bluuebunny/crossref_metadata_2025 huggingface dataset:
Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia
Authors: Shoesmith Wendy Diana , Borhanuddin Awang Faisal Bin Awang , Yong Pau Lin Pauline , Abdullah Ahmad Faris , Nordin Norhayati , Giridharan Beena , Forman Dawn , Fyfe Sue
Published: November 2017

Background:

A better understanding is needed about how people make decisions about help seeking.

Materials:

Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members.

Discussion:

Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment.

Conclusion:

Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.
The Vulnerability of Urban Elementary School Arts Programs: A Case Study
Authors: Shaw Ryan D.
Published: November 2017

With the intent of improving understanding of cuts to elementary arts programs, the purpose of this research was to investigate how one urban school district (Lansing School District in Lansing, Michigan) eliminated its elementary arts specialists. Research questions were (1) What policy conditions enabled the Lansing School District’s decision to cut its elementary arts specialists? and (2) How did the decision-making process unfold? This instrumental case study drew on policy analysis, and data sources included 18 interviews with former Lansing School District teachers, current employees, and community arts provider representatives as well as related documents and researcher memos. After coding for themes, I used the Advocacy Coalition Framework to organize findings by research question. Findings showed that a confluence of macro- and microlevel policy conditions enabled the cuts, including declining enrollment, budget problems, and a negative perception of elementary arts teachers facilitated by permissive teacher certification/assignment policies. Analysis also showed that the decision-making process was characterized by rival coalitions whose membership was defined by belief systems. Based on the findings, I offer critical reflection on a number of topics and offer general recommendations as well as implications for researchers.
Effects of Surprisal and Entropy on Vowel Duration in Japanese
Authors: Shaw Jason A. , Kawahara Shigeto
Published: November 2017

Research on English and other languages has shown that syllables and words that contain more information tend to be produced with longer duration. This research is evolving into a general thesis that speakers articulate linguistic units with more information more robustly. While this hypothesis seems plausible from the perspective of communicative efficiency, previous support for it has come mainly from English and some other Indo-European languages. Moreover, most previous studies focus on global effects, such as the interaction of word duration and sentential/semantic predictability. The current study is focused at the level of phonotactics, exploring the effects of local predictability on vowel duration in Japanese, using the Corpus of Spontaneous Japanese. To examine gradient consonant-vowel phonotactics within a consonant–vowel-mora, consonant-conditioned Surprisal and Shannon Entropy were calculated, and their effects on vowel duration were examined, together with other linguistic factors that are known from previous research to affect vowel duration. Results show significant effects of both Surprisal and Entropy, as well as notable interactions with vowel length and vowel quality. The effect of Entropy is stronger on peripheral vowels than on central vowels. Surprisal has a stronger positive effect on short vowels than on long vowels. We interpret the main patterns and the interactions by conceptualizing Surprisal as an index of motor fluency and Entropy as an index of competition in vowel selection.
Modeling and simulation of logistic processes: risk assessment with a fuzzy logic technique
Authors: Gajović Vladimir , Kerkez Marija , Kočović Jelena
Published: November 2017

Logistic processes imply the presence of a large number of different types of risks, primarily in the fields of transport, transshipment, and storage of goods. The main reason for this fact is the presence of numerous participants of logistic systems, the existence of various interactions between large numbers of subsystems or subprocesses, which causes disturbances and uncertainties, both locally and at the system level. The initial idea of this research is to model the total risk of logistic processes based on evaluation of the significance of different risk elements, their interrelations, and their influence on total risk. This paper presents a developed fuzzy logic model based on the analytic hierarchy process (AHP) model and fuzzy analytic hierarchy process (FAHP). The model is designed to be practical, understandable, and easy to implement and maintain. The incorporated data have different forms of crisp numbers, triangular fuzzy numbers, and linguistic variables. Logistic process data are incorporated into the proposed model and validated with an example case.
Stavenhagen and the Nation: Ethnicity, Community, and Political Project
Authors: Loza Jorgelina
Published: November 2017

There is consensus in Latin America that the modern states of the region emerged from a communal project based on the existence of pre-national societies. It remains important, however, to ask who the actors behind this construct are and how they understand the discourse of the nation promoted by those states. Rodolfo Stavenhagen, who took a critical view of the processes of construction of this modern organizational form, approached the concept of the nation as a construct that took into account the coalition of prevailing forces and could be disputed by those seeking to play a leading role in it.

