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To evaluate and synthesize research that has investigated interventions to train registered health professionals to effectively communicate with patients in acute settings who are establishing their goals of care, to develop an understanding of current practices and their effectiveness.
Design
Integrative review.
Methods
Medline, Embase, PsycINFO, SCOPUS, CINAHL, and ProQuest, searched from the date each database was available to December 2023. Forty-seven (n = 47) research studies investigating interventions to train registered health professionals to effectively communicate with patients in acute settings who are establishing their goals of care were critically appraised for methodological quality using the Joanna Briggs Institute Quality Appraisal Framework. Minimum essential criteria and scores were agreed prior to appraisal.
Results
Twenty-eight studies were excluded due to methodological quality. The 19 studies included comprised quasi experimental (n = 9), qualitative (n = 4), RCT (n = 2), text and opinion (n = 1), and mixed methods (n = 3). From these included studies 4 themes with embedded sub-themes were derived: (a) delivery of training programs, (b) clinician outcomes, (c) patient outcomes, and (d) system outcomes.
Significance of the results
Communication training is essential and beneficial however its effectiveness depends on overcoming existing barriers, providing continuous learning opportunities, and embedding these into clinical practice. Addressing these factors will ensure that clinicians and healthcare organizations can improve patient and system outcomes. When clinicians and organizations prioritize regular, context-specific communication training, which promotes the use of conversation guides and available technologies, Goals of Patient Care conversations are more likely to be embedded in practice, promoting effective and patient-centered communication.
As part of a broad survey of the trematodes of damselfishes (Pomacentridae) in the tropical Indo-West Pacific, zoogonids were collected from multiple localities in Australia, New Caledonia, and French Polynesia. All zoogonid specimens collected were consistent with the subfamily Lecithostaphylinae, and morphological and molecular data (ITS2 and 28S rDNA, and cox1 mtDNA) were generated for most host-locality combinations to enable an integrative species delimitation. The collection comprised three species: Deretrema stratiotes n. sp. from four species of Abudefduf Forsskål from Ningaloo Reef in Western Australia, and two species consistent with the genus Lecithostaphylus Odhner, 1911 for which Innuptacola n. gen. is proposed based on phylogenetic and morphological distinction, the type-species I. gibsoni (Cribb, Bray & Barker, 1992) n. comb. (= L. gibsoni) from six species of Abudefduf in Ningaloo Reef, Queensland and New Caledonia, and I. torquata n. sp. from 12 pomacentrid species in Ningaloo Reef, the Great Barrier Reef in Queensland, and the Gambier Islands in French Polynesia. The new collection demonstrates that some zoogonid species are geographically widespread (from the Pacific Ocean to the Indian Ocean) and can infect a broad range of hosts (multiple genera within a family), whereas others are apparently geographically restricted and exhibit higher host-specificity (fishes within a single genus).
Particle-laden horizontal turbulent pipe flow is studied experimentally in the two-way coupling regime with a focus on delineating the effects of particle-to-fluid density ratio $\rho _{p}/\rho _{f}=1$ and 1.05 on the fluid and particle statistics. Particle volume fraction $\phi _{v}$ up to $1\,\%$ and viscous Stokes numbers ranging from $St^+ \approx 1.2$ to $St^+ \approx 3.8$ are investigated at friction Reynolds number $Re_\tau \approx 195$ using time-resolved two-dimensional particle image and tracking velocimetry. Substantial differences are observed between the statistics of neutrally buoyant (i.e. $\rho _{p}/\rho _{f}=1$) and denser (i.e. $\rho _{p}/\rho _{f}=1.05$) settling particles (with settling velocities 0.12–0.32 times the friction velocity), which, at most instances, show opposing trends compared to unladen pipe flow statistics. Neutrally buoyant particles show a slightly increased overall drag and suppressed turbulent stresses, but elevated particle–fluid interaction drag and results in elongated turbulent structures compared to the unladen flow, whereas $\rho _{p}/\rho _{f}=1.05$ particles exhibit a slight overall drag reduction even with increased radial turbulent stresses, and shorter streamwise structures compared to the unladen flow. These differences are enhanced with increasing $St^+$ and $\phi _v$, and can be attributed to the small but non-negligible settling velocity of denser particles, which also leads to differing statistics in the upper and lower pipe halves.
