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It is widely known that people with a severe and persistent mental illness (SPMI) are more at risk of poor physical health outcomes because of disparities in healthcare access and provision. Less is known about the quality of end-of-life (EoL) care in people with SPMI who have a life-limiting disease.
Methods
A comprehensive and systematic literature search in PubMed, Embase, Web of Science, Scopus, and CINAHL electronic databases (from inception to November 2023) was conducted, without language restriction, for reviews on EoL care and/or palliative sedation for people with SPMI and a life-limiting disease. A critical appraisal of the selected reviews was performed. Data were analyzed according to the four principles of biomedical ethics.
Results
Ten reviews were included. These show that people with SPMI are at risk of suboptimal EoL care. Stigma among healthcare professionals, lack of integrated care policies, absence of advanced care planning, and insufficient expertise and training in palliative care of psychiatrists have been identified as key challenges to the provision of adequate EoL care for people with SPMI. No data were found about palliative sedation.
Conclusions
To optimize palliative and EoL care for SPMI patients with a life-limiting disease, a policy of coordinated and integrated mental and physical healthcare is needed. Moreover, education and training initiatives to reduce stigma and discrimination among all healthcare workers and to enhance palliative care skills in psychiatrists should be offered. Finally, more research is needed on EoL particularly on palliative sedation for people with SPMI and a life-limiting disease.
Preventing neonatal calf diarrhea (NCD) and bovine respiratory disease (BRD) in cow–calf herds is essential to optimizing calfhood health. Disease control can prevent morbidity and mortality; however, evidence concerning the effectiveness of practices to achieve this is limited. The objective of this systematic review was to assess and summarize the evidence on the effectiveness of management practices to prevent calf morbidity and mortality from NCD and BRD in beef cow–calf herds. The population of interest was preweaned beef calves. The outcomes were calf morbidity and mortality caused by NCD and BRD. Only studies reporting naturally occurring diseases were included. Seventeen studies were deemed relevant, 6 studies of which were controlled trials or randomized controlled trials (RCTs), and 11 were observational studies. Most management practices had some evidence to support their use; however, the certainty of the findings was low to very low. Most of the practices were shown to impact both NCD and BRD. Yet, the different levels of consistency in the directionality of the findings suggest that some outcomes are more affected by some practices than others. More well-designed RCTs and cohort studies are required to provide reliable estimates to support recommended practices for cow–calf herds.
Up to 40% of seriously ill patients develop a (temporary) desire to die which can lead to requests for assisted dying. Health professionals often feel uncertain about addressing these topics, while informal caregivers may feel guilty and left out. Open and respectful communication proves beneficial. It remains unclear how this communication ideal realizes within the lived experience of all 3 parties. Therefore, we conducted in-depth analysis of communication strategies about desire to die from triangulated perspectives of patients, informal caregivers, and health professionals.
Methods
We conducted semi-structured interviews with purposefully sampled triads consisting of seriously ill patients, their respective informal caregivers and health professionals. Interviews were part of the qualitative evaluation of a 3-phase mixed-methods study on the effects of communication about desire to die on seriously ill patients. We followed a framework analysis approach to build communication types.
Results
From the N = 13 patients, 54% suffered from oncological diseases. Health professionals (N = 13) were multiprofessional. Informal caregivers (N = 13) were partners, children, or another relation. All in all, we conducted N = 14 interview triads (n = 3 incomplete; N = 39 individual interviews).
Four key themes emerged from analysis: (a) how open communication was perceived, (b) whether participants reported shared reality, (c) how they talked about death, and (d) their communication strategies.
Ultimately, 3 communication types were inductively derived at from these key themes. Type 1 “Between the Lines,” type 2 “Past each Other” and type 3 “Matter of Fact” show differing expressions on the key themes, especially on (b) shared reality. Specific type characteristics produce suggestions for health professionals’ communicative practice.
Significance of results
Awareness of typical communication strategies is necessary to foresee potential pitfalls such as loss of information or acting on unchecked assumptions. To reduce distress and increase information flow, health professionals should actively approach informal caregivers for desire to die conversations.
