We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The hospital setting is often perceived as slow to change. While employee-driven approaches offer a promising alternative to traditional top-down methods, guidance is limited. This study provides a description and formative evaluation of an employee-driven working group (WG) approach to tailor ward-specific measures to improve care in the dying phase. The aim is to evaluate the WG process and offer practical insights for transferability to other hospitals.
Methods
Formative mixed-methods evaluation of a WG process to tailor ward-specific evidence-informed measures on 10 wards outside specialized palliative care at 2 German medical centers. To analyze factors relevant for the WG process, the Consolidated Framework for Implementation Research 2.0 was applied. Data included baseline evaluation (medical record analysis, staff survey and focus groups, informal caregiver interviews), WG protocols, and an online survey with WG participants.
Results
Multiprofessional WGs were established on all hospital wards, with an average of 7 meetings per ward within 1 year and 4 participants per meeting. Adapting the process to participants’ wishes and needs were crucial, particularly regarding the desired degree of external input. We identified 4 barriers (e.g. declining participation, institutional limits) and 7 facilitators (e.g. involvement of staff in leading positions, multiprofessional composition). The WGs tailored 34 measures, e.g. team meetings to improve communication within the team. Participants’ views were generally positive: 91% felt able to share their thoughts, 66% were satisfied with the outcome, and 77% would participate again.
Significance of results
The employee-driven approach was feasible and useful for tailoring ward-specific measures. However, integrating top-down elements proved to be beneficial. The identified barriers and facilitators provide insights for transferring an employee-driven approach to other hospitals to improve care in the dying phase outside specialized palliative care settings.
Clinical trial registration
The study was registered in the German Clinical Trials Register (DRKS00025405).
This study investigates the effect of visually perceived gestures on the overall (multimodal) prominence of naturally occurring stimuli extracted from a multimodal corpus of Maltese conversations. Experiment participants were required to rate the prominence of target words in sentences presented to them as audiovisual and audio-only stimuli. In half of the stimuli, the target word was accompanied by a co-speech hand gesture. The results of the experiment show (i) that words produced with a co-speech gesture were rated as more prominent than words that were produced without one and (ii) that this was the case independently of whether raters could see those gestures (audiovisual condition) or not (audio-only condition). An acoustic analysis of the data shows that the presence of a co-occurring gesture has a significant effect on the pitch of the target vowel. The study suggests that gestures may provide the listener with an additional but not necessary cue to perceiving prominence.
Distinguishing early domesticates from their wild progenitors presents a significant obstacle for understanding human-mediated effects in the past. The origin of dogs is particularly controversial because potential early dog remains often lack corroborating evidence that can provide secure links between proposed dog remains and human activity. The Tumat Puppies, two permafrost-preserved Late Pleistocene canids, have been hypothesized to have been littermates and early domesticates due to a physical association with putatively butchered mammoth bones. Through a combination of osteometry, stable isotope analysis, plant macrofossil analysis, and genomic and metagenomic analyses, this study exploits the unique properties of the naturally mummified Tumat Puppies to examine their familial relationship and to determine whether dietary information links them to human activities. The multifaceted analysis reveals that the 14,965–14,046 cal yr BP Tumat Puppies were littermates who inhabited a dry and relatively mild environment with heterogeneous vegetation and consumed a diverse diet, including woolly rhinoceros in their final days. However, because there is no evidence of mammoth consumption, these data do not establish a link between the canids and ancient humans.
We review experimental research on judicial decision-making with a focus on methodological issues. First, we argue that only experiments with relatively high realism, in particular real judges as study subjects, plausibly generalize to judicial decision-making in the real world. Most experimental evidence shows lay subjects to behave very differently from expert judges in specifically legal tasks. Second, we argue that studying the effects of non-law is not a substitute for studying the effects of law since large unexplained residuals could be attributed to either. Direct experimental studies of the law effect are few and find it to be puzzlingly weak. Third, we review the substantive findings of experiments with judges, distinguishing between studies investigating legal and nonlegal factors and paying close attention to the nature of the experimental task.
Normative conflict is at the centre of many current discussions about order and change in world politics. In this article, we argue that studying normativity in practice is necessary when analysing processes of global ordering, such as negotiating, cooperating, or protesting. Practices are imbued with normativity. This key aspect, however, remains often overlooked in current International Relations (IR) practice research due to a conservative bias that treats practices mainly as patterned. Focusing on normativity reveals the inherent contestation of practices, providing a conceptual avenue for understanding how international practices oscillate between social order and change. Normativity can be defined as evaluating criteria experienced in practice and used for the contextualised moral judgement of public performances. This perspective is relevant for IR scholars interested in how relational, contested, and learning processes relate to order and ordering in world politics. We propose taking a comprehensive approach hereto based on three key dimensions: how normativity is enacted and disputed in practice; how it must be learnt as practical knowledge in communities; and, how ambiguity remains due to the multiplicity of rules applied in everyday situations. We illustrate our approach by examining global protests in different fields (sports, the environment, and peace).
