An exploration of the perceptions and practice of community nursing staff within two care settings in relation to spiritual distress at the end of life

High quality end of life (EOL) care requires a range of holistic approaches. Patients approaching the end of their lives frequently experience a variety of debilitating and distressing symptoms(e.g. nausea, breathlessness, or pain). Patients may also experience spiritual distress: a multifaceted form of existential anxiety which can include fear, regret, loss of connection, loss of hope, and loss of meaning. Spiritual distress within EOL care appears to be influenced by a lack of international consensus regarding definition, uncertainty regarding assessment tools and their use, and variation in specific interventions used to help relieve such distress. This conceptual ambiguity appears to directly influence patient care, both in the identification and assessment of spiritual distress and in relation to specific interventions utilised to alleviate such distress. The assessment of spiritual distress in a community context is also problematic: most published studies to date are based within acute hospital settings. None would appear to describe how spiritual distress is perceived/experienced by community nurses within different care settings or attempt to evaluate spiritual distress as experienced by patients dying within their own homes. Likewise, literature describing the use of assessment tools within a community setting, specific interventions to alleviate such distress, and how practitioners perceive the effectiveness of such interventions appears scarce. This study explores the perceptions of twenty-one community nurses (11 hospice, 10 NHS) regarding spiritual distress, as observed in EOL community-based patients. An initial literature review first attempts to situate spiritual distress within the wider backdrop of spirituality, spiritual care and spiritual needs. A qualitative investigative study was then undertaken using semi-structured interviews. Textual data were subsequently transcribed and analysed using thematic analysis, as described by Braun and Clarke (2006). The study’s findings suggest that spiritual distress is a challenging phenomenon for practitioners to effectively manage within community nursing. Ambiguity associated with such distress would also appear to directly influence the quality and delivery of nursing care for EOL patients within both care settings

Potential for increasing producers' income from wool, fibre and pelts in Central Asia

The systems of livestock production, marketing and research have been profoundly transformed by recent policies in Central Asia since the break up of the Soviet Union. Decollectivisation of state farms has transferred livestock ownership to new private farming units. These receive little or no state support for inputs, or for processing and selling livestock products. Most livestock-keeping families have much-reduced incomes compared to the Soviet period. Live animal sales now constitute the main subsistence income for such families, but may be unsustainable for the majority of families who own small numbers of animals. Poverty is particularly prevalent in the more remote areas distant from urban markets

Recurrent pancreatitis after partial ileal bypass for hyperlipidaemia : a case report

CITATION: Du Toit, D. F., Knott-Craig, C. & Laker, L. 1985. Recurrent pancreatitis after partial ileal bypass for hyperlipidaemia : a case report. South African Medical Journal, 68:483-484.The original publication is available at http://www.samj.org.zaThe case of a 28-year-old man with alcohol-induced bouts of recurrent acute pancreatitis after a partial ileal bypass performed for hyperlipidaemia is presented. Serial computed tomography proved valuable for assessing the resolution of the pancreatic mass. Peripheral parenteral hyperalimentation for 6 weeks had a beneficial effect on the course of the pancreatitis and proved to be useful for nutritional support.Publisher’s versio

It's time for UK businesses to sell big, sell global and stay relevant

Selling is becoming harder than ever write Ben Laker and Claire Edmunds, CEO & Founder of Clarify, a specialist business development firm operating globally. In this article, the authors elaborate on three key messages that sales leaders must use to support their boards

Contextual adaptative interfaces for Industry 4.0

[EN] Information technologies are intrinsically connected to the manufacturing processes, with more data generated each second. To efficiently operate machines, users must sort out information that is relevant to them in specific moments and contexts. In this paper, we propose an architecture that combines context – e.g. location, type of order, available assets, previous actions – with information established through user stereotypes

Transcriptomic and epigenetic responses to short-term nutrient-exercise stress in humans

Abstract High fat feeding impairs skeletal muscle metabolic flexibility and induces insulin resistance, whereas exercise training exerts positive effects on substrate handling and improves insulin sensitivity. To identify the genomic mechanisms by which exercise ameliorates some of the deleterious effects of high fat feeding, we investigated the transcriptional and epigenetic response of human skeletal muscle to 9 days of a high-fat diet (HFD) alone (Sed-HFD) or in combination with resistance exercise (Ex-HFD), using genome-wide profiling of gene expression and DNA methylation. HFD markedly induced expression of immune and inflammatory genes, which was not attenuated by Ex. Conversely, Ex markedly remodelled expression of genes associated with muscle growth and structure. We detected marked DNA methylation changes following HFD alone and in combination with Ex. Among the genes that showed a significant association between DNA methylation and gene expression changes were PYGM, which was epigenetically regulated in both groups, and ANGPTL4, which was regulated only following Ex. In conclusion, while short-term Ex did not prevent a HFD-induced inflammatory response, it provoked a genomic response that may protect skeletal muscle from atrophy. These epigenetic adaptations provide mechanistic insight into the gene-specific regulation of inflammatory and metabolic processes in human skeletal muscle

The Folly of Employability: The Case for a Citizen-Driven Market Economy

In this conceptual essay, the authors argue that the present approach taken in crafting economic, educational, and employment policies and structures imagines people as inanimate objects for policy makers and industry titans to leverage for their own interests. When the population is not immediately willing or able to accommodate the production and profi t-making desires of the leaders, it is framed as a shortcoming in individuals and their communities rather than as a mismatch with the implicit assumptions of those promulgating such expectations. The authors develop an argument that if the policy makers and industry leaders truly believe in market solutions, then they should respect the vocational aspirations of the people and provide support for education and entrepreneurial skills to be developed in individuals to use as they wish. This recasting of a so-called “market” approach places the workers at the centre, believing that much stronger and sustainable economic returns would be realised whilst developing strong social capital in the process

aiWOM: Artificial Intelligence Word-of-Mouth. Conceptualizing Consumer-to-AI Communication

The advent of innovative technologies with installed artificial intelligence (AI) has raised the need to understand evolutive consumers’ behaviours. The dyadic communicative experience between consumers and technological artifacts with programmed social humanoid features shed the light on the emergence of an adaptative form of word-of-mouth (WOM) and that we label as “AI word-of-mouth” (aiWOM). We argue that there is a need for defining and investigating aiWOM as an emerging phenomenon which derive but diverge from WOM. Our conceptualization suggests that the communication interaction between consumers and AI technologies produce new consumers’ behaviors and psychological reactions