En América Latina, ya constituye un consenso afirmar que los estados modernos de la región emergen de un proyecto comunitario a partir de la existencia de sociedades pre-nacionales. Resulta urgente preguntarse por los actores que forman parte de dicha construcción y la forma en que reciben el discurso nacional promovido por el Estado. Rodolfo Stavenhagen, quien sostuvo una mirada crítica sobre los procesos de construcción de esta forma organizativa moderna, nos permite pensarla como una construcción que puede dar cuenta de la coalición de fuerzas vigente y ser disputada por aquellos que exigen tener un rol protagónico en la misma.
Accounting Restatements and Corporate Cash Policy
Authors: Chen Huili , Chen Zhihong , Dhaliwal Dan S. , Huang Yuan
Published: November 2017

Using a difference-in-differences approach, we find that the cash holdings of firms increase significantly after announcements of irregularity-related restatements. The increase is larger for firms with a higher demand for precautionary savings and is smaller for firms with less pronounced increase in shareholder control after the restatements. Investments and repurchases of irregularity firms become more sensitive to excess cash after the restatements. In addition, we find that the market value of cash holdings increases after restatements. Overall, the evidence suggests that strengthened shareholder control reduces cash holdings, but this effect is weaker than the increase in cash holdings due to exacerbated precautionary savings concerns. Our study contributes to the literature on the effect of financial reporting credibility on real corporate decisions.
The mtDNA of Human Rights
Authors: Douglas Benedict
Published: November 2017

Mitochondrial replacement therapy is a process whereby a child is created by combining the nuclear DNA of two people wishing to have a child with mitochondrial DNA (mtDNA) donated by a third person. It poses a new question as to the extent of a person’s right to know the identity of those from whom their DNA is inherited. In commentary upon Turkmendag’s paper, I evaluate the consistency of UK regulation of this issue with the European Convention of Human Rights. Under UK law, a person created using donated mtDNA is only entitled to information about the procedure which does not identify the donor. I argue that this approach is consistent with the previous European Court of Human Rights and UK judicial decisions on the rights of individuals to information about their identity and ancestry and with the deeper foundational principle which Kai Möller argues the Convention protects existential self-understanding. I conclude that, as mtDNA has not been proven to affect an individual’s life choices and outward characteristics to the extent that gamete donation does, it is acceptable to prioritize the interests that anonymous donation protects over the desire of the recipient to know the identity of their donor.
Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults
Authors: Shuman Clayton J. , Xie Xian-Jin , Herr Keela A. , Titler Marita G.
Published: November 2017

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.
High-pitch dual-source paranasal sinus CT in agitated patients with maxillofacial trauma: analysis of image quality, motion artifacts, and dose aspects
Authors: Frellesen Claudia , Wichmann Julian L , Tischendorf Patricia , Scholtz Jan-Erik , Beeres Martin , Vogl Thomas J , Bauer Ralf W
Published: November 2017

Background

Image quality benefits from high-pitch scanning in agitated patients by reducing acquisition time.

Purpose

To compare image quality and exposure parameters in patients with maxillofacial trauma on second- and third-generation dual-source computed tomography (DSCT).

Material and Methods

Four groups were compared. Group 1 was examined on second-generation DSCT (120 kV/50 mAs, pitch 3.0). The other three groups were examined on third-generation DSCT. Group 2 was scanned with 120 kV/50 mAs, pitch 2.2. Automated exposure control (AEC) was used in group 3 and group 4 with pitch factors of 2.2 and 3.0, respectively. Images of third-generation DSCT were reconstructed with iterative reconstruction (IR), of second-generation DSCT with filtered back-projection. CTDIvol, acquisition time, and image quality were compared.