The presence of pesticide residues in food products, particularly milk, poses significant public health risks, especially in developing regions where agricultural practices often involve extensive pesticide use. This study aimed to assess the levels of pesticide contamination in milk collected from agro-pastoral cattle settlements in Niger State, Nigeria, and evaluate the associated health risks for both children and adults. Milk samples were systematically collected and analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) to detect and quantify the concentrations of various pesticides, including organophosphates, organochlorines, and herbicides. The detected pesticides included Dichlorvos, β-Hexachlorocyclohexane, Malathion, DDT, and Dieldrin, among others, with Dichlorvos and β-Hexachlorocyclohexane showing the highest concentrations. Using the Estimated Daily Intake (EDI) model, we calculated the potential health risks associated with the consumption of contaminated milk for different age groups. The results indicated that children were particularly at risk, with EDI values exceeding the Acceptable Daily Intake (ADI) for certain pesticides, such as Dieldrin, leading to a risk ratio of 1.288. In contrast, adults showed a lower risk, with EDI values generally within safe limits. The findings underscore the urgent need for stricter pesticide regulation, enhanced monitoring of pesticide residues in livestock products, and the adoption of sustainable agricultural practices such as Integrated Pest Management (IPM) to mitigate the public health risks. This study highlights the vulnerability of children to pesticide exposure through dairy consumption and calls for immediate intervention to safeguard food safety and protect public health.
Reproductive health indicators in many developing countries including Nigeria are poor, and this is due to the less-than-optimum utilization of reproductive healthcare that has been linked to numerous factors including the educational attainment of women and their partners. In societies like Nigeria, marriage is nearly universal and upheld by patriarchal practices, while education is one of the determining factors for the choice of partner in the marriage market, as it also influences household power dynamics. Despite the plethora of studies investigating the link between education and utilization of these services, there is a paucity of research examining educational assortative mating (EAM) and its link to reproductive healthcare utilization. Hence, this study investigated EAM and explored its association with reproductive healthcare utilization from the perspective of family systems theory. Data from the 2018 Nigeria Demographic and Health Survey (n = 19,950) was analysed with frequencies presented and binary logistic regression models fitted. The result showed that high-education (34%) and low-education (46%) homogamy are the most prevalent types of EAM, while 40% of the partnered women reported facility delivery, 11% used modern contraceptives and 20% reported 8+ antenatal care visits. The multivariate analysis showed that compared to women in hypergamy, women in both high-education homogamy and hypogamy are more likely to deliver at a health facility but women in low-education are less likely. Women in both high-education homogamy and hypogamy are more likely, but those in low-education homogamy are less likely to use modern contraceptives. For antenatal care, only women in high-education homogamy are more likely to have 8 or more visits during pregnancy compared to women in hypergamy, while women in low-education homogamy and hypogamy are less likely. These findings provide evidence of the importance of an indicator of social stratification for important family decisions like healthcare utilization.
How does polarized politics affect electoral accountability? In this paper, I investigate the impact of political polarization on two channels through which voters can sanction incumbents for poor policy outcomes: voting for the opposition and abstaining. Using presidential election results at the county level, I show that, under polarized environments, the number of voters punishing the incumbent party for poor economic performances decreases in both channels. Survey analyses confirm that as the perceived ideological distance between parties increases, partisans are less likely to (i) negatively evaluate the economy when their party holds the Presidency and (ii) among those who have a negative view of the economy, they are less likely to penalize their party for negative economic assessments. These results show that polarization affects economic evaluation and clouds the responsibility for economic conditions, decreasing voters’ willingness to sanction the incumbent party.
The Lenin Memorial mass meeting, organized by the newly formed National Council of American–Soviet Friendship (NCASF) and featuring scenes from the Soviet play adapted and directed for the Theatre Guild, followed quickly on the heels of a similar mass meeting and rally, “Salute to Our Russian Ally,” staged at Madison Square Garden on 1 November 1942 and attended by twenty thousand supporters. Both events presented speeches by American political, military, and arts leaders and Soviet dignitaries, along with theatrical scenes and musical performances. The rallies concluded when the crowd had been effectively emotionally aroused and asked to stand for the playing of the national anthems of the United States and the USSR. The crowd was asked to approve statements on US–Soviet cooperation and peace to send to President Roosevelt and General Stalin, and it apparently roared back to the stage its approval.
