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The contexts for the acquisition of Scottish Gaelic have changed significantly in recent decades through the impact of ongoing language shift to English in traditionally Gaelic-speaking communities and different kinds of language revitalisation initiatives, especially in relation to education (for adults as well as schoolchildren). This chapter reviews the sociolinguistic and policy dynamics that have brought about these changes and presents key findings from a range of studies involving linguistic demography, community language use, intergenerational language change, dialect maintenance, family language policy, language acquisition and attainment, and issues of affinity and identity.
Objective. Witnessing existential suffering in patients is associated with increased risks of compassion fatigue and burnout in palliative care physicians. Finding meaning is a protective factor for burnout and is associated with increased job satisfaction and a sense of purpose.
While the significance of finding meaning through the doctor-patient relationship is widely recognized, less is known about the subjective experience of palliative care physicians, how they ascribe meaning, and how meaning sustains them. The aim of this study was to describe and interpret how palliative care physicians experience meaning when caring for patients.
Method. Hermeneutic-phenomenology, inspired by the philosophy of Heidegger and Gadamer, informed the methodological approach. Ten palliative care physicians, caring for adult patients, completed semi-structured interviews. Van Manen’s “lifeworld existentials” supported our reflexive hermeneutic analysis to interpret participants’ moments of meaning-making.
Results. Our analysis identified two interpretive concepts for meaning-making: moments of connection and moments of transformation. Meaningful connection occurred when physicians and patients together acknowledged existential suffering in death and dying and experienced it on a personal, human level. Often, experiences were fleeting but had a lasting impact. Experiences of connection had a transformational effect on physicians and were associated with a sense of reward and purpose in palliative care work.
Significance of results. Findings are discussed in relation to philosophical literature on the experience of time, contrasting man-made time with the existential experience of time. Moments of connection and transformation experienced by palliative care physicians fueled their commitment to their profession. At a time when burn-out is rife, identifying, describing, and understanding moments of meaning may offer protective benefits for physicians working in palliative care.
Throughout a three-year undergraduate nutrition degree, students learn the theoretical knowledge and technical skill set required to become a nutritionist. However, nutrition curriculum does not always include an opportunity to practice the application of knowledge and skills in a real-world setting or develop an understanding of the transferable skills required in a workplace, thus, general employability skills and information on workplace expectations are not developed(1). A mixed methods research study was undertaken to understand student perspectives of employer expectations and general employability skills. A validated work-ready tool(1) was used to survey undergraduate nutrition students at Australian universities (n = 171); students who participated in an industry placement were interviewed pre/post placement (n = 22); nutrition industry experts and employers (n = 9) were interviewed and an industry focus group (n = 6) was conducted to develop a deeper understanding of the impact of including curriculum that developed employability skills and exposure to workplaces and expectations. Survey data showed 74% of students had an understanding of how to effectively use their skills in the workplace, 75% indicated they knew what was expected of them if they used their skills in the workplace, and 64% understood the steps in the process of using their skills. Students who completed an employability subject at one university were invited to complete the same survey upon completion and 100% of students reported having this knowledge and understanding. Thematic analysis of student interviews revealed multiple benefits of placement such as industry insights; role clarity; deeper understanding of workplace expectations; the opportunity to practice application of knowledge and skills, identify unknown information, gain experience; networking opportunities; feeling better prepared for interviews and job searching post-degree and improved confidence across all themes identified. Thematic analysis of industry interviews and focus groups also revealed themes related to the benefits of a placement experience for students. Employers identified placement as an opportunity for students to develop an understanding of graduate and workplace expectations; better understand roles and industry; practice application of knowledge and skills; and to develop networks and confidence. Employers also identified a lack of confidence in some students asking for help; students’ inability to translate scientific knowledge to a range of lay audiences; and an understanding of how nutrition works with or within other departments, and suggested that employability skills should be developed within courses and/or on placement to better prepare students for the workplace. The results indicate that the inclusion of employability development and/or placements within the curriculum develops an understanding of the employability skills required by nutrition graduates, builds greater awareness of employment expectations, roles, industry, and workplaces, and provides an opportunity to practice the application of their knowledge and skills resulting in improved graduate confidence.
This paper asks whether much State taxation is currently avoiding proper constitutional scrutiny, including the issue of its compliance with s 90 of the Commonwealth Constitution. That provision gives sole power to the Commonwealth to levy duties of customs and excise. The second part of the paper argues that the current interpretation of s 90 is in any event not capable of a sensible application to State laws.
The relationship between the higher-order factor model and the hierarchical factor model is explored formally. We show that the Schmid-Leiman transformation produces constrained hierarchical factor solutions. Using a generalized Schmid-Leiman transformation and its inverse, we show that for any unconstrained hierarchical factor model there is an equivalent higher-order factor model with direct effects (loadings) on the manifest variables from the higher-order factors. Therefore, the class of higher-order factor models (without direct effects of higher-order factors) is nested within the class of unconstrained hierarchical factor models. In light of these formal results, we discuss some implications for testing the higher-order factor model and the issue of general factor. An interesting aspect concerning the efficient fitting of the higher-order factor model with direct effects is noted.
