7,823 research outputs found

    An Ethnographic Study of Interprofessional Collaboration in Palliative Care

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    Background: The concept of the modern palliative care movement was initially developed by Cecily Saunders. She believed that the complex emotional, physical, and spiritual needs of dying patients and their families were best met by a team of professionals working together rather than a sole practitioner. Today local, national, and international definitions of palliative care remain grounded in the philosophy established by Saunders, where care is most effectively delivered by an interprofessional team working in a collaborative manner to support patient and family centred goals. Research Aim: The purpose of this study was to better understand the differences in interprofessional collaboration between palliative care teams in different clinical settings. The research questions were: 1) Do palliative care providers believe interprofessional collaboration is important? and 2) What are the contextual factors that act as either facilitators or barriers to the implementation of interprofessional collaboration in practice? Methods: A qualitative ethnographic methodology was used to understand the factors impacting interprofessional collaboration in three separate teams providing palliative care in different settings in a city in Western Canada. Data were collected and analyzed using Carspecken’s five step process for ethnographic research. Participant observation and focus groups were conducted with interprofessional team members responsible for providing direct care for palliative care patients/families. Findings: Five themes emerged from the data: Interprofessional Collaboration: A Central Tenet of Palliative Care; Interprofessional Communication: The Single Most Important Ingredient for Effective Interprofessional Collaboration; Professional Hierarchy Impacts Interprofessional Collaboration; Role Understanding and Valuing Others; and Facilitators and Barriers to Team Function. Discussion: Findings from this study can be used to better understand how individual, professional, and organizational culture impacts teamwork in the delivery of palliative care and supports opportunities for understanding and mitigating the barriers to interprofessional collaboration in palliative care settings. The structure and values of the team impact interprofessional collaboration: how communication is enacted; how the hierarchy of the team influences who is viewed as having the ultimate authority over care; and how role understanding and valuing others drives interactions with other members of the team

    The development, feasibility, and acceptability of a breakfast group intervention for stroke rehabilitation

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    Background: There are 1.2 million stroke survivors in the UK and the number is projected to increase significantly over the next decade. Research suggests that between 50% and 80% of hospitalised stroke survivors experience difficulties with eating and drinking. Presently, rehabilitation approaches to address these difficulties involve individual rehabilitation sessions led by uni-professionals. Recent national stroke guidance recommends that stroke survivors receive three hours of daily rehabilitation and emphasises the importance of addressing the psychosocial aspects of recovery. Implementing these recommendations presents a challenge to healthcare professionals, who must explore innovative methods to provide the necessary rehabilitation intensity. This study aimed to address these challenges by codesigning a multi-disciplinary breakfast group intervention and implementation toolkit to improve psychosocial outcomes. Methods: The Hawkins 3-step framework for intervention design was used to develop a multidisciplinary breakfast group intervention and to understand if it was acceptable and feasible for patients and healthcare professionals in an acute stroke ward. The Hawkins 3- steps were 1) evidence review and consultations 2) coproduction 3) prototyping. In collaboration with fifteen stakeholders, a prototype breakfast group intervention and implementation toolkit were codesigned over four months. Experience-based Codesign was used to engage stakeholders. Results: The literature review is the first to investigate the psychosocial impact of eating and drinking difficulties post stroke. The key finding was the presence of psychological and social impacts which included, the experience of loss, fear, embarrassment shame and humiliation as well as social isolation. Stroke survivors were striving to get back to normality and this included the desire to socially dine with others. Two prototype iterations of the intervention were tested with 16 stroke survivors across three hospital sites. The multidisciplinary breakfast group intervention was designed to offer intensive rehabilitation in a social group context. The codesigned implementation toolkit guided a personalised and tailored approach. A perceived benefit of the intervention was the opportunity to address the psychosocial aspects of eating and drinking rehabilitation as well as providing physical rehabilitation. Stroke survivors highly value the opportunity to socialise and receive support from their peers. The intervention was acceptable to both patients and healthcare professionals, and the workforce model proved practical and feasible to deliver using a collaborative approach in the context of resource-limited healthcare. Conclusions: The breakfast group interventions, developed through codesign, were positively received by patients and staff and feasible to deliver. They introduce an innovative and novel approach to stroke rehabilitation, personalised to each individual's needs, and offer a comprehensive intervention which addresses both physical and psychosocial aspects which target challenges related to eating and drinking. Unique contributions of this study include a theoretical model for breakfast group interventions, a programme theory and practical tool kit for clinicians to support the translation of research findings and implement breakfast groups in clinical practice

