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.
Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease affecting 0.1% of the US population. Limited understanding of HS biology and ineffective treatments leave patients dissatisfied, facing misdiagnosis, and diagnostic delays. To address these challenges, the Rockefeller University Center for Clinical Translational Science, Clinical Directors Network, and the HS Foundation launched an initiative to foster engagement among stakeholders. Three full spectrum town halls (FSTH) were designed to engage patients, scientists, and clinicians bidirectionally. Topics spanned the translational research spectrum to amplify patient testimony, update the HS community on scientific and clinical research advances, and promote patient-centered research and care. The FSTH model aims to enhance empathy, foster trust, accelerate scientific discovery, and improve care. FSTH-2018 showcased patients’ experiences living with HS, the scientific and clinical state of the art, and tailored a new HS study to patient preferences. FSTH-2021 shared results of the study, including new insights into HS biology. FSTH-2023 highlighted best practices for outpatient surgical care of HS. Participant feedback underscored FSTH’s role in nurturing empathy and advancing discovery and patient engagement. FSTH serves as an effective model for uniting stakeholders, bridging gaps in knowledge and trust, and accelerating translational research to improve HS care.
In recognition of an increasing number of high-consequence infectious disease events, a group of subject-matter experts identified core safety principles that can be applied across all donning and doffing protocols for personal protective equipment.
The aims of this study are to identify the challenges faced by non-palliative care professionals (NPCPs) in caring for end-of-life patients; determine how these challenges interact with and influence each other systemically; and advance the theories and practices for supporting NPCPs in the provision of quality end-of-life care beyond the boundaries of palliative medicine.
Methods
A constructivist phenomenological research design with an Interpretive-Systemic Framework of inquiry was adopted. Thirty-five physicians, 35 nurses, and 35 Medical Social Workers who play critical roles in caring for end-of-life patients and belonging to the 9 major medical disciplines of Cardiology, Geriatric, Intensive Care Medicine, Internal Medicine, Nephrology, Neurology, Oncology, Respiratory Medicine, and Surgery were recruited through purposive snowball sampling from 3 major public hospitals.
Results
Framework analysis revealed 5 themes and 17 subthemes that illuminate the individual, relational, cultural, institutional, and structural challenges that NPCPs faced in rendering end-of-life care. These challenges influence each other within the health-care ecosystem, serving to perpetuate or heighten care obstacles.
Significance of results
This is the first known study exploring the systemic challenges of NPCPs spanning 9 major medical disciplines and encompassing 3 professional stakeholders responsible for the care for end-of-life patients, thus ensuring perspective inclusivity across the health-care system. Recommendations that consider the complexity of the interactions between these systemic challenges are presented in detail.
In 2013, the diagnosis of somatic symptom disorder (SSD) was introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This review aims to comprehensively synthesize contemporary evidence related to SSD.
Methods
A scoping review was conducted using PubMed, PsycINFO, and Cochrane Library. The main inclusion criteria were SSD and publication in the English language between 01/2009 and 05/2020. Systematic search terms also included subheadings for the DSM-5 text sections; i.e., diagnostic features, prevalence, development and course, risk and prognostic factors, culture, gender, suicide risk, functional consequences, differential diagnosis, and comorbidity.
Results
Eight hundred and eighty-two articles were identified, of which 59 full texts were included for analysis. Empirical evidence supports the reliability, validity, and clinical utility of SSD diagnostic criteria, but the further specification of the psychological SSD B-criteria criteria seems necessary. General population studies using self-report questionnaires reported mean frequencies for SSD of 12.9% [95% confidence interval (CI) 12.5–13.3%], while prevalence studies based on criterion standard interviews are lacking. SSD was associated with increased functional impairment, decreased quality of life, and high comorbidity with anxiety and depressive disorders. Relevant research gaps remain regarding developmental aspects, risk and prognostic factors, suicide risk as well as culture- and gender-associated issues.
Conclusions
Strengths of the SSD diagnosis are its good reliability, validity, and clinical utility, which substantially improved on its predecessors. SSD characterizes a specific patient population that is significantly impaired both physically and psychologically. However, substantial research gaps exist, e.g., regarding SSD prevalence assessed with criterion standard diagnostic interviews.
From the 1980s onwards, the Roslin Institute and its predecessor organizations faced budget cuts, organizational upheaval and considerable insecurity. Over the next few decades, it was transformed by the introduction of molecular biology and transgenic research, but remained a hub of animal geneticists conducting research aimed at the livestock-breeding industry. This paper explores how these animal geneticists embraced genomics in response to the many-faceted precarity that the Roslin Institute faced, establishing it as a global centre for pig genomics research through forging and leading the Pig Gene Mapping Project (PiGMaP); developing and hosting resources, such as a database for genetic linkage data; and producing associated statistical and software tools to analyse the data. The Roslin Institute leveraged these resources to play a key role in further international collaborations as a hedge against precarity. This adoption of genomics was strategically useful, as it took advantage of policy shifts at the national and European levels towards funding research with biotechnological potential. As genomics constitutes a set of infrastructures and resources with manifold uses, the development of capabilities in this domain also helped Roslin to diversify as a response to precarity.