Results

Thirty patients were included in each group. Average CTDIvol (2.76 ± 0.00 mGy, 2.66 ± 0.00 mGy, 0.74 ± 0.23 mGy, and 0.75 ± 0.17 mGy) was significantly lower on third-generation DSCT with AEC ( P < 0.001). Subjective image quality was rated worst in group 4 due to strong high-pitch artifacts, while in the remaining three groups it was rated good or very good with good inter-observer agreement (k > 0.64). Average acquisition time was significantly shorter with third-generation DSCT (0.47 s, 0.36 s, 0.38 s, 0.30 s; P < 0.001).

Conclusion

Third-generation DSCT yields faster acquisition times and substantial dose reduction with AEC. A pitch of 2.2 should be preferred, as it results in fewer artifacts. If AEC is used, latest IR ensures that diagnostic image quality is guaranteed.
Effectiveness of involving the industrial and business professions into mechanical engineering capstone course
Authors: Zhu Na
Published: November 2017

Capstone design, along with the last courses before graduation, is one of the major performance indicators of the student outcome in an undergraduate mechanical engineering program. Educational topics on the capstone course, such as the instruction content, course design, procedures, and timeline schedule, have been deliberated by engineering instructors in higher education. Meanwhile, more and more universities started to invite mentorship or advisement from industrial personnel to the capstone design classes as practical experience is also a significant factor in the engineering study. In this article, a senior design course for undergraduate mechanical engineering program is introduced. Collaboration and mentoring by industrial and business professions are offered in the course, though optional for students. As a result, the students in the same capstone course, though got the same lecture classes and follow the same design schedule, can be divided into three different groups: Group 1 worked in traditional design format, Group 2 received mentorship not only from the instructor but also from industrial professions, and Group 3 received help from a business profession. The course and project outcome of the three groups are evaluated by various assessment and results are demonstrated and discussed.
Conceptualizing ‘diaspora diplomacy’: Territory and populations betwixt the domestic and foreign
Authors: Ho Elaine L. E. , McConnell Fiona
Published: November 2017

This article bridges diaspora studies and diplomacy studies by proposing the concept of ‘diaspora diplomacy’, which considers the components of diplomacy and the changing relationships that diasporas have with states and other diplomatic actors. First, we ask who are the key actors engaged in diaspora diplomacy? Second, how is diplomatic work enacted by and through diasporas? Third, what are the geographies of diaspora diplomacy? Diaspora diplomacy directs researchers to reconsider the distinction between domestic and foreign policy, and the territorial dimensions of both diaspora and diplomacy. We engage with assemblage theory, highlighting the polylateral and multi-directional aspects of diaspora diplomacy.
Geographies of conservation II: Technology, surveillance and conservation by algorithm
Authors: Adams William M.
Published: November 2017

The wide range of wildlife tracking and surveillance technologies (radio and satellite tracking, cameras, and audio) that are being deployed in conservation have important implications for a geographical understanding of care for non-human nature. This report explores four dimensions of their influence. First, their detailed view of spatial dimensions of non-human lives affects conservation’s demarcation and control of space. Second, the application of surveillance technologies to people is central to the rise of coercive conservation strategies. Third, such technologies enable the creation and commoditization of spectacular nature. Fourth, spatial digital data enables the automation of conservation decisions, a trend described here as ‘conservation by algorithm’.
Contemporary Godparenthood in Central and Eastern Europe
Authors: Vasile Monica , Cash Jennifer R. , Heady Patrick
Published: November 2017

This introduction to the collection opens up the conversation between historians and anthropologists about the practical significance and social meaning of spiritual kinship. By discussing the key findings of five anthropological studies—in Italy, Hungary, Bulgaria, Romania, and Moldova—we point to resemblances and differences. We examine common structural elements of the spiritual kinship system and the religious and material meanings involved. We find differing symbolic logics as well as different intensities of godparental practices, which can be described as a geographical, east-west gradient. Speaking broadly, the more to the east a place is, the more thriving the practice. In explaining the variation, ethnographic insights suggest that long-term differentiating trends are important, and also contemporary historical factors—substantial economic and political changes since the mid-twentieth century.
Social and Cultural Innovation: Research Infrastructures Tackling Migration
Authors: Pozzo Riccardo , Virgili Vania
Published: November 2017