The localized nature of severe weather events leads to a concentration of correlated risks that can substantially amplify aggregate event-level losses. We propose a copula-based regression model for replicated spatial data to characterize the dependence between property damage claims arising from a common storm when analyzing its financial impact. The factor copula captures the location-based spatial dependence between properties, as well as the aspatial dependence induced by the common shock of experiencing the same storm. The framework allows insurers to flexibly incorporate the observed heterogeneity in marginal models of skewed, heavy-tailed, and zero-inflated insurance losses, while retaining the model interpretation in decomposing latent sources of dependence. We present a likelihood-based estimation to address the computational challenges from the discreteness and high dimensionality in the outcome of interest. Using hail damage insurance claims data from a US insurer, we demonstrate the effect of dependence on claims management decisions.
Independent experts are routinely appointed by international organisations for specific short-term assignments. Existing scholarship has studied their career trajectories, accumulation of resources, and mobility across occupational settings to explain their power and capacity to pursue their own agendas. However, it has neglected the fact that many transnational professionals not only move between professions but also practise them simultaneously. By using the example of the United Nations special rapporteur, an independent human rights expert, this article addresses this under-theorised feature by theorising them as plural professionals, or actors who practise multiple professions simultaneously. This multiple positioning in several professional settings at once can create tensions in how they approach their work. But, as I argue, it is also the source of their expert independence, rooted in a transnational social space connecting multiple professional identities, resources, and skills. Independence viewed through this lens is a socio-historical category which is made up of the combination of professional, biographical, and institutional resources as embodied and strategically mobilised by plural professionals. This argument builds on my original dataset of the professional biographies of 122 thematic special rapporteurs and 30 biographical interviews.
We offer a new explanation for the difference between cases where an auxiliary verb can and cannot contract, such as Kim is coming versus Kim is. Rather than a banning constraint, we argue that there is a positive syntactic licensing constraint. We consider, and reject, both the familiar Gap Restriction and a range of phonological explanations. Our analysis rests on the category of grammatical relations, valent, which includes all non-adjuncts (i.e. all subjects and complements); the analysis consists of a single claim, the Following Valent Constraint: that a contracted auxiliary has an overt following valent. We show how this analysis explains the full range of data that has been discussed in the literature and how a minor variant of the constraint captures the data of the Scots locative discovery expressions. We also propose a sociolinguistic explanation for the inability of auxiliaries to contract in certain environments, such as after a preposed negative. Finally, we suggest a functional explanation for the proposed constraint: It allows the hearer to predict the presence of a following valent and thereby to manage the burden of processing.
This article considers the question whether we can have direct, non-inferential knowledge of God, as experientialists such as Alston and Plantinga claim. Moreover, this needs to be done in a way that takes religious diversity into account. I contend that two developments in recent philosophy enable us to argue for direct knowledge of God in an inter-religious manner. The first is naturalized epistemology. I use a version of it in place of the epistemology employed by the experientialists. Specifically, I use methodological continuity between epistemology of science and epistemology of religion. This would help us to overcome dangers of religious balkanization and fideism. The second development is the increased focus on the importance of nature mysticism. This helps us to maintain the autonomy of religious experience. Since these experiences are considered universal, they enable us to engage in an experientialist version of natural theology in a manner that is at once continuous and discontinuous with Aquinas. It is continuous in its universality and generality and is discontinuous in using nature mystical experiences and not sense experience, as its starting point. The knowledge of God it gives is an inchoate awareness that finds different expression in different cultures.
