Developing a digital mind body medicine supportive care intervention for people with amyotrophic lateral sclerosis using stakeholder engagement and design thinking

Background Amyotrophic lateral sclerosis disease (ALS) is also called the disease of a thousand farewells. Consequently, it is important to offer supportive care interventions that can be applied continuously during the whole course of the disease. People with ALS are interested in complementary and integrative medicine. Due to ALS’ progressive nature, digital solutions might be most feasible and accessible for people with ALS in the long-term. Objectives In our study, we explored with stakeholders which digital complementary and integrative medicine interventions and formats are considered as supportive for people with ALS, and which settings are needed by the people with ALS to incorporate the interventions in everyday life. Methods We used a participatory research approach and conducted a stakeholder engagement process, applying a design thinking process with qualitative research methods (interviews, workshops). Results Due to the unpredictable course of the disease on their loss of abilities, people with ALS welcome online settings because they are accessible and easy to implement in their daily life. Stakeholders considered the following implementation factors for a complementary and integrative medicine intervention as essential: short-term realization of planned interventions, short duration of interventions, and user-friendliness in terms of accessibility and applicability. Concerning the complementary and integrative medicine interventions, the people with ALS preferred mind body medicine interventions, such as breathing, mindfulness and relaxation exercises. Conclusions Short-term treatment intervals and short online mind body medicine interventions align with the needs of people with ALS. The complementary and integrative medicine interventions as well as the digital infrastructure must meet the special accessibility and applicability needs of people with ALS

Linear entropy fails to predict entanglement behavior in low-density fermionic systems

Entanglement is considered a fundamental ingredient for quantum technologies and condensed matter systems are among the good candidates for quantum devices. For bipartite pure states the von Neumann entropy is a proper measure of entanglement, while the linear entropy, associated to the mixedness of the reduced density matrices, is a simpler quantity to be obtained and is considered to be qualitatively equivalent to the von Neumann. Here we investigate both linear and von Neumann entropies for quantifying entanglement in homogeneous, superlattice and disordered Hubbard chains. We find regimes of parameters for which the linear entropy fails in reproducing the qualitative behavior of the von Neumann entropy. This then may lead to incorrect predictions i) of maximum and minimum entanglement states and ii) of quantum phase transitions

Incorporating changes in albedo in estimating the climate mitigation benefits of land use change projects

International audienceSome climate scientists are questioning whether the practice of converting of non-forest lands to forest land (afforestation or reforestation) is an effective climate change mitigation option. The discussion focuses particularly on areas where the new forest is primarily coniferous and there is significant amount of snow since the increased climate forcing due to the change in albedo may counteract the decreased climate forcing due to carbon dioxide removal. In this paper, we develop a stand-based model that combines changes in surface albedo, solar radiation, latitude, cloud cover and carbon sequestration. As well, we develop a procedure to convert carbon stock changes to equivalent climatic forcing or climatic forcing to equivalent carbon stock changes. Using the model, we investigate the sensitivity of combined affects of changes in surface albedo and carbon stock changes to model parameters. The model is sensitive to amount of cloud, atmospheric absorption, timing of canopy closure, carbon sequestration rate among other factors. The sensitivity of the model is investigated at one Canadian site, and then the model is tested at numerous sites across Canada. In general, we find that the change in albedo reduces the carbon sequestration benefits by approximately 30% over 100 years, but this is not drastic enough to suggest that one should not use afforestation or reforestation as a climate change mitigation option. This occurs because the forests grow in places where there is significant amount of cloud in winter. As well, variations in sequestration rate seem to be counterbalanced by the amount and timing of canopy closure. We close by speculating that the effects of albedo may also be significant in locations at lower latitudes, where there are less clouds, and where there are extended dry seasons. These conditions make grasses light coloured and when irrigated crops, dark forests or other vegetation such as biofuels replace the grasses, the change in carbon stocks may not compensate for the darkening of the surface

Architettura e Realismo. Programma

Il convegno "«Uno spazio reale adeguato»: architettura e realismo", la giornata di studi e mostra "«Il sempre teorizzar nulla rileva...»: nuovo realismo e architettura della città", il convegno "Per una nozione operativa di realismo: espressione critica e impegno civile e la mostra Il realismo nella didattica del progetto: Torino Napoli Milano", uniti sotto il titolo comune di Architettura e realismo sono promossi da un gruppo di lavoro costituito da giovani ricercatori e docenti delle facoltà di Architettura di Torino, Milano e Napoli, a partire dalla avvertita esigenza di aggiornare la riflessione sulla architettura come pratica costruttiva e sulla città come luogo per eccellenza della vita dell'uomo a partire da una analisi critica di quanto si è prodotto negli ultimi decenni. Da un lato grandi architetture spettacolari che rispondono alle logiche del mercato e della comunicazione e, dall'altro - in una sorta di inspiegabile paradosso - la de- regolazione della città diffusa priva di struttura, elementi riconoscibili e spazio pubblico. In entrambi i casi, pur nella loro diversità, si è prodotto un pericoloso distacco della architettura dal suo obiettivo ultimo: conformare lo spazio fisico dei manufatti e della città, del territorio e del paesaggio, per determinare in maniera consistente lo scenario della vita dell'uomo, nella sua dimensione, innanzitutto, collettiv

