2,517 research outputs found

    The role of nursing in multimorbidity care

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    Background Multimorbidity (the co-occurrence of two or more chronic conditions in the same person) affects around one in three persons, and it is strongly associated with a range of negative outcomes including worsening physical function, increased health care use, and premature death. Due to the way healthcare is provided to people with multimorbidity, treatment can become burdensome, fragmented and inefficient. In people with palliative conditions, multimorbidity is increasingly common. Better models of care are needed. Methods A mixed-methods programme of research designed to inform the development of a nurse-led intervention for people with multimorbidity and palliative conditions. A mixed-methods systematic review explored nurse-led interventions for multimorbidity and their effects on outcomes. A cross-sectional study of 63,328 emergency department attenders explored the association between multimorbidity, complex multimorbidity (≥3 conditions affecting ≥3 body systems), and disease-burden on healthcare use and inpatient mortality. A focussed ethnographic study of people with multimorbidity and life-limiting conditions and their carers (n=12) explored the concept of treatment burden. Findings Nurse-led interventions for people with multimorbidity generally focus on care coordination (i.e., case management or transitional care); patients view them positively, but they do not reliably reduce health care use or costs. Multimorbidity and complex multimorbidity were significantly associated with admission from the emergency department and reattendance within 30 and 90 days. The association was greater in those with more conditions. There was no association with inpatient mortality. People with multimorbidity and palliative conditions experienced treatment burden in a manner consistent with existing theoretical models. This thesis also noted the effect of uncertainty on the balance between capacity and workload and proposes a model of how these concepts relate to one another. Discussion This thesis addresses a gap in what is known about the role of nurses in providing care to the growing number of people with multimorbidity. A theory-based nurse-led intervention is proposed which prioritises managing treatment burden and uncertainty. Conclusions Nursing in an age of multimorbidity necessitates a perspective shift which conceptualises chronic conditions as multiple overlapping phenomena situated within an individual. The role of the nurse should be to help patients navigate the complexity of living with multiple chronic conditions

    In the name of status:Adolescent harmful social behavior as strategic self-regulation

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    Adolescent harmful social behavior is behavior that benefits the person that exhibits it but could harm (the interest of) another. The traditional perspective on adolescent harmful social behavior is that it is what happens when something goes wrong in the developmental process, classifying such behaviors as a self-regulation failure. Yet, theories drawing from evolution theory underscore the adaptiveness of harmful social behavior and argue that such behavior is enacted as a means to gain important resources for survival and reproduction; gaining a position of power This dissertation aims to examine whether adolescent harmful social behavior can indeed be strategic self-regulation, and formulated two questions: Can adolescent harmful social behavior be seen as strategic attempts to obtain social status? And how can we incorporate this status-pursuit perspective more into current interventions that aim to reduce harmful social behavior? To answer these questions, I conducted a meta-review, a meta-analysis, two experimental studies, and an individual participant data meta-analysis (IPDMA). Meta-review findings of this dissertation underscore that when engaging in particular behavior leads to the acquisition of important peer-status-related goals, harmful social behavior may also develop from adequate self-regulation. Empirical findings indicate that the prospect of status affordances can motivate adolescents to engage in harmful social behavior and that descriptive and injunctive peer norms can convey such status prospects effectively. IPDMA findings illustrate that we can reach more adolescent cooperation and collectivism than we are currently promoting via interventions. In this dissertation, I argue we can do this in two ways. One, teach adolescents how they can achieve status by behaving prosocially. And two, change peer norms that reward harmful social behavior with popularity

