A qualitative study on family carers views on how end-of-life communication contributes to palliative oriented care in nursing home.

Background. Although family-centered communication about end-of-life care has been recognized to promote palliative-oriented care in nursing home (NH), how this communication may work is still unknown. Therefore, we explored the mechanisms by which end-of-life communication may contribute to palliative-oriented care in NH from the perspective of bereaved family carers.Methods. A descriptive qualitative design was performed. Interviews were conducted with 32 bereaved family carers whose relative had died between 45 days to 9 months prior from 13 different NHs. A two-steps analysis process firstly with deductive and then with inductive content analysis was adopted.Results. Four mechanisms by which end-of-life communication contributed to palliative-oriented care were identified: a) promoting family carers understanding about their relative's health conditions, prognosis, and treatments available; b) fostering shared decision-making between healthcare professionals and residents/family carers; c) improving knowledge of residents' preferences; and d) improving knowledge of family carers' preferences.Conclusion. Clear and in-depth communication provides insight into residents' and family carers' preferences for care and treatment at the end-of-life, and increases understanding and shared decision-making

Quality improvement interventions to prevent the use of hospital services among nursing home residents: protocol for a systematic review and meta-analysis

Introduction: Quality improvement interventions are a promising strategy for reducing hospital services use among nursing home residents. However, evidence for their effectiveness is limited. It is unclear which characteristics of the quality improvement intervention and activities planned to facilitate implementation may promote fidelity to organisational and system changes. This systematic review and meta-analysis will assess the effectiveness of quality improvement interventions and implementation strategies aimed at reducing hospital services use among nursing home residents. Methods and analysis: The MEDLINE, CINAHL, Cochrane Library, Embase and Web of Science databases will be comprehensively searched in September 2023. The eligible studies should focus on the implementation of a quality improvement intervention defined as the systematic, continuous approach that designs, tests and implements changes using real-time measurement to reduce hospitalisations or emergency department visits among long-stay nursing home residents. Quality improvement details and implementation strategies will be deductively categorised into effective practice and organisation of care taxonomy domains for delivery arrangements and implementation strategies. Quality and bias assessments will be completed using the Quality Improvement Minimum Quality Criteria Set and the Joanna Briggs Institute Critical Appraisal Tools.The results will be pooled in a meta-analysis, by combining the natural logarithms of the rate ratios across the studies or by calculating the rate ratio using the generic inverse-variance method. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies will be less than 10. Raw data will be requested from the authors, as required. Ethics and dissemination: Ethical approval is not required. The results will be published in a peer-review journal and presented at (inter)national conferences. Prospero registration number: CRD42022364195

The experience of individuals placed in quarantine: A systematic review, meta-summary, and meta-synthesis

Objective: To summarize the experience of individuals placed in quarantine during an outbreak. Design: A meta-summary and a meta-synthesis based upon a systematic review of qualitative studies. Sample: The Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Scopus databases were all searched up to April 2020. Measurements: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; then, the methodological quality of the studies included was assessed with the Critical Appraisal Screening Programme tool for qualitative studies. Results: Five studies have been included documenting the experience of 125 adult individuals. A total of 16 codes emerged: in the meta-summary, the most and least frequent codes were \u201cThinking about quarantine\u201d (80%) and \u201cEmotional roller coaster,\u201d \u201cBeing alert for any symptom,\u201d \u201cTrusting or not?,\u201d \u201cKnowing who brought the infection,\u201d and \u201cLiving in a surreal world\u201d (20%). The codes which emerged were categorized into three main themes which summarized the whole experience of being placed in quarantine: (a) \u201cBeing swamped with a thousand emotions\u201d; (b) \u201cBeing restrained\u201d; and (c) \u201cNeeding to be considered.\u201d. Conclusions: The experience of quarantine for people is a long journey which can feel chaotic due to uncertainty about the consequences on health, work, and the future. The findings of this study can help nurses in caring for quarantined individuals by enabling them to understand people's need for educational and emotional support. Ensuring the supply of consistent information is also important to increase people's compliance

EXPERIENCING THE INACCESSIBLE. A FRAMEWORK FOR VIRTUAL INTERPRETATION AND VISUALIZATION OF REMOTE, RISKY OR RESTRICTED ACCESS HERITAGE PLACES