Host–parasite adaptation is crucial for evolutionary success of a parasite. The nematode Angiostrongylus cantonensis has a heterogenic life cycle involving molluscs as intermediate hosts and rats as definitive hosts. Several mollusc species are susceptible hosts of A. cantonensis, allowing the development of first-stage larvae (L1) into third-stage larvae (L3). Changes in the metabolism of infected molluscs have been demonstrated, disturbing regular routes and inducing host defence mechanisms. This study aimed to identify changes in the proteomic content of Phyllocaulis spp. mucus during A. cantonensis infection. Proteins were extracted from the mucus samples of infected and non-infected slugs and identified using liquid chromatography–tandem mass spectrometry. We found 26 up-regulated and 15 down-regulated proteins in infected slugs compared to non-infected slugs. Protein profiles are promising markers of parasite infection, and a better understanding of proteomic profiles during infection may help inform in vivo studies and promote new tools for the non-invasive identification of infected hosts.
Palliative care (PC) professionals confront the suffering and mortality of their patients, adding to the conventional stressors related to work dynamics or personal life. However, the specific stressors inherent in end-of-life (EOL) care and their relation with the mental health of these professionals, remain inadequately explored. This study seeks to examine the respective roles of various stressors encountered by PC professionals and their associations with mental health. Additionally, it aims to elucidate the relationships between specific psychosocial factors (psychological resources or work environment perceptions) and mental health within the context of stress associated with PC.
Method
An online questionnaire was developed and distributed to PC professionals in France (e.g., doctors, nurses, care assistants, psychologists). The questionnaire contained measures of stress experienced in the last 6 months (personal, professional, or EOL); measures of mental health; and measures of psychosocial factors (perceptions of work environment and psychological resources).
Results
Three hundred and seventy-nine participants completed the entire questionnaire in November 2022. Among the various stress factors assessed, the accumulation of EOL care emerged as a robustly linked stressor to poorer mental health. In this specific context of EOL care stress, self-compassion and psychological flexibility are significantly related to well-being and mental health, even when other psychosocial factors related to the work environment are statistically controlled.
Significance of results
This study is the first to highlight the main stressor affecting the well-being of PC professionals – the accumulation of EOL care – along with the key resources – psychological flexibility and self-compassion – that are associated with their well-being.
Schistosomiasis is a parasitic disease that imposes a significant burden on society. The eggs are the primary pathogenic factor in schistosomiasis, and their accumulation in liver could lead to the formation of granulomas and liver fibrosis. However, the metabolic changes in liver resulting from schistosomiasis remain poorly understood. We established a mouse model of schistosomiasis japonica, where the eggs accumulate in the liver and form egg granulomas. We used mass spectrometry imaging to analyze the differences in metabolites among various liver regions, including the liver tissue from normal mice, the liver area outside the granulomas in schistosomiasis mice, and the granuloma region in schistosomiasis mice. There were significant differences in metabolites between different liver regions, which enriched in metabolic pathways such as the biosynthesis of unsaturated fatty acids, taurine and hypotaurine metabolism, glycerophospholipid metabolism, glycolysis/gluconeogenesis, purine metabolism, arachidonic acid metabolism, and bile secretion. In normal liver tissue, higher concentrations of oleic acid (FA (18:1)), eicosapentaenoic acid (FA (20:5)), and L-glutamine were observed. In liver regions outside the granulomas, D-glucose and pyruvic acid were elevated compared to those in normal mice. Taurine increased in the liver of schistosomiasis. Meanwhile, there were elevated uric acid and spermidine in the egg granulomas. We employed mass spectrometry imaging technology to investigate metabolic reprogramming in liver of Schistosoma japonicum-infected mice. We explored the spatial distribution of differential metabolites in liver of schistosomiasis including unsaturated fatty acids, taurine, glutamine, spermidine, and uric acid. Our research provides valuable insights for further elucidating metabolic reprogramming in schistosomiasis.
Bovine trichomoniasis is a venereal disease that causes significant losses in the US beef industry. The USDA Animal and Plant Health Inspection Service views bovine trichomoniasis as endemic and delegates control to state agencies and producers. Disease management’s positive externalities are not reflected in a producer’s profit maximization problem, leading to potentially suboptimal levels of control. Our objective was to assess the economic impacts of 50% and 100% reductions of herd-level bovine trichomoniasis prevalence. The cumulative present value of net welfare increased by $388.856 and $193.222 million under the 100% and 50% scenarios, respectively. Feeder cattle producers and retail beef consumers benefit most from enhanced control.