The NIH Center for Accelerated Innovations at Cleveland Clinic (NCAI-CC) was funded by the National Heart Lung and Blood Institute (NHLBI) to support academic investigators in technology development and commercialization. NCAI-CC was one of three multi-institutional Centers established in the fall of 2013. The goal of each Center was to catalyze the growth of an ecosystem of commercialization within their affiliated institutions and regions by managing a program of funding and guiding translational project development and by delivering commercialization education programs to participating investigators. NCAI-CC created and managed such a funding program, ultimately supporting 75 different projects across seven separate academic institutions and developed tailored educational content following the National Science Foundation I-Corps™ curriculum and delivered the program to 79 teams from 12 institutions. We determined early on that in establishment and implementation of projects, it is important to support the teams and principal investigators throughout the program. The support includes a change in principal investigator mindset from specific aims orientation to goals and deliverables on projects. Our skills development efforts emphasized commercialization and a deep understanding of customer needs for new technology adoption. Here, we review our experiences, outcomes, and insights, including the challenges identified in program implementation.
In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses’ death anxiety and improve nurses’ skills, knowledge, and attitude towards palliative care.
Methods
Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.
Results
There was a significant improvement in nurses’ knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.
Significance of results
The multimodal palliative care workshop was useful in improving nurses’ EOL knowledge and reducing their anxiety towards death. The positive change in nurses’ attitudes and practices were noted to be sustained for at least six weeks after the intervention.
We describe the experience of managing the dying moments of a nursing home patient via telemedicine.
Case presentation:
Ms. C was a 92-year-old frail woman with multiple medical problems, living in a nursing home. She spent her final days in the nursing home, choosing not to be transferred to an acute hospital should she turn ill. On the last day of her life, she complained of acute-onset breathlessness and agreed to a teleconsultation with the hospital physicians involved in acute care.
Case management:
During the telemedicine consultations (tele-consultation) process, Ms. C's condition deteriorated rapidly as she entered the dying phase of life. She died peacefully soon after, in the presence of the nurse, the pastoral care worker, and the physician who was conducting the tele-consultation session 30 km away. The family was not present at the patient's bedside when she died. They were, however, relieved to know and were appreciative of the fact that a physician had been “present” during the patient's death.
Conclusions:
Telemedicine could act as an effective communication tool in end-of-life care, between the patient and carers, up to the last moment of life.
High-mass stars are known to be born within giant molecular clouds (GMCs); However, the exact processes involved in forming a high-mass star are still not well understood. It is clear that high-mass stars do not form in isolation, and that the processes surrounding high-mass star formation may affect the environment of the entire molecular cloud. We are studying the GMC associated with RCW 106 (G333), which is one of the most active massive-star formation regions in the Galactic plane. This GMC, located at l = 333° b = − 0.5°, has been mapped in over 20 molecular line transitions with the Mopra radio telescope (83-110 GHz), in Australia, and with the Swedish-ESO Submillimeter Telescope (SEST) in the 1.2 mm cool dust continuum. The region is also within the Spitzer GLIMPSE infrared survey (3.6, 4.5, 5.8, and 8.0 μm) area. We have decomposed the dust continuum using a clump-finding algorithm (CLUMPFIND), and are using the multiple molecular line traditions from the Mopra radio telescope to classify the type and stage of star formation taking place therein. Having accurate physical temperatures of the star forming clumps is essential to constrain other parameters to within useful limits. To achieve this, we have obtained pointed NH3 observations from the Tidbinbilla 70-m radio telescope, in Australia, towards these clumps.
Pine leaf aphid infestation produces not only a general reduction in radial growth of white pine but also a modification of the normal pattern of annual radial increment along the length of the stem. The greatest growth reduction occurs in the lower stem with proportionately less in the midcrown area and least in the top. This appears to reflect the distribution of branch mortality which is greatest in the mid- and lower crown. Several defoliators studied by other workers produce the greatest effect on radial growth and on foliage survival in the tops of the tree.
Stem elongation reduction occurs only after crown damage and aphid infestation becomes extreme. Lighter infestations are reflected, however, in reduced needle length in the year of attack followed by reduced branch elongation in the year following attack. The combination of stunted and normal needles alternating with stunted and normal branch internodes is probably a unique characteristic of pine leaf aphid damage.