Abstract. In order to be properly handed down, especially in particular conditions with a high rate of vulnerability, cultural heritage requires documentation and enhancement strategies. The case study presented in this paper is particularly critical not only for the conservation conditions, but especially for the environmental conditions: the Catacombs of San Vittorino have complex conditions of recovery, because of the nature of the artefact and because of the poor lighting of the main environments. For this particularity, a workflow was developed that, in order to achieve the creation of an immersive device navigable by digital viewers such as Oculus Rift or similar, required the start-up of shooting by laser scanning, and then treat the point cloud with different software, in order to obtain a satisfactory result that, in other contexts, could have started easily from a photogrammetric shooting.</p

Photosynthetic activity buffers ocean acidification in seagrass meadows

Macrophytes growing in shallow coastal zones characterised by intense metabolic activity have the capacity to modify pH within their canopy and beyond. We observed diel pH changes in shallow (5–12 m) seagrass (<i>Posidonia oceanica</i>) meadows spanning 0.06 pH units in September to 0.24 units in June. The carbonate system (pH, DIC, and aragonite saturation state (&Omega;_Ar)) and O₂ within the meadows displayed strong diel variability driven by primary productivity, and changes in chemistry were related to structural parameters of the meadow, in particular, the leaf surface area available for photosynthesis (LAI). LAI was positively correlated to mean, max and range pH_NBS and max and range &Omega;_Ar. In June, vertical mixing (as Turbulent Kinetic Energy) influenced max and min &Omega;_Ar, while in September there was no effect of hydrodynamics on the carbonate system within the canopy. Max and range &Omega;_Ar within the meadow showed a positive trend with the calcium carbonate load of the leaves, pointing to a possible link between structural parameters, &Omega;_Ar and carbonate deposition. <br></br> Calcifying organisms, e.g. epiphytes with carbonate skeletons, may benefit from the modification of the carbonate system by the meadow. There is, however, concern for the ability of seagrasses to provide modifications of similar importance in the future. The predicted decline of seagrass meadows may alter the scope for alteration of pH within a seagrass meadow and in the water column above the meadow, particularly if shoot density and biomass decline, on which LAI is based. Organisms associated with seagrass communities may therefore suffer from the loss of pH buffering capacity in degraded meadows

TBA-like equations and Casimir effect in (non-)perturbative AdS/CFT

We consider high spin, $s$, long twist, $L$, planar operators (asymptotic Bethe Ansatz) of strong ${\cal N}=4$ SYM. Precisely, we compute the minimal anomalous dimensions for large 't Hooft coupling $\lambda$ to the lowest order of the (string) scaling variable $\ell \sim L/ (\ln \mathcal{S} \sqrt{\lambda})$ with GKP string size $\sim\ln \mathcal{S}\equiv 2 \ln (s/\sqrt{\lambda})$. At the leading order $(\ln \mathcal{S}) \cdot \ell ^2$, we can confirm the O(6) non-linear sigma model description for this bulk term, without boundary term $(\ln \mathcal{S})^0$. Going further, we derive, extending the O(6) regime, the exact effect of the size finiteness. In particular, we compute, at all loops, the first Casimir correction $\ell ^0/\ln \mathcal{S}$ (in terms of the infinite size O(6) NLSM), which reveals only one massless mode (out of five), as predictable once the O(6) description has been extended. Consequently, upon comparing with string theory expansion, at one loop our findings agree for large twist, while reveal for negligible twist, already at this order, the appearance of wrapping. At two loops, as well as for next loops and orders, we can produce predictions, which may guide future string computations.Comment: Version 2 with: new exact expression for the Casimir energy derived (beyond the first two loops of the previous version); UV theory formulated and analysed extensively in the Appendix C; origin of the O(6) NLSM scattering clarified; typos correct and references adde

Compensation of B-L charge of matter with relic sneutrinos

We consider massless gauge boson connected to B-L charge with and without compensation to complete the investigation of the gauging of B and L charges. Relic sneutrinos predicted by SUSY and composite models may compensate B-L charge of matter. As a consequence of the possible compensation mechanism we have shown that the available experimental data admit the range of the B-L interaction constant, 10^{-29} < {\alpha}_{B-L} < 10^{-12}, in addition to {\alpha}_{B-L} < 10^{-49} obtained without compensation.Comment: 6 page

