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At the core of this book is the importance to people’s wellbeing and health of their social connectedness, attachments and attachment capacities, and their social identities. It is clear that people crave society and that they gain support, meaning and a sense of control from their shared social identities that sustain them, day to day. Furthermore, their social connectedness and identities provide them with templates for how they respond, cope and are supported when they meet challenges and adversity.
But, turning the tables, what is it like to care for other people? While doing so may give much satisfaction and meaning to carers, that role is not without its own challenges. The focal matter in this chapter is that of how to encourage professional practitioners to engage fully in working compassionately for the people in their care while taking steps to reduce the potential burdens of so doing.
This chapter rounds off Section 2. In it, one of the authors, Jonathan Montgomery, begins by highlighting his view of the recurrent themes that arise from all eight chapters in this section.
Then, one of the editors, Alex Haslam, responds by substantially agreeing with Jonathan Montgomery. However, Haslam takes the opportunity to clarify one of the points that Montgomery makes with the intention of drawing attention to a key issue that runs like an artery through the body of this book. This concerns the nature of personalised healthcare and how this should best be understood and delivered. Haslam cautions that, in the process of developing personalised care, we should avoid the temptation to reduce peoples’ maladies to their individual conditions.
Healthcare professionals who work in palliative care units face stressful life events on a daily basis, most notably death. For this reason, these professionals must be equipped with the necessary protective resources to help them cope with professional and personal burnout. Despite the well-recognized importance of the construct “meaning of work,” the role of this construct and its relationship with other variables is not well-understood. Our objective is to develop and evaluate a model that examines the mediating role of the meaning of work in a multidisciplinary group of palliative care professionals. Using this model, we sought to assess the relationships between meaning of work, perceived stress, personal protective factors (optimism, self-esteem, life satisfaction, personal growth, subjective vitality), and sociodemographic variables.
Professionals (n = 189) from a wide range of disciplines (physicians, psychologists, nurses, social workers, nursing assistants, physical therapists, and chaplains) working in palliative care units at hospitals in Madrid and the Balearic Islands were recruited. Sociodemographic variables were collected and recorded. The following questionnaires were administered: Meaning of Work Questionnaire, Perceived Stress Questionnaire, Life Orientation Test-Revised, Satisfaction with Life Scale, Subjective Vitality Scale, Rosenberg Self-Esteem Scale, and the Personal Growth Scale.
The explanatory value of the model was high, explaining 49.5% of the variance of life satisfaction, 43% of subjective vitality, and 36% of personal growth. The main findings of this study were as follow: (1) meaning of work and perceived stress were negatively correlated; (2) optimism and self-esteem mediated the effect of stress on the meaning attached to work among palliative care professionals; (3) the meaning of work mediated the effect of stress on subjective vitality, personal growth, and life satisfaction; and (4) vitality and personal growth directly influenced life satisfaction.
Significance of results
The proposed model showed a high explanatory value for the meaning professionals give to their work and also for perceived stress, personal protective factors, and sociodemographic variables. Our findings could have highly relevant practical implications for designing programs to promote the psychological well-being of healthcare professionals.
Scientific observations of sea ice began more than a century ago, but detailed sea-ice models appeared only in the latter half of the last century. The high albedo of sea ice is critical for the Earth’s heat balance, and ice motion across the ocean’s surface transports fresh water and salt. The basic components in a complete sea-ice model must include vertical thermodynamics and horizontal dynamics, including a constitutive relation for the ice, advection and deformational processes. This overview surveys topics in sea-ice modeling from the global climate modeling perspective, emphasizing work that significantly advanced the state of the art and highlighting promising new developments.
