Inclusion of Social Workers in End-of-Life Discussions in Intensive Care Units

Clinical social workers have roles in providing end-of-life care in the United States. Although clinical social workers are present in the intensive care unit (ICU) setting and have expertise to address end-of-life care dynamics, social workers are not consistently included in end-of-life discussions in the ICU setting. The purpose of this action research study was to explore the barriers that prevent clinical social workers from being included in end-of-life discussions in the ICU and how clinical social workers perceive their roles in end-of-life discussions in the adult ICU setting. Open-ended questions were used to gather data by facilitating 4 focus groups with 17 clinical social workers employed at a Florida hospital. This study was guided by complexity theory, which is concerned with complex systems and how systems can produce order while simultaneously creating unpredictable system behavior. A thematic analysis coding technique was used to analyze the data collected. Three themes emerged from data analysis: the ICU setting as chaotic, complex, and unpredictable; role ambiguity; and lack of confidence of social workers to perform expected roles in end-of-life discussions. The implications of this study for social work practice and social change relate to closing the gap between the patient, family members, social workers, and the medical team by developing protocols that consistently include social workers in end-of-life discussions, including education for the multidisciplinary team in the ICU on the skill set and role of clinical social workers in end-of-life discussions and formal training and education for clinical social workers regarding end-of-life care

Improved irradiances for use in ocean heating, primary production, and photo-oxidation calculations

Accurate calculation of underwater light is fundamental to predictions of upper-ocean heating, primary production, and photo-oxidation. However, most ocean models simulating these processes do not yet incorporate radiative transfer modules for their light calculations. Such models are often driven by abovesurface, broadband, daily averaged irradiance or photosynthetically available radiation (PAR) values obtained from climatology or satellite observations, sometimes without correction for sea-surface reflectance, even though surface reflectance can reduce in-water values by more than 20%. We present factors computed by a radiative transfer code that can be used to convert above-surface values in either energy or quantum units to in-water net irradiance, as needed for calculations of water heating, and to inwater PAR, as needed for calculations of photosynthesis and photo-oxidation

Phase function effects on oceanic light fields

Numerical simulations show that underwater radiances, irradiances, and reflectances are sensitive to the shape of the scattering phase function at intermediate and large scattering angles, although the exact shape of the phase function in the backscatter directions (for a given backscatter fraction) is not critical if errors of the order of 10% are acceptable. We present an algorithm for generating depth–and wavelength-dependent Fournier–Forand phase functions having any desired backscatter fraction. Modeling of a comprehensive data set of measured inherent optical properties and radiometric variables shows that use of phase functions with the correct backscatter fraction and overall shape is crucial to achieve model–data closure

Challenges encountered applying equilibrium and nonequilibrium binding free energy calculations

Binding free energy calculations have become increasingly valuable to drive decision making in drug discovery projects. However, among other issues, inadequate sampling can reduce accuracy, limiting the value of the technique. In this paper, we apply absolute binding free energy calculations to ligands binding to T4 lysozyme L99A and HSP90 using equilibrium and nonequilibrium approaches. We highlight sampling problems encountered in these systems, such as slow side chain rearrangements and slow changes of water placement upon ligand binding. These same types of challenges are also likely to show up in other protein–ligand systems, and we propose some strategies to diagnose and test for such problems in alchemical free energy calculations. We also explore similarities and differences in how the equilibrium and the nonequilibrium approaches handle these problems. Our results show the large amount of work still to be done to make free energy calculations robust and reliable and provide insight for future research in this area

Optical modeling of ocean waters: Is the case 1 - case 2 classification still useful?

…two extreme cases can be identified and separated. Case 1 is that of a concentration of phytoplankton high compared to other particles…. In contrast, the inorganic particles are dominant in case 2.… In both cases dissolved yellow substance is present in variable amounts.… An ideal case 1 would be a pure culture of phytoplankton and an ideal case 2 a suspension of nonliving material with a zero concentration of pigments. Morel and Prieur emphasized that these ideal cases are not encountered in nature, and they suggested the use of high or low values of the ratio of pigment concentration to scattering coefficient as a basis for discriminating between Case 1 and Case 2 waters. Although no specific values of this ratio were proposed to serve as criteria for classification, their example data suggested that the ratio of chlorophyll a concentration (in mg m-3) to the scattering coefficient at 550 nm (in m-1) in Case 1 waters is greater than 1 and in Case 2 waters is less than 1. Importantly, however, Morel and Prieur also showed data classified as “intermediate waters” with the ratio between about 1 and 2.2. Although the original definition from 1977 did not imply a binary classification, the practice of most investigators in the following years clearly evolved toward a bipartite analysis