Quantum folded string and integrability: from finite size effects to Konishi dimension

Using the algebraic curve approach we one-loop quantize the folded string solution for the type IIB superstring in AdS(5)xS(5). We obtain an explicit result valid for arbitrary values of its Lorentz spin S and R-charge J in terms of integrals of elliptic functions. Then we consider the limit S ~ J ~ 1 and derive the leading three coefficients of strong coupling expansion of short operators. Notably, our result evaluated for the anomalous dimension of the Konishi state gives 2\lambda^{1/4}-4+2/\lambda^{1/4}. This reproduces correctly the values predicted numerically in arXiv:0906.4240. Furthermore we compare our result using some new numerical data from the Y-system for another similar state. We also revisited some of the large S computations using our methods. In particular, we derive finite--size corrections to the anomalous dimension of operators with small J in this limit.Comment: 20 pages, 1 figure; v2: references added, typos corrected; v3: major improvement of the references; v4: Discussion of short operators is restricted to the case n=1. This restriction does not affect the main results of the pape

Functional Integration Approach to Hysteresis

A general formulation of scalar hysteresis is proposed. This formulation is based on two steps. First, a generating function g(x) is associated with an individual system, and a hysteresis evolution operator is defined by an appropriate envelope construction applied to g(x), inspired by the overdamped dynamics of systems evolving in multistable free energy landscapes. Second, the average hysteresis response of an ensemble of such systems is expressed as a functional integral over the space G of all admissible generating functions, under the assumption that an appropriate measure m has been introduced in G. The consequences of the formulation are analyzed in detail in the case where the measure m is generated by a continuous, Markovian stochastic process. The calculation of the hysteresis properties of the ensemble is reduced to the solution of the level-crossing problem for the stochastic process. In particular, it is shown that, when the process is translationally invariant (homogeneous), the ensuing hysteresis properties can be exactly described by the Preisach model of hysteresis, and the associated Preisach distribution is expressed in closed analytic form in terms of the drift and diffusion parameters of the Markovian process. Possible applications of the formulation are suggested, concerning the interpretation of magnetic hysteresis due to domain wall motion in quenched-in disorder, and the interpretation of critical state models of superconducting hysteresis.Comment: 36 pages, 9 figures, to be published on Phys. Rev.

Abbreviated Versus Multiparametric Prostate MRI in Active Surveillance for Prostate-Cancer Patients: Comparison of Accuracy and Clinical Utility as a Decisional Tool

(1) Purpose: To compare the diagnostic accuracy between full multiparametric contrast-enhanced prostate MRI (mpMRI) and abbreviated dual-sequence prostate MRI (dsMRI) in men with clinically significant prostate cancer (csPCa) who were candidates for active surveillance. (2) Materials and Methods: Fifty-four patients with a diagnosis of low-risk PCa in the previous 6 months had a mpMRI scan prior to a saturation biopsy and a subsequent MRI cognitive transperineal targeted biopsy (for PI-RADS ≥ 3 lesions). The dsMRI images were obtained from the mpMRI protocol. The images were selected by a study coordinator and assigned to two readers blinded to the biopsy results (R1 and R2). Inter-reader agreement for clinically significant cancer was evaluated with Cohen’s kappa. The dsMRI and mpMRI accuracy was calculated for each reader (R1 and R2). The clinical utility of the dsMRI and mpMRI was investigated with a decision-analysis model. (3) Results: The dsMRI sensitivity and specificity were 83.3%, 31.0%, 75.0%, and 23.8%, respectively, for R1 and R2. The mpMRI sensitivity and specificity were 91.7%, 31.0%, 83.3%, and 23.8%, respectively, for R1 and R2. The inter-reader agreement for the detection of csPCa was moderate (k = 0.53) and good (k = 0.63) for dsMRI and mpMRI, respectively. The AUC values for the dsMRI were 0.77 and 0.62 for the R1 and R2, respectively. The AUC values for the mpMRI were 0.79 and 0.66 for R1 and R2, respectively. No AUC differences were found between the two MRI protocols. At any risk threshold, the mpMRI showed a higher net benefit than the dsMRI for both R1 and R2. (4) Conclusions: The dsMRI and mpMRI showed similar diagnostic accuracy for csPCa in male candidates for active surveillance