Knowledge, attitudes, and preferences of healthy young adults regarding advance care planning: A focus group study of university students in Pittsburgh, USA Health behavior, health promotion and society

Background: To date, research and promotion regarding advance care planning (ACP) has targeted those with serious illness or the elderly, thereby ignoring healthy young adults. The purpose of this study was to explore young adults' knowledge, attitudes, and preferences regarding advance care planning (ACP) and medical decision-making. Further, we aimed to understand the potential role of public health to encourage population-based promotion of ACP. Methods: Between February 2007 and April 2007, we conducted six focus groups comprising 56 young adults ages 18-30. Topics explored included (1) baseline knowledge regarding ACP, (2) preferences for ACP, (3) characteristics of preferred surrogates, and (4) barriers and facilitators to completing ACP specific to age and individuation. We used a qualitative thematic approach to analyze transcripts. Results: All participants desired more information regarding ACP. In addition, participants expressed (1) heterogeneous attitudes regarding triggers to perform ACP, (2) the opinion that ACP is a marker of individuation, (3) the belief that prior exposure to illness plays a role in prompting ACP, and (4) an appreciation that ACP is flexible to changes in preferences and circumstances throughout the life-course. Conclusion: Young adults perceive ACP as a worthwhile health behavior and view a lack of information as a major barrier to discussion and adoption. Our data emphasize the need for strategies to increase ACP knowledge, while encouraging population-level, patient-centered, healthcare decision-making

Memory-encoding vibrations in a disconnecting air bubble

Many nonlinear processes, such as the propagation of waves over an ocean or the transmission of light pulses down an optical fibre1, are integrable in the sense that the dynamics has as many conserved quantities as there are independent variables. The result is a time evolution that retains a complete memory of the initial state. In contrast, the nonlinear dynamics near a finite-time singularity, in which physical quantities such as pressure or velocity diverge at a point in time, is believed to evolve towards a universal form, one independent of the initial state2. The break-up of a water drop in air3 or a viscous liquid inside an immiscible oil4,5 are processes that conform to this second scenario. These opposing scenarios collide in the nonlinearity produced by the formation of a finite-time singularity that is also integrable. We demonstrate here that the result is a novel dynamics with a dual character

Diffusing an Innovation: Clinician Perceptions of Continuous Predictive Analytics Monitoring in Intensive Care

Background The purpose of this article is to describe neonatal intensive care unitclinician perceptions of a continuous predictive analytics technology and how thoseperceptions influenced clinician adoption. Adopting and integrating new technologyinto care is notoriously slow and difficult; realizing expected gains remain a challenge.Methods Semistructured interviews from a cross-section of neonatal physicians(n ¼ 14) and nurses (n ¼ 8) from a single U.S. medical center were collected 18 monthsfollowing the conclusion of the predictive monitoring technology randomized controltrial. Following qualitative descriptive analysis, innovation attributes from Diffusion ofInnovation Theory-guided thematic development.Results Results suggest that the combination of physical location as well as lack ofintegration into work flow or methods of using data in care decisionmaking may havedelayed clinicians from routinely paying attention to the data. Once data were routinelycollected, documented, and reported during patient rounds and patient handoffs,clinicians came to view data as another vital sign. Through clinicians" observation ofsenior physicians and nurses, and ongoing dialogue about data trends and patientstatus, clinicians learned how to integrate these data in care decision making (e.g.,differential diagnosis) and came to value the technology as beneficial to care delivery.Discussion The use of newly created predictive technologies that provide early warning ofillness may require implementation strategies that acknowledge the risk--benefit oftreatment cliniciansmust balance and take advantage of existing clinician trainingmethods