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Exploring spirituality in palliative care services: an All-Ireland survey
No full textBackgroundSpirituality and spiritual care are recognised as integral components of palliative care practice. Because of the diverse nature of this unique part of humanity, it may be challenging to describe what spirituality is or to ensure that spiritual care is delivered consistently in palliative care settings. However, failure to address the spiritual needs of a person and those who are important to them, who are in receipt of palliative care, can contribute to unnecessary distress.MethodologyThis study employed a mixed-method design. Using a purposefully selected non-probability sampling method, an adapted survey was specifically developed and conducted across the island of Ireland among healthcare professionals working in palliative and end-of-life care services. Data analysis included the use of a computer software programme (IBM SPSS Statistics, Version 28), qualitative data was analysed using Braun and Clarke’s (2022) six step approach to thematic analysis.ResultsCompleted surveys were received from a wide range of health care professionals (152 responses). Results showed that 113 (74.8%) had been working in palliative care for at least 6 years, and 109 (72.1%) respondents reported frequent/very frequent engagement in this aspect of care. Four themes emerged from the qualitative data relating to the concept of spiritual care (1) linked to holistic care which was seen as fundamental to palliative care, (2) closely linked to supporting someone in their search for meaning, which was often associated with existential issues, (3) it required practitioners to recognise that people often expressed their spirituality and spiritual needs within the context of the individual’s values & beliefs, (4) a form of accompaniment, closely related to a journey that included supporting someone as they moved towards death.ConclusionThe findings from this study show that many members of the palliative care team are actively engaged in supporting people with life-limiting illness and their families with their spiritual needs and concerns. Respondents were able to offer a rich insight into what they believed spiritual care is and the important role it plays in delivering palliative care. There was a clear recognition of the need for further support and training. It is hoped that the findings from this study will contribute to further discussion, learning and research, and encourage more members of the palliative care team to engage in this component of person-centred care
Identification of important outcomes for surgical and brace treatment of adolescent idiopathic scoliosis
No full textAimsHigh-quality clinical trials in adolescent idiopathic scoliosis (AIS) are needed to guide decision-making but progress is hindered by suboptimal selection of outcome measures. Identifying meaningful outcomes for consistent measurement across clinical trials and routine practice is critical. However, there is currently no understanding of which treatment outcome domains are considered important by adolescents, their parents, and healthcare professionals (HCPs). This study is the first to address this gap internationally.MethodsThis study represents the first stage of core outcome set (COS) development, following gold-standard guidance. A cross-sectional qualitative interview study with 40 participants (adolescents with AIS, their parents, and HCPs) was conducted. Semi-structured interviews were analyzed to identify and categorize important AIS treatment outcomes. Analytical rigour was ensured through coder agreement and stakeholder consultation.ResultsA total of 91 important outcome domains were identified; 53 outcome domains applying to both bracing and surgery, with 15 additional outcome domains for bracing only, and 23 additional outcome domains for surgery only. Of the 91 outcome domains, more than three-quarters (71/91, 78%) related to life impact, with smaller proportions relating to physiological/clinical outcomes (13/91, 14%), resource use (4/91, 4%), and adverse events (1/91, 1%).ConclusionThe current study highlights treatment outcomes considered important by adolescents with AIS, their parents, and HCPs. These findings will inform outcome selection in clinical trials and routine practice, as well as facilitating an ongoing programme of research to develop a COS for evaluating treatment of AIS
Budget impact analysis of a vision center-based community eye health program in an underserved urban slum in India