Researchers acknowledge the need to share study results with the patients and their communities, but this is not done consistently due to a plethora of barriers, including a paucity of data to guide best practice approaches in different populations.
Methods:
This study was nested within a large multi-center randomized controlled trial of antimalaria treatment. Data on dissemination preferences were collected at the third-month follow-up visit using a short questionnaire. Data were analyzed using descriptive statistics and subsequently fed into an iterative process with key stakeholders, to develop suitable strategies for result dissemination.
Results:
A total of 960 patients were enrolled in the trial, of whom 84.0% participated in the nested survey. A total of 601 (74.6%) participants indicated interest in receiving trial results. There was significant heterogeneity by study country, with 33.3% (58/174) of patients indicating being interested in Cambodia, 100% (334/334) in Ethiopia, 97.7% (209/214) in Pakistan, but none (0/85) in Indonesia. The preferred method of dissemination varied by site, with community meetings, favored in Ethiopia (79.0%, 264/334) and individualized communication such as a letter (27.6%, 16/58) or phone calls (37.9%, 22/58) in Cambodia. Dissemination strategies were designed with key stakeholders and based on patient preferences but required adaptation to accommodate local logistical challenges.
Conclusion:
The varying preferences observed across different sites underscore that a one-size-fits-all approach is inadequate. Strategies can be tailored to patient preference but require adaptation to accommodate logistical challenges.
Highly resolved simulations reveal the fundamental influence of a carrier fluid’s flow dynamics on triboelectric powder charging. We found that particles transported through a square-shaped duct charge faster than in a channel flow caused by secondary flows that led to more severe particle–wall collisions. Specifically, particles with a Stokes number of 4.69 achieve 85 % of their equilibrium charge approximately 1.5 times faster in duct flow than in channel flow. Also, charge distribution is more uniform in a duct cross-section compared with a channel cross-section. In channel flow, particles are trapped near the walls and collide frequently due to limited movement in the wall-normal direction, causing localized charge buildup. In contrast, duct flow promotes better mixing through secondary flows, reducing repeating collisions and providing uniform charge distribution across the cross-section. Upon charging, electrostatic forces significantly reshape particle behaviour and distribution. Once the powder achieves half of its equilibrium charge, particles increasingly accumulate at the wall, leading to a reduced concentration in the central region. These changes in particle distribution have a noticeable impact on the surrounding fluid phase and alter the overall flow dynamics. These findings open the possibility for a new measure to control powder charging by imposing a specific pattern.
At the turn of the twentieth century, Euro-American colonialism remade the lives of thousands of Samoan, Melanesian, and Chinese workers on coconut plantations in Samoa. Since plantation discipline was strict, workers resisted the heavy demands on their bodies through a broad arsenal of behaviors, ranging from keeping crops for themselves to making appeals to the state to waging violent attacks on overseers. Resistance against colonial subjection turned workers in Samoa into subjects of their own lives and allowed them to forge bonds of solidarity beyond the spatial, social, and racial boundaries maintained by colonial administrations. In doing so, Samoa's workers shaped their own version of Oceanian globality.
We conduct a field experiment with Amazon Mechanical Turk (“AMT”) workers to causally assess the effect of introducing a control mechanism in an existing work relationship on workers’ performance on tasks of varying difficulty. We find that introducing control significantly reduces performance. This reduction occurs primarily on challenging tasks, while performance on simple tasks is unaffected. The negative effects are primarily driven by workers who exhibit non-pecuniary motivation in the absence of control. Our results show that there are adverse effects of control, and they suggest that these adverse effects are of particular concern to firms that rely on high performance on challenging tasks.
This study investigates the influence of seismic activities on the optical synchronization system of the European X-ray Free-Electron Laser. We analyze the controller input/output data of phase-locked loops in length-stabilized links, focusing on the response to earthquakes, ocean-generated microseism and civilization noise. By comparing the controller data with external data, we were able to identify disturbances and their effects on the control signals. Our results show that seismic events influence the stability of the phase-locked loops. Even earthquakes that are approximately 5000 km away cause remarkable fluctuations in the in-loop control signals. Ocean-generated microseism in particular has an enormous influence on the in-loop control signals due to its constant presence. The optical synchronization system is so highly sensitive that it can even identify vibrations caused by civilization, such as road traffic or major events like concerts or sport events. The phase-locked loops manage to eliminate more than 99% of the existing interference.