This article analyses how governments across Australia and the world have employed ‘soft law’ in their responses to the COVID-19 pandemic. Rather than simply directing the public to the text of voluminous, complex and everchanging public health orders, executive officials have utilised a variety of non-legal soft law instruments to inform the community of their rights and obligations. These instruments are beneficial — especially in a public health crisis — as they are comprehensible, adaptable and effective. However, their non-legal nature also presents significant accountability issues which challenge the Australian conception of the separation of powers. Soft law exists independent of any parliamentary authorisation or oversight. Subsequently, those affected by soft law lack almost any ability to challenge its use in court. To remedy such issues, this article recommends a greater role for administrative complaint mechanisms (such as Ombudsman recommendations and discretionary payment schemes) in combatting abuses of soft law. It further suggests that the limited adoption of two foreign doctrines — substantive legitimate expectations and epistemic deference — into Australian judicial review could aid in addressing this dilemma.
Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
Bell’s palsy is acute facial palsy due to inflammation involving the facial nerve related to infections. Rates have not been noted to differ by ethnicity. We studied the lifetime prevalence in First Nations and all other Manitobans in people with type 2 diabetes mellitus aged 7 and older in 2013–2014 and 2016–2017. We found a crude lifetime prevalence of 9.9% [95% CI 9.4–10.4%] in the First Nations population versus 3.9% [95% CI 3.8–4.0%] in all other Manitobans. It is unknown if there were differences in glycemic control. The increased prevalence was found in all five provincial health regions. This study indicates that ethnicity may be an important risk factor for Bell’s palsy.
This study evaluates the safety and utility of Eustachian tube balloon dilatation in treating Eustachian tube dysfunction symptoms in adults without middle-ear disease.
Methods
A prospective cohort study was performed. Adults with dilatory Eustachian tube dysfunction symptoms and no middle-ear disease underwent Eustachian tube balloon dilatation. A clinical assessment including tympanometry, pure tone audiometry, otoscopy, ability to Valsalva, and Eustachian Tube Dysfunction Questionnaire-7 was performed pre-operatively and repeated during a 12-month follow-up period.
Results
Fifteen participants were enrolled. The mean pre-operative Eustachian Tube Dysfunction Questionnaire-7 score of 4.6 reduced to 2.5 at six weeks (P < 0.01), 3.0 at six months (P = 0.02) and 2.6 at 12 months (P < 0.01) post-operatively. All patients without evidence of negative middle-ear pressure had Eustachian Tube Dysfunction Questionnaire-7 score improvements. There were no post-operative complications.
Conclusion
Eustachian tube balloon dilatation is safe and effective at treating Eustachian tube dysfunction in patients with no middle-ear disease or evidence of negative middle-ear pressure.
This scoping review aimed to systematically map and describe the existing evidence regarding the knowledge, attitudes and practices of health professionals with regard to plant-based diets during pregnancy and to highlight areas for further research.
Design:
Following a pre-registered protocol, online databases were searched using a comprehensive search string, in addition to selected grey literature sources, and reference lists of included studies. The studies were independently screened for eligibility by two authors, SM and JM. Data from all eligible studies were charted by the first author, and a narrative summary was performed.
Setting:
Maternal health care services.
Results:
Ten studies were included for review, from New Zealand (n 2), Australia (n 2), Germany, Netherlands, United Kingdom, France, Italy and Peru. Most of these studies were observational, employed various validated and non-validated survey instruments, interviews and one education intervention. Knowledge was the most frequently assessed outcome in the reviewed studies. Health professionals’ knowledge of plant-based nutrition in pregnancy was reported to be limited and frequently attributed to a lack of nutrition training. Participants’ personal dietary patterns and work specialisation appear to be closely associated with their knowledge, attitudes and practices regarding plant-based diets.
Conclusion:
This review identified a significant research gap regarding health professionals’ practices in relation to plant-based diets during pregnancy. Additionally, this review has demonstrated the need for further research, awareness and practice protocols to promote high-quality care and education or professional development to address the prevalent lack of knowledge among this group.
Social anxiety and paranoia are connected by a shared suspicion framework. Based on cognitive-behavioural approaches, there is evidence for treating social anxiety and psychosis. However, mechanisms underlying the relationship between social anxiety and paranoia remain unclear.
Aims:
To investigate mediators between social anxiety and paranoia in schizophrenia such as negative social appraisals (i.e. stigma or shame; Hypothesis 1), and safety behaviours (i.e. anxious avoidance or in situ safety behaviours; Hypothesis 2).