Polarized light field under dynamic ocean surfaces: Numerical modeling compared with measurements

As part of the Radiance in a Dynamic Ocean (RaDyO) program, we have developed a numerical model for efficiently simulating the polarized light field under highly dynamic ocean surfaces. Combining the advantages of the three-dimensional Monte Carlo and matrix operator methods, this hybrid model has proven to be computationally effective for simulations involving a dynamic air-sea interface. Given water optical properties and ocean surface wave slopes obtained from RaDyO field measurements, model-simulated radiance and polarization fields under a dynamic surface are found to be qualitatively comparable to their counterparts from field measurements and should be quantitatively comparable if the light field measurement and the wave slope/water optical property measurements are appropriately collocated and synchronized. This model serves as a bridge to connect field measurements of water optical properties, wave slopes and polarized light fields. It can also be used as a powerful yet convenient tool to predict the temporal underwater polarized radiance in a real-world situation. When appropriate surface measurements are available, model simulation is shown to reveal more dynamic features in the underwater light field than direct measurements

Toward closure of upwelling radiance in coastal waters

We present three methods for deriving water-leaving radiance Lw(λ) and remote-sensing reflectance using a hyperspectral tethered spectral radiometer buoy (HyperTSRB), profiled spectroradiometers, and Hydrolight simulations. Average agreement for 53 comparisons between HyperTSRB and spectroradiometric determinations of Lw(λ) was 26%, 13%, and 17% at blue, green, and red wavelengths, respectively. Comparisons of HyperTSRB (and spectroradiometric) Lw(λ) with Hydrolight simulations yielded percent differences of 17% (18%), 17% (18%), and 13% (20%) for blue, green, and red wavelengths, respectively. The differences can be accounted for by uncertainties in model assumptions and model input data (chlorophyll fluorescence quantum efficiency and the spectral chlorophyll-specific absorption coefficient for the red wavelengths, and scattering corrections for input ac-9 absorption data and volume scattering function measurements for blue wavelengths) as well as radiance measurement inaccuracies [largely differences in the depth of the Lu(λ, z) sensor on the HyperTSRB]. © 2003 Optical Society of America

Intensified biochip system using chemiluminescence for the detection of Bacillus globigii spores

This paper reports the first intensified biochip system for chemiluminescence detection and the feasibility of using this system for the analysis of biological warfare agents is demonstrated. An enzyme-linked immunosorbent assay targeting Bacillus globigii spores, a surrogate species for Bacillus anthracis, using a chemiluminescent alkaline phosphatase substrate is combined with a compact intensified biochip detection system. The enzymatic amplification was found to be an attractive method for detection of low spore concentrations when combined with the intensified biochip device. This system was capable of detecting approximately 1 × 105Bacillus globigii spores. Moreover, the chemiluminescence method, combined with the self-contained biochip design, allows for a simple, compact system that does not require laser excitation and is readily adaptable to field use

Brewster-angle measurements of sea-surface reflectance using a high resolution spectroradiometer

This paper describes the design, construction and testing of a ship-borne spectroradiometer based on an imaging spectrograph and cooled CCD array with a wavelength range of 350-800 nm and 4 nm spectral sampling. The instrument had a minimum spectral acquisition time of 0.1 s, but in practice data were collected over periods of 10 s to allow averaging of wave effects. It was mounted on a ship's superstructure so that it viewed the sea surface from a height of several metres at the Brewster angle (53 degrees) through a linear polarizing filter. Comparison of sea-leaving spectra acquired with the polarizer oriented horizontally and vertically enabled estimation of the spectral composition of sky light reflected directly from the sea surface. A semi-empirical correction procedure was devised for retrieving water-leaving radiance spectra from these measurements while minimizing the influence of reflected sky light. Sea trials indicated that reflectance spectra obtained by this method were consistent with the results of radiance transfer modelling of case 2 waters with similar concentrations of chlorophyll and coloured dissolved organic matter. Surface reflectance signatures measured at three locations containing blooms of different phytoplankton species were easily discriminated and the instrument was sufficiently sensitive to detect solar-stimulated fluorescence from surface chlorophyll concentrations down to 1 mg m−3