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A sense of security is important in palliative home care. Yet, knowledge about which components contribute most to feeling secure from the patients’ and family caregivers’ perspectives, especially since the introduction of specialist palliative home care, is sparse. The goal of the current study was to determine the key components contributing to a sense of security and how they relate to each other as experienced by patients and family caregivers in specialist and generalist palliative home care.
The current sub-study, as part of a larger study, was performed in different regions in Germany. Palliative care patients and family caregivers of at least 18 years of age, being cared for at home were interviewed using semi-structured interview guides following a three-factor model and analyzed by using a combined quantitative-qualitative-content approach.
One hundred and ninty-seven patients and 10 carers completed interviews between December 2017 and April 2019. The majority of patients were diagnosed with an oncological disease. Sense of security was mentioned particularly often suggesting its high relevance. We identified nine subcategories that were all mentioned more frequently by specialist than generalist palliative home care recipients in the following order of priority and relation: (i) patient-centeredness: availability, provision of information/education, professional competence, patient empowerment, and trust (ii) organizational work: comprehensive responsibility, external collaboration, and internal cooperation, and (iii) direct communication.
Significance of results
The work of specialist palliative home care services in particular was perceived as very effective and beneficial. Our findings confirm a previously developed three-factor model allowing for generalizability and revealed that availability was most important for improving the sense of security for effective palliative home care.
In view of many problems associated with the availability of global navigation satellite system (GNSS) signals in high-altitude space, this paper presents a comprehensive and systematic analysis. First, the coverage and strength characteristics of GNSS signals in high-altitude space (i.e., space above the GNSS constellation) are presented, and the visibility of GNSS signals is evaluated by combining these two factors. Second, the geometric configuration and geometric dilution of precision (GDOP) of visible GNSS satellites are analysed. Then, the Doppler shift range of the GNSS signals is deduced based on the dynamic performance of high-altitude spacecraft. Finally, taking GaoFen-4 (GF-4) as the application object, the availability of GNSS signals is simulated and evaluated. GNSS signals in high-altitude space are generally weak, and the visible GNSS satellites are concentrated in the high-elevation range. The combination of main and side lobe signals and compatibility of multiple constellations can increase the number of visible satellites, improve the geometry configuration, reduce GDOP, and thus improve the availability of GNSS signals. The results of this research can provide technical support for the design and development of GNSS receivers suitable for high-altitude space.
Critical thinking in science and many other disciplines should encompass creative, analytical, practical, and wise thinking. Underlying it are both cognitive processes and dispositions–that is, what a person can do and what a person chooses to do. Critical thinking is both domain-general and domain-specific. The domain-specific elements of it cannot be well captured by general tests of critical thinking. We have found that critical thinking in STEM disciplines involves skills that are quite different from those involved in taking tests of cognitive and academic skills. Some of these skills are generating hypotheses, generating experiments, and drawing conclusions. In our tests of these skills, which we have administered to students at Cornell University, scores on the tests correlated not at all or even negatively with tests of academic preparation, such as the SAT and the ACT. Thus, universities that select future scientists and engineers on the basis of such standardized tests may be choosing the wrong people unless they can assure that those people are good scientific reasoners, not just good takers of analytically-oriented tests.
Behavioral paternalists often distinguish their views from harder forms of paternalism by emphasizing the moderate character of their proposals. Insights from the academic literature on slippery slopes suggest that behavioral paternalist policies are particularly vulnerable to expansion, which makes the claim to moderation unsustainable. This is true even if policymakers are rational (in the neoclassical sense), but the slippery-slope threat is even greater if policymakers share the behavioral and cognitive biases attributed to the people their policies are supposed to help. Rational slope mechanisms include altered incentive slopes, authority and simplification slopes, and expanding justification slopes. Behavioral slope mechanisms include action bias, overconfidence, confirmation bias, present bias, availability and salience effects, framing and extremeness aversion, and affect and prototype heuristics. The theoretical and empirical vagueness of behavioral paternalism creates gradients that encourage the gradual expansion of policies. Finally, the particular way in which leading behavioral paternalists have framed the issue of paternalism gives rise to an inherently expansionist dynamic, which we call the paternalism-generating framework.
