Patients' quality of life - Living with incurable cancer in palliative homecare

My clinical experience is that living in incurable cancer at the end of life is complex to patients and their families. Patients seem to have a rather good quality of life (QoL) but problems related to the progression of the illness constantly challenges and changes QoL. These changes seem to at some points improve or diminish QoL which are distressing to patients and their families. But what meaning do patients give QoL when illness progress? Further, my clinical experience is that QoL assessments are not integrated naturally in the daily care of dying patients and professionals do not ask patients how they apprehend their QoL in general. The overall aim was to explore how QoL is influenced and its importance for patients living with incurable cancer at the end of life, while being cared for at home with support from family caregivers and a palliative homecare team (PHT). The participants lived in the middle of Sweden, and the sample included patients (n=76) who were more or less confined to bed (ECOG PS), cared for by family caregivers (n=4). Mixed methods were used, mainly qualitative methods, analyzed by content analyses. Data collected with quantitative method was analyzed using mainly non-parametric methods. This thesis consists of four empirical papers (I-IV). Major findings illustrated how complex QoL in fact is and that it was essential to patients QoL to be a part of a daily and social life. The last weeks of life was not a calm transitory phase during which patients, family and professionals had time to adjust emotionally. Further, body and mind became more segregated than at any other time during the transition phase. This is strengthened by paper IV with patients in particular, which provided abundant information on different aspects related to the concept of QoL. Moreover, the quantitative study (I) showed that medical care and QoL could actually improve after patients had been designated to a PHT, despite their progressive disease. The social dimension of QoL was more obvious in the qualitative studies with patients (II and IV) and family caregivers (III), and not at all in the quantitative study (I). The existential dimension on the other hand was more evident in paper I and III than in paper II and IV. In addition, the physical and psychological dimensions appeared equally important in all of the papers. Findings also illustrated that some patients with incurable cancer did not regard their QoL as being as negative as one might expect. Positive factors that have been identified for potentially improving QoL was receiving optimal support by family caregivers and optimal symptom control, being able to stay at home, and maintaining as normal an everyday life as possible and being regarded as an autonomous individual.The findings in this thesis also point out the necessity for healthcare professionals in palliative care to seriously discuss what issues patients close to death and their families consider as important for providing an optimal QoL

Local, global, and diasporic interaction in the Cape Breton dance tradition

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‘Putting the dirt back in’ : an investigation of step dancing in Scotland

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Optimising cow traffic in automatic milking systems

This thesis comprises the results from three separate studies performed in the experimental automatic milking system at Kungsängen Research Centre, Swedish University of Agricultural Sciences, Uppsala, Sweden. In the first study, 30 high-yielding cows in early lactation were subjected to two different degrees of controlled cow traffic, and the effects on milk yield, dry matter intake, feeding patterns and voluntary visits to the milking unit and the control gates were measured. A model of mixed distributions for estimations of biologically relevant meal criteria from registrations in roughage stations was also evaluated. In the second study, the behaviour of 24 cows after they had been redirected in control gates was observed, and the cause of long redirection times from gates until they showed up in the milking unit was examined. In the third study, 9 cows were subjected to three different cow traffic systems in a carry-over design and the effects on cortisol concentrations in milk and ruminating patterns were studied. The studies showed that milking frequency and thereby milk production can be altered by different time settings in the control gates without limiting the daily feed intake of the cows. A high degree of guidance provokes social effects in the queue in front of the milking unit and in the feeding areas. It also makes it difficult for the cows to follow their natural feeding patterns. Judging from measurements of milk cortisol concentrations, controlled cow traffic was not stressful for the cows. Cows initiated meals with short intervals, which offered many opportunities to milk them. But the queue in front of the milking unit caused long redirection times, and the control gates failed to guide cows to high milking frequencies. Individual differences in feeding patterns and how cows respond to redirections in the control gates suggest that the control gates should be making decisions on an individual level

On the relationship of continuity and boundary regularity in PMC Dirichlet problems

