CASTRO: A New Compressible Astrophysical Solver. II. Gray Radiation Hydrodynamics

We describe the development of a flux-limited gray radiation solver for the compressible astrophysics code, CASTRO. CASTRO uses an Eulerian grid with block-structured adaptive mesh refinement based on a nested hierarchy of logically-rectangular variable-sized grids with simultaneous refinement in both space and time. The gray radiation solver is based on a mixed-frame formulation of radiation hydrodynamics. In our approach, the system is split into two parts, one part that couples the radiation and fluid in a hyperbolic subsystem, and another parabolic part that evolves radiation diffusion and source-sink terms. The hyperbolic subsystem is solved explicitly with a high-order Godunov scheme, whereas the parabolic part is solved implicitly with a first-order backward Euler method.Comment: accepted for publication in ApJS, high-resolution version available at https://ccse.lbl.gov/Publications/wqzhang/castro2.pd

One chance to get it right: improving clinical handovers for better symptom control at the end of life.

Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relatives’ perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in Córdoba city, Argentina. By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care. Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (March–May 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method. During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night. Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one. The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to ‘Did doctors and nurses do enough for the patient to be comfortable during the night?’ increased from 75% to 100% between the first and the second QI cycle. In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients

Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway.

BackgroundThe ERANet-LAC CODE (Care Of the Dying Evaluation) international survey assessed quality of care for dying cancer patients in seven countries, by use of the i-CODE questionnaire completed by bereaved relatives. The aim of this sub study was to explore which factors improve or reduce quality of end-of-life (EOL) care from Norwegian relatives' point of view, as expressed in free text comments.Methods194 relatives of cancer patients dying in seven Norwegian hospitals completed the i-CODE questionnaire 6-8 weeks after bereavement; recruitment period 14 months; response rate 58%. Responders were similar to non-responders in terms of demographic details.104 participants (58% spouse/partner) added free text comments, which were analyzed by systematic text condensation.ResultsOf the 104 comments, 45% contained negative descriptions, 27% positive and 23% mixed. 78% described previous experiences, whereas 22% alluded to the last 2 days of life. 64% of the comments represented medical/surgical/oncological wards and 36% palliative care units. Four main categories were developed from the free text comments: 1) Participants described how attentive care towards the practical needs of patients and relatives promoted dignity at the end of life, which could easily be lost when this awareness was missing. 2) They experienced that lack of staff, care continuity, professional competence or healthcare service coordination caused uncertainty and poor symptom alleviation. 3) Inadequate information to patient and family members generated unpredictable and distressing final illness trajectories. 4) Availability and professional support from healthcare providers created safety and enhanced coping in a difficult situation.ConclusionsOur findings suggest that hospitals caring for cancer patients at the end of life and their relatives, should systematically identify and attend to practical needs, as well as address important organizational issues. Education of staff members ought to emphasize how professional conduct and communication fundamentally affect patient care and relatives' coping

‘Making such bargain’:Transcribe Bentham and the quality and cost-effectiveness of crowdsourced transcription

In recent years, important research on crowdsourcing in the cultural heritage sector has been published, dealing with topics such as the quantity of contributions made by volunteers, the motivations of those who participate in such projects, the design and establishment of crowdsourcing initiatives, and their public engagement value. This article addresses a gap in the literature, and seeks to answer two key questions in relation to crowdsourced transcription: (1) whether volunteers’ contributions are of a high enough standard for creating a publicly accessible database, and for use in scholarly research; and (2) if crowdsourced transcription makes economic sense, and if the investment in launching and running such a project can ever pay off. In doing so, this article takes the award-winning crowdsourced transcription initiative, Transcribe Bentham, which began in 2010, as its case study. It examines a large data set, namely, 4,364 checked and approved transcripts submitted by volunteers between 1 October 2012 and 27 June 2014. These data include metrics such as the time taken to check and approve each transcript, and the number of alterations made to the transcript by Transcribe Bentham staff. These data are then used to evaluate the long-term cost-effectiveness of the initiative, and its potential impact upon the ongoing production of The Collected Works of Jeremy Bentham at UCL. Finally, the article proposes more general points about successfully planning humanities crowdsourcing projects, and provides a framework in which both the quality of their outputs and the efficiencies of their cost structures can be evaluated

Good quality care for patients with cancer dying in hospitals, but information needs not met : bereaved relatives’ survey within seven countries

Background Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. Materials and Methods Postbereavement survey by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6–8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patients’ last days of life. Results From 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate 54%). Approximately 94% reported the doctors treated their family member with dignity and respect “always” or “most of the time”; similar responses were given about nursing staff (94%). Additionally, 89% participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3–17.8). Although 87% participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. Conclusion This is the first study assessing quality of care for patients dying from cancer from the bereaved relatives’ perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. Clinical trial information: NCT03566732 Implications for Practice Previous studies have shown that bereaved relatives’ views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement

Design procedures of reinforced concrete framed buildings in Nepal and its impact on seismic safety

The present paper analyses the design procedure and its impact on seismic safety of the structures. For this, a representative reinforced concrete frame building (WDS) is designed and the results are compared with similar buildings detailed with: i) Current Construction Practices (CCP); ii) the Nepal Building Code (NBC) and iii) the Modified Nepal Building Code (NBC+) recommendations. The seismic performance evaluation is done with global strength, inter-storey drift and displacement of the structures. Likewise, the sensitivity of the structural and geometrical parameters of the RC frame building is studied through nonlinear analysis. The study parameters considered for parametric analysis are column size, beam size, inter-storey height, bay length, bay width, and compressive strength of concrete. The results show that the influence on the structural behaviour, particularly by variation in column size and inter-storey height. Additionally, the influence of the seismic zone factor on reinforcement demand of the structure is studied. The result shows that structures designed for high to medium seismic hazard demands double the reinforcement in beams compared to structures in low seismic zone