Rational beliefs need not be truth-tracking nor adhere strictly to basic logical or statistical-inference principles. They must simply be appropriate to the attainment of the individual’s purposes in specific contexts. We analyze various “errors” that behavioral economists have supposedly discovered in belief formation. Specifically, we examine supposed errors related to imperfect logical deduction, the conjunction fallacy (including the famous “Linda problem”), availability bias, overconfidence bias, and distorted salience. In each case we show that the standard behavioral analysis is too simple and that many of their behaviors qualify as inclusively rational. The fundamental error of behavioral analysts is to expect that universal, abstract methods of belief formation will be appropriate for guiding all concrete choices.
Real-world policymakers face pressure to take action, to legislate, and to attempt to solve problems even in imperfect ways. What kind of paternalistic policies can we reasonably expect policymakers to create? We argue that public-choice pressures will tend to produce suboptimal paternalistic policies, even if we assume behavioral paternalists’ conclusions about human behavior are generally correct. Rational ignorance, bureaucratic self-interest, concentrated benefits and diffuse costs, the influence of rent-seekers and moralists, and other factors will tend to shape policy in undesirable ways. If policymakers are susceptible to biases such as those attributed to regular people, the results could be even worse. Biases with the potential to adversely affect policymaking include action bias, overconfidence, confirmation bias, availability and salience effects, affect and prototype heuristics, and present bias. Because the political sphere offers weak incentives for the self-correction of biases, we expect such biases to be more significant in the public than in the private sphere.
Signal-in-space (SIS) continuity and availability are important indicators of performance assessment for Global Navigation Satellite Systems (GNSSs). The BeiDou Navigation Satellite System (BDS) Open Service Performance Standard (BDS-OS-PS-1.0) has been released, and the corresponding public performance indicators have been provided, but the actual SIS performance is uncertain to users. SIS continuity and availability are primarily related to unscheduled outages (failures). Therefore, based on the existing failure classification system and actual operation modes, four types of failure modes are first analysed: long-term failure related to satellite service period, maintenance failure related to satellite manoeuvring, short-term failure associated with random repairable anomalies and equivalent failure corresponding to a combination of the above three types of failures. Second, based on the failure classification and selected precise and broadcast ephemerides from 2015–2016, the Mean Time Between Failure (MTBF) and Mean Time To Repair (MTTR) of each failure type are obtained using appropriate detection methods. Finally, using a corresponding assessment model, the SIS continuity and availability of BeiDou are calculated for individual and equivalent failure cases, and these are compared with the provided index in the BDS Open Service Performance Standard.
ART was pioneered in Africa in the 1980’s. Subsequently, ART centres emerged around the continent, mostly by specialists acquiring skills abroad. Despite this, ART activity remains scant in most African countries and absent in several others.
Historically, ART surveillance in Africa has been similarly scant and fragmented. Recently however, the African Network and Registry for ART (ANARA) has been established with the vision to reduce the high burden of infertility in Africa through ART; and its mission to bring together ART centres within and across countries and to collect data pertaining to availability, utilization, effectiveness and safety of ART. First registry data, collected from 40 centres in 13 countries, and will be published shortly. ANARA protects the anonymity of centres and patients and the ownership of data.
The successful establishment of ANARA is rooted in a collaborative spirit of engagement with ART centres and other stakeholders, developmental assistance from both the Latin American and World Registry, and the importance of data in reducing the burden of infertility in Africa.
Asia is composed of more than 40 countries where about 60% of the global population live. Since Asia is the largest and geographically variable continent, where cultural and social backgrounds are very diverse in every part of this area, it is almost impossible to describe the whole area in one chapter. Rapid decline of birth rates in multiple countries, particularly in eastern Asia, drew wide public attention and promoted the treatment and care for infertile couples. Particularly, assisted reproductive technology (ART) has significantly spread in many Asian countries and its growth is still ongoing. Although ART registries were established in several Asian countries many years ago, there is no Asian regional registry because of this diverse situation of this area.