‘Social and Cultural Innovation’ is a syntagma that is receiving increased usage among researchers since it was the title chosen by the European Strategy Forum Research Infrastructures for the working group that deals with research infrastructures primarily connected with Social Sciences and the Humanities. Innovation refers to the creation of new products and services by bringing a new idea to the market. Economic growth turns on infrastructures, which provide access to services and knowledge, e.g. by overcoming the digital divide. The current migrant and refugee crisis has made it clear with extraordinary effectiveness that a most urgent objective is to work out policies of social and cultural innovation to the advantage of new citizens – policies that will make them feel welcome in full dignity.
Mechanically Ventilating the Severe Asthmatic
Authors: Laher Abdullah E. , Buchanan Sean K.
Published: November 2017

The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to various other pathologies requiring mechanical ventilation, acute asthma is generally associated with better outcomes. This review serves as a practical guide to the physician managing patients with severe acute asthma requiring mechanical ventilation. In addition to specifics relating to endotracheal intubation, we also discuss the interpretation of ventilator graphics, the recommended mode of ventilation, dynamic hyperinflation, permissive hypercapnia, as well as the role of extracorporeal membrane oxygenation and noninvasive mechanical ventilation.
Strategically Stealthy
Authors: Larance Lisa Young , Garrison Spencer , Seeley J. Lotus
Published: November 2017

Research on women who divorce their abusive husbands typically draws on the experiences of those who have had contact with formal intimate partner violence (IPV) support services. The experiences of women who have not sought such support remain poorly understood. Drawing upon a series of longitudinal, in-depth interviews with 12 women who did not seek formal IPV services, this work illuminates women’s “strategically stealthy” agency, as they navigate spousal violence, seek human connection and formal support, and eventually file for divorce. This article proposes a revision of the transtheoretical model’s (TTM) preparation stage from 30 days to a flexible time frame of months and even years, which allows a more complex, agentic understanding of IPV survivors’ actions, behaviors, and help-seeking efforts deployed in planning for divorce. By expanding the time frame of TTM’s preparation stage, this work has broad implications for social work practice.
Extending the functionality of a symbolic computational dynamic solver by using a novel term-tracking method
Authors: Motazedi Niloufar , Cartmell Matthew P , Rongong Jem A
Published: November 2017

Symbolic computational dynamic solvers are currently under development in order to provide new and powerful tools for modelling nonlinear dynamical systems. Such solvers consist of two parts; the core solver, which comprises an approximate analytical method based on perturbation, averaging, or harmonic balance, and a specialised term-tracker. A term-tracking approach has been introduced to provide a powerful new feature into computational approximate analytical solutions by highlighting the many mathematical connections that exist, but which are invariably lost through processing, between the physical model of the system, the solution procedure itself, and the final result which is usually expressed in equation form. This is achieved by a highly robust process of term-tracking, recording, and identification of all the symbolic mathematical information within the problem. In this paper, the novel source and evolution encoding method is introduced for the first time and an implementation in Mathematica is described through the development of a specialised algorithm.
Effects of space environment temperature on the mechanical properties of carbon fiber/bismaleimide composites laminates
Authors: Yang Baifeng , Yue Zhufeng , Geng Xiaoliang , Wang Peiyan , Gan Jian , Liao Baohua
Published: November 2017