We describe the design and performance of the Engineering Development Array, which is a low-frequency radio telescope comprising 256 dual-polarisation dipole antennas working as a phased array. The Engineering Development Array was conceived of, developed, and deployed in just 18 months via re-use of Square Kilometre Array precursor technology and expertise, specifically from the Murchison Widefield Array radio telescope. Using drift scans and a model for the sky brightness temperature at low frequencies, we have derived the Engineering Development Array’s receiver temperature as a function of frequency. The Engineering Development Array is shown to be sky-noise limited over most of the frequency range measured between 60 and 240 MHz. By using the Engineering Development Array in interferometric mode with the Murchison Widefield Array, we used calibrated visibilities to measure the absolute sensitivity of the array. The measured array sensitivity matches very well with a model based on the array layout and measured receiver temperature. The results demonstrate the practicality and feasibility of using Murchison Widefield Array-style precursor technology for Square Kilometre Array-scale stations. The modular architecture of the Engineering Development Array allows upgrades to the array to be rolled out in a staged approach. Future improvements to the Engineering Development Array include replacing the second stage beamformer with a fully digital system, and to transition to using RF-over-fibre for the signal output from first stage beamformers.
This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study’s analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.
To examine the choices Canadian family medicine residents make for oral anticoagulation (OAC) for patients with nonvalvular atrial fibrillation (AF).
AF increases the risk of strokes. An important consideration in AF management is risk stratification for stroke and prescription of appropriate OAC. Family physicians provide the vast majority of OAC prescriptions.
We administered a survey to residents in multiple Canadian family medicine training programmes. Questions explored the experiences and attitudes towards risk stratification and choices of OAC when presented with standardized clinical scenarios. In each scenario, a novel oral anticoagulant (NOAC) would be the preferred treatment according to the contemporary Canadian and European guidelines.
A total of 247 residents participated in the survey. Most used the congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, stroke or TIA (2 points) (81%) and congestive heart failure, hypertension, age ≥ 75 (2 points) or age 65-74 (1 point), diabetes mellitus, stroke or TIA, vascular disease including peripheral arterial disease, myocardial infarction, or aortic plaque, sex (female) (67%) risk stratification schemes while the preferred bleeding risk stratification scheme was hypertension, abnormal liver or renal function, stroke, bleeding, labile international normalized ratio, elderly (age ≥ 65), drugs or alcohol (84%). In the clinical scenarios, residents generally preferred warfarin in favour of NOACs, independent of training level. Residents ranked the risk of adverse events and the cost to the patient as their most and least important consideration when prescribing OAC, respectively. Therefore in patients with nonvalvular AF, Canadian family medicine residents prefer warfarin in comparison with NOACs despite the latest Canadian and European guideline recommendations. This knowledge gap may be enhanced by multiple factors, including a sometimes magnified fear of adverse events and a rapidly changing landscape in stroke prophylaxis.
The lower Palaeozoic marine succession of NE Vietnam accumulated on the South China plate. Despite historical works dating to French colonial times, the stratigraphy and palaeontology of the succession is poorly constrained. Chief amongst the lower Palaeozoic lithostratigraphical divisions is the Than Sa Formation, a c. 1200 m thick succession of clastic rocks of Cambrian and early Ordovician age. Newly collected graptolites (including Rhabdinopora? sp. and Tetragraptus approximatus) from the upper part of the formation identify strata assignable to the Tremadocian and Floian stages of the Lower Ordovician. The same succession also probably records the Cambrian–Ordovician boundary. Our analysis identifies one or more intervals of graptolite-bearing laminated mudstones in the upper part of the Than Sa Formation that may be widespread in NE Vietnam during the early Tremadocian.
Richard Williams, OBE, Emeritus Professor of Mental Health Strategy, Welsh Institute for Health and Social Care, University of South Wales,
Verity Kemp, Director of Healthplanning Ltd, Associate of the Welsh Institute for Health and Social Care, University of South Wales,
Adrian Neal, Consultant Clinical Psychologist, Head of Employee Wellbeing, Aneurin Bevan University Health Board, NHS Wales
‘Compassion (which is an element of loving-kindness) involves being open to the suffering of self and others, in a non-defensive and non-judgemental way. Compassion also involves a desire to relieve suffering, cognitions related to understanding the causes of suffering, and behaviours – acting with compassion. Hence it is from a combination of motives, emotions, thoughts and behaviours that compassion emerges.’ (Gilbert, 2005)
As we write, the world is extremely concerned about the Ebola outbreak. Viral haemorrhagic fevers make carers’ proximity to their patients dangerous and the protective equipment severely limits communication. The staff experience anguish because of the lethality of Ebola but also because very restricted personal contact with their patients limits their ability to express compassion and there are wide sociocultural impacts on western Africa and elsewhere (Ravi & Gaudlin, 2014). Perhaps there are lessons that could be learned from this awful epidemic and disasters generally about the nature of compassionate care and the care and support that staff require in order to sustain their work in more ordinary circumstances.