To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring.
Design and Setting.
Epidemiologic investigation of an acute outbreak of hospital-associated Legionnaires disease among outpatients and visitors to a Wisconsin hospital.
Patients.
Patients with laboratory-confirmed Legionnaires disease who resided in southeastern Wisconsin and had illness onsets during February and March 2010.
Methods.
Patients with Legionnaires disease were interviewed using a hypothesis-generating questionnaire. On-site investigation included sampling of water and other potential environmental sources for Legionella testing. Case-finding measures included extensive notification of individuals potentially exposed at the hospital and alerts to area healthcare and laboratory personnel.
Results.
Laboratory-confirmed Legionnaires disease was diagnosed in 8 patients, all of whom were present at the same hospital during the 10 days prior to their illness onsets. Six patients had known exposure to a water wall-type decorative fountain near the main hospital entrance. Although the decorative fountain underwent routine cleaning and maintenance, high counts of Legionella pneumophila serogroup 1 were isolated from cultures of a foam material found above the fountain trough.
Conclusion.
This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.
The longitudinal associations of older sibling substance use as well as dyadic sibling conflict and collusion to younger sibling substance use were examined in a community-based sample of 244 same-sex sibling pairs. Indirect effects of older siblings on younger sibling substance use were hypothesized via younger sibling deviant peer affiliation and conflict with friends. Adolescents, parents, friends, and teachers completed measures of substance use, conflict, and deviant peer involvement. Observational data were used for both measures of collusion and conflict. Findings suggest that older sibling substance use has a direct effect on younger sibling use, but relationship dynamics and reinforcement played a significant role as well. Specifically, collusion and conflict in the sibling relationship both had indirect effects through younger siblings’ deviant peer affiliation. Findings validate the powerful socializing role of both siblings and peers, and elucidate the complex mechanisms through which socialization occurs. Furthermore, data underscore the importance of considering how multiple dimensions of socialization operate in the elaboration of antisocial behavior.
Introduction: A common reason for utilizing local paramedics and the emergency medical services is for the recognition and immediate treatment of chest pain, a complaint that has multiple possible etiologies. While many of those complaining of disease processes responsible for chest pain are benign, some will be life-threatening and will require immediate identification and treatment. The ability of paramedics to not only perform field electrocardiograms (ECGs), but to accurately diagnose various unstable cardiac rhythms has shown significant reduction in time to specific treatments. Increasing the overall accuracy of ECG interpretation by paramedics has the potential to facilitate early and appropriate treatment and decrease patient morbidity and mortality.
Methods: A convenient training device (flip book) on ambulances and in common areas in the fire station could improve field interpretation of certain cardiac rhythms. This training device consists of illustrated sample ECG tracings and their associated diagnostic criteria. The goal was to enhance the recognition and interpretation of ECGs, and thereby, reduce delays in the initiation of treatment and potential complications associated with misinterpretation.
This study was a prospective, observational study using a matched pre-test/post-test design. The study period was from November 2008 to December 2008. A total of 136 paramedics were approached to participate in this study. A pre-test consisting of 15 12-lead ECGs was given to all paramedics who agreed to participate in the study. Once the pre-tests were completed, the flip books were placed in common areas. Approximately one month after the flip books were made available to the paramedics, a post-test was administered.
Statistical comparisons were made between the pre- and post-test scores for both the global test and each type of rhythm.
Results: Using these data, there were no statistically significant improvements in the global ECG interpretation or on individual rhythm interpretations.
Conclusions: A flip book with multiple ECG rhythms and definitions without the benefit of any outside support was not effective in improving paramedic identification of ECG rhythms on a post-test. Suggestions for further research include repeating the study with a larger sample size; utilizing a lecturer to explain how to use the flip book in the most efficient manner; reiterating how to read and interpret ECGs; and answering questions. Comparing test scores of paramedic students, and newly certified paramedics as opposed to veteran paramedics also may indicate that the flip books are more suited for one group over another.
Adolescents presenting with self-harm have poor adherence to community follow-up. Poor adherence is a principal obstacle to treatment delivery and is associated with poor psychosocial outcomes. Therapeutic assessment is a novel method of assessing adolescents with self-harm. We compared therapeutic assessment with assessment as usual in a pilot study of 38 adolescents referred for psychosocial assessment following self-harm.
Results
Significantly more adolescents assessed with therapeutic assessment than with usual assessment attended the first community follow-up appointment (75% v. 40%, χ2=3.89, P < 0.05) and engaged with services (62% v. 30% χ2=4.49, P < 0.05).
Clinical Implications
Young people assessed using therapeutic assessment may be more likely to engage with community follow-up. A therapeutic intervention at the time of the initial assessment might be necessary to enable future therapeutic work.