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Timely integration of palliative care (PC) into standard oncology hospital care offers significant benefits to patients with incurable cancer and their families. International recognition of the importance of timely PC has shifted the focus from integration to determining the optimal timing for introducing PC. The specific care responsibilities of oncology clinicians acting as generalists in PC and the optimal timing for involving PC specialists remain uncertain.
Objectives
This study aimed to (1) explore how the concept of “timely PC” is understood by oncology clinicians and patients with incurable cancer and (2) investigate how PC is provided in a timely manner in daily clinical practice.
Methods
An interview study was conducted with 18 oncology clinicians (7 physicians, 1 physician assistant, and 10 nurses/nurse practitioners) and 12 patients with incurable cancer. The interviews were conducted between October 2022 and June 2023 and a thematic analysis of the interviews was performed.
Results
Three main themes emerged regarding “timely PC”: (1) timely PC is individual and situational, (2) identification of the right time is an ongoing challenge, and (3) proactive care is essential. Regarding the provision of timely PC, 3 themes were identified: (1) having a strong collaboration among various clinicians, (2) having the courage to start a clear and sincere conversation, and (3) being sensitive and personal.
Significance of results
Being timely is not a fixed point in time, but depends on the individual patient and their situation. Clinicians should be proactive and gradual in bringing up PC-related topics and be careful to use the right words. Tools such as the surprise question can support in timely integrating PC but being timely PC highly depends on a patient’s individual context. Therefore, clinicians should be aware that timely PC is a constant search for the most fitting moment.
While adapting to future sea-level rise (SLR) and its hazards and impacts is a multidisciplinary challenge, the interaction of scientists across different research fields, and with practitioners, is limited. To stimulate collaboration and develop a common research agenda, a workshop held in June 2024 gathered 22 scientists and policymakers working in the Netherlands. Participants discussed the interacting uncertainties across three different research fields: sea-level projections, hazards and impacts, and adaptation. Here, we present our view on the most important uncertainties within each field and the feasibility of managing and reducing those uncertainties. We find that enhanced collaboration is urgently needed to prioritize uncertainty reductions, manage expectations and increase the relevance of science to adaptation planning. Furthermore, we argue that in the coming decades, significant uncertainties will remain or newly arise in each research field and that rapidly accelerating SLR will remain a possibility. Therefore, we recommend investigating the extent to which early warning systems can help policymakers as a tool to make timely decisions under remaining uncertainties, in both the Netherlands and other coastal areas. Crucially, this will require viewing SLR, its hazards and impacts, and adaptation as a whole.
A lognormal model for response times is used to check response times for aberrances in examinee behavior on computerized adaptive tests. Both classical procedures and Bayesian posterior predictive checks are presented. For a fixed examinee, responses and response times are independent; checks based on response times offer thus information independent of the results of checks on response patterns. Empirical examples of the use of classical and Bayesian checks for detecting two different types of aberrances in response times are presented. The detection rates for the Bayesian checks outperformed those for the classical checks, but at the cost of higher false-alarm rates. A guideline for the choice between the two types of checks is offered.
A set of linear conditions on item response functions is derived that guarantees identical observed-score distributions on two test forms. The conditions can be added as constraints to a linear programming model for test assembly that assembles a new test form to have an observed-score distribution optimally equated to the distribution on an old form. For a well-designed item pool and items fitting the IRT model, use of the model results into observed-score pre-equating and prevents the necessity of post hoc equating by a conventional observed-score equating method. An empirical example illustrates the use of the model for an item pool from the Law School Admission Test.
The COVID-19 pandemic challenged older adults’ health behaviours, making it even more difficult to engage in healthy diets and physical activity than it had been prepandemic. A resource to promote these could be social support. This study uses data from 136 older adults (Mage = 71.39 years, SD = 5.15, range: 63–87) who reported their daily fruit and vegetable consumption, steps, and health-behaviour-specific support from a close other every evening for up to 10 consecutive days. Findings show that on days when participants reported more emotional support than usual, fruit and vegetable consumption and step counts were higher. Daily instrumental support was positively associated with step counts, only. Participants receiving more overall emotional support across the study period consumed more fruit and vegetables; no parallel person-level association was found for overall steps. There were no significant interactions between dyad type and support links for our outcomes.
