Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review

Objectives: To determine which training methods positively influenced healthcare professionals’ communication skills and families’ deceased organ donation decision-making. Methods: An integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument. Results: Training programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families’ perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates. Conclusions: Multiple training strategies are effective in improving interprofessional healthcare professionals’ confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences. Practice implications: Learning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing

A Symmetry for the Cosmological Constant

We study a symmetry, schematically Energy -> - Energy, which suppresses matter contributions to the cosmological constant. The requisite negative energy fluctuations are identified with a "ghost" copy of the Standard Model. Gravity explicitly, but weakly, violates the symmetry, and naturalness requires General Relativity to break down at short distances with testable consequences. If this breakdown is accompanied by gravitational Lorentz-violation, the decay of flat spacetime by ghost production is acceptably slow. We show that inflation works in our scenario and can lead to the initial conditions required for standard Big Bang cosmology.Comment: 18 pages, 3 figures, References correcte

Computational approaches for understanding the diagnosis and treatment of Parkinson's disease

This study describes how the application of evolutionary algorithms (EAs) can be used to study motor function in humans with Parkinson's disease (PD) and in animal models of PD. Human data is obtained using commercially available sensors via a range of non-invasive procedures that follow conventional clinical practice. EAs can then be used to classify human data for a range of uses, including diagnosis and disease monitoring. New results are presented that demonstrate how EAs can also be used to classify fruit flies with and without genetic mutations that cause Parkinson's by using measurements of the proboscis extension reflex. The case is made for a computational approach that can be applied across human and animal studies of PD and lays the way for evaluation of existing and new drug therapies in a truly objective way

On the Lipschitz continuity of spectral bands of Harper-like and magnetic Schroedinger operators

We show for a large class of discrete Harper-like and continuous magnetic Schrodinger operators that their band edges are Lipschitz continuous with respect to the intensity of the external constant magnetic field. We generalize a result obtained by J. Bellissard in 1994, and give examples in favor of a recent conjecture of G. Nenciu.Comment: 15 pages, accepted for publication in Annales Henri Poincar

Clouds, shadows, or twilight? Mayfly nymphs recognise the difference

1. We examined the relative changes in light intensity that initiate night-time locomotor activity changes in nymphs of the mayfly, Stenonema modestum (Heptageniidae). Tests were carried out in a laboratory stream to examine the hypothesis that nymphs increase their locomotion in response to the large and sustained reductions in relative light intensity that take place during twilight but not to short-term daytime light fluctuations or a minimum light intensity threshold. Ambient light intensity was reduced over a range of values representative of evening twilight. Light was reduced over the same range of intensities either continuously or in discrete intervals while at the same time nymph activity on unglazed tile substrata was video recorded. 2. Nymphs increased their locomotor activity during darkness in response to large, sustained relative light decreases, but not in response to short-term, interrupted periods of light decrease. Nymphs did not recognise darkness unless an adequate light stimulus, such as large and sustained relative decrease in light intensity, had taken place. 3. We show that nymphs perceive light change over time and respond only after a lengthy period of accumulation of light stimulus. The response is much lengthier than reported for other aquatic organisms and is highly adaptive to heterogeneous stream environments

Higgs Scalars in the Minimal Non-minimal Supersymmetric Standard Model

We consider the simplest and most economic version among the proposed non-minimal supersymmetric models, in which the $\mu$-parameter is promoted to a singlet superfield, whose all self-couplings are absent from the renormalizable superpotential. Such a particularly simple form of the renormalizable superpotential may be enforced by discrete $R$-symmetries which are extended to the gravity-induced non-renormalizable operators as well. We show explicitly that within the supergravity-mediated supersymmetry-breaking scenario, the potentially dangerous divergent tadpoles associated with the presence of the gauge singlet first appear at loop levels higher than 5 and therefore do not destabilize the gauge hierarchy. The model provides a natural explanation for the origin of the $\mu$-term, without suffering from the visible axion or the cosmological domain-wall problem. Focusing on the Higgs sector of this minimal non-minimal supersymmetric standard model, we calculate its effective Higgs potential by integrating out the dominant quantum effects due to stop squarks. We then discuss the phenomenological implications of the Higgs scalars predicted by the theory for the present and future high-energy colliders. In particular, we find that our new minimal non-minimal supersymmetric model can naturally accommodate a relatively light charged Higgs boson, with a mass close to the present experimental lower bound.Comment: 63 pages (12 figures), extended versio

