Miracle-dz/UniFAR-FTUs huggingface dataset:
Narrative Accounts of Volunteers in Palliative Care Settings

The long and evolving tradition of palliative care has always had a strong volunteer dimension. The difficult nature of palliative care invites questions around why volunteers choose this particular line of contribution. To expand our knowledge of the elements that create meaning and capture the essence of volunteer experience, we asked volunteers to share the rewards and the challenges of their work and its personal meaning. Significant themes emerged around what volunteers considered the most valuable aspects of their experience. Volunteers identified freedom of choice and the ability to use their natural gifts as an important condition for satisfaction. In addition, they perceived emotional resilience and personal hardiness as important dimensions of their suitability for working in palliative care. Finally, volunteers felt that their approach must be one of a balanced perspective, with an understanding of life and death as part of the human condition.
Developing and Recognising Advanced Practitioners in Australia: An Opportunity for a Maturing Profession?

The need to ensure patient safety through assured professional competence needs little justification. The National Competency Standards Framework for Pharmacists in Australia (NCSFPA) outlines the key competencies required by registered pharmacists to successfully practice to the desired minimum standard. Professional development is clearly a necessary requirement for continued competence, which in turn is essential to ensure sustained and effective performance. The use of competency standards together with practitioner development tools (such as the General Level Framework) can significantly improve the consistency of a pharmacist's performance.
An efficient early-termination mode decision algorithm for H.264

We present a novel early-termination motion estimation scheme specifically designed for the H.264 standard. Our method takes advantage of correlation between the rate-distortion cost of the 16times16 pixel motion search and the cost of the potential best choice for the block size in order to terminate the motion search before all possible options have been checked. A pixel decimation method yields additional reduction in computational complexity. The method is suitable for supplementing various existing fast motion estimation algorithms. When supplementing the EPZS method [1] presently used in H.264, our method achieves total computational savings of 55% for almost the same picture quality, and a slight increase in bitrate.
foxl3 is a germ cell–intrinsic factor involved in sperm-egg fate decision in medaka

How germ cells become sperm or egg During vertebrate development, germ cells switch from a sexually indifferent to a committed state for either egg or sperm. Signals from somatic gonadal cells are generally thought to influence the sexual differentiation of germ cells. However, Nishimura et al. demonstrate that germ cell–intrinsic sex determination cues are at play in the teleost fish medaka. The forkhead box transcriptional factor foxl3 represses the initiation of spermatogenesis. In the absence of foxl3 function, females develop ovaries filled with functional sperm. Thus, the male gonad environment is not required for spermatogenesis. Science, this issue p. 328 The switch mechanism involved in germ cell fate determination is identified in medaka fish. Sex determination is an essential step in the commitment of a germ cell to a sperm or egg. However, the intrinsic factors that determine the sexual fate of vertebrate germ cells are unknown. Here, we show that foxl3, which is expressed in germ cells but not somatic cells in the gonad, is involved in sperm-egg fate decision in medaka fish. Adult XX medaka with disrupted foxl3 developed functional sperm in the expanded germinal epithelium of a histologically functional ovary. In chimeric medaka, mutant germ cells initiated spermatogenesis in female wild-type gonad. These results indicate that a germ cell–intrinsic cue for the sperm-egg fate decision is present in medaka and that spermatogenesis can proceed in a female gonadal environment.
Radio promotion of family planning in the Gambia.

The Gambia Family Planning Association initiated a two-year IEC and Training Materials Project in 1989 with technical assistance from the Johns Hopkins University and US Agency for International Development funding. The projects main objectives were to improve awareness and knowledge of family planning and STDs to increase the number of new and continuing contraceptive users at Gambia Family Planning Association clinics and to increase the couple years of protection provided through the clinics. Radio materials were designed to convey the beliefs that Islam supports the use of modern contraception that the modern methods are safe that family planning service providers are knowledgeable and caring and that couples should discuss family planning. 30-second radio spots and a 39-episode radio drama were aired as components of the campaign. Approximately 400 randomly chosen men and women living in a selected area of the Gambia were surveyed in 1991 to determine the effects of the radio drama about family planning issues. People who heard the serial drama could name significantly more contraceptive methods than those who had not and they were significantly more positive about family planning. Those who heard the program were also more likely to use a modern method than those who did not. The effect of the campaign was greatest among uneducated individuals; program exposure was associated with an increase in knowledge from 3.8 to 5.2 contraceptive methods an increase in positive values from 9.9 to 11.3 and an increase in contraceptive users from 10% to 27%.
Paediatric Eczema, Illness Beliefs and Psychosocial Morbidity: How Does Eczema Affect Children (in Their Own Words)?

