The Essential Characteristics of Advocacy Associated with the Nurse-Client Relationship: The Client\u27s Perspective

The purpose of this phenomenological study was to describe clients\u27 lived experiences of advocacy associated with the nurse-client relationship. The sample consisted of ten non-hospitalized adults, 19 to 72 years of age, who had a hospitalization or ambulatory relationship with a registered nurse within the previous six months. Data were gathered via interviews initiated with the same open-ended question. Georgi\u27s five step method was used for data analysis. Four essential characteristics of advocacy associated with the nurse-client relationship were identified. Described by clients as nurse attributes, behaviors, and actions, they were labelled: Competent Knower, Competent Doer, Humanizer, and Communicator. Clients perceived the Competent Knower to be knowledgeable about client conditions and needs, experienced in nursing practice, and capable. The Competent Doer acted on behalf of clients, either by own initiative or at clients\u27 requests, solved problems, served as intermediary, followed through on the clients\u27 needs and desires, demonstrated competence in technical and supportive skills, and exhibited leadership, including taking responsibility for care given by others under supervision. In relationships with client, family, and professional colleagues, the Humanizer was perceived as a personable, caring team member/leader who intervened on clients\u27 behalf, supported their decisions, treated them as valued individuals, encouraged clients, went the extra mile and made self available to clients by being there in presence. The Communicator transmitted and exchanged information with client, family, physician, and other health care professionals, served as liaison between them, provided explanations and education, and kept clients informed by disclosing pertinent information voluntarily and by request. Clients perceived that advocacy was not demonstrated by all nurses and was integrated with other roles within the whole of the nurse-client relationship. Comparisons are made between clients\u27 positive experiences (nurses demonstrated characteristics of advocacy) and negative experiences (which lacked advocacy), and between clients\u27 and nurses\u27 perspectives of advocacy. Implications and research recommendations for clinical practice, education, and administration are addressed, including the development of further validation studies to determine generalizability, and dissemination of the new description to other nurses and disciplines

Neural Signatures of Spatial Statistical Learning: Characterizing the Extraction of Structure from Complex Visual Scenes

Behavioral evidence has shown that humans automatically develop internal representations adapted to the temporal and spatial statistics of the environment. Building on prior fMRI studies that have focused on statistical learning of temporal sequences, we investigated the neural substrates and mechanisms underlying statistical learning from scenes with a structured spatial layout. Our goals were twofold: (1) to determine discrete brain regions in which degree of learning (i.e., behavioral performance) was a significant predictor of neural activity during acquisition of spatial regularities and (2) to examine how connectivity between this set of areas and the rest of the brain changed over the course of learning. Univariate activity analyses indicated a diffuse set of dorsal striatal and occipitoparietal activations correlated with individual differences in participants' ability to acquire the underlying spatial structure of the scenes. In addition, bilateral medial-temporal activation was linked to participants' behavioral performance, suggesting that spatial statistical learning recruits additional resources from the limbic system. Connectivity analyses examined, across the time course of learning, psychophysiological interactions with peak regions defined by the initial univariate analysis. Generally, we find that task-based connectivity with these regions was significantly greater in early relative to later periods of learning. Moreover, in certain cases, decreased task-based connectivity between time points was predicted by overall posttest performance. Results suggest a narrowing mechanism whereby the brain, confronted with a novel structured environment, initially boosts overall functional integration and then reduces interregional coupling over time

Genetic Testing Reveals Germline Mutations Among Patients Undergoing Surgery for Colorectal Carcinoma in a Community Hospital Setting

Introduction: Defined germline mutations contribute to 5% to 10% of cases of colorectal carcinoma (CRC). While protocols for universal tumor screening have been adopted to detect mismatch repair (MMR) protein deficiency, widespread multigene panel testing has not been achieved. Barriers to implementing testing protocols may occur in community settings. Methods: A total of 160 patients presenting for surgical management of CRC between 2011 and 2020 were considered for retrospective analysis in a single-surgeon, single-institution, community-based cohort. The rate of multigene panel testing and prevalence of germline mutations were calculated, and patient characteristics were assessed. Results: A total of 32/160 (20%) patients underwent multigene panel testing, with 14/160 (9%) patients having germline mutations. While 88% of patients underwent panel testing after CRC diagnosis, 43% of these patients would have met testing criteria before diagnosis. Among the patients meeting criteria before diagnosis, 50% were found to carry a germline mutation. Discussion: The prevalence of germline mutations was similar to previously reported values, while the rate of multigene panel testing was higher than previously reported. These results may be unique to the study setting or result from multidisciplinary conference discussion. A significant number of patients with abnormal panel testing were not tested before CRC diagnosis, despite meeting the criteria. This finding represents a missed opportunity for risk stratification and underscores the importance of addressing testing barriers in the primary care setting. Conclusions: Primary care providers and oncologists in community hospitals must remain cognizant of changing guidelines as multigene panel testing becomes increasingly available

