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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.
In Arabidopsis, seed germination is a biphasic process involving rupture of the seed coat followed by emergence of the radicle through the micropylar endosperm. Embryo expansion results in seed coat rupture and removal of seed coat imposed dormancy with DELLA proteins blocking embryo expansion in the absence of gibberellins. Exogenous abscisic acid (ABA) treatment does not block seed coat rupture but does block radicle emergence. We used this limited effect of exogenous ABA to further investigate the mechanism by which it blocks the onset of germination marked by seed coat rupture. We show that physical nicking of the seed coat results in exogenous ABA treatment blocking both seed coat and endosperm rupture and this block requires the transcription factors ABI3 and ABI5, but not ABI4. Furthermore, we show that the repression of expression of several EXPANSIN genes (EXPA1, EXPA2, EXPA3, EXPA9 and EXPA20) by exogenous ABA requires ABI5. We conclude that ABI5 plays an important role in the ABA-mediated repression of germination through prevention of seed coat rupture and propose that this involves EXPANSIN related control of cell wall loosening.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Gut microbes have a substantial influence on systemic immune function and allergic sensitisation. Manipulation of the gut microbiome through prebiotics may provide a potential strategy to influence the immunopathology of asthma. This study investigated the effects of prebiotic Bimuno-galactooligosaccharide (B-GOS) supplementation on hyperpnoea-induced bronchoconstriction (HIB), a surrogate for exercise-induced bronchoconstriction, and airway inflammation. A total of ten adults with asthma and HIB and eight controls without asthma were randomised to receive 5·5 g/d of either B-GOS or placebo for 3 weeks separated by a 2-week washout period. The peak fall in forced expiratory volume in 1 s (FEV1) following eucapnic voluntary hyperpnoea (EVH) defined HIB severity. Markers of airway inflammation were measured at baseline and after EVH. Pulmonary function remained unchanged in the control group. In the HIB group, the peak post-EVH fall in FEV1 at day 0 (−880 (sd 480) ml) was unchanged after placebo, but was attenuated by 40 % (−940 (sd 460) v. −570 (sd 310) ml, P=0·004) after B-GOS. In the HIB group, B-GOS reduced baseline chemokine CC ligand 17 (399 (sd 140) v. 323 (sd 144) pg/ml, P=0·005) and TNF-α (2·68 (sd 0·98) v. 2·18 (sd 0·59) pg/ml, P=0·040) and abolished the EVH-induced 29 % increase in TNF-α. Baseline C-reactive protein was reduced following B-GOS in HIB (2·46 (sd 1·14) v. 1·44 (sd 0·41) mg/l, P=0·015) and control (2·16 (sd 1·02) v. 1·47 (sd 0·33) mg/l, P=0·050) groups. Chemokine CC ligand 11 and fraction of exhaled nitric oxide remained unchanged. B-GOS supplementation attenuated airway hyper-responsiveness with concomitant reductions in markers of airway inflammation associated with HIB.
We have undertaken an adaptive optics imaging survey of extra-solar planetary systems and stars showing interesting radial velocity trends from high precision radial velocity searches. Adaptive Optics increases the resolution and dynamic range of an image, substantially improving the detectability of faint close companions. This survey is sensitive to objects less luminous than the bottom of the main sequence at separations as close as 1″. We have detected stellar companions to the planet bearing stars HD 114762 and Tau Boo. We have also detected a companion to the non-planet bearing star 16 Cyg A.
This paper treats a holomorphic self-mapping f: Ω → Ω of a bounded domain Ω in a separable Hilbert space with a fixed point p. In case the domain is convex, we prove an infinite-dimensional version of the Cartan-Carathéodory-Kaup-Wu Theorem. This is basically a rigidity result in the vein of the uniqueness part of the classical Schwarz lemma. The main technique, inspired by an old idea of H. Cartan, is iteration of the mapping f and its derivative. A normality result for holomorphic mappings in the compact-weak-open topology, due to Kim and Krantz, is used.
To identify the behavioral determinants—both barriers and enablers—that may impact physician hand hygiene compliance.
A qualitative study involving semistructured key informant interviews with staff physicians and residents.
An urban, 1,100-bed multisite tertiary care Canadian hospital.
A total of 42 staff physicians and residents in internal medicine and surgery.
Semistructured interviews were conducted using an interview guide that was based on the theoretical domains framework (TDF), a behavior change framework comprised of 14 theoretical domains that explain health-related behavior change. Interview transcripts were analyzed using thematic content analysis involving a systematic 3-step approach: coding, generation of specific beliefs, and identification of relevant TDF domains.
Similar determinants were reported by staff physicians and residents and between medicine and surgery. A total of 53 specific beliefs from 9 theoretical domains were identified as relevant to physician hand hygiene compliance. The 9 relevant domains were knowledge; skills; beliefs about capabilities; beliefs about consequences; goals; memory, attention, and decision processes; environmental context and resources; social professional role and identity; and social influences.
We identified several key determinants that physicians believe influence whether and when they practice hand hygiene at work. These beliefs identify potential individual, team, and organization targets for behavior change interventions to improve physician hand hygiene compliance.
