Religious leaders\u27 perceptions of advance care planning: a secondary analysis of interviews with Buddhist, Christian, Hindu, Islamic, Jewish, Sikh and Bahai leaders

Background: International guidance for advance care planning (ACP) supports the integration of spiritual and religious aspects of care within the planning process. Religious leaders’ perspectives could improve how ACP programs respect patients’ faith backgrounds. This study aimed to examine: (i) how religious leaders understand and consider ACP and its implications, including (ii) how religion affects followers’ approaches to end-of-life care and ACP, and (iii) their implications for healthcare. Methods: Interview transcripts from a primary qualitative study conducted with religious leaders to inform an ACP website, ACPTalk, were used as data in this study. ACPTalk aims to assist health professionals conduct sensitive conversations with people from different religious backgrounds. A qualitative secondary analysis conducted on the interview transcripts focussed on religious leaders’ statements related to this study’s aims. Interview transcripts were thematically analysed using an inductive, comparative, and cyclical procedure informed by grounded theory. Results: Thirty-five religious leaders (26 male; mean 58.6-years-old), from eight Christian and six non-Christian (Jewish, Buddhist, Islamic, Hindu, Sikh, Bahá’í) backgrounds were included. Three themes emerged which focussed on: religious leaders’ ACP understanding and experiences; explanations for religious followers’ approaches towards end-of-life care; and health professionals’ need to enquire about how religion matters. Most leaders had some understanding of ACP and, once fully comprehended, most held ACP in positive regard. Religious followers’ preferences for end-of-life care reflected family and geographical origins, cultural traditions, personal attitudes, and religiosity and faith interpretations. Implications for healthcare included the importance of avoiding generalisations and openness to individualised and/ or standardised religious expressions of one’s religion. Conclusions: Knowledge of religious beliefs and values around death and dying could be useful in preparing health professionals for ACP with patients from different religions but equally important is avoidance of assumptions. Community-based initiatives, programs and faith settin

Survey of Pasture Species and Management, Manure Management, Milk Production and Reproduction on Pasture-Based Dairy Farms in Florida and Georgia, USA

Traditionally, most dairy farms in the south-eastern United States confine cows to barns or on pasture lots year-round and feed stored forages and concentrated feeds (Fontaneli et al. 2005). Often, much of the feed is purchased, however, the cost of purchased feed and fuel has risen rapidly in the last 5 years (NASS 2009). In addition, a significant amount of capital is tied up in buildings, machinery and manure management systems on the farms. For these reasons, many dairy farmers have shown an interest in or started transitioning to pasture-based dairy systems (Ricks and Hardee 2012). The management practices and production results of pasture-based dairy farms in the south-east appear to vary widely (Macoon et al. 2011), but have not been described. The objective of this study was to document pasture and crop management, manure management and milk production on pasture-based dairy farms in Florida and Georgia

Seasonal abundance of small cladocerans in Lake Mangakaware, Waikato, New Zealand

The seasonal changes in the dynamics and life histories of the Cladocera in Lake Mangakaware, North Island, New Zealand, were studied over 19 months by sampling at weekly or 2-weekly intervals. Lake Mangakaware is a 13.3 ha polymictic lake with high nutrient status, low Secchi disc transparencies, and an unstable thermal regime. The four planktonic cladoceran species (Bosmina longirostris, B. meridionalis, Ceriodaphnia pulchella, and C. dubia) exhibited disjunct population maxima. Only B. longirostris was perennially present. All species exhibited low fecundities and low lipid content, indicating that food resources were limited and that competitive interactions and resistance to starvation were probably important in determining species success. Increases in body size in cooler seasons were unrelated to clutch size, giving further support for the view that available food was limited. These results are consistent with previous experimental findings that subtle differences in life history can determine seasonal success and the outcome of competition between similar species

Discovery of tissue-specific exons using comprehensive human exon microarrays

Comprehensive exon microarrays with a simple intra-gene normalization algorithm were used to detect human tissue-specific alternative splicing events, suggesting significant expression outside of known exons and well annotated genes and a high frequency of alternative splicing events