In 1976, Leon Simon showed that if a compact subset of the boundary of a domain is smooth and has negative mean curvature, then the non-parametric least area problem with Lipschitz continuous Dirichlet boundary data has a generalized solution which is continuous on the union of the domain and this compact subset of the boundary, even if the generalized solution does not take on the prescribed boundary data. Simon's result has been extended to boundary value problems for prescribed mean curvature equations by other authors. In this note, we construct Dirichlet problems in domains with corners and demonstrate that the variational solutions of these Dirichlet problems are discontinuous at the corner, showing that Simon's assumption of regularity of the boundary of the domain is essential.Comment: 19 pages; typos corrected, figure added (in Figure 11), submitted to the Pacific Journal of Mathematics; additional typos corrected. 20 pages, accepted by the Pacific Journal of Mathematics. UPDATE: 20 pages, accepted for publication by the Pacific Journal of Mathematic

Scalp cooling with adjuvant/neoadjuvant chemotherapy for breast cancer and the risk of scalp metastases: systematic review and meta-analysis.

PurposeThe risk of scalp metastases in patients using scalp cooling for preservation of hair during chemotherapy has been a concern but is poorly described.MethodsA systematic review and meta-analysis of longitudinal studies was undertaken to evaluate the effect of scalp cooling versus no scalp cooling on the risk of scalp metastasis in patients treated for breast cancer with chemotherapy. Electronic databases, journal specific, and hand searches of articles identified were searched. Patients were matched based on disease, treatment, lack of metastatic disease, and sex.ResultsA total of 24 full-text articles were identified for review. Of these articles, ten quantified the incidence of scalp metastasis with scalp cooling over time. For scalp cooling, 1959 patients were evaluated over an estimated mean time frame of 43.1 months. For no scalp cooling, 1238 patients were evaluated over an estimated mean time frame of 87.4 months. The incidence rate of scalp metastasis in the scalp cooling group versus the no scalp cooling group was 0.61% (95% CI 0.32-1.1%) versus 0.41% (95% CI 0.13-0.94%); P = 0.43.ConclusionThe incidence of scalp metastases was low regardless of scalp cooling. This analysis suggests that scalp cooling does not increase the incidence of scalp metastases

Feasibility of Determining Diffuse Ultra-High Energy Cosmic Neutrino Flavor Ratio through ARA Neutrino Observatory

The flavor composition of ultra-high energy cosmic neutrinos (UHECN) carries precious information about the physical properties of their sources, the nature of neutrino oscillations and possible exotic physics involved during the propagation. Since UHECN with different incoming directions would propagate through different amounts of matter in Earth and since different flavors of charged leptons produced in the neutrino-nucleon charged-current (CC) interaction would have different energy-loss behaviors in the medium, measurement of the angular distribution of incoming events by a neutrino observatory can in principle be employed to help determine the UHECN flavor ratio. In this paper we report on our investigation of the feasibility of such an attempt. Simulations were performed, where the detector configuration was based on the proposed Askaryan Radio Array (ARA) Observatory at the South Pole, to investigate the expected event-direction distribution for each flavor. Assuming $\nu_{\mu}$-$\nu_{\tau}$ symmetry and invoking the standard oscillation and the neutrino decay scenarios, the probability distribution functions (PDF) of the event directions are utilized to extract the flavor ratio of cosmogenic neutrinos on Earth. The simulation results are summarized in terms of the probability of flavor ratio extraction and resolution as functions of the number of observed events and the angular resolution of neutrino directions. We show that it is feasible to constrain the UHECN flavor ratio using the proposed ARA Observatory.Comment: 40 pages, 16 figures; v2 figures improved, Sec. II, III, and IV revised, as publishe

An exploratory study of co-authorships among Iranian scientists in experimental sciences

This paper investigates the factors that made international co-authorship between scientists in Iran and elsewhere possible. A questionnaire was sent out to Iranian scientists in fields of physics, chemistry, and biology who had co-authored an internationally published journal article during 2003. The main foreign co-author in each of the articles was identified and questions regarding this co-author and the collaborative event were asked. The results show that not all co-authored articles were the results of collaborative projects. Also, the main collaborative motives behind the co-authorships were identified and described. Among these, we could mention sharing laboratory devices, accessing knowledge, and increase the efficiency of the study at hand. It is clear that emigrated Iranian scientists play an important role as collaborators and probably also as links to the international scientific community as a whole. Cultural factors mix with scientific and work related one