The effects of space environment temperatures on specific carbon fiber/bismaleimide composite laminates were evaluated using the simulated environment test method. The tests were performed at −120 ℃, room temperature, 150 ℃, 170 ℃, and 200 ℃. The material responses were characterized through an assessment of mechanical properties including tensile, compressive, and in-plane shear properties. The experimental results showed that transverse tensile/compressive and in-plane shear responses, which are strongly related to matrix properties, were sensitive to temperature especially high temperature above the glass transition temperature. Failure morphologies on both the microscopic and macroscopic scales were discussed. It was found that matrix fracture and delamination was more likely at high temperatures, while the interface strength was higher at low temperatures. The effects of extreme temperatures on mechanical responses of composites, as well as dynamic thermomechanical analysis results, are shown. Failure envelopes for these carbon fiber / bismaleimide composites at different temperatures based on Hashin criteria are depicted to help designers to avoid drawbacks introduced by temperature.
Understanding political discourses about Europe: A multilevel contextual approach to discourse
Authors: Trimithiotis Dimitris
Published: November 2017

This article contributes to the theoretical and methodological discussion on textual-contextual analysis in political communication and media research. It argues that taking into consideration both text and context throughout an analysis of the process of production enables the observation of the relation between the social and the linguistic. It opens up a non-deterministic perspective for the analysis of the above relation. The article rests upon an empirical study on the production of discourses for the campaign of European Parliament elections. The use of such a multilevel approach adds important elements to the research findings, particularly in terms of showing on the one hand how power relations within ‘Europarties’ results in the construction of common European identities in different European Union (EU) states, and on the other hand how professionalization of political communication reinforces discursive dissimilarities between parties of the same ideological family in different EU states.
Is Trump always rambling like a fourth-grade student? An analysis of stylistic features of Donald Trump’s political discourse during the 2016 election
Authors: Wang Yaqin , Liu Haitao
Published: November 2017

During the 2016 election, Donald Trump was characterized by his simple, pompous and repetitive language. However, studies have shown that sometimes he does not speak the way he used to. Critical discourse analysis suggests that political discourse analysis should include both the characterization of the text and the systematic description of the context. Thus, this study intends to evaluate stylistic features of Donald Trump’s political discourse based on the evolution over time as well as the genre variation by employing a comparison between Obama, Clinton and Trump. Results show that in debates, Trump uses less diverse vocabulary and simpler sentences. In campaign speeches, nonetheless, along with the change of circumstances, he sometimes employed a richer vocabulary and well-edited sentences. In addition, Trump’s speeches contain relatively more central themes in his campaign speeches. His concentration on political themes may meet key interests of a large proportion of electorates.
Land use, settlement, and plant diversity in Iron Age Northwest France
Authors: van Beek Roy , Marguerie Dominique , Burel Francoise
Published: November 2017

Various studies using pollen stratigraphies have demonstrated significant correlations between Holocene plant diversity, climate, and human activities. Studies that have analyzed longer Holocene timescales tend to discuss cultural data very superficially. This is remarkable because detailed insights into past human activities may be key to gain an understanding of the observed trends in biodiversity. This study aims to reconstruct and explain spatio-temporal trends in past plant diversity (alpha, temporal, and spatial beta diversity) by integrating data on vegetation dynamics, human subsistence economy, and land-use patterns. The landscape of Northwest France during the greater part of the Iron Age and the start of the Roman period (600 BC–AD 100) is selected as a case study. In total, 30 high-quality pollen-stratigraphical sequences allow for the reconstruction of the main long-term trends in plant diversity and more generally of the changing fabric of the landscape. Additionally, increasingly detailed images of the Iron Age rural landscape are available because of a steep increase in archaeological data (aerial photography, surveys, and excavations). These different types of data are integrated and used as input for a wider discussion on the relation between human activities and plant diversity. In general, the taxonomic richness increases steadily during the period under study. Some spatio-temporal differences are observed. The increasing richness values correspond with the growing impact of human activities on the landscape. Archaeologically documented land-use changes on smaller timescales are less clearly reflected in the richness values and vegetation dynamics, which might result from the (large-scale) research design.
Survey of risks and benefits communication strategies by research nurses
Authors: Nusbaum Lika , Douglas Brenda , Estrella-Luna Neenah , Paasche-Orlow Michael , Damus Karla
Published: November 2017

Background:

An ethical, informed consent process requires that potential participants understand the study, their rights, and the risks and benefits. Yet, despite strategies to improve communication, many participants still lack understanding of potential risks and benefits. Investigating attitudes and practices of research nurses can identify ways to improve the informed consent process.