This study examines to what extent phonetic reduction in different accents affects intelligibility for non-native (L2) listeners, and whether similar reduction processes in listeners’ first language (L1) facilitate the recognition and processing of reduced word forms in the target language. In two experiments, 80 Dutch-speaking and 80 Spanish-speaking learners of English were presented with unreduced and reduced pronunciation variants in native and non-native English speech. Results showed that unreduced words are recognized more accurately and more quickly than reduced words, regardless of whether these variants occur in non-regionally, regionally or non-native accented speech. No differential effect of phonetic reduction on intelligibility and spoken word recognition was observed between Dutch-speaking and Spanish-speaking participants, despite the absence of strong vowel reduction in Spanish. These findings suggest that similar speech processes in listeners’ L1 and L2 do not invariably lead to an intelligibility benefit or a cross-linguistic facilitation effect in lexical access.
This study tests whether prediction error underlies structural priming in a later-learnt L2 across two visual world eye-tracking priming experiments. Experiment 1 investigates priming when learners encounter verbs biased to double-object-datives (DO, “pay”) or prepositional-object-datives (PO, “send”) in the other structure in prime sentences. L1-German–L2-English learners read prime sentences crossing verb bias and structure (DO/PO). Subsequently, they heard target sentences – with unbiased verbs (“show”) – while viewing visual scenes. In line with implicit learning models, gaze data revealed priming and prediction-error effects, namely, more predictive looks consistent with PO following PO primes with DO-bias verbs. Priming in comprehension persisted into (unprimed) production, indicating that priming by prediction error leads to longer-term learning. Experiment 2 investigates the effects of target verb bias on error-based priming. Priming and prediction-error effects were reduced for targets with non-alternating verbs (“donate”) that only allow PO structures, suggesting learners’ knowledge of the L2 grammar modulates prediction-error-based priming.
The longitudinal process that leads to university student dropout in STEM subjects can be described by referring to (a) inter-individual differences (e.g., cognitive abilities) as well as (b) intra-individual changes (e.g., affective states), (c) (unobserved) heterogeneity of trajectories, and d) time-dependent variables. Large dynamic latent variable model frameworks for intensive longitudinal data (ILD) have been proposed which are (partially) capable of simultaneously separating the complex data structures (e.g., DLCA; Asparouhov et al. in Struct Equ Model 24:257–269, 2017; DSEM; Asparouhov et al. in Struct Equ Model 25:359–388, 2018; NDLC-SEM, Kelava and Brandt in Struct Equ Model 26:509–528, 2019). From a methodological perspective, forecasting in dynamic frameworks allowing for real-time inferences on latent or observed variables based on ongoing data collection has not been an extensive research topic. From a practical perspective, there has been no empirical study on student dropout in math that integrates ILD, dynamic frameworks, and forecasting of critical states of the individuals allowing for real-time interventions. In this paper, we show how Bayesian forecasting of multivariate intra-individual variables and time-dependent class membership of individuals (affective states) can be performed in these dynamic frameworks using a Forward Filtering Backward Sampling method. To illustrate our approach, we use an empirical example where we apply the proposed forecasting method to ILD from a large university student dropout study in math with multivariate observations collected over 50 measurement occasions from multiple students (\documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$N = 122$$\end{document}). More specifically, we forecast emotions and behavior related to dropout. This allows us to predict emerging critical dynamic states (e.g., critical stress levels or pre-decisional states) 8 weeks before the actual dropout occurs.
The Roman army was a vast military machine that demanded huge amounts of material and complex supply mechanisms. A 14kg hoard of mail armour from near the Roman legionary fortress of Bonn, Germany, offers insight into the organisation of recycling and repair on Rome's northern frontier. Computed tomography reveals there are at least four garments and suggests a likely date. The authors explore the hoard's context and motivations for its deposition and non-retrieval, arguing it formed a collection of ‘donor’ mail for repairing other mail garments. Its discovery in a settlement outside the military fortress indicates the involvement of local craftworkers. The settlement was abandoned in the mid-third century AD.
The fundamentals of cubic norm structures and Jordan algebras are laid out in the first two sections of the chapter. We then derive elementary principles of building up “big” cubic norm structures out of “smaller” ones before we proceed to study cubic Jordan matrix algebras, the most important “hands-on” examples of cubic Jordan algebras. Next we turn to elementary idempotents, which will be used to present a special version of the Jacobson Coordinatization Theorem. Proceeding to Freudenthal algebras, we show that they exist only in ranks 1, 3, 6, 9, 15, and 27, with those of rank 27 being (finally!) called Albert algebras. We define the notion of a split Freudenthal algebra and prove, in analogy with composition algebras, that all Freudenthal algebras are split by some faithfully flat extension, though not always by an étale cover. After having investigated isotopies and norm similarities, with an important characterization of isotopes in Jordan matrix algebras over LG rings as its central result, we study reduced Freudenthal algebras over fields by exhibiting various classifying quadratic form invariants, particularly those pertaining to the invariants mod 2 of Albert algebras.