We conducted a large-scale online experiment to examine whether climate change messaging can induce emotions and motivate pro-environmental action. We study how exposure to explicit positive (‘warm glow’) and negative (‘cold prickle’) emotional appeals as well as a traditional social norm communication affects pro-environmental action. We find that a simple call to take action to mitigate climate change is at least as affective as social norm message framing and emotional appeals. Our results highlight the difficulty of designing messaging interventions that effectively harness emotional incentives to promote pro-environmental action. Messages that explicitly emphasise the personal emotional benefits of contributing to environmental causes or the adverse emotional effects of not doing so seem to fall short of motivating pro-environmental effort. Our findings underscore the need for caution when incorporating emotive appeals into policy interventions.
This study investigated everyday associations between one key facet of mindfulness (allocating attention to the present moment) and pain. In Study 1, 89 community-dwelling adults (33–88 years; Mage = 68.6) who had experienced a stroke provided 14 daily end-of-day present-moment awareness and pain ratings. In Study 2, 100 adults (50–85 years; Mage = 67.0 years) provided momentary present-moment awareness and pain ratings three times daily for 10 days. Multi-level models showed that higher trait present-moment awareness was linked with lower overall pain (both studies). In Study 1, participants reported less pain on days on which they indicated higher present-moment awareness. In Study 2, only individuals with no post-secondary education reported less pain in moments when they indicated higher present-moment awareness. Findings add to previous research using global retrospective pain measures by showing that present-moment awareness might correlate with reduced pain experiences, assessed close in time to when they occur.
Misinformation presents a significant societal problem. To measureindividuals’ susceptibility to misinformation and study its predictors,researchers have used a broad variety of ad-hoc item sets, scales, questionframings, and response modes. Because of this variety, it remains unknownwhether results from different studies can be compared (e.g., in meta-analyses).In this preregistered study (US sample; N = 2,622), we comparefive commonly used question framings (eliciting perceived headline accuracy,manipulativeness, reliability, trustworthiness, and whether a headline is realor fake) and three response modes (binary, 6-point and 7-point scales), usingthe psychometrically validated Misinformation Susceptibility Test (MIST). Wetest 1) whether different question framings and response modes yield similarresponses for the same item set, 2) whether people’s confidence in theirprimary judgments is affected by question framings and response modes, and 3)which key psychological factors (myside bias, political partisanship, cognitivereflection, and numeracy skills) best predict misinformation susceptibilityacross assessment methods. Different response modes and question framings yieldsimilar (but not identical) responses for both primary ratings and confidencejudgments. We also find a similar nomological net across conditions, suggestingcross-study comparability. Finally, myside bias and political conservatism werestrongly positively correlated with misinformation susceptibility, whereasnumeracy skills and especially cognitive reflection were less important(although we note potential ceiling effects for numeracy). We thus find moresupport for an “integrative” account than a “classicalreasoning” account of misinformation belief.
It is widely acknowledged that co-occurring symptoms in patients with a psychosocial and spiritual aspects should also be considered. However, this multidimensional approach is difficult to integrate into daily practice, especially for generalist clinicians not specialized in palliative care. We aimed to identify the barriers and facilitators to multidimensional symptom management.
Methods
Focus group meetings were conducted with the following stakeholders: (1) patient representatives, (2) generalist community nurses, (3) generalist hospital nurses, (4) general practitioners, (5) generalist hospital physicians, and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analyzed.
