The level of provision of specialist palliative care services in Scotland: an international benchmarking study

Objectives: Comparative benchmarking of specialist palliative care (SPC) services across jurisdictions can be used to assess the adequacy of provision. Published in 2016, the Scottish Atlas of Palliative Care unlocks the possibility of benchmarking Scotland’s provision against other European Union (EU) countries. Our objectives were to describe the provision of SPC services in Scotland and compare this with other EU countries, assessing coverage against European norms. Methods: We conducted a secondary analysis of data collected as part for the Scottish Atlas by structured telephone (n=33) or online (n=3) survey with informants from 14 territorial health boards and 15 hospices who provided information about SPC services in their locality. National-level Scottish data were compared with data from other EU countries allowing ranking for each service type and service coverage as calculated against European Association for Palliative Care norms. Results: Scotland had a total of 23 SPC inpatient units containing 349 beds, 27 SPC hospital support teams and 38 SPC home care teams. Relative to other EU countries, Scotland ranked seventh for provision of SPC inpatient units and hospital support teams, and fifth for home care teams. Coverage for these services was 85%, 100% and 72%, respectively. Conclusion: Scotland is positioned among the top 10 EU countries for the level of provision of SPC services. National policy in Scotland has focused on the delivery of palliative care at home or in a homely setting. These data support a focus on developing services in community settings to meet Scotland’s policy ambitions

'Learning together': Sharing international experience on new models of primary care

No abstract available

What can a mean-field model tell us about the dynamics of the cortex?

In this chapter we examine the dynamical behavior of a spatially homogeneous two-dimensional model of the cortex that incorporates membrane potential, synaptic flux rates and long- and short-range synaptic input, in two spatial dimensions, using parameter sets broadly realistic of humans and rats. When synaptic dynamics are included, the steady states may not be stable. The bifurcation structure for the spatially symmetric case is explored, identifying the positions of saddle–node and sub- and supercritical Hopf instabilities. We go beyond consideration of small-amplitude perturbations to look at nonlinear dynamics. Spatially-symmetric (breathing mode) limit cycles are described, as well as the response to spatially-localized impulses. When close to Hopf and saddle–node bifurcations, such impulses can cause traveling waves with similarities to the slow oscillation of slow-wave sleep. Spiral waves can also be induced. We compare model dynamics with the known behavior of the cortex during natural and anesthetic-induced sleep, commenting on the physiological significance of the limit cycles and impulse responses

High Speed Production of Large Coal to Facilitate Easier and More Effective Cleaning

Track I: Power GenerationIncludes audio file (14 min.)Due to technical difficulties, the audio portion of this presentation is joined in progress.Most modern mining equipment extracts coal through grinding it from the solid using a set of rotating picks. This produces coal that is quite small in average size and generates a lot of dust in the process. The coal is also more expensive to collect and process to remove contained undesirable components. The use of high-pressure water jets as a cutting tool has been shown to provide a product that is larger in size, while con-commitantly eliminating the generation of dust (which carries with it the risk of ignition and explosion) and reducing the energy required for the mining process. Two different mining machines are described, one for use on longwall faces and one in room and pillar mines, and the potential for their development is discussed

Insecticide resistance and the future of malaria control in Zambia.

BACKGROUND: In line with the Global trend to improve malaria control efforts a major campaign of insecticide treated net distribution was initiated in 1999 and indoor residual spraying with DDT or pyrethroids was reintroduced in 2000 in Zambia. In 2006, these efforts were strengthened by the President's Malaria Initiative. This manuscript reports on the monitoring and evaluation of these activities and the potential impact of emerging insecticide resistance on disease transmission. METHODS: Mosquitoes were captured daily through a series of 108 window exit traps located at 18 sentinel sites. Specimens were identified to species and analyzed for sporozoites. Adult Anopheles mosquitoes were collected resting indoors and larva collected in breeding sites were reared to F1 and F0 generations in the lab and tested for insecticide resistance following the standard WHO susceptibility assay protocol. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 14 years. RESULTS: A total of 619 Anopheles gambiae s.l. and 228 Anopheles funestus s.l. were captured from window exit traps throughout the period, of which 203 were An. gambiae malaria vectors and 14 An. funestus s.s.. In 2010 resistance to DDT and the pyrethroids deltamethrin, lambda-cyhalothrin and permethrin was detected in both An. gambiae s.s. and An. funestus s.s.. No sporozoites were detected in either species. Prevalence of P. falciparum in the sentinel sites remained below 10% throughout the study period. CONCLUSION: Both An. gambiae s.s. and An. funestus s.s. were controlled effectively with the ITN and IRS programme in Zambia, maintaining a reduced disease transmission and burden. However, the discovery of DDT and pyrethroid resistance in the country threatens the sustainability of the vector control programme

Indigenous Knowledge in Post-secondary Educators' Practices: Nourishing the Learning Spirit