Background:A lack of information about disease in children can lead to erroneous views such as children believing that hospital admittance or the presence of a disease is a punishment for a perceived wrong. There has thus far been no standard tool available to measure children’s illness conceptualisations from a Leventhalian framework. Furthermore, research on children with eczema suggests significant effects on children’s psychological wellbeing and everyday activities but few studies have adequately obtained the views of children themselves. Patients and Methods: Children with eczema, children with asthma and healthy controls between 7 and 12 years of age were recruited. Children were given the Children’s Illness Perception Questionnaire (CIPQ), a new 26-item instrument adapted from the Illness Perception Questionnaire for adults and The Piers-Harris Children’s Self-concept Scale. Results: Results suggested that the children with eczema felt greater consequences as a result of their disease than those with asthma. Furthermore, as regards psychosocial morbidity, the children’s understanding of the consequences of their disease was more important than the presence or visibility of the condition. Conclusions: As health professionals, we need to develop the means to further understand how paediatric illness beliefs relate to specific disease types, age and psychosocial factors. The understanding of children’s illness beliefs is discussed within this context.
Multidisciplinary Family Meetings in the ICU Facilitate End-of-Life Decision Making

Objective: The aim of this study was to assess the feasibility of establishing a multi-disciplinary family meeting (MDFM) program and the impact of such a program on the end-of-life decision making in the setting of an ICU. Methods: During the study period MDFMs were scheduled for patients requiring mechanical ventilation for 5 or more days. The meeting followed a structured format. The pertinent details of the meeting as well as the treatment goals were recorded. Results: Twenty-nine patients were enrolled in this study. Thirty-five MDFM’s were held on 24 patients. A meeting could not be arranged for four patients. All meetings addressed patient’s diagnosis, prognosis and goals of care. Fifteen (52%) patients (9 of whom had metastatic malignancy) had life support withdrawal and died a mean of 4.8 + 4.2 days after the first family meeting. In the remaining 9 patients (3 with localized cancer and 6 with non-cancer diagnoses), the plan following the family meeting was to continue supportive care; all of these patients survived to hospital discharge. Conclusions: Proactive MDFM’s improve communication and understanding between patients’ family and the treating team and facilitates end-of-life decision making.
Multiple images of a highly magnified supernova formed by an early-type cluster galaxy lens

Finding four for the light of one Seeing double may cause concern for some, but seeing quadruple? It's just what astronomers have been hoping for. Kelly et al. have now detected four images of the same distant supernova with the sharp eye of a space telescope. The supernova shines brightly from the arm of a spiral galaxy that lies far beyond another galaxy between it and us. This intervening galaxy is massive enough to bend the light from the supernova and its host galaxy into multiple images. This behavior relies on the curvature of spacetime and will provide insight into the luminous and dark matter in the lensing galaxy. Science, this issue p. 1123 Light from a distant supernova at z = 1.491 is detected in four images after being deflected en route by gravitational forces. In 1964, Refsdal hypothesized that a supernova whose light traversed multiple paths around a strong gravitational lens could be used to measure the rate of cosmic expansion. We report the discovery of such a system. In Hubble Space Telescope imaging, we have found four images of a single supernova forming an Einstein cross configuration around a redshift z = 0.54 elliptical galaxy in the MACS J1149.6+2223 cluster. The cluster’s gravitational potential also creates multiple images of the z = 1.49 spiral supernova host galaxy, and a future appearance of the supernova elsewhere in the cluster field is expected. The magnifications and staggered arrivals of the supernova images probe the cosmic expansion rate, as well as the distribution of matter in the galaxy and cluster lenses.
Reduced vaccination and the risk of measles and other childhood infections post-Ebola

Vaccinate children despite Ebola During the medical emergency caused by the Ebola virus outbreak in West Africa, routine childhood vaccination programs have been suspended. If vaccination is not resumed soon, there could be even more deaths. Measles is highly infectious, and outbreaks are a sign of health care systems in trouble. Using mathematical modelling, Takahashi et al. estimate that about a million children across Liberia, Sierra Leone, and Guinea are vulnerable to measles. Aggressive public health programs are vital for this region to minimize harm, not only from measles but also from polio, malaria, tuberculosis, and other childhood infections. Science, this issue p. 1240 Ebola is terrible, but childhood vaccination needs to resume in West Africa to prevent more deaths from common infections. The Ebola epidemic in West Africa has caused substantial morbidity and mortality. The outbreak has also disrupted health care services, including childhood vaccinations, creating a second public health crisis. We project that after 6 to 18 months of disruptions, a large connected cluster of children unvaccinated for measles will accumulate across Guinea, Liberia, and Sierra Leone. This pool of susceptibility increases the expected size of a regional measles outbreak from 127,000 to 227,000 cases after 18 months, resulting in 2000 to 16,000 additional deaths (comparable to the numbers of Ebola deaths reported thus far). There is a clear path to avoiding outbreaks of childhood vaccine-preventable diseases once the threat of Ebola begins to recede: an aggressive regional vaccination campaign aimed at age groups left unprotected because of health care disruptions.
Pregnant women's perception of the implementation of smoking cessation advice