No full textPurpose: We aim to study the Vision Centre-Based Community Eye Health Programs in an underserved urban slum in Pune city, India, using Budget Impact Analysis from a payer’s perspective. Methods: Input costs, training, human resources, capital equipment cost, recurrent consumable costs, salaries, and rent were calculated from January 2015 to December 2022. The income earned from subsidized outpatient care, optical services, and surgeries was calculated. The monthly reports of the center were used to calculate the number of beneficiaries. Data were stored in Excel and analyzed in R software. Free surgeries, consultations, and spectacles were distributed to needy patients occasionally during these years. Results: The Vision Centre at Phulenagar, Vishrantwadi, Pune, in partnership with Operation Eyesight Universal, has been operational since January 2015, providing critical eye health services to the community. Over 5 years, the center examined 44,535 individuals, with 98.1% re-examined in 2019, and significantly reduced the prevalence of blindness and visual impairment. Budget impact analysis revealed the center’s establishment cost, net budget impact, and the economic impacts of various operational scenarios. Sensitivity analysis showed that income from surgeries had the highest influence on total income, while spectacle costs affected total costs the most. Scenario analysis highlighted that a combined approach of reducing costs and increasing income, particularly in the absence of District Blindness Control Society subsidy, could improve the financial sustainability of the Vision Centre. Conclusion: Vision center-based prevention of blindness and vision impairment programs, combined with home screening, is effective clinically and economically
Rethinking adversarial attacks on neuromorphic models
No full textSpiking neural networks (SNN) are biologically inspired artificial neural networks that emulate the behaviour of biological neurons in spiking-based computational units. However, machine learning models are known to be vulnerable to adversarial noise, and particularly to universal adversarial perturbations (UAP) and adversarial patch (AP) attacks. Despite the claimed inherent robustness of SNNs to adversarial noise, attacks with UAP and AP remain under-explored in the spiking domain. This paper revisits the adversarial noise generation method from its first principles. Specifically, we consider a realistic spiking-aware setting that takes into account constraints from the neuromorphic domain, such as event sparsity and spike-timing integrity. We introduce our approach for creating Spiking-compatible adversarial attacks and a spiking UAP and AP destined for event-based computer vision systems. We propose a novel, efficient spike-based adversarial noise generation approach that respects neuromorphic constraints and show that SNNs can be the victims of more tangible and realistic types of attack
Little red dots as young supermassive black holes in dense ionized cocoons
No full textThe James Webb Space Telescope (JWST) has uncovered many compact galaxies at high redshift with broad hydrogen and helium lines, including the enigmatic population of little red dots (LRDs)1,2. The nature of these galaxies is debated and is attributed to supermassive black holes (SMBHs)3,4 or intense star formation5. They exhibit unusual properties for SMBHs, such as black holes that are overmassive for their host galaxies4 and extremely weak X-ray6, 7, 8, 9–10 and radio6,11, 12–13 emission. Here we show that in most objects studied with the highest-quality JWST spectra, the lines are broadened by electron scattering with a narrow intrinsic core. The data require very high electron column densities and compact sizes (light days), which, when coupled with their high luminosities, can be explained only by SMBH accretion. The narrow intrinsic line cores imply black hole masses of 105−7M⊙, two orders of magnitude lower than previous estimates. These are the lowest mass black holes known at high redshift, to our knowledge, and suggest a population of young SMBHs. They are enshrouded in a dense cocoon of ionized gas producing broad lines from which they are accreting close to the Eddington limit, with very mild neutral outflows. Reprocessed nebular emission from this cocoon dominates the optical spectrum, explaining most LRD spectral characteristics, including the weak radio and X-ray emission14,15.</p
Unravelling co-mutational patterns with prognostic implications in NPM1 mutated adult acute myeloid leukemia - a HARMONY study
No full textNPM1-mutated (NPM1-mut) acute myeloid leukemia (AML) is generally associated with a more favorable outcome, although the presence of additional gene mutations can influence patient prognosis. We analyzed intensively-treated adult NPM1-mut AML patients included in the HARMONY Alliance database. A newly developed risk classification, which included combinations of co-mutations in FLT3-ITD, DNMT3A, IDH1/IDH2, and TET2 genes, was applied to a training cohort of NPM1-mut AML patients included in clinical trials (n = 1001), an internal validation cohort more representative of real-world settings (n = 762), and an external validation cohort enrolled in UK-NCRI trials (n = 585). The HARMONY classification considered 51.8% of the NPM1-mut AML training cohort patients as favorable, 24.8% as intermediate, and 23.4% as adverse risk, with median overall survival (OS) of 14.4, 2.2, and 0.9 years, respectively; p < 0.001), thereby reclassifying 42.7% of NPM1-mut patients into a different European LeukemiaNet (ELN) 2022 risk category. These results were confirmed both in an internal and external validation cohort. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1) showed the highest benefit in the NPM1-mut adverse-risk subgroup. The HARMONY classification provides the basis for a refined genetic risk stratification for adult NPM1-mut AML with potential clinical impact on allo-HSCT decision-making.<br/