Since 1999 surveillance of ART in Europe is carried out by the European IVF-monitoring (EIM) Consortium, founded in June 1999 by the European Society of Human Reproduction and Embryology (ESHRE). EIM is organized by the representatives of national registries of European countries offering ART. The high diversity of participating European countries pose a serious challenge for obtaining complete data and interpreting the results. Notwithstanding this challenge EIM has managed in 2014 to collect the data of 38 from 42 participating European countries (90.5%) and 1280 institutions (90.2% of all known in Europe). Annual meetings supported by ESHRE have created a spirit of mutual understanding and have contributed much to increase the level of participation. Every year, EIM published an annual report with cross-sectional data, typically made of more than 700'000 treatment cycles of ART. The first data set of 1997 was published in 2001 and was followed by 17 reports in the journal „Human Reproduction“.
To (i) describe the proportion of foods and beverages available on school canteen menus classified as having high (‘green’), moderate (‘amber’) or low (‘red’) nutritional value; (ii) describe the proportion of these items purchased by students; and (iii) examine the association between food and beverage availability on school canteen menus and food and beverage purchasing by students.
A cross-sectional study was conducted as part of a larger randomised controlled trial (RCT).
A nested sample of fifty randomly selected government schools from the Hunter New England region of New South Wales, Australia, who had participated in an RCT of an intervention to improve the availability of healthy foods sold from school canteens, was approached to participate.
School principals, canteen managers and students.
The average proportion of green, amber and red items available on menus was 47·9, 47·4 and 4·7 %, respectively. The average proportion of green, amber and red items purchased by students was 30·1, 61·8 and 8·1 %, respectively. There was a significant positive relationship between the availability and purchasing of green (R2=0·66), amber (R2=0·57) and red menu items (R2=0·61). In each case, a 1 % increase in the availability of items in these categories was associated with a 1·21, 1·35 and 1·67 % increase in purchasing of items of high, moderate and low nutritional value, respectively.
The findings provide support for school-based policies to improve the relative availability of healthy foods for sale in these settings.
Research evidence guiding the identification of pragmatic and effective actions aimed at improving the selection, availability, affordability and rational prescribing of medicines for mental disorders is sparse and inconsistent. In order to boost the development of new research, in this commentary we suggest to organise and classify all the activities in this area under a common theoretical framework and nomenclature, adopting the term ‘public health psychopharmacology’. Public health psychopharmacology is proposed as a research discipline, based on contributions from the fields of regulatory science, health services research and implementation science. Implementing the term public health psychopharmacology may offer advantages, as the scientific community would be more focused on common goals and objectives, with, likely, an increasing body of research evidence of practical use.
Gorgona National Park (GNP) protects the only known feeding aggregation of juvenile green turtles Chelonia mydas on the Pacific coast of Colombia. This study was undertaken to compare the diet of the two known C. mydas morphotypes (black and yellow), and to determine availability, selectivity, and quality of food resources at GNP. Oesophageal lavages and isotopic analysis of epidermal tissue were performed on turtles captured between February and December 2012. Food quantity was estimated by determining per cent cover in quadrats randomly placed on the reefs. Food quality of algae species was estimated by proximate analysis. Food selection was estimated using Ivlev's electivity index, and the trophic level of sea turtles at GNP was calculated. A total of 30 black (mean = 63.9 cm SCL) and 47 yellow (mean = 54.3 cm SCL) morphotype turtles were lavaged. Eight invertebrate and nine algae food items were identified in oesophageal contents. The most frequently found and abundant items in lavages were terrestrial plants, plastic fibres, invertebrates and algae. A total of 27 items, including 15 algae species, were identified on the reefs, of which Cladophora sp. was selected by black turtles, and Hypnea pannosa and Dictyota sp. were selected by both morphotypes; the latter species had the highest protein and lipid content, and low lignin content. A trophic level of 3.5 for black and 3.4 for yellow turtles was calculated. No significant difference in diet between the two morphotypes could be determined through lavage or isotopic analysis.