This article draws upon archival documents from Mexico's Nationalist Campaign to argue that the rise of radio, advertising, and consumer culture significantly shaped Mexican musical nationalism in the early 1930s. The Nationalist Campaign, led by Rafael Melgar, sought to promote the consumption of national products as a patriotic act to secure the nation's future amid the growing economic dominance of the United States during the interwar period. The campaign utilized radio broadcasts of speeches, slogans, and national music concerts to publicize a unified brand of national identity, aligning with the needs of modernizing the state economy and centralizing political authority through the newly formed PNR (Partido Nacional Revolucionario). This research seeks to explore the role of media, popular music, and consumer culture as an alternative track to Mexican musical nationalism, which has primarily been studied through art music.
In 2022, uptake of all seven Core Elements of Antibiotic Stewardship were reported by 83% of US long-term care facilities. Though 98% of facilities reported access to an electronic health record, less than one-third utilized it for tracking antibiotic use, suggesting opportunities to leverage electronic data for automated reporting.
We give a new proof of an unpublished result of Dale Peterson, proved by Lam and Shimozono, which identifies explicitly the structure constants, with respect to the quantum Schubert basis, for the T-equivariant quantum cohomology $QH^{\bullet }_T(G/P)$ of any flag variety $G/P$ with the structure constants, with respect to the affine Schubert basis, for the T-equivariant Pontryagin homology $H^T_{\bullet }(\mathcal {G}r)$ of the affine Grassmannian $\mathcal {G}r$ of G, where G is any simple simply-connected complex algebraic group.
Our approach is to construct an $H_T^{\bullet }(pt)$-algebra homomorphism by Gromov-Witten theory and show that it is equal to Peterson’s map. More precisely, the map is defined via Savelyev’s generalized Seidel representations, which can be interpreted as certain Gromov-Witten invariants with input $H^T_{\bullet }(\mathcal {G}r)\otimes QH_T^{\bullet }(G/P)$. We determine these invariants completely, in a way similar to how Fulton and Woodward did in their proof of the quantum Chevalley formula.
People with an intellectual disability are vulnerable to additional disorders such as dementia. Psychometrically sound and specific instruments are needed for assessment of cognitive functioning in cases of suspected dementia.
Aims
To evaluate the construct and item validity, internal consistency and test–retest reliability of a new neuropsychological test battery, the Dementia Test for People with Intellectual Disability (DTIM).
Method
The DTIM was applied to 107 individuals with intellectual disability with (n = 16) and without (n = 91) dementia. The psychometric properties of the DTIM were assessed in a prospective study. The assessors were blinded to the diagnostic assignment.
Results
Confirmatory factor analysis at the scale level showed that a one-factor model fitted the data well (root mean square error of approximation < 0.06, standardised root mean square residual < 0.08, comparative fit index > 0.9). At the domain level, one-factor models showed reasonable-to-good fit index for five of seven domains. Internal consistency indicated excellent reliability of the overall scale (Cronbach’s α: 0.94 for dementia and 0.95 for controls). Item analysis revealed a wide range of difficulties (0.19–0.75 for dementia, 0.31–0.87 for controls), with minimal floor and ceiling effects. Eleven items (26%) had discrimination value ≤ 0.50. Test–retest reliability (n = 82) was high, with intraclass correlations of 0.95 (total score) and 0.69–0.96 (domains).
Conclusions
The DTIM fits a one-factor model and demonstrates internal and test–retest reliability; thus, it is suitable for use in cases of suspected dementia in people with various intellectual disabilities.
Much work is concerned with the effects of mainstream parties accommodating the positions of populist radical right parties. Little is known about the role of political rhetoric in mainstream party responses to radical right challengers though. This is a significant gap given the evident shifts in mainstream party discourse across European democracies. Using a pre-registered survey experiment in Germany, I analyze how voters react when mainstream parties engage in populist rhetoric and adopt radical right issue positions. Theoretically, I propose that voters, particularly those with populist attitudes, may use populist rhetoric as a heuristic when evaluating parties. I find that, in line with spatial theories of voting, voters penalize or reward mainstream parties based on their adoption of radical right positions, but that the use of populist rhetoric does not significantly impact voter evaluations. These findings demonstrate the relevance of programmatic party strategies in mainstream-challenger competition and cast doubt on the effectiveness of populist rhetoric.