Research question:

What are the attitudes, practices, and preparedness of nurses involved in the informed consent process regarding communication of risks and benefits?

Research design:

A survey was developed and administered online to a national purposive sample of 107 research nurses with experience obtaining informed consent for clinical trials. Survey responses stratified by selected work-related characteristics were analyzed.

Ethical considerations:

Participants were instructed they need not answer each question and could stop at any time. They consented by clicking “accept” on the email which linked to the survey. The study was approved by the Northeastern University Institutional Review Board, Boston, Massachusetts (NU-IRB Protocol #: 13-06-17).

Findings:

Most research nurses (87%) used a teach-back method to assess participant comprehension, while 72% relied on their intuition. About one-third did not feel prepared to communicate related statistics. About 20% did not feel prepared to tailor information, and half did not feel competent using supplemental materials to enhance risks and benefits comprehension. Only 70% had received training in the informed consent process which included in-person training (84%), case studies (69%), online courses (57%), feedback during practice sessions (54%), and simulation, such as role playing (49%) and viewing videos (45%). Perceived preparedness was significantly associated with greater informed consent experience and training.

Conclusion:

Research nurses may have inadequate training to encourage, support, and reinforce communication of risks and benefits during the informed consent process. Relevant purposeful education and training should help to improve and standardize the ethical informed consent process.
Measuring judicial independence in international law
Authors: Dimitropoulos Georgios
Published: November 2017

This article searches for paths, frameworks and modules for the measurement and evaluation of judicial independence in international law. First, it discusses the measurability of the concept. Judicial independence, both as such and especially at the international level, is very difficult to measure, given the ambivalence of some proxies and variables that have been used in empirical research in order to measure it, and given the competing interests and actors in international adjudication: independence does not stand alone as the only value that needs to be protected in international adjudication. Second, the article presents methodologies for the evaluation of international judicial independence. The three competing methodologies are (i) the subjective, which looks at the subjective perception of the judges themselves or the public; (ii) the output-based, which looks at the decisions of the courts and tribunals; and (iii) the institutional, which looks at the personal independence guarantees of the judge, and the organizational safeguards of independence. Finally, this article presents its preferred model for the measurement of international judicial independence. The study takes an institutional-psychological approach that focuses on the judge and the individual institutions.
Amidst fury, regret, and remorse: An analysis of university students who were placed in disliked majors
Authors: Toprak Mustafa , Tosten Rasim
Published: November 2017

This study is an attempt to uncover the factors leading students to study in the majors they dislike. Using a qualitative design, the study aims to explore the forces that cause students to make career choices against their will, and to investigate their future plans during their struggles with their parents and disliked majors. The study was conducted with 13 first-year university students who studied different majors within a school of education. Since the foci of the study were students who disliked their majors and were placed in teaching departments against their will, a purposive sampling technique was used during the selection of participants, and data were analyzed through the content analysis technique. The study revealed that the students had been placed into disliked majors under the simultaneous influence of either one or several forces, such as parental pressure to keep their children geographically close, perceived employment opportunities, life-time job security given to teachers at public schools, fatigue, and failure to get a high scores to be placed in their preferred choice. The study presents suggestions for educational policy-makers by discussing determinants of teaching career choices, by making specific references to parental influences on their children’s decision-making, and by showing that some teacher candidates are placed in teaching majors by making random choices.
Professional development in the creative industries: Methods and insights from regional practitioners
Authors: Daniel Ryan , Fleischmann Katja , Welters Riccardo
Published: November 2017

Professional development for those pursuing a career in creative industries is typically driven by individual practitioners, given most areas (e.g. photography, design, film) do not require membership with a regulatory organisation or evidence of continuing skills development. For those based regionally, opportunities for professional development are also less available than for those in capital cities. This paper reports on the findings of a survey (N = 151) and follow-up interviews (N = 29) with current creative industries practitioners in the regional city of Townsville in northern Australia, in relation to professional development opportunities and issues faced as a result of being located a substantial distance from the nearest capital city. The findings reveal a range of key challenges for regional practitioners due to distance and access to specialists in the field, yet at the same time a number of opportunities for those who display human agency and who are agentic learners.
Paternal and maternal support and Taiwanese college students’ indecision: Gender differences
Authors: Mao Ching-Hua
Published: November 2017