Method:
A cross-sectional study was conducted among Asian out-patients with schizophrenia (January–April 2020). Data on social anxiety, paranoia, depression, shame, stigma, anxious avoidance, and in situ behaviours were collected. Associations between social anxiety and paranoia were investigated using linear regressions. Mediation analysis via 10,000 bias-corrected bootstrap samples with 95% confidence intervals (CI) was used to test the indirect effects (ab) of mediators.
Results:
Participants (n=113, 59.3% male) with a mean age of 44.2 years were recruited. A linear relationship between social anxiety and paranoia was found. In multiple mediation analyses (co-varying for depression), stigma and shame (Hypothesis 1) did not show any significant indirect effects with ab=.004 (95%CI=–.013, .031) and –.003 (–.023, .017), respectively, whereas in situ behaviours (Hypothesis 2) showed a significant effect with ab=.110 (.038, .201) through the social anxiety–paranoia relationship.
Conclusions:
Social anxiety and paranoia are positively correlated. In situ safety behaviours fully mediated the social anxiety and paranoia relationship. Targeted interventions focusing on safety behaviours could help reduce paranoia in psychosis. Symptom severity should be measured to help characterise the participants’ characteristics.
For a qualified nutritionist to obtain registration with the Nutrition Society of Australia they must first demonstrate that they meet a set of competencies relating to required nutrition knowledge and skills(1). However, theoretical knowledge and a technical skillset may not be enough to actively contribute to the workforce as a new graduate(2). Employers have previously expressed a desire for nutrition graduates to also develop employability skills in undergraduate studies to be better prepared for the workforce(3). Universities across Australia appear to have heterogeneous approaches to building nutrition students employability skills. To better understand student workforce readiness and employability skills, the research team undertook a mixed-methods study. A validated work-ready tool was used to survey undergraduate nutrition students self-perception of work readiness (n = 88) and semi-structed interviews of students pre/post nutrition industry placements (n = 18) were conducted to assess factors impacting student understanding and development of work readiness. Preliminary data from the survey showed higher levels of perceived ability related to higher age in, written communication (P<0.05), decision making (P<0.05), working unsupervised (P<0.05) and managing challenges (P<0.05). Lower age showed lower perceived ability in understanding how to apply skills (P<0.001). Lower levels of work experience showed lower perceived ability to work in a team (P<0.01), collaborate (P<0.01), work under pressure (P<0.05), and identify problems (P<0.01). Thematic analysis from interviews revealed themes related to improved confidence following a placement experience, communicating to stakeholders, the importance of translation skills, the benefits of networking and self-efficacy. The results suggest there are numerous identified gaps and significant room for improvement. To have a systematic approach to skill development, universities training nutrition students should consider developing a framework that builds understanding and scaffolds skill development across year levels. An employability framework has the potential to increase students employability skills and knowledge, enhance student confidence and increase graduate employment.
This essay examines an 1877 Gujarati translation of Queen Victoria's Leaves from the Journal of Our Life in the Highlands. It was the work of M. M. Bhownaggree, later a British MP. The essay explores the circumstances under which Bhownaggree undertook the translation, its content, and its intended audience. It closes with some observations on the book's place in the history of Indian royalism, the place of Indian royalism in the development of modern Gujarati literature, and the interplay of the Gujarati identity that was emerging in the latter part of the nineteenth century with both royalism and Indian nationalism.
While investigating a tranche of captains in the mid-eighteenth century in The National Archives, a unique cache of documents was found in the letters to the Admiralty in Captain Archibald Kennedy's file. The importance of these documents is that they reveal the events in New York and the eastern seaboard of North America during the Stamp Act crisis which occupied the last three months of 1765, as they impinged on a naval captain – not a politician, colonial official or merchant. This perspective is different from that usually described in histories and is worthy of a wider audience.
Captain Kennedy was senior naval officer at New York from 1763, and most of his correspondence with the Admiralty had to do with the difficulties of impressing men from the merchant vessels trading in and out of New York. Trade was booming in the years after what was known in America as the French and Indian War and in Britain as the Seven Years’ War. Merchant vessel owners could afford to pay their crews more than the navy offered, which made manning his vessels difficult. Kennedy reported to his Commander-in-Chief Lord Colvill, stationed in Halifax, and copied his letters to the Admiralty when it seemed likely that ships would reach England more quickly than ice-bound Halifax. He deployed the three sloops he had at his disposal as best he could to meet the many conflicting demands of the local colonial officials.
In 1764 everything changed. The Grenville administration had long planned to recoup from the colonists themselves some of the costs of protecting the American colonies from the French. Leading lawyers from the colonies, such as John Tabor Kempe, the young Attorney General in New York, had discussed this in London. Politicians in Britain anticipated no difficulty in levying taxes in America. If they had realised that the cost of collecting customs dues charged on American trade was three times the amount that officials raised in money they might have thought again. It is easy with hindsight to see that politicians in London should have paid more attention to the warnings of colonial administrators in America who were unable to persuade the colonial assemblies to vote them any income. Trading with the enemy was not confined to the American colonies: the Irish supplied beef to the French army despite being much more closely governed than the colonies were.