Sputter sample preparation for ion beam delivery of radium-223 at ATLAS.

A radium-223 ion beam was delivered to an experiment from the electron cyclotron resonance ion source, ECR2, at the Argonne Tandem Linac Accelerator System (ATLAS). The radium-223 material was in a nitrate salt form within a vial, prior to being converted to a usable sputter sample. The sputter sample was produced using a new sample preparation method, where the radium nitrate was dissolved into a solution and pipetted onto pressed aluminum powder. This sample was then allowed to dry, distributing the radium-223 material throughout the sputter sample. Ion source operation using the radium sputter sample is described with the operating parameters listed. The intensity and energy requirements for this ion beam were 1 × 106 particles/s and 1.07 GeV, respectively. Because the intensity is relatively low compared to most experiments at ATLAS, previously developed accelerator mass spectrometry methods were used Scott et al. [Rev. Sci. Instrum. 87, 02A732 (2016)] to avoid the need for tuning of the low-intensity beam of interest. Handling of the radium material, as well as loading and unloading of the sputter sample from ECR2, required collaboration with Health Physics. Procedures were used and dry runs were carried out before, during, and after the experiment to ensure the safety of the workers. The processes used and lessons learned are described within.

Quenching of Single-Particle Strength in A=15 Nuclei.

Absolute cross sections for the addition of s- and d-wave neutrons to ^{14}C and ^{14}N have been determined simultaneously via the (d,p) reaction at 10 MeV/u. The difference between the neutron and proton separation energies, ΔS, is around -20 MeV for the ^{14}C+n system and +8 MeV for ^{14}N+n. The population of the 1s_{1/2} and 0d_{5/2} orbitals for both systems is reduced by a factor of approximately 0.5 compared with the independent single-particle model, or about 0.6 when compared with the shell model. This finding strongly contrasts with results deduced from intermediate-energy knockout reactions between similar nuclei on targets of ^{9}Be and ^{12}C. The simultaneous technique used removes many systematic uncertainties.

A Place to Live and to Die: A Qualitative Exploration of the Social Practices and Rituals of Death in Residential Aged Care.

In many countries, an increasing proportion of deaths occur in residential aged care (RAC) (nursing homes) meaning that these have become both a place to live - a home- and a place to die. This paper reports on death practices and rituals in 49 RAC facilities in Aotearoa/New Zealand narrated in semi-structured interviews with staff. Themes coalesced around 'good death'. Dying alone was not seen as a good death and the demands of trying to prevent this caused tension for staff. Meeting family wishes, post death decision-making, after death practices and rituals, including communicating and remembrance of the death, were explored as part of good death. Overall, death rituals in RAC were limited. Balancing the needs of the living, the dying and the dead created tension. The rituals and practices facilities are currently enacting in death/post-death require attention, since more people will die in RAC with increasingly diverse needs.

First Exploration of Neutron Shell Structure below Lead and beyond N=126.

The nuclei below lead but with more than 126 neutrons are crucial to an understanding of the astrophysical r process in producing nuclei heavier than A∼190. Despite their importance, the structure and properties of these nuclei remain experimentally untested as they are difficult to produce in nuclear reactions with stable beams. In a first exploration of the shell structure of this region, neutron excitations in ^{207}Hg have been probed using the neutron-adding (d,p) reaction in inverse kinematics. The radioactive beam of ^{206}Hg was delivered to the new ISOLDE Solenoidal Spectrometer at an energy above the Coulomb barrier. The spectroscopy of ^{207}Hg marks a first step in improving our understanding of the relevant structural properties of nuclei involved in a key part of the path of the r process.

Psychosocial distress in haematological cancer survivors: An integrative review.

Haematological cancers are becoming more prevalent, however, survival is also increasing. Many survivors are faced with psychosocial issues after treatment ends, and they may not receive the support they need. This review aims to examine peer reviewed literature reporting psychosocial distress faced by haematological cancer survivors in the early post-treatment period. Database and hand searches were conducted between August and September 2015, with no year restriction. Eligible studies were those reporting on psychosocial sequelae in haematological cancer survivors up to 5 years post-treatment. The search yielded 512 studies, of these only seven (five quantitative and two qualitative) included data that addressed psychosocial distress in early post-treatment haematological cancer survivors. Data were thematically analysed to explore the presence and nature of distress. Most studies reported mild to moderate distress for survivors, with some evidence that younger age was an indicator of increased distress. However, predominately this review identified a gap in current literature regarding distress among this group of survivors. More research is needed to address the psychosocial issues facing this growing survivor group, to enable them to receive the support required to maintain good physical and psychological health in this period of the cancer trajectory and into the future.

