6Al-4V ALLOY
Authors: RAHMAN M. S. , TANIMOTO S. , YONEKURA D. , MURAKAMI R.
Published: May 2011

An experimental investigation was conducted to examine the fretting fatigue behavior of physical vapor deposition-coated CrN film deposited on Ti - 6Al - 4V specimens contacted on both sides with pads of the same material. Behavior against the CrN -coated specimens was characterized through the determination of fretting fatigue strength up to 107 cycles. Fretting damage of specimen surface was characterized by SEM and surface profilometer. The experimental results from the S – N tests indicate that the CrN coating is effective to improve the fretting fatigue strength until about 106 cycles, but over 106 cycles, the strength is lower than that of uncoated specimens. The enhanced fretting fatigue resistance can be attributed to the improved hardness of the CrN film due to change of bias voltage during the film deposition. It has also been concluded that below and about 106 cycles, there is smaller influence of bias voltage on fatigue strength, whereas, over 106 cycles, fatigue strength is clearly changed by bias voltage as well as contact pressure.
LUMINESCENCE MECHANISM STUDY OF A POTENTIAL SCINTILLATION CRYSTAL YBa3B9O18
Authors: HE MING , ZHANG Z. H. , CHEN X. L. , QIU M. H. , JI Y. K. , XIU J. L.
Published: May 2011

The luminescence mechanisms of a potential scintillation crystal YBa 3 B 9 O 18 were investigated by experimental methods. As a first step, the optical band gap energy Eg was estimated to be 7.3 eV from the optical absorption spectrum and vacuum ultraviolet excited luminescence spectra. The X-ray photoelectron spectroscopy measured in the valence region coincided with the first principle energy band calculation. Based on the analysis of valence band structure and vacuum ultraviolet excited luminescence spectra the origins of emission bands of YBa 3 B 9 O 18 were studied. The intrinsic luminescence of YBa 3 B 9 O 18 was attributed to the radiative decay of self-trapped excitons. The elucidation of the luminescence mechanism provides a physical picture on the property-structure correlation and may help to accelerate the applications of the potential scintillation crystal.
IMPURITY EFFECT ON THE TRANSITION TEMPERATURE OF THE SUPERCONDUCTING FULLERIDES
Authors: HUANG H. , GAN Z.-Z.
Published: May 2011

We study the alkali-metal-doped fulleride systems based on an impurity model. The bound states are induced by the impurity potential, and the local density of states of the neighboring molecules at the Fermi level is remarkably reduced. We point out that the superconductivity of the whole system will be destroyed when the average distance between the impurities reaches the order of the coherence length. It gives a reasonable explanation to the strange behavior of the transition temperature of the superconducting fullerides.
QUALITATIVE COMPARISON OF THE THERMODYNAMICS OF Mn12-ac AND Fe8 MOLECULE MAGNETS FOR Dβ ~ 0.031
Authors: THOMAZ M. T. , ROJAS ONOFRE , CORRÊA-SILVA E. V.
Published: May 2011

The magnetization and the specific heat of two single molecule magnets (SMM) with spin-10, Mn 12- ac and Fe 8, are compared for Dβ ~ 0.031. The rhombic term in the Fe 8 molecule makes the x-component of its magnetization to be larger than that of the Mn 12- ac molecule. The axial symmetry of the Mn 12- ac favors the z-component of its magnetization, in comparison to the Fe 8 molecule. For T ≳ 18 K, the specific heat of the Mn 12- ac is large (80%, at most) than that of the Fe 8, at the same temperature. The corrections from the S = 9 excited states of these SMM's do not invalidate our results. An unexpected result occurs when the angle between the easy-axis and the external magnetic field equals π/4: the aforementioned percentage difference of the specific heat reaches 3% for D β ≲ 0.025 and h/k ∈[1.93, 2.04], when they are compared at distinct temperatures [Formula: see text]. This small percentage difference also happens for the average specific heat of both SMM's at those temperatures and h/D Mn ∈ [1.97, 2.1].
ION- AND ELECTRON-LO PHONON EFFECTS ON BOUND POLARONS IN POLAR RECTANGULAR QUANTUM WIRES
Authors: SONG TIE-LEI , LIANG X. X.
Published: May 2011

The impurity binding energy in a polar rectangular quantum wire is studied by a variational approach. The electron- and ion-longitudinal-optical-phonon interactions are both taken into account in the calculations. The numerical results for GaAs quantum wire indicate that the phonon effects reduce obviously the binding energy and cannot been neglected. The ion-phonon coupling is dominant in various phonon effects. The phonon contribution is sensitive to the size and shape of the quantum wire section.
ISOMORPHIC CHARACTER TABLES OF NESTED GVZ-GROUPS
Authors: NENCIU ADRIANA
Published: May 2011

In this paper we introduce the notion of nested GVZ-groups. We give necessary and sufficient conditions for two non-isomorphic nested GVZ-groups to have isomorphic character tables.
Efficient synthesis and in vitro photodynamic anticancer study of new purpurinimide-hydrazone conjugates
Authors: Li Jia Zhu , Li Li , Kim Jung Hwa , Cui Bing Cun , Wang Jin Jun , Shim Young Key
Published: May 2011

A series of new purpurinimide-hydrazone conjugates were synthesized, and their in vitro anticancer efficacy against A549 lung cancer cell lines was evaluated. It was found that the incorporation of the hydrazone group to the purpurinimide could increase their anticancer activities via a combination of photodynamic therapy and chemotherapy.