Regression analysis using 633 Taiwanese college students revealed that only maternal support had a significant predictive effect on the developmental indecision of male and female college students; furthermore, neither paternal nor maternal support had a significant predictive effect on the indecisiveness of male and female college students. For male college students, maternal tangible assistance predicted a lower level of developmental indecision due to the lack of information on decisions, whereas maternal information support predicted a higher level of developmental indecision due to the lack of information on decisions. For female college students, maternal emotional support predicted a lower level of developmental indecision arising from unreliable information.
Student congruence with academic major: Do hours worked and attitude affect satisfaction and success?
Authors: Mathis Erica L , Bullock-Yowell Emily , Leuty Melanie E , Nicholson Bonnie C
Published: November 2017

The current study sought to determine if student employment was a significant moderator of the relationship between congruence with college major, academic major satisfaction, and academic major success. Correlation results suggested that student employment has a negative relationship with academic success as measured by grade point average. No study hypotheses were supported but regression analyses showed significant impact of cognitive influences on academic major satisfaction and academic major success. Clinicians are encouraged to aid students in planning the relationship between required work and educational responsibilities, as well as consider implications of negative career thinking on academic satisfaction and success.
Developing Equitable Primary Health Care in Conflict-Affected Settings: Expert Perspectives From the Frontlines
Authors: Atallah Devin G. , Djalali Ahmadreza , Fredricks Karla , Arlington Lauren , Bussio Milagros , Nelson Brett D.
Published: November 2017

Health systems are frequently among the casualties of conflict. Within these settings, increased knowledge is needed on how to rebuild and strengthen health infrastructure resilience, such as primary health care (PHC) systems, in context-specific ways that promote health equity. Therefore, this study aimed to explore perspectives of experts with experience working on frontlines of social crises to contribute to understandings of pathways toward equitable PHC in conflict-affected settings. Semistructured qualitative interviews with 18 expert participants were completed. Through engaging elements of grounded theory situational analysis, three themes emerged iteratively, including (a) Building Blocks, (b) Intermediating Factors, and (c) a Roadmap. These emergent themes contribute to conceptual frameworks explaining key contextually specific priorities, challenges, and facilitating factors for developing resilient health infrastructures under social crises. Findings inform policy and practical guidelines that address complexities of conflict conditions and underscore the importance of PHC development toward promoting health as a human right.
Earlier Goals of Care Discussions in Hospitalized Terminally Ill Patients and the Quality of End-of-Life Care: A Retrospective Study
Authors: Gieniusz Marzena , Nunes Rosane , Saha Valerie , Renson Audrey , Schubert Finn David , Carey Jeanne
Published: November 2017

Background:

The association between physician-directed goals of care discussions (GOCDs) and the use of aggressive interventions in terminally ill patients has not been well characterized in the literature. We examined the associations between the timing of physician-directed GOCDs in terminally ill patients and the use of aggressive interventions, probability of dying in the inpatient setting, and intensive care unit (ICU) utilization.

Methods:

This retrospective cohort study included patients admitted to our urban community hospital in 2015 who had a terminal diagnosis on admission and either died on an inpatient unit or were discharged to hospice. The primary independent variable was the number of days from admission to GOCD, expressed as a proportion of the patient’s length of stay (LOS). We used robust variance Poisson and zero-inflated negative binomial regression, as appropriate, to estimate the associations between goals of care timing and risk of having an intervention, risk of dying in the inpatient setting, odds of ICU admission, and ICU LOS.

Results:

A total of 197 cases were included. After adjusting for age, language, gender, insurance, dementia, and decision maker (patient versus surrogate decision maker), later GOCD was significantly associated with greater risk of having an aggressive intervention (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 1.02-1.06), greater risk of death as an inpatient (RR = 1.04, 95% CI = 1.02-1.06), and greater odds of ICU admission (odds ratio = 1.19, 95% CI = 1.02-1.39).