Nuclear and optical dual-labelled imaging agents. Design and challenges.

Over the last two decades, molecular imaging has been established as a valuable technology, aiming at visualization and characterization of biochemical processes on a molecular level in isolated cells, tissues and higher organisms. Within the wide scope of the various imaging techniques, dual-labelled modalities for nuclear (PET, SPECT) and near-infrared fluorescence (NIRF) imaging show promise owing to their comparable detection sensitivity. Novel materials offer excellent prospects for the development of new non-invasive strategies of early diagnosis and efficient monitoring of therapeutic treatments. In the field of cancer medicine, the combination of different imaging techniques such as PET/SPECT and OI for tracking down tumours and metastases, and subsequent image-guided surgery for tumour resection is particularly attractive. This review focuses on the development of promising dual-labelled agents to be applied in bimodal nuclear/optical imaging, combining radionuclides and fluorescent dyes. The discussion encompasses modular ligands as well as nanoscale systems, including antibodies and their fragments.

Perceived risks around choice and decision making at end-of-life: a literature review.

BACKGROUND: the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. AIM: to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. DESIGN: an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. DATA SOURCE: the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. RESULTS: thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. CONCLUSION: the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

Barriers to advance care planning in chronic obstructive pulmonary disease.

The English End of Life Care Strategy promises that all patients with advanced, life limiting illness will have the opportunity to participate in Advance Care Planning (ACP). For patients with Chronic Obstructive Pulmonary Disease (COPD), the barriers to this being achieved in practice are under-explored. Five focus groups were held with a total of 39 health care professionals involved in the care of patients with COPD. Participants reported that discussions relating to ACP are very rarely initiated with patients with COPD and identified the following barriers: inadequate information provision about the likely course of COPD at diagnosis; lack of consensus regarding who should initiate ACP and in which setting; connotations of comparing COPD with cancer; ACP discussions conflicting with goals of chronic disease management; and a lack of understanding of the meaning of 'end of life' within the context of COPD. The findings from this study indicate that, for patients with COPD, significant service improvement is needed before the objective of the End of Life Care Strategy regarding patient participation in end of life decision-making is to be achieved. Whilst the findings support the Strategy's recommendations regarding an urgent for both professional education and increased public education about end of life issues, they also indicate that these alone will not be enough to effect the level of change required. Consideration also needs to be given to the integration of chronic disease management and end of life care and to developing definitions of end of life care that fit with concepts of 'continuous palliation'.

Older people's views of a good death in heart failure: implications for palliative care provision.

Palliative care in the UK has been developed to meet the needs of predominantly middle aged and younger old people with cancer. Few data are available regarding the extent to which services respond to the specific needs of an older group of people with other illnesses. This paper draws on in-depth interviews conducted with 40 people (median age 77) with advanced heart failure and poor prognosis to explore the extent to which older people's views and concerns about dying are consistent with the prevalent model of the 'good death' underpinning palliative care delivery. That prevalent model is identified as the "revivalist" good death. Our findings indicate that older people's views of a 'good death' often conflict with the values upon which palliative care is predicated. For example, in line with previous research, many participants did not want an open awareness of death preceded by acknowledgement of the potential imminence of dying. Similarly, concepts of autonomy and individuality appeared alien to most. Indeed, whilst there was evidence that palliative care could help improve the end of life experiences of older people, for example in initiating discussions around death and dying, the translation of other aspects of specialist palliative care philosophy appear more problematic. Ultimately, the study identified that improving the end of life experiences of older people must involve addressing the problematised nature of ageing and old age within contemporary society, whilst recognising the cohort and cultural effects that influence attitudes to death and dying.

Elderly patients compliance and elderly patients and health professional's, views, and attitudes towards prescribed sip- feed supplements.