The staff of health services are renowned for their resilience and resourcefulness under pressure. Provided that resources are sufficient and the environment conducive, and they are well led, the quality of healthcare services is substantially related to the values and capabilities of the people who work in them. Public expectations are that staff consistently deliver effective, evidence-based care and interventions sensitively and compassionately, even if the environments in which they work are not optimal. However, there are, from time to time, lamentable lapses in the quality of care that patients receive and, despite an increasing focus on corporate and clinical governance over the last 20 years, there continue to be high-profile instances of catastrophic system failure in which organisations fail to deliver the minimum standards of compassionate care (Francis, 2013; Andrews & Butler, 2014).
This chapter focuses on the importance of providing staff within mental health services with effective leadership, support and care in order to sustain them. It is our evidence-informed and values-based position that doing so is likely to enable staff to continue to consistently deliver compassionate care for their patients.
Seed-oriented planting provides a manner to influence canopy structure. The purpose of this research was to improve maize light interception using seed-oriented planting to manipulate leaf azimuth across the row thereby minimizing leaf overlap. To achieve leaf azimuths oriented preferentially across the row, seeds were planted: (i) upright with caryopsis pointed down, parallel to the row (upright); and (ii) laying flat, embryo up, perpendicular to the row (flat). These treatments were compared to conventionally planted seeds with resulting random leaf azimuth distribution. Seed orientation effects were contrasted with three levels of plant population and two levels of hybrid specific canopy structures. Increased plant population resulted in greater light interception but yield tended to decrease as plant population increased. The planophile hybrid produced consistently greater yields than the erectophile hybrid. The difference between planophile and erectophile hybrids ranged from 283 to 903 kg ha−1. Overall, mean grain yield for upright and flat seed placement increased by 351 and 463 kg ha−1 compared to random seed placement. Greater cumulative intercepted photosynthetically active radiation (CIPAR) was found for oriented seeds rather than random-oriented seeds. At physiological maturity upright, flat and random-oriented seeds intercepted 555, 525 and 521 MJ m−2 of PAR, respectively. Maize yield responded positively to improved light interception and better radiation use efficiency. Under irrigated conditions, precision planting of maize increased yield by 9 to 14% compared to random-oriented seeds.
The characteristics of silicon films deposited by plasma depend strongly on the reactor parameters. In our experiments, the two-level factorial design was implemented. Pressure, silane and hydrogen flows were set at high and low values for the synthesis of silicon films. Results showed that the flows of silane and hydrogen played a key role, being the influence of pressure low. In particular, the samples at high level of hydrogen exhibited the lowest deposition rate and photosensitivity. On the other hand, the samples at low level of hydrogen showed crystalline regions and high deposition rate. For the lowest dilution ratio, nano/meso-structured silicon films were obtained, showing high photosensitivity and high roughness that increases the scattering of light. These characteristics of our films make them suitable to be used in photovoltaics.
Medical factors including tuberculosis, scurvy, lead poisoning and botulism have been proposed to explain the high death rate prior to desertion of the ships on Sir John Franklin's expedition of 1845–1848 but their role remains unclear because the surgeons’ Sick books which recorded illness on board have eluded discovery. In their absence, this study examines the Sick books of Royal Naval search squadrons sent in search of Franklin, and which encountered similar conditions to his ships, to consider whether their morbidity and mortality might reflect that of the missing expedition. The Sick books of HMS Assistance, Enterprise, Intrepid, Investigator, Pioneer and Resolute yielded 1,480 cases that were coded for statistical analysis. On the basis of the squadrons’ patterns of illness it was concluded that Franklin's crews would have suffered common respiratory and gastro-intestinal disorders, injuries and exposure and that deaths might have occurred from respiratory, cardiovascular and tubercular conditions. Scurvy occurred commonly and it was shown that the method of preparing ‘antiscorbutic’ lemon juice for the search squadrons and Franklin's ships would have reduced its capacity to prevent the disease but there were no grounds to conclude that scurvy was significant at the time of deserting the ships. There was no clear evidence of lead poisoning despite the relatively high level of lead exposure that was inevitable on ships at that time. There was no significant difference between the deaths of non-officer ranks on Franklin's ships and several of the search ships. The greater number of deaths of Franklin's officers was proposed to be more probably a result of non-medical factors such as accidents and injuries sustained while hunting and during exploration.