    Panic Gardening in the End Times: An Interventional Study of Homescale Gardening on Food Security During Times of Crisis

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    While the 20th century was characterized by decreasing food insecurity globally due to innovations in food production and distribution, disruptions in both energy availability and climate stability in the 21st century are presenting profound challenges to all populations dependent on the industrial food system. Proximity to subsistence farming has proven to be the most durable characteristic of food security. This thesis examines the fragilities built into the industrial food system and reports on an intervention designed to model the potential impact and challenges associated with subsistence gardening in peri-urban settings under conditions designed to mimic a low-carbon, climate-disrupted environment. The study finds that time, expressed in multiple dimensions, is the greatest limiting factor for growing enough food to meaningfully offset dependence on the industrial food system with dietary choice ranking second. Developing a low-input method for starting seeds apart from the gardening space is also recommended to maximize impact

    Embers of Autoregression: Understanding Large Language Models Through the Problem They are Trained to Solve

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    The widespread adoption of large language models (LLMs) makes it important to recognize their strengths and limitations. We argue that in order to develop a holistic understanding of these systems we need to consider the problem that they were trained to solve: next-word prediction over Internet text. By recognizing the pressures that this task exerts we can make predictions about the strategies that LLMs will adopt, allowing us to reason about when they will succeed or fail. This approach - which we call the teleological approach - leads us to identify three factors that we hypothesize will influence LLM accuracy: the probability of the task to be performed, the probability of the target output, and the probability of the provided input. We predict that LLMs will achieve higher accuracy when these probabilities are high than when they are low - even in deterministic settings where probability should not matter. To test our predictions, we evaluate two LLMs (GPT-3.5 and GPT-4) on eleven tasks, and we find robust evidence that LLMs are influenced by probability in the ways that we have hypothesized. In many cases, the experiments reveal surprising failure modes. For instance, GPT-4's accuracy at decoding a simple cipher is 51% when the output is a high-probability word sequence but only 13% when it is low-probability. These results show that AI practitioners should be careful about using LLMs in low-probability situations. More broadly, we conclude that we should not evaluate LLMs as if they are humans but should instead treat them as a distinct type of system - one that has been shaped by its own particular set of pressures.Comment: 50 pages plus 11 page of references and 23 pages of appendice

    AI: Limits and Prospects of Artificial Intelligence

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    The emergence of artificial intelligence has triggered enthusiasm and promise of boundless opportunities as much as uncertainty about its limits. The contributions to this volume explore the limits of AI, describe the necessary conditions for its functionality, reveal its attendant technical and social problems, and present some existing and potential solutions. At the same time, the contributors highlight the societal and attending economic hopes and fears, utopias and dystopias that are associated with the current and future development of artificial intelligence

    Efficacy of an Online Caregiver Education Series for Promoting Collaboration with Autistic Adolescents without Intellectual Disability on Daily Living Skills