We perform simulations of a two-fluid–structure interaction problem involving liquid–gas flow past a fully submerged stationary circular cylinder. Interactions between the liquid–gas interface with finite surface tension and flow disturbances arising from the cylinder induce a variety of interfacial phenomena and wake structures. We map different interface regimes in a parameter space defined by the Bond number $Bo \in [100, 5000]$ and the submergence depth $h/D \in [1, 2.5]$ of the cylinder while keeping the Reynolds (Re) and Weber (We) numbers fixed at 150 and 1000, respectively. The emerging interface features are classified into three distinct regimes: interfacial waves generated by Strouhal vortices, the entrainment of multi-scale gas bubbles and the reduced deformation state. In the interfacial wave regime, we demonstrate that the frequency of transverse interface fluctuations at a specific streamwise location is identical to the vortex shedding frequency. Additionally, the wavelength of interfacial waves is determined by the size of vortex pairs consisting of alternating Strouhal vortices. In the gas entrainment regime at $ Bo = 1000$, our bubble-size distributions reveal that the entrained bubbles have sizes ranging from one to two orders of magnitude smaller than the cylinder. These multi-scale bubbles are formed primarily through plunging and surfing breakers at $h/D = 2.5$. In contrast, at $h/D = 1$, smaller bubbles initially emerge from the breakup of a gas finger. Over time, some of these bubbles grow in size through coalescence cascades. The influence of $ Re \in [50, 150]$ and $ We \in [700, 1100]$ on gas entrainment is quantified in terms of mean bubble size and count. Lastly, we demonstrate how the deformability of the liquid–gas interface drives the hydrodynamic lift force acting on the cylinder. The net downward lift materializes only in the gas entrainment and reduced deformation regimes due to the broken symmetry of the front stagnation point. While our study focuses on two-dimensional simulations, we also provide insights into the three-dimensional gas entrainment mechanism for one of the extreme cases at $h/D = 1$.
Previous research indicates that strong right-hand preference predicts performance in other skills, such as vocabulary size and executive function (EF). The purpose of this study was to assess the relationship between these functions, as well as social competence (SC), in a sample of preschool children. We used parent questionnaires and/or tabletop assessments to measure hand preference, fine motor skills, language, EF, and SC in 81 three- to five-year-old children. The results strengthened the evidence of a connection between right-hand use for pointing and vocabulary performance but indicated that right-hand use was not related to EF or SC. Further, the findings revealed a reciprocal connection between vocabulary and SC as well as EF and SC, but not vocabulary and EF. We discuss the implications of these connections for early childhood development.
Each year, I brace for National Hispanic Heritage Month, the intensely rich and active national holiday that takes months to plan, weeks to execute, and days from which to recover. With community partners, we often discuss how to best make use of this public holiday to spotlight our most pressing needs. As an educator, I use this public holiday to show students and colleagues, who are ever-more concerned about curricular alignment with workforce needs, about the importance of my mother tongue and its superpower to bridge communication in our multilingual nation. In the United States, more than 40 million people speak Spanish as their first language and there are more than 50 million speakers of Spanish. We can use this national public holiday to unearth and commemorate more widely – and loudly – that Spanish is also an American language. However, we might also realize that honoring our national Hispanic heritage needs more than one month.
Charcoal economies in central-east Africa are deep and powerful: they connect military and state financing with everyday family cooking. This article, based on new fieldwork in the understudied charcoal economy in South Sudan, explores the hierarchies and systems of self-employed producers, cash-for-piecework workers, middlemen and transporters, large-scale investors, and the public and defence sector financiers, landlords, brokers and security providers who all work in this political economy of forestry and charcoal-making. Drawing on local colonial archives and extensive fieldwork over 2020–2022, we break down the forms of work, investment and exploitation across this historical post/colonial landscape of labour, tree cultures, land rights and regional trade. In doing this we expand and escape the dominant and neatening metaphor of the value chain; we present a wider view of the expansion of the armed, privatised state economy; and we highlight current debates over the value, commodification and sale of forests and rural life.
