Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

What are the problems of the nuclear age that you think we can solve and how?

Abstract not availabl

Les effets des contextes territoriaux pour les intervenant·es de l’Aide sociale à l’enfance

Cet article s’appuie sur les résultats d’une recherche menée en 2019-2020 dans un département de l’ouest de la France au sujet de la dimension spatiale de la protection de l’enfance. Il porte sur les spécificités des situations sociofamiliales et des pratiques professionnelles selon les contextes territoriaux à l’échelle infra-départementale. La recherche s’est appuyée sur une méthodologie mixte croisant enquête qualitative auprès des intervenant·es de l’Aide sociale à l’enfance et analyse spatialisée des données statistiques disponibles.Même si la plupart des facteurs de risque connus en protection de l’enfance sont présents sur tous les territoires d’action sociale investigués, la probabilité de les rencontrer peut différer d’un espace à l’autre en lien avec les caractéristiques sociodémographiques des populations présentes et des effets des contextes territoriaux. La recherche montre par ailleurs l’existence de fortes inégalités spatiales en termes de ressources de l’Aide sociale à l’enfance selon les territoires infra-départementaux. Enfin, l’analyse fait apparaître une différenciation territoriale de la visibilité sociale des difficultés sociofamiliales ainsi que le poids du facteur spatial dans la construction sociale du niveau de danger.This article is based on the results of a research carried out in 2019-2020 in a county of western France about the spatial dimension of child protection system. It focuses on the specificities of social and family situations and professional practices according to local contexts. The research was based on a mixed methodology combining a qualitative survey towards child welfare social workers and a spatial analysis of available statistical data.Even if most of the risk factors known in child welfare are present in all the territories investigated, the probability of encountering them may differ from one area to another in relation to socio-demographic characteristics and the effects of territorial contexts. The research also shows the existence of strong spatial inequalities in terms of child protection services between territories. Finally, the analysis shows a spatial difference in social visibility of families difficulties as well as the weight of the spatial factor in the social construction of danger level.Este artículo se basa en los resultados de un estudio llevado a cabo en 2019-2020 en un departamento situado en el oeste de Francia sobre el tema de la dimensión espacial de la protección de la infancia. Aborda las especificidades de las situaciones sociofamiliares y de las prácticas profesionales en función de los contextos territoriales a nivel subdepartamental. El estudio se basa en una metodología mixta que cruza la encuesta cualitativa entre las partes interesadas de la Ayuda social para la infancia y el análisis espacial de los datos estadísticos disponibles.Si bien la mayor parte de los factores de riesgo conocidos en el ámbito de la protección de la infancia están presentes en todos los territorios de acción social estudiados, la probabilidad de encontrarlos puede diferir de un espacio a otro según las características sociodemográficas de las poblaciones presentes y los efectos de los contextos territoriales. Por otra parte, el estudio muestra la existencia de grandes desigualdades espaciales en materia de los recursos de la Ayuda social para la Infancia en función de los territorios subdepartamentales. Por último, el análisis muestra una diferenciación territorial de la visibilidad social de las dificultades sociofamiliares, así como la importancia del factor espacial en la construcción social del nivel de peligro

Rally Against Racism

2 p. : ill. ; 27 c

The potential impact of reforms to the essential parameters of the council tax

Council Tax was introduced in Britain in 1993 and represents a unique international property tax. There is a growing belief that it is time to reform the number and structure of council tax bands but such views have a minimal empirical base. This paper sets out to assess the impact on personal and local government finances, and extends the analysis to the role of the tax multipliers linked to each band. The research is based on the experience of a representative sample of local authorities in Scotland. A statistical revaluation for 2000 is estimated for the existing eight band system, and from this base a ten band system is calculated. Financial implications are then simulated for each local authority taking account of central resource equalisation mechanisms. The results indicate that increases in bands will have little impact on the burden of the council tax compared with regular revaluations. Changing the tax multiplier range has the greatest impact on local authority finances and council tax payments

Effects of compassion training on brain responses to suffering others

Compassion meditation (CM) is a promising intervention for enhancing compassion, although its active ingredients and neurobiological mechanisms are not well-understood. To investigate these, we conducted a three-armed placebo-controlled randomized trial (N = 57) with longitudinal functional magnetic resonance imaging (fMRI). We compared a 4-week CM program delivered by smartphone application with (i) a placebo condition, presented to participants as the compassion-enhancing hormone oxytocin, and (ii) a condition designed to control for increased familiarity with suffering others, an element of CM which may promote compassion. At pre- and post-intervention, participants listened to compassion-eliciting narratives describing suffering others during fMRI. CM increased brain responses to suffering others in the medial orbitofrontal cortex (mOFC) relative to the familiarity condition, p \u3c 0.05 family-wise error rate corrected. Among CM participants, individual differences in increased mOFC responses positively correlated with increased compassion-related feelings and attributions, r = 0.50, p = 0.04. Relative to placebo, the CM group exhibited a similar increase in mOFC activity at an uncorrected threshold of P \u3c 0.001 and 10 contiguous voxels. We conclude that the mOFC, a region closely related to affiliative affect and motivation, is an important brain mechanism of CM. Effects of CM on mOFC function are not explained by familiarity effects and are partly explained by placebo effects

Fact Book 1991-1992

65 p. : ill. ; 22 c