Silence as an element of care:A meta-ethnographic review of professional caregivers’ experience in clinical and pastoral settings

Background: In interactions between professional caregivers, patients and family members at the end of life, silence often becomes more prevalent. Silence is acknowledged as integral to interpersonal communication and compassionate care but is also noted as a complex and ambiguous phenomenon. This review seeks interdisciplinary experience to deepen understanding of qualities of silence as an element of care. Aim: To search for published papers which describe professional caregivers’ experience of silence as an element of care, in palliative and other clinical, spiritual and pastoral care settings and to synthesise their findings. Design: Meta-ethnography: employing a systematic search strategy and line-of-argument synthesis. Data sources: PsycINFO and seven other cross-disciplinary databases, supplemented by hand-search, review of reference lists and citation tracking. No date range was imposed. Inclusion criteria focused on reported experience of silence in professional caregiving. Selected papers (n = 18) were appraised; none were rejected on grounds of quality. Results: International, interdisciplinary research and opinion endorses the value of silence in clinical care. As a multi-functional element of interpersonal relationships, silence operates in partnership with speech to support therapeutic communication. As a caregiving practice, silence is perceived as particularly relevant in spiritual and existential dimensions of care when words may fail. Conclusion: Experience of silence as an element of care was found in palliative and spiritual care, psychotherapy and counselling supporting existing recognition of the value of silence as a skill and practice. Because silence can present challenges for caregivers, greater understanding may offer benefits for clinical practice

An experimental and computational study of the Hydrodynamics of High-velocity water microdrops for interproximal tooth cleaning

The flow field and local hydrodynamics of high-velocity water microdrops impacting the interproximal (IP) space of typodont teeth were studied experimentally and computationally. Fourteen-day old Streptococcus mutans biofilms in the IP space were treated by a prototype AirFloss delivering 115 µL of water at a maximum exit-velocity of 60 m?s?1 in 33-ms burst. Using high-speed imaging, footage was generated showing the details of the burst, and demonstrating the removal mechanism of the biofilms. Footage was also generated to characterize the viscoelastic behaviour of the biofilms when impacted by an air-only burst, which was compared to the water burst. Image analysis demonstrated the importance of fluid forces on the removal pattern of interdental biofilms. X-ray micro-Computed Tomography (µ-CT) was used to obtain 3D images of the typodont and the IP spaces. Computational Fluid Dynamics (CFD) simulations were performed to study the effect of changing the nozzle position and design on the hydrodynamics within the IP space. Results confirmed our previous data regarding the wall shear stress generated by high-velocity water drops which dictated the efficacy of biofilm detachment. Finally, we showed how CFD models could be used to optimize water drop or burst design towards a more effective biofilm removal performanc

Stratigrafia dei depositi pleistocenico-olocenici dell’area costiera di Metaponto compresa fra Marina di Ginosa ed il Torrente Cavone (Italia meridionale): carta geologica in scala 1:25.000

In order to improve the geological and stratigraphic knowledge of the Metaponto coastal area a detailed geological survey has been performed between Marina di Ginosa (Taranto) and Cavone river (Matera). Furthermore, a facies analysis either along stratigraphic sections or on cores obtained from five continuously-cored boreholes, drilling in the Holocene and middle – upper Pleistocene deposits up to 120 m of depth, has been carried out. The outcropping deposits have been distinguished in: upper Pleistocene “sandy-conglomeratic deposits of the regressive coastal prisms” and Holocene “Metaponto plain deposits”. The first deposits are subdivided into three lithostratigraphic units. The first two units have a thickness variable up to 15 m, and are represented by sandy-conglomeratic prisms resulting from the interplay between sea-level fluctuations and regional uplift; they are referred to “sabbie e conglomerati di Policoro” and “sabbie e conglomerati di Masseria Ricotta”, showing facies features of shoreface passing upward to continental environments. The third unit, up to 2 m thick, is an “eluvial product”, made up of reddish sands with gravelly layers unconformably and discontinuously overlaying the previous deposits. The Holocene “Metaponto plain deposits” have been distinguished in: “continental deposits” and “transitional deposits”. Continental deposits are represented by mainly some meters thick fine- to coarse-grained sediments of eluvial, fluvial, lacustrine and palustrine environments. Transitional deposits are represented by some meters thick sandy and silty Holocene beach-dune systems (modern and ancient) and sandy and clayey-silty deltaic systems (modern and ancient). The buried deposits of the Metaponto coastal area have been distinguished in three units thanks to the facies analysis and mainly to the recognition of two important erosional surfaces. The lower unit (called substratum), found beginning from a depth variable from 13 m to 44 m moving seaward, is at least 76 m thick and made up of clayey-silty deposits, with interbedded sandy beds passing landward and upward to sandy and/or sandy-gravelly deposits. The lower boundary was not found, whilst the upper boundary is represented by an erosional surface (SE) highlighted by a lag deposit. The facies features of these deposits can be referred to offshore passing upward to shallow marine environments. The age is middle - late Pleistocene. The intermediate unit is bounded both on bottom and on top by erosional surfaces (SE and ST). This intermediate upper Pleistocene wedge-shaped unit, called “Metaponto buried plain deposits”, pinches out landward, passing from about 7 m to 0 m in thickness. It is made up of sandy-gravelly deposits of continental to shallow marine environments. The third upper unit erosionally overlies both the previous unit and the substratum by the ST surface. This unit is made up of sands and gravelly sands, and its thickness varies from 13 m to 48 moving seaward, and has been attributed to the progradation of a beach system, laterally linked to a deltaic system, and passing seaward to an offshore system. A lamellibranch shell yielded a not calibrated 14C age of 7.572±50 yr BP for these deposits. The overall collected data allow us to draw a geological map on 1: 25.000 scale that provides a new stratigraphic framework of the outcropping Metaponto plain deposits. Furthermore, the geological sections obtained also utilizing the boreholes allow us both to reconstruct the geometry of the buried deposits and to outline the evolutionary history of the Holocene transgressive prism along the coastal study area

Multi-proxy analysis in defining sedimentary processes in very recent prodelta deposits: the Northern Phlegraean offshoreexample (Eastern Tyrrhenian Margin)

A multi-proxy analysis of Volturno River prodelta deposits in the outer shelf of Northern Phlegraean margin (Eastern Tyrrhenian Sea) has been carried out to reconstruct the sedimentary processes acting during recent times. The late Holocene sediments were characterized through Subbottom Chirp profiles coupled with sedimentological and petrophysical data. The chronostratigraphic framework was achieved by means of colorimetric parameter a* correlations with nearby dated marine sediment. A time interpretation of about 2,300 years BP is estimated for the sedimentary record collected in the cores. Seismic stratigraphic analysis shows late Holocene outer shelf deposits, characterized by fluid escape features and small-offset faults. However, the undisturbed sedimentation and the preservation of an internal geometry at decimetre scale, as detected by the sedimentological and petrophysical analysis, indicates a slow sliding without sediment reworking for this sedimentological body. So far a possible recent (\2,300 years BP) shear dominated downward displacement of high water content sediments, triggered by the occurrence of seismic activity, is inferred. Based on the depth-age conversion of the detected lithological features, a regular climatically driven change in the sediment supply of the prodelta depositional environment is suggested. The detection of spectrophotometry correlations of Holocene shelf margin sediments, several km apart, goes beyond the previous work and confirms even for continental shelf area the potential value of spectrophotometer data in high-resolution stratigraphic correlations