Charged Higgs bosons in the Next-to MSSM (NMSSM)

The charged Higgs boson decays $H^\pm\to W^\pm A_1$ and $H^\pm\to W^\pm h_i$ are studied in the framework of the next-to Minimal Supersymmetric Standard Model (NMSSM). It is found that the decay rate for $H^\pm\to W^\pm A_1$ can exceed the rates for the $\tau^\pm\nu$ and $tb$ channels both below and above the top-bottom threshold. The dominance of $H^\pm\to W^\pm A_1$ is most readily achieved when $A_1$ has a large doublet component and small mass. We also study the production process $pp\to H^\pm A_1$ at the LHC followed by the decay $H^\pm\to W^\pm A_1$ which leads to the signature $W^\pm A_1 A_1$. We suggest that $p p\to H^\pm A_1$ is a promising discovery channel for a light charged Higgs boson in the NMSSM with small or moderate $\tan\beta$ and dominant decay mode $H^\pm \to W^\pm A_1$. This $W^\pm A_1 A_1$ signature can also arise from the Higgsstrahlung process $pp\to W^\pm h_1$ followed by the decay $h_1\to A_1 A_1$. It is shown that there exist regions of parameter space where these processes can have comparable cross sections and we suggest that their respective signals can be distinguished at the LHC by using appropriate reconstruction methods.Comment: 20 pages, 22 eps figures, more reference adde

N-body simulations of gravitational dynamics

We describe the astrophysical and numerical basis of N-body simulations, both of collisional stellar systems (dense star clusters and galactic centres) and collisionless stellar dynamics (galaxies and large-scale structure). We explain and discuss the state-of-the-art algorithms used for these quite different regimes, attempt to give a fair critique, and point out possible directions of future improvement and development. We briefly touch upon the history of N-body simulations and their most important results.Comment: invited review (28 pages), to appear in European Physics Journal Plu

Causes and clinical features of childhood encephalitis: a multicenter, prospective cohort study

BACKGROUND:We aimed to determine the contemporary causes, clinical features, and short-term outcome of encephalitis in Australian children. METHODS:We prospectively identified children (≤14 years of age) admitted with suspected encephalitis at 5 major pediatric hospitals nationally between May 2013 and December 2016 using the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. A multidisciplinary expert panel reviewed cases and categorized them using published definitions. Confirmed encephalitis cases were categorized into etiologic subgroups. RESULTS:From 526 cases of suspected encephalitis, 287 children met criteria for confirmed encephalitis: 57% (95% confidence interval [CI], 52%-63%) had infectious causes, 10% enterovirus, 10% parechovirus, 8% bacterial meningoencephalitis, 6% influenza, 6% herpes simplex virus (HSV), and 6% Mycoplasma pneumoniae; 25% (95% CI, 20%-30%) had immune-mediated encephalitis, 18% acute disseminated encephalomyelitis, and 6% anti-N-methyl-d-aspartate receptor encephalitis; and 17% (95% CI, 13%-21%) had an unknown cause. Infectious encephalitis occurred in younger children (median age, 1.7 years [interquartile range {IQR}, 0.1-6.9]) compared with immune-mediated encephalitis (median age, 7.6 years [IQR, 4.6-12.4]). Varicella zoster virus encephalitis was infrequent following high vaccination coverage since 2007. Thirteen children (5%) died: 11 with infectious causes (2 influenza; 2 human herpesvirus 6; 2 group B Streptococcus; 2 Streptococcus pneumoniae; 1 HSV; 1 parechovirus; 1 enterovirus) and 2 with no cause identified. Twenty-seven percent (95% CI, 21%-31%) of children showed moderate to severe neurological sequelae at discharge. CONCLUSIONS:Epidemic viral infections predominated as causes of childhood encephalitis in Australia. The leading causes include vaccine-preventable diseases. There were significant differences in age, clinical features, and outcome among leading causes. Mortality or short-term neurological morbidity occurred in one-third of cases.Philip N Britton, Russell C Dale, Christopher C Blyth, Julia E Clark, Nigel Crawford, Helen Marshall ... et al