Infect Control Hosp Epidemiol 2014;35(12):1511–1520
Direct social contact interventions are known to reduce mental health stigma. Filmed social contact may be equally effective and have practical and cost advantages.
To compare the effectiveness of a DVD, a live intervention and a lecture control, in reducing stigma, testing the hypotheses that: (a) DVD and live interventions will be equally effective; and (b) the interventions with social contact (DVD/live) will be more effective than the lecture. Cost-effectiveness, process and acceptability are also assessed.
Student nurses were randomised to: (a) watch a DVD of service users/informal carers talking about their experiences, (b) watch a similar live presentation, or (c) attend a lecture. Primary outcomes were changes in attitudes (using the Mental Illness: Clinicians Attitudes Scale, MICA), emotional reactions (using the Emotional Reactions to Mental Illness Scale, ERMIS), intended proximity (using the Reported and Intended Behaviour Scale, RIBS), and knowledge (using the Social Contact Intended Learning Outcomes, SCILO), immediately after the intervention and at 4-month follow-up.
For the 216 participants, there were no differences between the DVD and live groups on MICA, ERMIS or RIBS scores. The DVD group had higher SCILO (knowledge) scores. The combined social contact group (DVD/live) had better MICA and RIBS scores than the lecture group, the latter difference maintained at 4 months. The DVD was the most cost-effective of the interventions, and the live session the most popular.
Our hypotheses were confirmed. This study supports the wider use of filmed social contact interventions to reduce stigma about mental illness.
The formal commissioning of the IRWG occurred at the 1991 Buenos Aires General Assembly, following a Joint Commission meeting at the IAU GA in Baltimore in 1988 that identified the problems with ground-based infrared photometry. The meeting justification, papers, and conclusions, can be found in Milone (1989). In summary, the challenges involved how to explain the failure to achieve the milli-magnitude precision expected of infrared photometry and an apparent 3% limit on system transformability. The proposed solution was to redefine the broadband Johnson system, the passbands of which had proven so unsatisfactory that over time effectively different systems proliferated, although bearing the same “JHKLMNQ” designations; the new system needed to be better positioned and centered in the spectral windows of the Earth's atmosphere, and the variable water vapour content of the atmosphere needed to be measured in real time to better correct for atmospheric extinction.
Agents of opportunity (AO) in academic medical centers (AMC) are defined as unregulated or lightly regulated substances used for medical research or patient care that can be used as “dual purpose” substances by terrorists to inflict damage upon populations. Most of these agents are used routinely throughout AMC either during research or for general clinical practice. To date, the lack of careful regulations for AOs creates uncertain security conditions and increased malicious potential. Using a consensus-based approach, we collected information and opinions from staff working in an AMC and 4 AMC-affiliated hospitals concerning identification of AO, AO attributes, and AMC risk and preparedness, focusing on AO security and dissemination mechanisms and likely hospital response. The goal was to develop a risk profile and framework for AO in the institution. Agents of opportunity in 4 classes were identified and an AO profile was developed, comprising 16 attributes denoting information critical to preparedness for AO misuse. Agents of opportunity found in AMC present a unique and vital gap in public health preparedness. Findings of this project may provide a foundation for a discussion and consensus efforts to determine a nationally accepted risk profile framework for AO. This foundation may further lead to the implementation of appropriate regulatory policies to improve public health preparedness. Agents of opportunity modeling of dissemination properties should be developed to better predict AO risk.
(Disaster Med Public Health Preparedness. 2010;4:318-325)
Background: Agents of opportunity (AO) are potentially harmful biological, chemical, radiological, and pharmaceutical substances commonly used for health care delivery and research. AOs are present in all academic medical centers (AMC), creating vulnerability in the health care sector; AO attributes and dissemination methods likely predict risk; and AMCs are inadequately secured against a purposeful AO dissemination, with limited budgets and competing priorities. We explored health care workers' perceptions of AMC security and the impact of those perceptions on AO risk.
Methods: Qualitative methods (survey, interviews, and workshops) were used to collect opinions from staff working in a medical school and 4 AMC-affiliated hospitals concerning AOs and the risk to hospital infrastructure associated with their uncontrolled presence. Secondary to this goal, staff perception concerning security, or opinions about security behaviors of others, were extracted, analyzed, and grouped into themes.
Results: We provide a framework for depicting the interaction of staff behavior and access control engineering, including the tendency of staff to “defeat” inconvenient access controls. In addition, 8 security themes emerged: staff security behavior is a significant source of AO risk; the wide range of opinions about “open” front-door policies among AMC staff illustrates a disparity of perceptions about the need for security; interviewees expressed profound skepticism concerning the effectiveness of front-door access controls; an AO risk assessment requires reconsideration of the security levels historically assigned to areas such as the loading dock and central distribution sites, where many AOs are delivered and may remain unattended for substantial periods of time; researchers' view of AMC security is influenced by the ongoing debate within the scientific community about the wisdom of engaging in bioterrorism research; there was no agreement about which areas of the AMC should be subject to stronger access controls; security personnel play dual roles of security and customer service, creating the negative perception that neither role is done well; and budget was described as an important factor in explaining the state of security controls.