    Conversations on Empathy

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    In the aftermath of a global pandemic, amidst new and ongoing wars, genocide, inequality, and staggering ecological collapse, some in the public and political arena have argued that we are in desperate need of greater empathy — be this with our neighbours, refugees, war victims, the vulnerable or disappearing animal and plant species. This interdisciplinary volume asks the crucial questions: How does a better understanding of empathy contribute, if at all, to our understanding of others? How is it implicated in the ways we perceive, understand and constitute others as subjects? Conversations on Empathy examines how empathy might be enacted and experienced either as a way to highlight forms of otherness or, instead, to overcome what might otherwise appear to be irreducible differences. It explores the ways in which empathy enables us to understand, imagine and create sameness and otherness in our everyday intersubjective encounters focusing on a varied range of "radical others" – others who are perceived as being dramatically different from oneself. With a focus on the importance of empathy to understand difference, the book contends that the role of empathy is critical, now more than ever, for thinking about local and global challenges of interconnectedness, care and justice

    Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea

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    ObjectiveTo reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010.MethodsWe used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action’s effectiveness.ResultsFollowing the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (−10% per year) trend after adoption and enforcement of these laws (β2 = 0.18, p-value = 0.07; β3 = −0.10, p-value = 0.02). SHS exposure at home (β2 = 0.10, p-value = 0.09; β3 = −0.03, p-value = 0.14) and the primary cigarette smoking rate (β2 = 0.03, p-value = 0.10; β3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females.ConclusionStrengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK

    Improving Prediction Performance and Model Interpretability through Attention Mechanisms from Basic and Applied Research Perspectives

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    With the dramatic advances in deep learning technology, machine learning research is focusing on improving the interpretability of model predictions as well as prediction performance in both basic and applied research. While deep learning models have much higher prediction performance than conventional machine learning models, the specific prediction process is still difficult to interpret and/or explain. This is known as the black-boxing of machine learning models and is recognized as a particularly important problem in a wide range of research fields, including manufacturing, commerce, robotics, and other industries where the use of such technology has become commonplace, as well as the medical field, where mistakes are not tolerated.Focusing on natural language processing tasks, we consider interpretability as the presentation of the contribution of a prediction to an input word in a recurrent neural network. In interpreting predictions from deep learning models, much work has been done mainly on visualization of importance mainly based on attention weights and gradients for the inference results. However, it has become clear in recent years that there are not negligible problems with these mechanisms of attention mechanisms and gradients-based techniques. The first is that the attention weight learns which parts to focus on, but depending on the task or problem setting, the relationship with the importance of the gradient may be strong or weak, and these may not always be strongly related. Furthermore, it is often unclear how to integrate both interpretations. From another perspective, there are several unclear aspects regarding the appropriate application of the effects of attention mechanisms to real-world problems with large datasets, as well as the properties and characteristics of the applied effects. This dissertation discusses both basic and applied research on how attention mechanisms improve the performance and interpretability of machine learning models.From the basic research perspective, we proposed a new learning method that focuses on the vulnerability of the attention mechanism to perturbations, which contributes significantly to prediction performance and interpretability. Deep learning models are known to respond to small perturbations that humans cannot perceive and may exhibit unintended behaviors and predictions. Attention mechanisms used to interpret predictions are no exception. This is a very serious problem because current deep learning models rely heavily on this mechanism. We focused on training techniques using adversarial perturbations, i.e., perturbations that dares to deceive the attention mechanism. We demonstrated that such an adversarial training technique makes the perturbation-sensitive attention mechanism robust and enables the presentation of highly interpretable predictive evidence. By further extending the proposed technique to semi-supervised learning, a general-purpose learning model with a more robust and interpretable attention mechanism was achieved.From the applied research perspective, we investigated the effectiveness of the deep learning models with attention mechanisms validated in the basic research, are in real-world applications. Since deep learning models with attention mechanisms have mainly been evaluated using basic tasks in natural language processing and computer vision, their performance when used as core components of applications and services has often been unclear. We confirm the effectiveness of the proposed framework with an attention mechanism by focusing on the real world of applications, particularly in the field of computational advertising, where the amount of data is large, and the interpretation of predictions is necessary. The proposed frameworks are new attempts to support operations by predicting the nature of digital advertisements with high serving effectiveness, and their effectiveness has been confirmed using large-scale ad-serving data.In light of the above, the research summarized in this dissertation focuses on the attention mechanism, which has been the focus of much attention in recent years, and discusses its potential for both basic research in terms of improving prediction performance and interpretability, and applied research in terms of evaluating it for real-world applications using large data sets beyond the laboratory environment. The dissertation also concludes with a summary of the implications of these findings for subsequent research and future prospects in the field.博士(工学)法政大学 (Hosei University