Conclusion:

Later GOCDs were associated with greater risk of aggressive interventions and death as an inpatient and greater odds of ICU admission. Goals of care discussion should be done routinely and early during the hospitalization of terminally ill patients.
The Use of Corticosteroids as Adjuvant Therapy for Painful Bone Metastases: A Large Cross-Sectional Survey of Palliative Care Providers
Authors: White Patrick , Arnold Robert , Bull Janet , Cicero Brandon
Published: November 2017

Context:

Bone metastases are a common complication in patients with advanced cancer but little is known regarding current practice patterns of palliative care providers when prescribing corticosteroids as adjuvant therapy for painful bone metastases.

Objective:

To identify current practice patterns among palliative care providers when prescribing corticosteroids for the treatment of painful bone metastases.

Methods:

A cross-sectional, online survey of the membership of the American Academy of Hospice and Palliative Medicine. Providers were asked to report how frequently they prescribed corticosteroids as adjuvant therapy in patients with painful bone metastases, and to specify the corticosteroid, dosage, treatment duration, and the gastroprotective strategy most frequently utilized.

Results:

Seven hundred sixty-five participants responded to the survey and 600 (78%) of respondents completed the survey. Ninety-eight percent of respondents completing the survey reported having prescribed corticosteroids as adjuvant pain therapy, and 66% ordered corticosteroids for the majority of their patients with painful bone metastases. Dexamethasone was the most widely prescribed corticosteroid. Eight milligrams divided twice daily was the most common dosage selected and once started, it was usually continued indefinitely.

Conclusion:

Corticosteroids are commonly prescribed as adjuvant therapy in the treatment of painful bone metastases in patients with limited life expectancy. Dexamethasone is the most commonly selected corticosteroid by American palliative care providers with variation existing among providers regarding dosing schedule, treatment duration, and gastroprotective strategies. Clinical trials comparing a total daily dose of four versus eight milligrams of dexamethasone would be clinically useful to inform evidence-based practice.
Palliative Care Exposure in Internal Medicine Residency Education: A Survey of ACGME Internal Medicine Program Directors
Authors: Edwards Asher , Nam Samuel
Published: November 2017

As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education–accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was “very important” (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.
Health-Care Utilization After Hospice Enrollment in Patients With Heart Failure and Cancer
Authors: MacKenzie Meredith A. , Hanlon Alexandra
Published: November 2017

This study aimed to examine the role of diagnosis in health-care utilization patterns after hospice enrollment. Using 2007 National Home and Hospice Care Survey data from hospice patients with heart failure (n = 311) and cancer (n = 946), we analyzed emergency service use and discharge to hospital via logistic regression pre- and postpropensity score matching. Prematching, patients with heart failure had twice the odds of emergency services use than patients with cancer ( P < .001) and twice the odds of discharge to hospital ( P = .02). Differences were reduced postmatching for emergency service use (odds ratio [OR]: 1.6, P = .05) and eliminated for discharge to hospital (OR: 1.32, P = .45). Health-care utilization correlates included diagnosis, place of care, and advance directives. Attention to the unique needs of patients with heart failure is needed, along with improved advanced care planning.
The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center
Authors: Carey Elise C. , Dose Ann M. , Humeniuk Katherine M. , Kuan Yichen C. , Hicks Ashley D. , Ottenberg Abigale L. , Tilburt Jon C. , Koenig Barbara
Published: November 2017

Background:

The quality of perimortem care received by patients who died at our hospitals was unknown.

Objective:

To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families.

Design:

Telephone survey that included established measures and investigator-developed content.

Setting:

Large, tertiary care center known for high-quality, cost-effective care.

Participants:

Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year.

Intervention:

None.

Measurements:

Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination.

Results:

Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%).

Conclusion:

Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.
Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil
Authors: Soares Luiz Guilherme L. , Japiassu André M. , Gomes Lucia C. , Pereira Rogéria
Published: November 2017

Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.