To send 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 sending content to .
To send content items to your Kindle, first ensure email@example.com
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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence of the accuracy of measures used to screen adults for spiritual suffering.
A systematic review of the literature. We searched five scientific databases to identify relevant articles. Two independent reviewers screened, extracted data, and assessed study methodological quality.
We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the two-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82–87%), and the revised Rush protocol had the highest specificity (81–90%). The methodological quality of all included studies was low.
Significance of Results
While most of the identified spiritual screening measures are brief (comprised 1 to 12 items), few had sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.
Current coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment.
To identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.
In the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options.
Key challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries.
Including mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities.
Declaration of interest
D.C. is a staff member of the World Health Organization.
Introduction: Patient satisfaction is an essential component of effective delivery of quality care in the emergency department (ED). Frequent reflection on current practices is required to detect areas in need of improvement. The Ontario Hospital Association (OHA) outlined five ‘Leading Practices’ (LPs) targeted to increase patient satisfaction in this setting. The ED volunteers are a group of individuals who have unique perspectives on ED practices that are unbiased by confounders affecting patients and staff. The goal of this study was to explore the unique perspectives of ED volunteers involving what they believe will improve the delivery of patient-centered care, as well as to examine to what extent Saskatoon EDs are embracing the principles outlined in the OHA LPs. Methods: A two-phase mixed methods approach, with a survey followed by interviews that allowed participants to expand on survey findings was used. The pool of 45 ED volunteers was extended the opportunity to participate resulting in 36 survey responses and 6 interviews. The 13 Likert-grade survey questions were generated to align to each of the LPs and allowed room for qualitative feedback. Interview questions were generated following 15 survey responses to expand on the LPs that were rated below average. Results: Analysis of responses identified inefficient ED processes leading to increased waiting times, inefficient patient location, inadequate signage, a lack of physical space, unclean environments, and a lack of staff and volunteer awareness regarding spiritual care and interpreter services, perceptions of received care by patients due to long wait times and level of cultural safety training of ED staff. Themes reduced from interviews yielded common themes such as patient frustration, disorganization, uncomfortable environment, overcrowding, prolonged wait times, and patient misconception of ED processes at Site 1. Themes common to Site 2 included organization, patient-friendly environment, patient misconception of ED processes, and prolonged wait times. Additionally, the volunteers suggested a plethora of interventions that could improve the current processes in Saskatoon's EDs to make them more patient friendly. Conclusion: Saskatoon EDs comply reasonably well to the OHA Leading practices. Surveying ED volunteers provides important insight into current practices and areas for improvement, and should be considered at other sites to improve adherence to the OHA LPs.
Little is known about the household economic costs associated with mental, neurological and substance use (MNS) disorders in low- and middle-income countries.
To assess the association between MNS disorders and household education, consumption, production, assets and financial coping strategies in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda.
We conducted an exploratory cross-sectional household survey in one district in each country, comparing the economic circumstances of households with an MNS disorder (alcohol-use disorder, depression, epilepsy or psychosis) (n = 2339) and control households (n = 1982).
Despite some heterogeneity between MNS disorder groups and countries, households with a member with an MNS disorder had generally lower levels of adult education; lower housing standards, total household income, effective income and non-health consumption; less asset-based wealth; higher healthcare expenditure; and greater use of deleterious financial coping strategies.
Households living with a member who has an MNS disorder constitute an economically vulnerable group who are susceptible to chronic poverty and intergenerational poverty transmission.
Declaration of interest
D.C. is a staff member of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.
This paper describes a model of electron energization and cyclotron-maser emission applicable to astrophysical magnetized collisionless shocks. It is motivated by the work of Begelman, Ergun and Rees [Astrophys. J. 625, 51 (2005)] who argued that the cyclotron-maser instability occurs in localized magnetized collisionless shocks such as those expected in blazar jets. We report on recent research carried out to investigate electron acceleration at collisionless shocks and maser radiation associated with the accelerated electrons. We describe how electrons accelerated by lower-hybrid waves at collisionless shocks generate cyclotron-maser radiation when the accelerated electrons move into regions of stronger magnetic fields. The electrons are accelerated along the magnetic field and magnetically compressed leading to the formation of an electron velocity distribution having a horseshoe shape due to conservation of the electron magnetic moment. Under certain conditions the horseshoe electron velocity distribution function is unstable to the cyclotron-maser instability [Bingham and Cairns, Phys. Plasmas 7, 3089 (2000); Melrose, Rev. Mod. Plasma Phys. 1, 5 (2017)].
Detailed x-ray double-axis rocking-curve analysis has been made of a series of silicon wafers, polished using various colloidal silicas with a number of different conditions. Significant differences, attributable to the polishing conditions, were observed in the tails of the rocking curves, using a four-reflection, non-dispersive beam conditioner. These have been compared with theoretical simulations in order to deduce the strain profile near the surface.
The Upper Famennian (Upper Devonian) Strud locality has yielded very abundant and diversified flora as well as vertebrate and arthropod faunas. The arthropod fauna, mostly recovered from fine shales deposited in a calm, confined floodplain habitat including temporary pools, has delivered a putative insect and various crustaceans including eumalacostracans and notostracan, spinicaudatan and anostracan branchiopods. Here we present the Strud eurypterids, consisting of semi-articulated juvenile specimens assigned to Hardieopteridae recovered from the pool and floodplain deposits, as well as larger isolated fragments of potential adults recovered from stratigraphically lower, coarser dark sandy layers indicative of a higher-energy fluvial environment. The Strud fossils strongly suggest that, as proposed for some Carboniferous eurypterids, juvenile freshwater eurypterids inhabited sheltered nursery pools and migrated to higher-energy river systems as they matured.
Although federal regulation of vehicle fuel economy is often seen as environmental policy, over 70% of the estimated benefits of the 2017–2025 federal standards are savings in consumer expenditures on gasoline. Rational-choice economists question the counting of these benefits since studies show that the fuel efficiency of a car is reflected in its price at sale and resale. We contribute to this debate by exploring why most consumers in the United States do not purchase a proven fuel-saving innovation: the hybrid-electric vehicle (HEV). A database of 110 vehicle pairs is assembled where a consumer can choose a hybrid or gasoline version of virtually the same vehicle. Few choose the HEV. A total cost of ownership model is used to estimate payback periods for the price premiums associated with the HEV choice. In a majority of cases, a rational-choice explanation is sufficient to understand consumer disinterest in the HEV. However, in a significant minority of cases, a rational-choice explanation is not readily apparent, even when non-pecuniary attributes (e.g., performance and cargo space) are considered. Future research should examine, from a behavioral economics perspective, why consumers do not choose HEVs when pricing and payback periods appear to be favorable.