BACKGROUND: Although nutritional supplements are widely prescribed in hospital and community settings compliance with supplements and factors affecting compliance are not well understood. AIMS: The aims of this study were therefore to examine compliance, factors that influence compliance, views and attitudes of elderly patients and their health professionals on prescribed oral nutritional supplements. METHODS: Forty medically stable hospitalised elderly patients prescribed nutritional supplements by a hospital dietician after nutritional screening had their compliance with supplement intake measured. Sixteen patients prescribed nutritional supplements and their health professionals had their views and attitudes on the factors that influence compliance with supplements intake explored using qualitative face-to- face interviews and postal questionnaires respectively. Qualitative data analysis adhered to the principles of grounded theory and followed the 'Framework' approach. Quantitative data were entered on to a standard spreadsheet and simple descriptive statistics was examined. RESULTS: A total of 40 hospitalised elderly patient (Age range 60-91 yrs; mean age 78 years; 20 female); 24 doctors, 13 dietician and 33 nurses were recruited. The main finding of this study was that compliance with prescribed nutritional supplements was low in hospital and in the community. Only 43% of the study population consumed more than 80% of the prescribed amount. Factors that affected compliance included flavour, taste, texture and predictability of the supplements as well as personal preferences and life style. Health professionals dealing with elderly patients have wide-range and different views on the criteria used to prescribe nutritional supplements and factors affecting their subsequent intake. CONCLUSION: Compliance with prescribed nutritional supplements was low in hospital and in the community. Elderly patients and their health professionals have wide-range and different views on factors that influence compliance with nutritional supplements.

Correlation of hyperforin content of Hypericum perforatum (St John's Wort) extracts with their effects on alcohol drinking in C57BL/6J mice: a preliminary study.

Extracts of the herb St John's Wort have been shown to reduce alcohol intake in alcohol-preferring rats, but it is not known which of the constituent(s) are responsible for this effect. In this study, the effect of a crude methanolic extract of Hypericum perforatum (negligible hyperforin content) on alcohol drinking in C57BL/6J alcohol-preferring mice was compared with that of a hyperforin-rich extract (45% hyperforin) prepared by extracting the herb with supercritical carbon dioxide. The dose of the hyperforin-rich extract required to significantly reduce 10% ethanol intake (5 mg/kg) was 125-fold less than that required for the crude extract (625 mg/kg), and was comparable to the dose of fluoxetine (10 mg/kg) required to produce a similar effect. None of these agents significantly affected water intake. These results suggest that the effects of H. perforatum extracts on alcohol drinking behaviour are due to the hyperforin content of the herb rather than to other, more polar constituents. Hyperforin is an unstable compound and this study also highlights the effect of different methods of extract preparation on hyperforin content.

How many inpatients at an acute hospital have palliative care needs? Comparing the perspectives of medical and nursing staff.

The primary aim of this prospective face-to-face interview survey was to identify the proportion of inpatients at an acute hospital (Royal Hallamshire Hospital, Sheffield, UK) considered to have palliative care needs by medical and nursing staff directly responsible for their care. During the 1-week period of the survey (6-10 September 1999), 452 inpatients were present in the hospital. Nursing staff were interviewed for 99% of patients; medical staff for 81%. Staff interview data were supplemented by case note review. Overall, 23% of the total inpatient population were identified as having palliative care needs and/or being terminally ill by staff and 11% were considered suitable for referral to a specialist palliative care bed. However, there was a low level of concurrence between medical and nursing staff as to which individual patients had palliative care needs (although this increased with perceived increased proximity to death), including which would be suitable for referral to a specialist palliative care bed. A need for further palliative care education for medical and nursing staff working within acute hospital settings was identified to ensure that the best use is made of hospital-based specialist palliative care services.

Doctoral education in nursing for practitioner knowledge and for academic knowledge: the University of Adelaide, Australia.

Australian nursing has undergone rapid academization in the past 10 years and this radical change has tended to meld the somewhat different academic traditions of North America and Britain. The introduction of doctoral education in nursing in 1987 has led to a massive increase in scholarly activity and to the preparation of talented leaders. We concur with the view expressed by Henry (1997), "I am convinced that the problems we face in the nursing services would be much more creatively solved if the majority of our doctoral programs prepared young, energetic nurses, early in their career, for clinical practice, not for research and teaching" (p. 162).

The quality of community nursing services: report of an exploratory study in a UK health authority.

Describes a study of three community nursing services provided by North Staffordshire Health Authority, which was carried out during the summer of 1991. Both the type and focus of quality measurement reported here are fairly unique. While the development of quality measures is yet at an early stage, most measures to date are quantitative. These can inform about volume of use of a service, but not its quality. The measures designed for this study were qualitative. These, when combined with quantitative data (statistics, routinely collected), yield much richer and more complete information as a basis for decision making in service planning. Quality data on the use of community services are also under-represented in the quality literature--most studies to date have used hospital patient services as their source for data collection. Goes some way towards redressing the imbalance.

Neighbourhood health forums: local democracy at work.

People in the North Staffordshire district in the United Kingdom have planned and implemented a community service project designed to increase local participation in health matters. Neighbourhood Forums meet to examine local needs and make decisions involving available resources and services. Self-observation by the Forums has revealed a potential for initiating positive change. Such interventions are applicable in other communities worldwide.