While international investment law (IIL) and business and human rights (BHR) could have been one legal domain, they are today seen as distinct legal worlds. States’ National Action Plans (NAPs) on BHR, aimed at prescribing policies to realize the UN Guiding Principles, are one of the many places where this phenomenon can be observed. Embracing a Law and Political Economy (LPE) perspective, this article contributes to the existing literature by enhancing the understanding of how NAPs on BHR currently engage with the intersection between BHR and the international investment regime. This article is the first to offer an analysis of the integration of BHR with the IIL in all publicly available NAPs, through the lenses of Fineman’s ‘vulnerability theory’, which we relate to LPE. Our analysis shows that NAPs, while not binding, can in principle be mobilized for change. Yet, despite their relevance and potential, we have also shown that, in their current forms, these instruments tend to replicate the BHR/IIL separation. As such, they perpetuate existing power dynamics that favour foreign investors over other actors negatively impacted by foreign investments. The analysis also demonstrates that the limited recognition of the interplay between foreign investment and human rights in separate NAPs, coupled with restricted inclusiveness of affected stakeholders and states’ readiness to adapt their legal and policy frameworks, significantly hampers the ability of NAPs to foster the resilience of individuals adversely affected by foreign investment.
The last half of the previous century has seen an explosion in publications on biocrusts, communities of eukaryotic and prokaryotic organisms inhabiting the uppermost surface of predominantly dryland soils. Much of the early work emanated from the western United States, yet there have been few attempts to document the breadth of this work and its contribution to our understanding of the ecosystem roles of biocrusts. We used a structured literature search to extract the 868 publications on biocrusts published between January 1900 and July 2024, and explored the trends in publications in 12 subject areas over that time. We found that almost half of the 868 publications focussed on the ecological and physiological effects of biocrusts and that more recent research explored emerging fields such as restoration, monitoring and climate change impacts. Five authors comprised about 10% of all authors on these publications, and 5.5% of publications had 10 or more authors. The number of authors per publication tended to increase over time. We identified three main periods of research ranging from basic ecology and exploration of ecological mechanisms pre-2000 to biocrust function, physiology and climatic drivers up to 2020. The post-2020 period was characterized by a greater emphasis on molecular approaches, restoration and climate change impacts. Our literature review identifies knowledge gaps associated with the need for more trained taxonomists, and greater education on biocrust ecology and function. Potential developments in biocrust research include a greater use and recognition of biocrust species traits, the establishment of a dedicated international biocrust society, and the development of a global research and monitoring network to coordinate methods and provide a framework to answer critical knowledge gaps.
Mandatory thresholds for the accuracy of reported energy on food and beverage product labels do not exist in many countries. Accurate nutrition information is essential for ensuring nutritional adequacy among hospital patients. The aim of this study was to compare direct measures of energy of nutritional fluids provided in hospitals to values determined via manufacturers’ specifications. Nutritional fluids were identified as any liquid provided to hospital patients orally, enterally or parenterally, to deliver nutrition. These were categorised into six groups aligned to food/medical standards, including (1) local recipes, (2) pre-packaged general fluids, (3) supplementary fluids, (4) prescribed nutrition fluids – thickened, (5) prescribed nutrition fluids – oral/enteral and (6) prescribed medical nutrition – intravenous (IV) and parenteral. An equivalence testing statistical approach (±10 % thresholds) was used to compare energy values derived directly via bomb calorimetry against those obtained from manufacturer specifications. A total of sixty-nine fluids were measured. One-fifth (n 14) exhibited non-equivalent energy values, with the majority of these (n 11; 79 %) likely to contain less energy than that calculated from reported values. Almost all (34/35; 97 %) prescribed nutrition fluids (oral/enteral (20/20; 100 %), IV and parenteral (7/7; 100 %) and thickened fluid (7/8; 88 %) products were equivalent. In contrast, only 21/34 (62 %) non-prescribed fluids (local recipes (2/11; 18 %), supplementary fluids (4/5; 80 %) and pre-packaged general fluid (15/18; 83 %) products) demonstrated equivalence. Energy content of nutritional fluids prescribed to hospital patients typically aligns with manufacturers’ values. Consumption of non-prescribed fluids may result in lower energy intakes than expected.