Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC ...interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II–IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included ‘patient-centred care’, ‘quality of life’ and ‘shared decision making’. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.
The Cosmic Ray Energetics And Mass (CREAM) instrument is configured with a suite of particle detectors to measure TeV cosmic-ray elemental spectra from protons to iron nuclei over a wide energy ...range. The goal is to extend direct measurements of cosmic-ray composition to the highest energies practical, and thereby have enough overlap with ground based indirect measurements to answer questions on cosmic-ray origin, acceleration and propagation. The balloon-borne CREAM was flown successfully for about 161days in six flights over Antarctica to measure elemental spectra of Z=1–26 nuclei over the energy range 1010 to >1014eV. Transforming the balloon instrument into ISS-CREAM involves identification and replacement of components that would be at risk in the International Space Station (ISS) environment, in addition to assessing safety and mission assurance concerns. The transformation process includes rigorous testing of components to reduce risks and increase survivability on the launch vehicle and operations on the ISS without negatively impacting the heritage of the successful CREAM design. The project status, including results from the ongoing analysis of existing data and, particularly, plans to increase the exposure factor by another order of magnitude utilizing the International Space Station are presented.
We report a study of ν(μ) charged-current quasielastic events in the segmented scintillator inner tracker of the MINERvA experiment running in the NuMI neutrino beam at Fermilab. The events were ...selected by requiring a μ- and low calorimetric recoil energy separated from the interaction vertex. We measure the flux-averaged differential cross section, dσ/dQ², and study the low energy particle content of the final state. Deviations are found between the measured dσ/dQ² and the expectations of a model of independent nucleons in a relativistic Fermi gas. We also observe an excess of energy near the vertex consistent with multiple protons in the final state.
We have isolated ν(μ) charged-current quasielastic (QE) interactions occurring in the segmented scintillator tracking region of the MINERvA detector running in the NuMI neutrino beam at Fermilab. We ...measure the flux-averaged differential cross section, dσ/dQ², and compare to several theoretical models of QE scattering. Good agreement is obtained with a model where the nucleon axial mass, M(A), is set to 0.99 GeV/c² but the nucleon vector form factors are modified to account for the observed enhancement, relative to the free nucleon case, of the cross section for the exchange of transversely polarized photons in electron-nucleus scattering. Our data at higher Q² favor this interpretation over an alternative in which the axial mass is increased.
The Cosmic Ray Energetics and Mass experiment at the International Space Station (ISS-CREAM) is developed for studying the origin, acceleration and propagation mechanism of high energy cosmic rays. ...The Top and Bottom Counting Detectors (TCD/BCD), sub-detectors of the ISS-CREAM instrument, are developed for electron/γ-ray physics. The TCD/BCD help distinguish electrons from protons by comparing the hit and shower width distributions for electrons and protons. The e/p separation capability of the TCD/BCD is studied by using the GEANT3 simulation package, and optimal parameters for the e/p separation are obtained.
Abstract A role for the beta genus HPVs in keratinocyte carcinoma (KC) remains to be established. In this article we examine the potential role of the beta HPVs in cancer revealed by the epidemiology ...associating these viruses with KC and supported by oncogenic properties of the beta HPV proteins. Unlike the cancer associated alpha genus HPVs, in which transcriptionally active viral genomes are invariably found associated with the cancers, that is not the case for the beta genus HPVs and keratinocyte carcinomas. Thus a role for the beta HPVs in KC would necessarily be in the carcinogenesis initiation and not in the maintenance of the tumor.
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