The eastern bettong Bettongia gaimardi, a potoroid marsupial, has been extinct on the Australian mainland since the 1920s. Sixty adult bettongs were reintroduced from the island of Tasmania to two predator-free fenced reserves on mainland Australia. We examined baseline health parameters (body weight, haematology and biochemistry, parasites and infectious disease exposure) in a subset of 30 (13 male, 17 female) individuals at translocation and again at 12–24 months post-reintroduction. The mean body weight increased significantly post-reintroduction but there were no significant differences in body weight between the two reintroduction sites or between the sexes in response to reintroduction. Differences were evident in multiple haematological and biochemical variables post-reintroduction but there were few differences between the two reintroduced populations or between the sexes in response to reintroduction. Ectoparasite assemblages differed, with five of 13 species failing to persist, and an additional four species were identified post-reintroduction. None of the bettongs had detectable antibodies to the alphaherpesviruses Macropodid herpesvirus 1 and 2 post-reintroduction, including one individual that was seropositive at translocation. Similarly, the novel gammaherpesvirus potoroid herpesvirus 1 was not detected by polymerase chain reaction (PCR) in any of the bettongs post-reintroduction, including one individual that was PCR-positive at translocation. None of the bettongs had detectable antibodies to Toxoplasma gondii either at translocation or post-reintroduction. Our data demonstrate changing baseline health parameters in eastern bettongs following reintroduction to the Australian mainland are suggestive of improved health in the reintroduced populations, and provide additional metrics for assessing the response of macropodoids to reintroduction.
The dynamic model Nitrogen Dynamics in Crop rotations in Ecological Agriculture (NDICEA) was used to assess the nitrogen (N), phosphorus (P) and potassium (K) balance of long-term organic cropping trials and typical organic crop rotations on a range of soil types and rainfall zones in the UK. The measurements of soil N taken at each of the organic trial sites were also used to assess the performance of NDICEA. The modeled outputs compared well to recorded soil N levels, with relatively small error margins. NDICEA therefore seems to be a useful tool for UK organic farmers. The modeling of typical organic rotations has shown that positive N balances can be achieved, although negative N balances can occur under high rainfall conditions and on lighter soil types as a result of leaching. The analysis and modeling also showed that some organic cropping systems rely on imported sources of P and K to maintain an adequate balance and large deficits of both nutrients are apparent in stockless systems. Although the K deficits could be addressed through the buffering capacity of minerals, the amount available for crop uptake will depend on the type and amount of minerals present, current cropping and fertilization practices and the climatic environment. A P deficit represents a more fundamental problem for the maintenance of crop yields and the organic sector currently relies on mined sources of P which represents a fundamental conflict with the International Federation of Organic Agriculture Movements organic principles.
Reintroductions are used to re-establish populations of species within their indigenous range, but their outcomes are variable. A key decision when developing a reintroduction strategy is whether to include a temporary period of confinement prior to release. Pre-release confinement is primarily used for the purpose of quarantine or as a delayed-release tactic to influence the performance or behaviour of founders post-release. A common difference between these approaches is that quarantine tends to be conducted in ex situ captivity, whereas delayed releases tend to involve in situ confinement at the release site. Although these practices are commonly viewed independently, it may be possible for a single confinement period to be used for both purposes. We tested whether temporarily holding wild eastern bettongs Bettongia gaimardi in ex situ captivity for 95–345 days prior to release (delayed release) influenced their body mass, pouch occupancy or survival during the first 1.5 years post-release, compared to founders released without confinement (immediate release). Our results suggest that exposing founders to captivity did not alter their body mass or performance post-release, despite being heavier and having fewer pouch young when released. We conclude that, for this species, ex situ captivity does not represent a tactical opportunity to improve post-release performance but can be used for quarantine without affecting the probability of establishment.