Duel and sweep algorithm for order-preserving pattern matching

Given a text $T$ and a pattern $P$ over alphabet $\Sigma$, the classic exact matching problem searches for all occurrences of pattern $P$ in text $T$. Unlike exact matching problem, order-preserving pattern matching (OPPM) considers the relative order of elements, rather than their real values. In this paper, we propose an efficient algorithm for OPPM problem using the "duel-and-sweep" paradigm. Our algorithm runs in $O(n + m\log m)$ time in general and $O(n + m)$ time under an assumption that the characters in a string can be sorted in linear time with respect to the string size. We also perform experiments and show that our algorithm is faster that KMP-based algorithm. Last, we introduce the two-dimensional order preserved pattern matching and give a duel and sweep algorithm that runs in $O(n^2)$ time for duel stage and $O(n^2 m)$ time for sweeping time with $O(m^3)$ preprocessing time.Comment: 13 pages, 5 figure

Practice Matters: Red Flags in Adults with Mental Illnesses

Faith Community Nurses have common beliefs, principles, ethics, and a level of trust with their population making them well-positioned to positively impact parishioners. FCNs provide support for people’s spiritual needs and nursing care. This makes FCNs a vital and approachable resource for parishioners when seeking advisement and assistance regarding their mental healthcare. In this article, we define red flags as suicidal idealization, mania, and psychosis, which if not promptly assessed and referred for treatment may result in serious harm or death. These red flags are predominately found in people with schizophrenia, depression, bipolar disorder, and post-traumatic stress disorder. People with mental illnesses can develop red flags that require timely assessments. FCNs are readily accessible to people with mental illnesses and can screen for red flags of suicidal idealization, mania, and psychosis

PainDroid: An android-based virtual reality application for pain assessment

Earlier studies in the field of pain research suggest that little efficient intervention currently exists in response to the exponential increase in the prevalence of pain. In this paper, we present an Android application (PainDroid) with multimodal functionality that could be enhanced with Virtual Reality (VR) technology, which has been designed for the purpose of improving the assessment of this notoriously difficult medical concern. Pain- Droid has been evaluated for its usability and acceptability with a pilot group of potential users and clinicians, with initial results suggesting that it can be an effective and usable tool for improving the assessment of pain. Participant experiences indicated that the application was easy to use and the potential of the application was similarly appreciated by the clinicians involved in the evaluation. Our findings may be of considerable interest to healthcare providers, policy makers, and other parties that might be actively involved in the area of pain and VR research

Spontaneous and deliberate future thinking: A dual process account

© 2019 Springer Nature.This is the final published version of an article published in Psychological Research, licensed under a Creative Commons Attri-bution 4.0 International License. Available online at: https://doi.org/10.1007/s00426-019-01262-7.In this article, we address an apparent paradox in the literature on mental time travel and mind-wandering: How is it possible that future thinking is both constructive, yet often experienced as occurring spontaneously? We identify and describe two ‘routes’ whereby episodic future thoughts are brought to consciousness, with each of the ‘routes’ being associated with separable cognitive processes and functions. Voluntary future thinking relies on controlled, deliberate and slow cognitive processing. The other, termed involuntary or spontaneous future thinking, relies on automatic processes that allows ‘fully-fledged’ episodic future thoughts to freely come to mind, often triggered by internal or external cues. To unravel the paradox, we propose that the majority of spontaneous future thoughts are ‘pre-made’ (i.e., each spontaneous future thought is a re-iteration of a previously constructed future event), and therefore based on simple, well-understood, memory processes. We also propose that the pre-made hypothesis explains why spontaneous future thoughts occur rapidly, are similar to involuntary memories, and predominantly about upcoming tasks and goals. We also raise the possibility that spontaneous future thinking is the default mode of imagining the future. This dual process approach complements and extends standard theoretical approaches that emphasise constructive simulation, and outlines novel opportunities for researchers examining voluntary and spontaneous forms of future thinking.Peer reviewe

Influence of resource availability on the foraging strategies of the triangle butterflyfish chaetodon triangulum in the Maldives.