Effects of blended learning training for oncology physicians to advise their patients about complementary and integrative therapies: results from the multicenter cluster-randomized KOKON-KTO trial

Background: Many oncology physicians are confronted with the topic of complementary and integrative medicine (CIM) by cancer patients. This study examined whether a blended learning (e-learning and a workshop) to train oncology physicians in providing advice on CIM therapies to their cancer patients, in addition to distributing an information leaflet about reputable CIM websites, had different effects on physician-reported outcomes in regard to consultations compared with only distributing the leaflet. Methods: In a multicenter, cluster-randomized trial, 48 oncology physicians were randomly allocated to an intervention group (CIM consultation and an information leaflet) or a control group (information leaflet only). After the training, the oncology physicians conducted 297 consultations with their cancer patients. Measurements were assessed at oncology physician, physician-patient-interaction (measured by external reviewers), and patient levels. This analysis focused on the physician outcomes of stress reaction and perceived consultation skill competency. In addition, qualitative interviews were conducted with a subsample of oncology physicians who experienced both, the intervention and control condition. Results: The oncology physicians in the intervention group showed a lower stress reaction in all measured dimensions after CIM consultations than those in the control group. There was no significant difference between oncology physicians in the intervention and control groups regarding the perceived consultation skill competency (overburden: intervention 1.4 [95% CI: 0.7;2.1]; control 2.1 [95% CI: 1.4;2.7], tension: 1.3 [95% CI: 0.7;2.0] vs. 1.9 [95% CI: 1.3;2.5], and discomfort with consultation situations: 1.0 [95% CI: 0.4;1.7]; vs. 1.7 [95% CI: 1.2;2.3]). The qualitative data showed that only providing the leaflet seemed impersonal to oncology physicians, while the training made them feel well prepared to conduct a full conversation about CIM and provide the information leaflet. Conclusions: In our exploratory study providing structured CIM consultations showed positive effects on the perceived stress of oncology physicians, and the training was subjectively experienced as an approach that improved physician preparation for advising cancer patients about CIM, however no effects regarding perceived consultation skill competency were found

Effects of training oncology physicians advising patients on complementary and integrative therapies on patient‐reported outcomes: A multicenter, cluster‐randomized trial

Background: Many patients with cancer do not disclose complementary medicine use but want their physician's advice on this matter. This study evaluated whether using blended learning (e-learning plus a workshop) to train oncology physicians in providing advice on complementary and integrative medicine (CIM) therapies to their patients with cancer, in addition to distributing an information leaflet on reputable CIM websites, had different effects on patient-reported outcomes for the consultation than only distributing the leaflet. Methods: In this multicenter, cluster-randomized trial, patients from private practices/hospital departments, recruited by 48 oncology physicians randomly allocated to an intervention group (CIM consultation plus information leaflet) or a control group (information leaflet), received CIM information. Patient-reported outcomes included satisfaction (Patient Satisfaction With Information on Cancer Treatment), readiness to make a decision (Preparation for Decision Making), and physician-patient communication (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and Communication 26 [EORTC QLQ-COMU26]) for the consultation. Qualitative interviews were conducted with a physician subsample. Results: A total of 291 patients (128 in the intervention group and 169 in the control group) advised by 41 physicians participated. Patients in the intervention group rated physician-patient communication higher on all EORTC QLQ-COMU26 scales (mean total score, 84.3 [95% CI, 79.5-89.2] vs 73.6 [95% CI, 69.3-78.0]; P = .002), were more satisfied with the advice (mean, 4.2 [95% CI, 4.0-4.4] vs 3.7 [95% CI, 3.5-3.8]; P < .001), and were readier to make a decision (mean, 63.5 [95% CI, 57.4-69.6] vs 53.2 [95% CI, 47.8-58.7]; P = .016) than the control group. Physicians who reported patients in both settings seemed satisfied with the advice given. Conclusions: This study evaluated a novel education intervention for training oncology physicians in providing CIM advice in routine care. Providing structured CIM consultations had positive effects on patient satisfaction, readiness to make decisions, and physician-patient communication

Design and Optimization of a Pneumatic Clamping System for Direct-Driven Rotary Tables

Modern direct-driven and high-speed rotary tables with torque motor are optimally suited for all handling and assembly applications that require the shortest indexing times and flexible positioning. The following paper is devoted to the study, the design, and the optimization of an innovative table clamping system (brake for accurate positioning) actuated by pneumatic energy, working at a maximum clamping pressure of 6 bar. The challenge for the aforementioned application is related to developing a solution able to provide a maximum tangential torque (with clamping actuated) in the range of thousands of Nm without leveraging the use of high-pressure hydraulic energy. The optimization of the proposed solution is based on the precise calculation of the stresses in order to perform a fatigue assessment and on the elastic deformation of the clamps in order to set the correct tolerances between the mating parts. Eventually, an experimental campaign is carried out in order to tune the numerical model, which is then used to validate the proposed design solution