Results
Fifty-one participants (6–12 per group) reported barriers and facilitators with 3 main themes: multidimensional symptom assessment, initiating management of nonphysical problems, and multidisciplinary collaboration. As barriers, generalist clinicians and palliative care specialists reported that generalist clinicians often lack the communication skills to address nonphysical problems and are unaware of available resources for multidimensional symptom management. Palliative care specialists felt that generalist clinicians may be unaware that assessing nonphysical problems is important and focus on pharmacological interventions. Generalist nurses and palliative care specialists indicated that hierarchical difficulties between them and generalist physicians are barriers to multidisciplinary collaboration. Reported facilitators included using symptom assessment scales and standardized questions on nonphysical problems.
Significance of results
Generalist clinicians can be supported by improving their communication skills, increasing their awareness of available resources for multidimensional symptom management, and by using a standardized approach to assess all 4 dimensions of palliative care.
Many mental disorders take a chronic course, associated with disability and/or participation restrictions. This is well recognized in social psychiatry. It is assumed that in psychotherapy milder disorders are seen, but there are no data available in this regard. In a survey in outpatient psychotherapy the rate of patients with chronic disorders and associated impairment was assessed.
Objectives
Goal of the present study was to assess the prevalence and meaning of long term and prevailing disorders in psychotherapy
Methods
A total of 131 psychotherapists (43.5% psychodynamic, 55.7% cognitive behavior therapy) reported about 322 outpatients. Therapists were interviewed in person by two research psychotherapists in regard to illness characteristics of unselected patients.
Results
The duration of illness was longer than 1 year in 98.1% of patients or longer than a decade in 54.5%. In the judgement of the therapists 79% of disorders had a chronic or recurrent course. In 25% there were relevant participation impairments in regard to daily activities, leisure time, social relations, or work. About one quarter had already been in inpatient treatment.
Conclusions
The data show that chronic disorders are the rule rather than the exception in psychotherapy. This requires a multidimensional and interdisciplinary treatment approach, including sociomedical interventions in order to sustain participation in life. This should be recognized in the treatment concepts and also get proper attention in the education and reimbursement of psychotherapists.
Embitterment is an emotion which is known to everybody in reaction to injustice, humiliation, and breach of trust. In greater intensity it can cause severe suffering for the affected person and the social envirnment, can result in lasting impairment, and even lead to dysfunctional behavior, including aggression. Embittered patients need therapeutic help and are regularly seen in psychotherapy. The problem is often not properly recognized, because of the multiple accompanying symptoms and accusations against the environment.
Objectives
Goal of the present study was to learn about the prevalence of embitterment in psychotherapy patients
Methods
Outpatients in routine psychotherapy filled in the PTED scale (post-traumatic embitterment disorder selfrating scale), the K-FAF (short assessment of aggression) and the SCL-90 (symptom-checklist-90). Additionally, sociodemographic data were available.
Results
Included were 118 patients, of whom 22% showed a relevant severity of embitterment, 23.7% a relevant score for reactive aggression, and 54.2% a relevant score for irritable aggression. There was a significant correlation between the PTED scale and the aggression scale.
Conclusions
The data show that embitterment and related aggression are frequent phenomena in psychotherapy patients. Therapists should be aware of this emotion and take proper action to diagnose embitterment and aggressive ideation, which are often covered by other complaints. Special treatments are needed, as the aggressive and negativistic features of embitterment complicate the psychotherapy process.
Copy number variants (CNVs) have been associated with the risk of schizophrenia, autism and intellectual disability. However, little is known about their spectrum of psychopathology in adulthood.
Methods
We investigated the psychiatric phenotypes of adult CNV carriers and compared probands, who were ascertained through clinical genetics services, with carriers who were not. One hundred twenty-four adult participants (age 18–76), each bearing one of 15 rare CNVs, were recruited through a variety of sources including clinical genetics services, charities for carriers of genetic variants, and online advertising. A battery of psychiatric assessments was used to determine psychopathology.