Conclusions: We determined that AMCs seeking to reduce AO risk should assess their institutionally unique AO risks, understand staff security perceptions, and install access controls that are responsive to the staff's tendency to defeat them. The development of AO attribute fact sheets is desirable for AO risk assessment; new funding and administrative or legislative tools to improve AMC security are required; and security practices and methods that are convenient and effective should be engineered.
(Disaster Med Public Health Preparedness. 2010;4:291-299)
This paper presents an analysis of access to social and health services of elderly people at three community and social service centres (CLSCs) in Montreal. Workers at the CLSCs were interviewed about service accessibility for elderly people in their neighbourhood. The elderly clientele of one CLSC, located in the centre of Montreal, primarily consists of French-Canadians and English-Canadians; the second CLSC is in a neighbourhood with many elderly Portuguese and the third CLSC is in a neighbourhood where a large concentration of elderly Chinese people live. No problems of access to services were perceived for elderly French-Canadian, English-Canadian or Portuguese people while serious problems of access were perceived for elderly Chinese people. Services provided for elderly people of the dominant cultures and elderly Portuguese are limited or unavailable to elderly Chinese people of Montreal. This suggests institutional racism against elderly Chinese people.
The purpose of this paper is to introduce, define and test a theoretical model which explains elderly people's use of urban shopping centres as places for social exchange. We suggest that elderly people use shopping centres to satisfy social and leisure are individual or predisposing variables and environmental or encouraging variables which differentiate elderly people who engage in this activity. Using a secondary data analysis of a probability sample of 300 non-institutionalized elderly people in Montreal, we found that mallingering is an activity that 67 per cent of this sample do in three shopping centres in this city. Predisposing variables such as age, gender, education and feelings of loneliness, along with encouraging variables such as design and ambiance of the centre are related to this activity. Based on these findings, we suggest that this model contributes to our understanding of the leisure activities of non-institutionalized elderly people.
Several writers have suggested that there is an inverted U-curve of status or prestige across the lifespan in Western society. The old and the young are apparently accorded less status than persons in midlife, and women are seen as having less status than men.
In this study of 198 older individuals (mean age 67), the same inverted U-curve was found, but gender differences were very small. Much less extreme status ratings were given by this older sample than by the earlier samples of young adults. Also, status ratings were again mostly unaffected by respondents' characteristics such as age, sex, marital status, or social class. Older adults, therefore, seem to accept the broad cultural views of age stratification, but are slightly more egalitarian than the young.
Objectives: The objective of this study is to profile the health technology assessments (HTAs) produced in Canada and other selected countries and assess their potential to inform policy making about health systems in jurisdictions other than the ones for which they were produced, and to develop and pilot test prototypes for packaging and assessing the relevance of HTAs for health system managers and policy makers.
Methods: We compiled an inventory of all HTAs that were produced by nine HTA agencies between September 2003 and August 2006; coded the title and abstract of each HTA according to the technologies assessed, methods used, and whether or not context-specific actionable messages were provided; developed a prototype for a structured, decision-relevant HTA summary and for a relevance-assessment form; and pilot-tested the prototypes using semistructured telephone interviews with a purposive sample of Canadian healthcare managers and policy makers.
Results: Our review of the 223 HTAs identified that: (i) 44 HTAs addressed health system arrangements (20 percent); (ii) 205 incorporated a systematic review (92 percent), whereas only 12 incorporated a sociopolitical assessment using explicit methods (5 percent); and (iii) 50 contained context-specific actionable messages (22 percent). Our interviews identified significant support for both the general idea of an HTA summary and the prototype's specific elements, but mixed views about using peer assessments of relevance.
Conclusions: Those involved in supporting the use of HTAs in policy making about health systems may wish to produce structured decision-relevant summaries for their systematic review-containing HTAs to increase the prospects for their HTAs being used outside the jurisdiction for which they were produced.
The broad-scale effects of salmon farming on benthic and epibenthic macrofaunal
communities of four Scottish sea lochs (Kishorn, Duich, Hourn and Nevis) with different
aquaculture loadings were investigated based on the first benthic surveys to be undertaken
in these lochs. Significant variation in the benthic communities was identified between
lochs, mainly related to differences in the abundance of echinoderms and polychaetes (the
dominant components of the benthic communities). Variance partitioning using partial
redundancy analysis suggested that approximately 9.6% of this variation could be related
to aquaculture activity in the lochs (as expressed through “production” and previously
modelled “impact” levels), as compared to 20.6% attributable to measured environmental
factors. Epibenthic communities were dominated by echinoderms and arthropods and there was
no significant between-loch variation in epibenthic community composition. No significant
differences were apparent in the benthic or epibenthic community assemblages between
samples taken within 2000 m of a fish farm and those taken beyond this distance. In
general, our results support previous studies suggesting a spatially limited impact of
salmon culture installations on the benthos, although impacts on the aquatic food web on a
wide spatial scale cannot be ruled out and the link between benthic community variation
and aquaculture variables identified through variance partitioning requires further