No / Depression in patients receiving palliative and end-of-life care is difficult to distinguish from grief and sadness. However, there are some important distinctions and it is a clinical condition that is treatable and should not be considered a necessary or normal part of the dying process. This article examines the nature of depression and describes the stress vulnerability model of depression, linking it to recent developments in the neurobiology of depression. It also discusses how to distinguish depression from other symptoms that patients may be experiencing.

No / This article presents a review of key issues around caring for people in the last hours and days of life. The aim is that community nurses will be able to support patients and families, and to provide and explain decisions and interventions to promote comfort and dignity based on current evidence.

No / Laura Middleton-Green, lecturer and researcher in palliative and end of life care, writes about how attitudes to death influence care of the dying.

Yes / The prevalence of dementia is rising worldwide and many people will die with the disease. Symptoms towards the end of life may be inadequately managed and informal and professional carers poorly supported. There are few evidence-based interventions to improve end-of-life care in advanced dementia. To develop an integrated, whole systems, evidence-based intervention that is pragmatic and feasible to improve end-of-life care for people with advanced dementia and support those close to them. Design: A realist-based approach in which qualitative and quantitative data assisted the development of statements. These were incorporated into the RAND/UCLA appropriateness method to achieve consensus on intervention components. Components were mapped to underlying theory of whole systems change and the intervention described in a detailed manual. Setting/participants: Data were collected from people with dementia, carers and health and social care professionals in England, from expert opinion and existing literature. Professional stakeholders in all four countries of the United Kingdom contributed to the RAND/UCLA appropriateness method process. Results: A total of 29 statements were agreed and mapped to individual, group, organisational and economic/political levels of healthcare systems. The resulting main intervention components are as follows: (1) influencing local service organisation through facilitation of integrated multi-disciplinary care, (2) providing training and support for formal and informal carers and (3) influencing local healthcare commissioning and priorities of service providers. Conclusion: Use of in-depth data, consensus methods and theoretical understanding of the intervention components produced an evidence-based intervention for further testing in end-of-life care in advanced dementia.

No / Complete : FC 16. We aimed to develop a complex intervention to improve end of life care (EOLC) for people with advanced dementia and their carers. We collected data from 4 sources: literature review; qualitative data from health and social care professionals, carers and people with early dementia; quantitative data from people with advanced dementia and their carers; review of UK health and social care policy documents. Method and results: To develop the intervention we synthesised these data. 49 emerging statements were considered in workshops with health and social care professionals across UK to achieve consensus using the RAND Appropriateness Method (RAM) to develop components of the intervention. 1. Prior to workshops we sent invitees the RAM form consisting of 49 statements and asked them to rate these on a scale of 1-9 for appropriateness. 2. At the workshops statements rated as ‘uncertain’ or ‘inappropriate’ were discussed and all 49 items were rated again. 3. Analysis resulted in the retention of 29 statements rated as appropriate. 4. Post workshop attendees were sent the RAM form and asked to rate 29 statements for necessity. All 29 statements were rated as necessary and retained then mapped onto impact theories (Grol 2007) comprised of individual, social interaction, organisational or political/ economic context, and categorised as enablers and barriers for an intervention. Three core intervention components emerged: 1. Integrated systems and approaches to the delivery of careoperational plan 2. Education, training and support for health and social care professionals and carers - utilisation plan 3. Political and economic context dependent on reimbursement and contracting through CCG commissioning. Discussion: The next phase is to pilot components 1 and 2 of the intervention in a naturalistic experiment in one inner city and one suburban locality at different stages of development for services for EOLC for people with dementia and their carers.

No

Yes

京都大学 / 新制・論文博士 / 博士(人間健康科学) / 乙第13614号 / 論人健博第14号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 古田 真里枝, 教授 宮下 美香, 教授 片岡 仁美 / 学位規則第4条第2項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The aim of this thesis is to come up with cost-efficient, accurate and fast schemes for link-level network anomaly detection and localization. It has been established that for detecting all potential link-level anomalies, a set of paths that cover all links of the network must be monitored, whereas for localizing all potential link-level anomalies, a set of paths that can distinguish between all links of the network pairwise must be monitored. Either end-node of each path monitored must be equipped with a monitoring device. Most existing link-level anomaly detection and localization schemes are two-step. The first step selects a minimal set of monitor locations that can detect/localize any link-level anomaly. The second step selects a minimal set of monitoring paths between the selected monitor locations such that all links of the network are covered/distinguishable pairwise. However, such stepwise schemes do not consider the interplay between the conflicting optimization objectives of the two steps, which results in suboptimal consumption of the network resources and biased monitoring measurements. One of the objectives of this thesis is to evaluate and reduce this interplay. To this end, one-step anomaly detection and localization schemes that select monitor locations and paths that are to be monitored jointly are proposed. Furthermore, we demonstrate that the already established condition for anomaly localization is sufficient but not necessary. A necessary and sufficient condition that minimizes the localization cost drastically is established. The problems are demonstrated to be NP-Hard. Scalable and near-optimal heuristic algorithms are proposed.

Reliable and efficient data transfer on the Internet is an important issue. Since late 70's the protocol responsible for that has been the de facto standard TCP, which has proven to be successful through out the years, its self-managed congestion control algorithms have retained the stability of the Internet for decades. However, the variety of existing new technologies such as high-speed networks (e.g. fibre optics) with high-speed long-delay set-up (e.g. cross-Atlantic links) and wireless technologies have posed lots of challenges to TCP congestion control algorithms. The congestion control research community proposed solutions to most of these challenges. This dissertation adds to the existing work by: firstly tackling the highspeed long-delay problem of TCP, we propose enhancements to one of the existing TCP variants (part of Linux kernel stack). We then propose our own variant: TCP-Gentle. Secondly, tackling the challenge of differentiating the wireless loss from congestive loss in a passive way and we propose a novel loss differentiation algorithm which quantifies the noise in packet inter arrival times and use this information together with the span (ratio of maximum to minimum packet inter arrival times) to adapt the multiplicative decrease factor according to a predefined logical formula. Finally, extending the well-known drift model of TCP to account for wireless loss and some hypothetical cases (e.g. variable multiplicative decrease), we have undertaken stability analysis for the new version of the model.