Results
The frequencies of psychopathology were consistently higher for the CNV group compared to general population rates. We found particularly high rates of neurodevelopmental disorders (NDDs) (48%), mood disorders (42%), anxiety disorders (47%) and personality disorders (73%) as well as high rates of psychiatric multimorbidity (median number of diagnoses: 2 in non-probands, 3 in probands). NDDs [odds ratio (OR) = 4.67, 95% confidence interval (CI) 1.32–16.51; p = 0.017) and psychotic disorders (OR = 6.8, 95% CI 1.3–36.3; p = 0.025) occurred significantly more frequently in probands (N = 45; NDD: 39[87%]; psychosis: 8[18%]) than non-probands (N = 79; NDD: 20 [25%]; psychosis: 3[4%]). Participants also had somatic diagnoses pertaining to all organ systems, particularly conotruncal cardiac malformations (in individuals with 22q11.2 deletion syndrome specifically), musculoskeletal, immunological, and endocrine diseases.
Conclusions
Adult CNV carriers had a markedly increased rate of anxiety and personality disorders not previously reported and high rates of psychiatric multimorbidity. Our findings support in-depth psychiatric and medical assessments of carriers of CNVs and the establishment of multidisciplinary clinical services.
We present experiments and theory relating to transpiration through unrestrained hydrogel beads in contact with a water reservoir below and air above. Experimentally, we find that saturated hydrogel beads shrink until a steady state is reached in which water flows continuously through the beads. The size of the bead in steady state is sensitive to the evaporation rate, which depends on the relative humidity and speed of the surrounding air, and to the pressure head imposed by the fluid reservoir. Specifically, the bead size decreases with increasing pressure head or evaporation rate. Our one-dimensional model proposes that transport in the hydrogel is driven by gradients in osmotic pressure, caused by gradients in polymer concentration in the hydrogel that correspond to gradients in swelling. If the evaporation rate or the pressure head changes, the adjustment of this gradient requires the bead to change shape and size. Smaller beads have larger gradients of osmotic pressure, which drive higher transpiration rates and can draw water against larger pressure heads.
Through laboratory experiments and numerical simulations, we examine the evolution of buoyant plumes as they are influenced by background rotation in a uniform density ambient fluid. The source Rossby number is sufficiently large that rotation does not directly affect the plume at early times. However, on a time scale of the order of half a rotation period, the plume becomes deflected from the vertical axis. For some experiments and simulations, the deflection persists and the flow precesses about the vertical axis. In other cases, shortly after being deflected, the plume laminarizes near the source to form a near-vertical columnar vortex, which we refer to as a ‘tornado’. Tornado formation occurs in some experiments and not in others even if the source and background rotation parameters are identical. However, their formation is more likely if the plumes are ‘lazy’. Simulations reveal that this is a consequence of the competing dynamics that occurs on comparable time scales. As a consequence of entrainment, vertical vorticity builds up within the plume reducing the Rossby number and suppressing vertical motion at distances progressively closer to the source. Meanwhile, the swirl (the ratio of the azimuthal to vertical flow) around the vicinity of the source increases, which tends to suppress three-dimensional turbulence in the near-source flow. Although the former process ultimately acts to deflect the plume off axis, in some instances, the swirl around the source succeeds in laminarizing the flow, resulting in tornado formation.
Just like group actions are represented by group automorphisms, Lie algebra actions are represented by derivations: up to isomorphism, a split extension of a Lie algebra $B$ by a Lie algebra $X$ corresponds to a Lie algebra morphism $B\to {\mathit {Der}}(X)$ from $B$ to the Lie algebra ${\mathit {Der}}(X)$ of derivations on $X$. In this article, we study the question whether the concept of a derivation can be extended to other types of non-associative algebras over a field ${\mathbb {K}}$, in such a way that these generalized derivations characterize the ${\mathbb {K}}$-algebra actions. We prove that the answer is no, as soon as the field ${\mathbb {K}}$ is infinite. In fact, we prove a stronger result: already the representability of all abelian actions – which are usually called representations or Beck modules – suffices for this to be true. Thus, we characterize the variety of Lie algebras over an infinite field of characteristic different from $2$ as the only variety of non-associative algebras which is a non-abelian category with representable representations. This emphasizes the unique role played by the Lie algebra of linear endomorphisms $\mathfrak {gl}(V)$ as a representing object for the representations on a vector space $V$.