Safety accounts of knowledge intend to explain why certain true and intuitively justified beliefs fail to be knowledge in terms of such beliefs falling prey to a modal veritic type of luck. In particular, they explain why true and intuitively justified beliefs in “lottery propositions” (highly likely propositions reporting that a particular statistical outcome obtains) are not knowledge. In this paper, I argue that there is a type of case involving lottery propositions that inevitably lies beyond the scope of any reasonable safety account of epistemic luck. I offer counterexamples to accounts of epistemic luck in terms of safety conditions that involve both “locally” and “globally” reliable ways of forming beliefs in nearby worlds. All such counterexamples present a lottery case illustrating the next possibility: the process of selecting the lottery winner might be such that any world in which it delivers a different outcome is extremely far away from the actual world. In addition to being a case of safe ignorance, this type of lottery case shows that, ultimately, either veritic epistemic luck is not unsafe true belief or beliefs in lottery propositions are not epistemically luckily true.
Haemosporidians constitute a monophyletic group of vector-borne parasites that infect a wide range of vertebrate hosts, including Neotropical lizards. The remarkable diversity of these host-parasite associations and inadequate research on certain parasite groups have resulted in controversial haemosporidian taxonomy. Herein, we rediscover erythrocytic and non-erythrocytic haemosporidians infecting golden tegus (Tupinambis teguixin) from Brazil and Colombia. The erythrocyte-inhabiting parasite belongs to Plasmodium sp., and the non-erythrocytic form was identified as Saurocytozoon tupinambi, previously attributed to the Family Leucocytozoidae. These non-pigmented haemosporidian parasites do not multiply in the blood. The relationships between the Saurocytozoon and Leucocytozoidae species were discussed for many years, especially during the 1970s. However, cytochrome b (cytb) sequences and the mitochondrial genomes recovered for this species strongly support classifying this parasite as a Plasmodium taxon. Therefore, we proposed a new combination for this parasite, Plasmodium (Saurocytozoon) tupinambi comb. nov., where Saurocytozoon is retained as a subgenus due to its distinct morphology. These results reinforce that a broader definition of Plasmodiidae must include saurian parasites that develop non-pigmented leucocytozoid-like gametocytes.
Let M be a von Neumann algebra, let $\varphi $ be a normal faithful state on M and let $L^p(M,\varphi )$ be the associated Haagerup noncommutative $L^p$-spaces, for $1\leq p\leq \infty $. Let $D\in L^1(M,\varphi )$ be the density of $\varphi $. Given a positive map $T\colon M\to M$ such that $\varphi \circ T\leq C_1\varphi $ for some $C_1\geq 0$, we study the boundedness of the $L^p$-extension $T_{p,\theta }\colon D^{\frac {1-\theta }{p}} MD^{\frac {\theta }{p}}\to L^p(M,\varphi )$ which maps $D^{\frac {1-\theta }{p}} x D^{\frac {\theta }{p}}$ to $D^{\frac {1-\theta }{p}} T(x) D^{\frac {\theta }{p}}$ for all $x\in M$. Haagerup–Junge–Xu showed that $T_{p,{\frac {1}{2}}}$ is always bounded and left open the question whether $T_{p,\theta }$ is bounded for $\theta \not ={\frac {1}{2}}$. We show that for any $1\leq p<2$ and any $\theta \in [0, 2^{-1}(1-\sqrt {p-1})]\cup [2^{-1}(1+\sqrt {p-1}), 1]$, there exists a completely positive T such that $T_{p,\theta }$ is unbounded. We also show that if T is $2$-positive, then $T_{p,\theta }$ is bounded provided that $p\geq 2$ or $1\leq p<2$ and $\theta \in [1-p/2,p/2]$.