Resolving Magnetopause Shadowing Using Multimission Measurements of Phase Space Density

Loss mechanisms act independently or in unison to drive rapid loss of electrons in the radiation belts. Electrons may be lost by precipitation into the Earth's atmosphere, or through the magnetopause into interplanetary space—a process known as magnetopause shadowing. While magnetopause shadowing is known to produce dropouts in electron flux, it is unclear if shadowing continues to remove particles in tandem with electron acceleration processes, limiting the overall flux increase. We investigated the contribution of shadowing to overall radiation belt fluxes throughout a geomagnetic storm starting on the 7 September 2017. We use new, multimission phase space density calculations to decipher electron dynamics during each storm phase and identify features of magnetopause shadowing during both the net‐loss and the net‐acceleration storm phases on sub‐hour time scales. We also highlight two distinct types of shadowing; “direct,” where electrons are lost as their orbit intersects the magnetopause, and “indirect,” where electrons are lost through ULF wave driven radial transport toward the magnetopause boundary

Engaging with issues of emotionality in mathematics teacher education for social justice

This article focuses on the relationship between social justice, emotionality and mathematics teaching in the context of the education of prospective teachers of mathematics. A relational approach to social justice calls for giving attention to enacting socially-just relationships in mathematics classrooms. Emotionality and social justice in teaching mathematics variously intersect, interrelate or interweave. An intervention, usng creative action methods, with a cohort of prospective teachers addressing these issues is described to illustrate the connection between emotionality and social justice in the context of mathematics teacher education. Creative action methods involve a variety of dramatic, interactive and experiential tools that can promote personal and group engagement and embodied reflection. The intervention aimed to engage the prospective teachers with some key issues for social justice in mathematics education through dialogue about the emotionality of teaching and learning mathematics. Some of the possibilities and limits of using such methods are considered

Enhancing self-regulation as a strategy for obesity prevention in Head Start preschoolers: the growing healthy study

Abstract Background Nearly one in five 4-year-old children in the United States are obese, with low-income children almost twice as likely to be obese as their middle/upper-income peers. Few obesity prevention programs for low-income preschoolers and their parents have been rigorously tested, and effects are modest. We are testing a novel obesity prevention program for low-income preschoolers built on the premise that children who are better able to self-regulate in the face of psychosocial stressors may be less likely to eat impulsively in response to stress. Enhancing behavioral self-regulation skills in low-income children may be a unique and important intervention approach to prevent childhood obesity. Methods/design The Growing Healthy study is a randomized controlled trial evaluating two obesity prevention interventions in 600 low-income preschoolers attending Head Start, a federally-funded preschool program for low-income children. Interventions are delivered by community-based, nutrition-education staff partnering with Head Start. The first intervention (n = 200), Preschool Obesity Prevention Series (POPS), addresses evidence-based obesity prevention behaviors for preschool-aged children and their parents. The second intervention (n = 200) comprises POPS in combination with the Incredible Years Series (IYS), an evidence-based approach to improving self-regulation among preschool-aged children. The comparison condition (n = 200) is Usual Head Start Exposure. We hypothesize that POPS will yield positive effects compared to Usual Head Start, and that the combined intervention (POPS + IYS) addressing behaviors well-known to be associated with obesity risk, as well as self-regulatory capacity, will be most effective in preventing excessive increases in child adiposity indices (body mass index, skinfold thickness). We will evaluate additional child outcomes using parent and teacher reports and direct assessments of food-related self-regulation. We will also gather process data on intervention implementation, including fidelity, attendance, engagement, and satisfaction. Discussion The Growing Healthy study will shed light on associations between self-regulation skills and obesity risk in low-income preschoolers. If the project is effective in preventing obesity, results can also provide critical insights into how best to deliver obesity prevention programming to parents and children in a community-based setting like Head Start in order to promote better health among at-risk children. Trial registration number Clinicaltrials.gov Identifier: NCT01398358http://deepblue.lib.umich.edu/bitstream/2027.42/112539/1/12889_2012_Article_4758.pd

Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development

Background: Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process