We describe here efforts to create and study magnetized electron–positron pair plasmas, the existence of which in astrophysical environments is well-established. Laboratory incarnations of such systems are becoming ever more possible due to novel approaches and techniques in plasma, beam and laser physics. Traditional magnetized plasmas studied to date, both in nature and in the laboratory, exhibit a host of different wave types, many of which are generically unstable and evolve into turbulence or violent instabilities. This complexity and the instability of these waves stem to a large degree from the difference in mass between the positively and the negatively charged species: the ions and the electrons. The mass symmetry of pair plasmas, on the other hand, results in unique behaviour, a topic that has been intensively studied theoretically and numerically for decades, but experimental studies are still in the early stages of development. A levitated dipole device is now under construction to study magnetized low-energy, short-Debye-length electron–positron plasmas; this experiment, as well as a stellarator device that is in the planning stage, will be fuelled by a reactor-based positron source and make use of state-of-the-art positron cooling and storage techniques. Relativistic pair plasmas with very different parameters will be created using pair production resulting from intense laser–matter interactions and will be confined in a high-field mirror configuration. We highlight the differences between and similarities among these approaches, and discuss the unique physics insights that can be gained by these studies.
Although the relative importance of airborne transmission of the SARS-CoV-2 virus is controversial, increasing evidence suggests that understanding airflows is important for estimation of the risk of contracting COVID-19. The data available so far indicate that indoor transmission of the virus far outstrips outdoor transmission, possibly due to longer exposure times and the decreased turbulence levels (and therefore dispersion) found indoors. In this paper we discuss the role of building ventilation on the possible pathways of airborne particles and examine the fluid mechanics of the processes involved.
Households in Canada and Australia have exhibited similar trends in the gendered allocation of additional child care responsibilities resulting from policy responses to the COVID-19 pandemic. In this article, we employ survey data to analyze the extent to which policy interventions related to COVID-19 have exacerbated gender disparities in child care obligations. We find that existing asymmetrical distributions of child care obligations in Canada and Australia have been amplified during the pandemic, resulting in a disproportionate burden on women. During the pandemic we also find that, in households with children, women tend to report experiencing poorer mental health than men.
We give a list of statements on the geometry of elliptic threefolds phrased only in the language of topology and homological algebra. Using only notions from topology and homological algebra, we recover existing results and prove new results on torsion pairs in the category of coherent sheaves on an elliptic threefold.
Negative life events can result in adjustment disorders. If there are feelings of having been treated unfair, been let down or been humiliated one type of reaction are prolonged states of embitterment, which has been described as Posttraumatic Embitterment Disorder, PTED. A new approach in the treatment of PTED is cognitive behavioral psychotherapy which uses special strategies based on wisdom psychology. Wisdom has been defined as the capacity to cope with unsolvable and serious problems and questions in life.
Method
In a controlled clinical trial psychosomatic inpatients which suffered from PTED, were randomly assigned to “wisdom therapy” (N=28), which focusses on the reframing of the traumatic event and to “wisdom and headonia therapy” (N=29), which additionally encourages patients to focus on positive aspects in life. Another group of PTED patients (N=50) and patients with other mental disorders (N=50) received treatment as usual.
Results
PTED patients who were treated with wisdom psychotherapy showed a reduction in the SCL-90-PST score of initially 55,7 and at the end of 40,1 and those treated with hedonia therapy of initially 58,7 and at the end of 41,3. Measures of therapist adherence showed that therapists in both groups used wisdom strategies. PTED controls started initially with a SCL-90-PST score of 52,2 and ended with 50,2. Other patients started treatment with 39,3 and finished with 25,9.
Discussion
This first treatment study on cognitive wisdom therapy suggests that wisdom can be helpful in the treatment of adjustment and embitterment disorders.