Objective To assess pregnant smokers'views on smoking cessation advice provided by health professionals who were following specific guidelines. These smoking cessation guidelines consisted of a nine-point intervention framework developed to achieve a reduction in the smoking and pregnancy rate. Design Data were collected through semi-structured interviews. Setting The participants were identified from three health and social care settings within one health board in Northern Ireland, namely: a hospital maternity unit, a community midwifery team and a general practitioner (GP) practice. Results Of the nine-point guidelines, some aspects such as establishing if the women smoked and their intention to quit were implemented at all initial consultations. However, none of the respondents reported receiving help in developing a quit plan or about educating their partner and family about the risks of active and passive smoking. Women accepted that assessing smoking status and providing advice was part of routine care and considered that this did not affect their relationship with health professionals. The respondents felt that smoking cessation advice should be sustained throughout pregnancy. Midwives were most likely to provide smoking cessation advice, yet respondents felt their GP to be the most appropriate person to do so. Conclusions These findings have implications for the delivery of smoking cessation advice. Providing appropriate advice and support for pregnant smokers at the end of their pregnancy may be as important as interventions at the beginning. Health professionals should maintain the level of smoking cessation advice provided throughout a woman's pregnancy.
Psychosocial Concerns in Patients With Advanced Cancer: An Observational Study at Regional Cancer Centre, India

Introduction: The diagnosis and treatment of cancer is associated with substantial physical, psychological, and social morbidity. The objective of this study was to identify the prevalence of psychosocial concerns in the patients with advanced cancer admitted to our institute. Materials and Methods: A total of 100 patients admitted to the inpatient palliative care unit of our institute were enrolled in this study. A descriptive questionnaire that dealt with the patient’s psychological acceptance of the disease and emotional distress that accompanies the diagnosis was prepared. Patient’s social and spiritual needs were addressed, and the future concerns that the patient is preoccupied with were discussed on a one-on-one basis with the patient himself or herself. Results: It was found that a majority of patients, though aware of their diagnosis, were not aware of the disease prognosis. There was a generalized anxiety regarding the treatment of the disease and fear of suffering. Most patients preferred to keep the revelation of the diagnosis to those close to them and not reveal it publicly. Financial drain out of resources was a major concern. Future concerns about their own fitness, the settlement of their children, and the family’s well-being were seen commonly in almost all the patients. Conclusions: Attention to psychosocial and spiritual health needs of patients with cancer is an integral part of an effective palliation, though they are less commonly expressed but are strongly felt by patients with cancer. It is therefore recommended that all clinicians and health care providers should address psychosocial health needs as a part of their routine practice.
Cancer Symptom Clusters: Old Concept But New Data

Individuals with cancer have multiple symptoms, which frequently co-occur. A nonrandom distribution of symptoms suggests a common mechanism. Symptom clusters (SCs) were considered part of various syndromes in the early years of medicine. The SC concept in clinical medicine is old. Symptom clusters were commonly described in the psychology/psychiatry and neurology literature. Symptom cluster may be defined either clinically or statistically. Statistically derived clusters can differ from clinically defined clusters. The clinical importance of statistically derived clusters is unclear. Pain-insomnia-fatigue and pain-depression-fatigue are commonly recognized clinical clusters. Nausea-vomiting and anxiety-depression are also statistically observed clusters. The longitudinal stability of clusters is unknown. Certain SCs, appear to have a greater adverse influence on outcomes (such as performance status and survival) than others. Comorbidities probably influence symptoms at different levels, but their effect on cancer clusters is unknown. Comprehensive symptom assessment is crucial to cluster identification. The potential use of the cluster concept to abbreviate symptom assessment tools needs validation. Symptom cluster can be disease and/or treatment related and may change as individuals undergo antitumor therapies. Polypharmacy in symptom management is frequent but could be minimized if 1 drug could be used to treat cluster symptoms. Symptom cluster appears to vary with the assessment tool, disease stage, symptom domain used to cluster, cluster methodology, and number of symptoms assessed. The validity and reliability of SCs need universally accepted statistical methods, assessment tools, and symptom domains. For now, nausea-vomiting is recognized as a consistent cluster across multiple studies. Pain-depression-fatigue and pain-insomnia-fatigue are also well recognized. Symptom clusters may help in cancer diagnosis, symptom management, and prognostication. However, the cluster method, reliability, and validity need to be established before assessment or treatment guidelines are established. Symptom clusters require further research before becoming part of routine medical symptom assessment and management.
Residents’ Practices and Perceptions About Do Not Resuscitate Orders and Pronouncing Death: An Opportunity for Clinical Training