Magnesium has essential functions in cellular metabolism and bone development. Its actions are closely linked to calcium and phosphorus, making the achievement of the right proportion of these elements in diets an important issue in poultry nutrition. The magnesium requirement of poultry has rarely been studied and most studies conducted are more than 35 years old. Despite the fact that magnesium is adequately present in most plant-based diets, supplemental magnesium may positively affect poultry meat quality and body weight at certain developmental stages. However, excessive dietary magnesium could influence calcium and phosphorus availability and metabolism through different mechanisms. Understanding the effects of supplemental magnesium on the availability and metabolism of other dietary constituents and vice versa is important for formulating balanced diets and achieving maximal performance in poultry. Here we review this complex, insufficiently explored issue.
To systematically review literature examining the association between vegetable home availability and vegetable intake in youth.
Articles were identified through December 2012 using a search of PubMed, PsychINFO and OVID/Medline databases, using the following keywords in varying combinations: home, environment, availability, vegetable, intake, consumption, children. Quantitative studies examining home vegetable availability and vegetable intake in children and adolescents were included. Fifteen studies were included that met inclusion criteria.
Studies were conducted in the USA (n 8), Australia (n 1), Greece (n 1), Iceland (n 1), Denmark (n 1), the UK (n 1), the Netherlands (n 1) and a combination of nine European countries (n 1).
Various populations of children and adolescents were examined.
Seven of the studies (47 %) found a positive association between vegetable availability and intake, with the others reporting null findings. There were no clear patterns of association by study design, age of subjects included, comprehensiveness of measures, or inclusion of covariates in analyses. Child report of home availability was associated with child vegetable intake (n 6, all found a positive association), while parent report of home availability was only minimally associated (n 9, one found a positive association; P=0·001 from post hoc Fisher’s exact test comparing parent v. child report).
Parent perception of availability may be closer to truth, given the parental role in food shopping and preparation. Therefore, to impact child vegetable intake, absolute availability may not be as important as child perception of vegetables in the home. Child perception of availability may be altered by level of familiarity with vegetables.
To investigate a 9-year trend of fresh fruit and vegetable availability and factors associated with the net availability change in two contrasting neighbourhoods.
Longitudinal design. Data were collected in 2003, 2009 and 2012 through in-store observations. Fresh fruit and vegetable availability was presented by weight-adjusted counts of stores having designated varieties per 10 000 population.
A low-income minority neighbourhood and an adjacent middle-income racially mixed neighbourhood in Albany, NY, USA. These neighbourhoods became sites of fresh produce interventions after baseline data were collected.
A total of 111, 128 and 146 eligible food stores in respective years.
Fresh fruit availability (two or more varieties) increased in both neighbourhoods. Inventory expansion of existing stores and the convenience store intervention contributed to the significant increase (P for trend=0·04) of fresh fruit availability in the minority neighbourhood. Although not statistically significant (P>0·05), the availability of two or more dark-coloured fresh vegetables also increased in the mixed neighbourhood, but declined slightly in the minority neighbourhood. The secular (non-intervention) fresh vegetable availability rate ratio by neighbourhood reached 3·0 in 2012 (P<0·01). The net decline of fresh vegetable availability in the minority neighbourhood was primarily attributed to inventory reduction of existing stores.
Longitudinal observations revealed narrowed neighbourhood disparities of fresh fruit availability and widened gaps of fresh vegetable availability. Inventory shifts of existing stores impacted the net availability change more profoundly than store opening or closing in the minority neighbourhood. Findings support increasing the programme capacity of the convenience store intervention to address the fresh vegetable disparity.
The variability of phosphorus (P) availability in poultry feeds is large,
primarily caused by differences in the contents of phytate and intrinsic or
exogenous phytase and by differences between non-phytate sources of P. Attempts
to consider this variability in feed formulations has led to the development of
different approaches to determine P availability. In the past seventy years,
different response criteria and descriptive terms for available P have been
used. In this review, response criteria that are often used will be described,
including their development over time. Focus is be given to growing poultry and
to quantitative approaches based on P retention and precaecal digestibility,
relative bioavailability based on bone data, and in
vitro solubility tests. In conclusion, precaecal digestibility
and retention are the most appropriate criteria for evaluating P sources in
poultry. The use of blood inorganic phosphorus (Pi) concentrations and
performance data is discouraged for the purpose of evaluation. Bone response
data can provide relative availability values for P sources. More research is
needed to explore whether P retention data can be re-calculated from existing
bone response data. Improvements in in vitro
approaches for estimating P availability are suggested.