From 2006 to 2009, Indigenous Elders and scholars shared their insights in the Comprehending and Nourishing the Learning Spirit Animation Theme Bundle of the Aboriginal Learning Knowledge Centre (ABLKC). The ABLKC was an applied research, knowledge exchange, and monitoring program with a mandate to advance Aboriginal education in Canada. One of the six bundles, Nourishing the Learning Spirit, was led by Mi’kmaw education scholar and Academic Director of the Aboriginal Education Research Centre at the University of Saskatchewan, Dr. Marie Battiste. In this paper, the authors discuss how they applied knowledge gained in the Nourishing the Learning Spirit Animation Theme Bundle to their post-secondary classroom practice. The authors argue that teachers are better able to nourish the learning spirit of students when they understand themselves as lifelong learners, validate and learn from their students, and use holistic teaching pedagogies.  De 2006 à 2009, les aînés autochtones et les pédagogues ont partagé leur compréhension de l’esprit de l’apprentissage dans un ensemble de trousses d’animation (Comprehending and Nourishing the Learning Spirit Animation Theme Bundle). L’une des six trousses, Nourishing the Learning Spirit, a été chapeautée par la directrice de l’Aboriginal Education Research Centre (ABLKC) à l’Université de la Saskatchewan, Dre Marie Battiste, chercheure en éducation d’origine micmaque (mi’ kmaq). L’ABLKC était un programme de recherche appliquée, d’échange d’idées et de contrôle, ayant un mandat de reportage visant l’avancement de l’éducation autochtone au Canada. Dans le présent document, les chercheurs discutent des connaissances acquises au cours de l’implantation de la trousse Nourishing the Learning Spirit dans leur salle de classe postsecondaire. Ils affirment que les professeurs peuvent nourrir l’esprit d’apprentissage de leurs élèves quand ils se voient eux-mêmes comme apprenants perpétuels, valorisent et apprennent de leurs élèves, et utilisent des pédagogies d’enseignement holistiques

What Postgraduates Appreciate in Online Tutor Feedback on Academic Writing

Improving postgraduate student writing in English is an ongoing concern in the increasingly internationalised UK Higher Education context. Although the importance of feedback for developing academic writing skills is well-established (Hyland and Hyland 2006), there is still much debate about the components of effective feedback. In response to the call for research investigating teachers’ real-world practices in giving feedback in specific contexts (Lee 2014 and 2012), this article presents an initiative to develop students’ abilities to tackle written postgraduate writing (essays and dissertations) through collaborative on-line academic writing courses. The Grounded Theory-inspired study explores student perceptions of the effectiveness of online formative feedback on postgraduate academic writing in order to identify best practices which can contribute to developing skills in providing feedback. The study analyses tutor feedback on student texts and student responses to feedback. We applied categories which emerged from this data and concluded that the students we investigated had responded most positively when a combination of confidence-developing feedback practices were employed. These included both principled corrective language feedback and positive, personalised feedback on academic conventions and practices. This collaboration between academic writing and content specialists continues to provide further opportunities for embedding practices that encourage the development of academic writing skills on one year postgraduate programmes at the University of Edinburgh.

Must . . . stay . . . strong!

This is the fourth installment in our trilogy of papers on epistemic modality.It is a recurring matra that epistemic must creates a statement that is weaker than the corresponding flat-footed assertion: It must be raining vs. It’s raining. Contrary to classic discussions of the phenomenon such as by Karttunen, Kratzer, and Veltman, we argue that instead of having a weak semantics, must presupposes the presence of an indirect inference or deduction rather than of a direct observation. This is independent of the strength of the claim being made. Epistemic must is therefore quite similar to evidential markers of indirect evidence known from languages with rich evidential systems. We work towards a formalization of the evidential component, relying on a structured model of information states (analogous to some models used in the belief dynamics literature). We explain why in many contexts, one can perceive a lack of confidence on the part of the speaker who uses must

Circulating gluten-specific FOXP3 + CD39 + regulatory T cells have impaired suppressive function in patients with celiac disease

Background Celiac disease is a chronic immune-mediated inflammatory disorder of the gut triggered by dietary gluten. Although the effector T-cell response in patients with celiac disease has been well characterized, the role of regulatory T (Treg) cells in the loss of tolerance to gluten remains poorly understood. Objective We sought to define whether patients with celiac disease have a dysfunction or lack of gluten-specific forkhead box protein 3 (FOXP3)+ Treg cells. Methods Treated patients with celiac disease underwent oral wheat challenge to stimulate recirculation of gluten-specific T cells. Peripheral blood was collected before and after challenge. To comprehensively measure the gluten-specific CD4+ T-cell response, we paired traditional IFN-γ ELISpot with an assay to detect antigen-specific CD4+ T cells that does not rely on tetramers, antigen-stimulated cytokine production, or proliferation but rather on antigen-induced coexpression of CD25 and OX40 (CD134). Results Numbers of circulating gluten-specific Treg cells and effector T cells both increased significantly after oral wheat challenge, peaking at day 6. Surprisingly, we found that approximately 80% of the ex vivo circulating gluten-specific CD4+ T cells were FOXP3+CD39+ Treg cells, which reside within the pool of memory CD4+CD25+CD127lowCD45RO+ Treg cells. Although we observed normal suppressive function in peripheral polyclonal Treg cells from patients with celiac disease, after a short in vitro expansion, the gluten-specific FOXP3+CD39+ Treg cells exhibited significantly reduced suppressive function compared with polyclonal Treg cells. Conclusion This study provides the first estimation of FOXP3+CD39+ Treg cell frequency within circulating gluten-specific CD4+ T cells after oral gluten challenge of patients with celiac disease. FOXP3+CD39+ Treg cells comprised a major proportion of all circulating gluten-specific CD4+ T cells but had impaired suppressive function, indicating that Treg cell dysfunction might be a key contributor to disease pathogenesis