    Navigating the Cultures of Health Care and Health Insurance: Highly skilled migrants in the US

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    What are the barriers preventing migrants from accessing and successfully utilizing health care in their new home country? Do these barriers vary across different migrant origin countries? And are they still a problem for highly skilled migrants, who often have well-paid jobs and health insurance provided by their employers? Based on field research conducted in the Washington D.C. area, Navigating the Cultures of Health Care and Health Insurance takes a mixed methods, qualitative and quantitative approach to the study of foreign patients’ utilization and assessment of health care in the US. Through interviews with both health care providers and patients, attitudes towards US health insurance and medical treatment are compared for migrants from three countries with very different cultural backgrounds and health insurance systems: Germany, India and Japan. Combined with an in-depth literature review, historical and contemporary surveys of health care across countries and analysis of health-related terms in the media, the results of this research indicate that foreign patients’ barriers to good health care persist despite access to health care services and insurance coverage, and reveal recurring transnational care seeking patterns, such as bringing medicines from abroad, delaying treatment for medical visits, insurance juggling and more. By describing their difficulties in integrating into the US health care system, the migrants in this study show the challenges and the potential for improvements in providing the care that migrants need in their new home

    Expert Ignorance:The Law and Politics of Rule of Law Reform

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    Developing International Mindedness through the Arts in the International Baccalaureate (IB) Diploma Programme (DP): An International Survey Design Conducted across all Continents

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    One distinct purpose of international education is to develop greater international understanding and intercultural competences. For the International Baccalaureate, this translates into students developing international mindedness throughout its programmes and courses. However, international mindedness is not measured and the impact of the programmes on the development of international mindedness remains mainly anecdotal. Furthermore, in the Diploma Programme, the choice of Arts courses is optional and the value of an Arts education, or specifically the value of taking a Diploma Programme Arts course in developing international mindedness, is equally unclear. This study investigated the development of international mindedness in students who opted for a Diploma Programme Arts course versus those who did not. The study followed a repeated measures, comparative and mixed-methods research design using a survey tool for data collection. The survey consisted of a quantitative section based on existing surveys and a qualitative section with six open-ended questions. The quantitative data showed an increase in intercultural knowledge and behaviours, while no change in attitudes, and a decrease in values was identified for both student groups, Diploma Programme Arts and Non-Arts-students. Furthermore, there was an increase in intercultural communication skills particularly in Diploma Programme Arts-students. Qualitative data analysis revealed a spectrum of categories of responses. The qualitative data also identified themes in addition to those identified in International Baccalaureate documentation and literature. Recommendations include for the International Baccalaureate Organization to integrate some of the emerging themes in their documentations, for example themes relating to adaptability and interconnectedness, which may also provide an interesting focus for curriculum design. Furthermore, curriculum and programme design should place a greater focus on the development of attitudes and values in the Diploma Programme and a reconsideration of the optionality of the Arts in this context

    Sensing Collectives: Aesthetic and Political Practices Intertwined

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    Are aesthetics and politics really two different things? The book takes a new look at how they intertwine, by turning from theory to practice. Case studies trace how sensory experiences are created and how collective interests are shaped. They investigate how aesthetics and politics are entangled, both in building and disrupting collective orders, in governance and innovation. This ranges from populist rallies and artistic activism over alternative lifestyles and consumer culture to corporate PR and governmental policies. Authors are academics and artists. The result is a new mapping of the intermingling and co-constitution of aesthetics and politics in engagements with collective orders
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