Optimising the supply of dietary phosphorus (P) to animals requires sound
knowledge regarding the availability of P from feed raw materials. Different
definitions of available P have been proposed and various approaches are in use
to determine P availability. These differences make it difficult to compare
published data and to compile comprehensive feeding tables for use in the
industry. This is disadvantageous in regard to feeding costs and sustainable
handling of the limited global phosphate reserves. Working Group No 2
(Nutrition) of the European Federation of Branches of WPSA has developed a
standard protocol for determination of available P in broilers. It is based on
precaecal P digestibility and the details of this proposed protocol are
explained in the following paper. Unresolved questions in regard to the
determination of available P are also addressed. Researchers are encouraged to
implement this standard protocol in future P availability studies and to
contribute to its further improvement.
Available amino acids are those absorbed from the gastrointestinal tract in a form suitable for body protein synthesis. True ileal digestible amino acids are determined based on the difference between dietary amino acid intake and unabsorbed dietary amino acids at the terminal ileum. The accuracy of ileal digestible amino acid estimates for predicting available amino acid content depends on several factors, including the accuracy of the amino acid analysis procedure. In heat processed foods, lysine can react with compounds to form nutritionally unavailable derivatives that are unstable during the hydrochloric acid hydrolysis step of amino acid analysis and can revert back to lysine causing an overestimate of available lysine. Recently, the true ileal digestible reactive (available) lysine assay based on guanidination has provided a means of accurately determining available lysine in processed foods. Methionine can be oxidised during processing to form methionine sulphoxide and methionine sulphone and cysteine oxidised to cysteic acid. Methionine sulphoxide, but not methionine sulphone or cysteic acid, is partially nutritionally available in some species of animal. Currently, methionine and cysteine are determined as methionine sulphone and cysteic acid respectively after quantitative oxidation prior to acid hydrolysis. Consequently, methionine and cysteine are overestimated if methionine sulphone or cysteic acid are present in the original material. Overall, given the problems associated with the analysis of some amino acids in processed foodstuffs, the available amino acid content may not always be accurately predicted by true ileal amino acid digestibility estimates. For such amino acids specific analytical strategies may be required.
To protect a worst-case user, Satellite-Based Augmentation System (SBAS) transmits inflated integrity information for protection level computation. In this work, a novel user-based technique for autonomous protection level computation is proposed. Its quality is examined over Key Performance Indicators tests for integrity and availability using real European Geostationary Navigation Overlay Service (EGNOS) data. The accomplished experiments confirm that this technique allows significant availability improvement without breaches of the integrity.
To investigate the intakes of sugar-sweetened beverages (SSB), fruit and vegetables (FV) among adolescents and their parents and to explore differences in the perceived availability by gender and parental education.
Baseline data from the HEIA (HEalth In Adolescents) study.
Data on intake of SSB were collected assessing frequency and amounts, whereas consumption of FV was assessed on the basis of frequency. Further, perceived availability at home and at school (taken from home) was reported.
Participants were 1528 Norwegian adolescents aged 11 years, as well as 1200 mothers and 1057 fathers.
The adolescents’ intake of SSB was low on weekdays but doubled during weekend days. This pattern was observed among parents as well. There were significant differences in intake between boys, girls, mothers and fathers, except for vegetables. Fathers reported the lowest frequency of FV intake. Compared with adolescents, mothers reported lower availability of SSB and higher availability of FV. Compared with their sons, fathers reported higher availability of vegetables and lower availability of sugar-sweetened fruit drinks at school. Significant differences in adolescents’ intake of SSB and in the perceived availability of both SSB and FV by parental education were found.
The intake of SSB was higher during weekend days than during weekdays, whereas the frequency of FV intake was low. Differences in adolescents’ perceived availability of both SSB and FV on the basis of parental education were found, whereas the differences in intake were significant only for SSB. Increasing parental awareness of availability and their potential as role models across parental gender and educational level could improve adolescents’ dietary habits.