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    An estimated 50,000 autistic young adults in the United States transition out of high school each year, and more than a third of them do not engage in any form of employment or formal education in their twenties. Daily living skills (DLS) are one key predictor of autistic adults attending post-secondary education, obtaining employment, and living independently. Adolescents with autism have indicated a desire for more DLS supports, and explicit instruction on DLS is most effective for this population prior to adulthood. Despite this evidence, autistic adolescents without intellectual disability (ID) are unlikely to receive DLS instruction in their general education coursework. Caregivers of autistic adolescents have indicated a desire to support DLS at home, but they are unsure of how to motivate and collaborate with their teen to work on these skills. To address these concerns, we developed an eLearning instructional tool to support caregivers of autistic adolescents without ID in teaching DLS at home. The online module series presents caregivers with strategies for working with their teen, setting goals, and using evidence-based practices to teach DLS. The current single case design study measured the impact of the modules on caregiver-adolescent collaboration, caregiver fidelity to the evidence-based practices, and adolescent independence with DLS. The study also assessed the social validity of the modules. The results of this study reveal functional relationships between the module series and caregiver fidelity to the evidence-based practices and to adolescent independence with targeted DLS. Collaboration between the caregivers and their autistic adolescents was high across all phases resulting in no evidence of a functional relationship between the intervention and dyadic collaboration. The caregivers and the adolescents both rated the acceptability, feasibility, and significance of the intervention favorably.Doctor of Philosoph

    Fall 2023 Supplement to Brauneis & Schechter, Copyright: A Contemporary Approach

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    This Fall 2023 Supplement is the product of our effort to capture important developments in copyright law since the publication of the second edition of Copyright: A Contemporary Approach. It includes three Supreme Court decisions as principal cases: the fair use cases of Google LLC v. Oracle America, Inc. (p. 23) and Andy Warhol Foundation v. Goldsmith (p. 41) and the 2020 decision about copyright protection for state statutes, Georgia v. Public.Resources.Org (p. 74).. (Because there are now so many Supreme Court fair use cases to cover, this supplement also includes a note on Harper & Row, Publishers v. Nation Enterprises (pp. 13-14), as an option to replace its treatment as a principal case in the second edition of the casebook. The supplement also includes notes on many other cases, and a few new features that we thought would enhance study of U.S. copyright law. It includes new material on copyright and artificial intelligence, both on the issue of AI authorship, (see the new notes on page 7-9), and the issue of infringement and fair use in training generative AI models (see the new feature on p. 21). Because the Copyright Claims Board (“CCB”) opened up its doors for business in June 2022, we have included a new section at the end of Chapter 6 on the CASE Act and CCB proceedings (p. 67). We have also completely revised Chapter 12.E., on digital audio transmission rights, and Chapter 12.F., on rights in pre-1972 sound recordings. The new Chapter 12.E. in this supplement, “Digital Streaming of Music After the Musical Works Modernization Act” (p. 101), now consists of a general introduction to copyright and the streaming of music, covering both rights in sound recordings and rights in musical works, and all of the relevant exclusive rights

    A critical analysis of the strategies of terminology creation in the context of a multilingual Namibia: the case of ruManyo

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    This study examines the strategies used to develop terms in the language ruManyo. The study focuses on existing strategies used by language practitioners to construct analogous key-concept terms in ruManyo for application in various fields. The sample was taken through purposive sampling, and the investigation was carried out in Namibia's Kavango East region, in domains such as education, radio, agriculture, law, hospital, bank, and church. The data for this report was collected using a case study, which included document analysis, participant observations and interviews with ruManyo language practitioners. The findings of the study indicate that ruManyo language practitioners lack the skills and information needed to build appropriate terminology solutions for specific domains. Furthermore, it appears that linguistic competence is not guiding word-generation efforts in certain disciplines. The study re-evaluated the evolution of multilingual word-generation techniques, and discovered that specific domains necessitate specific tactics, based on the context in which terms are employed. Based on the findings of this study, the recommendation is to design unambiguous wordinvention strategies for specific domains that are consistent with the terminology development guidelines for indigenous African languages. Due to the deficiencies in African indigenous language terminologies highlighted in this study, the researcher proposes the creation of a manual for ruManyo, detailing each method for application in different domains
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