Obligate coral feeders such as many members of the Chaetodontidae family (also known as butterflyfish) often show strong preferences for particular coral species. This is thought to have evolved through natural selection as an energy-maximising strategy. Although some species remain as highly specialised feeders throughout their lifetime, many corallivores show a degree of dietary versatility when food abundance is limited; a strategy described by the optimal foraging theory. This study aimed to examine if, within-reef differences in the feeding regime and territory size of the Triangle Butterflyfish Chaetodon triangulum occurred, as a function of resource availability. Results showed that the dietary specialisation of C. triangulum was significant in both areas of low and high coral cover (χL22 = 2.52 x 102, P<0.001 and χL22 = 3.78 x 102, P<0.001 respectively). Resource selection functions (RSFs), calculated for the two main sites of contrasting coral assemblage, showed that in the resource-rich environments, only two Genera (Acropora and Pocillopora) were preferentially selected for, with the majority of other corals being actively ‘avoided’. Conversely, in territories of lower coral coverage, C. triangulum was being less selective in its prey choice and consuming corals in a more even distribution with respect to their availability. Interestingly, coral cover appeared to show no significant effect on feeding rate, however it was a primary determinant of territory size. The findings of the study agree with the predictions of the optimal foraging theory, in that where food supply is scarce, dietary specialisation is minimised and territory size increased. This results in maximising energy intake. This study represents the first scientific evidence that C. triangulum is an obligate corallivore and, as with many other butterflyfish, is therefore dependent on healthy scleractinian corals for survival.N

First report of generalized face processing difficulties in möbius sequence.

Reverse simulation models of facial expression recognition suggest that we recognize the emotions of others by running implicit motor programmes responsible for the production of that expression. Previous work has tested this theory by examining facial expression recognition in participants with Möbius sequence, a condition characterized by congenital bilateral facial paralysis. However, a mixed pattern of findings has emerged, and it has not yet been tested whether these individuals can imagine facial expressions, a process also hypothesized to be underpinned by proprioceptive feedback from the face. We investigated this issue by examining expression recognition and imagery in six participants with Möbius sequence, and also carried out tests assessing facial identity and object recognition, as well as basic visual processing. While five of the six participants presented with expression recognition impairments, only one was impaired at the imagery of facial expressions. Further, five participants presented with other difficulties in the recognition of facial identity or objects, or in lower-level visual processing. We discuss the implications of our findings for the reverse simulation model, and suggest that facial identity recognition impairments may be more severe in the condition than has previously been noted

Worldwide Genetic Variability of the Duffy Binding Protein: Insights into Plasmodium vivax Vaccine Development

The dependence of Plasmodium vivax on invasion mediated by Duffy binding protein (DBP) makes this protein a prime candidate for development of a vaccine. However, the development of a DBP-based vaccine might be hampered by the high variability of the protein ligand (DBPII), known to bias the immune response toward a specific DBP variant. Here, the hypothesis being investigated is that the analysis of the worldwide DBPII sequences will allow us to determine the minimum number of haplotypes (MNH) to be included in a DBP-based vaccine of broad coverage. For that, all DBPII sequences available were compiled and MNH was based on the most frequent nonsynonymous single nucleotide polymorphisms, the majority mapped on B and T cell epitopes. A preliminary analysis of DBPII genetic diversity from eight malaria-endemic countries estimated that a number between two to six DBP haplotypes (17 in total) would target at least 50% of parasite population circulating in each endemic region. Aiming to avoid region-specific haplotypes, we next analyzed the MNH that broadly cover worldwide parasite population. The results demonstrated that seven haplotypes would be required to cover around 60% of DBPII sequences available. Trying to validate these selected haplotypes per country, we found that five out of the eight countries will be covered by the MNH (67% of parasite populations, range 48–84%). In addition, to identify related subgroups of DBPII sequences we used a Bayesian clustering algorithm. The algorithm grouped all DBPII sequences in six populations that were independent of geographic origin, with ancestral populations present in different proportions in each country. In conclusion, in this first attempt to undertake a global analysis about DBPII variability, the results suggest that the development of DBP-based vaccine should consider multi-haplotype strategies; otherwise a putative P. vivax vaccine may not target some parasite populations