Background: Although ‘‘Do not resuscitate’’ (DNR) orders are among the most commonly discussed patient preference treatment measures, few studies have assessed internal medicine residents’ views on this complex topic. Our objective was to assess resident practices in establishing code status. We also examined resident training and experiences in pronouncing death. Methods: An 18-question survey addressing DNR discussions and pronouncing death was emailed to internal medicine residents in the state of Illinois. Each question had multiple-choice options. Results: A total of 175 residents completed the questionnaire (22% response rate). Seventy-eight percent of the residents had discussed DNR status with patients or their families at least 9 times. However, only one third of the residents felt very comfortable in such discussions. Only 26% of the residents had been observed by a faculty member during a code status discussion and fewer (16%) while pronouncing death. Do not resuscitate discussions rarely occurred in an outpatient clinic (27%). Most residents (90%) thought they would benefit from formal training in DNR discussion. Conclusion: Although most residents discuss DNR status with patients and families, only a quarter are observed in such discussions by attending physicians and only a third feel comfortable with this aspect of clinical care. Developing a structured residency program curriculum to address resident skills in end-of-life care would benefit residency training.
The Latest Evidence on Hourly Rounding and Rapid Response Teams in Decreasing Adverse Events in Hospitals

The purpose of Evidence Digest, a recurring column in Worldviews, is to provide concise summaries of well-designed and/or clinically important recent studies along with implications for practice, research, administration, and/or health policy. Articles highlighted in this column may include quantitative and qualitative studies, systematic and integrative reviews as well as consensus statements by expert panels. Along with relevant implications, the level of evidence generated by the studies or reports highlighted in this column (see Figure 1) is included at the end of each summary so that readers can integrate the strength of evidence into their healthcare decisions.
Smart home energy management system using IEEE 802.15.4 and zigbee

Wireless personal area network and wireless sensor networks are rapidly gaining popularity, and the IEEE 802.15 Wireless Personal Area Working Group has defined no less than different standards so as to cater to the requirements of different applications. The ubiquitous home network has gained widespread attentions due to its seamless integration into everyday life. This innovative system transparently unifies various home appliances, smart sensors and energy technologies. The smart energy market requires two types of ZigBee networks for device control and energy management. Today, organizations use IEEE 802.15. 4 and ZigBee to effectively deliver solutions for a variety of areas including consumer electronic device control, energy management and efficiency, home and commercial building automation as well as industrial plant management. We present the design of a multi-sensing, heating and airconditioning system and actuation application - the home users: a sensor network-based smart light control system for smart home and energy control production. This paper designs smart home device descriptions and standard practices for demand response and load management "Smart Energy" applications needed in a smart energy based residential or light commercial environment. The control application domains included in this initial version are sensing device control, pricing and demand response and load control applications. This paper introduces smart home interfaces and device definitions to allow interoperability among ZigBee devices produced by various manufacturers of electrical equipment, meters, and smart energy enabling products. We introduced the proposed home energy control systems design that provides intelligent services for users and we demonstrate its implementation using a real testbad.
Dust measurements in the coma of comet 67P/Churyumov-Gerasimenko inbound to the Sun

Critical measurements for understanding accretion and the dust/gas ratio in the solar nebula, where planets were forming 4.5 billion years ago, are being obtained by the GIADA (Grain Impact Analyser and Dust Accumulator) experiment on the European Space Agency’s Rosetta spacecraft orbiting comet 67P/Churyumov-Gerasimenko. Between 3.6 and 3.4 astronomical units inbound, GIADA and OSIRIS (Optical, Spectroscopic, and Infrared Remote Imaging System) detected 35 outflowing grains of mass 10−10 to 10−7 kilograms, and 48 grains of mass 10−5 to 10−2 kilograms, respectively. Combined with gas data from the MIRO (Microwave Instrument for the Rosetta Orbiter) and ROSINA (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) instruments, we find a dust/gas mass ratio of 4 ± 2 averaged over the sunlit nucleus surface. A cloud of larger grains also encircles the nucleus in bound orbits from the previous perihelion. The largest orbiting clumps are meter-sized, confirming the dust/gas ratio of 3 inferred at perihelion from models of dust comae and trails.