Ritual, Pastoral Presence, and Character Virtues in Healthcare Chaplaincy: A study of chaplains’ support to bereaved parents following the in utero or neonatal death of their baby.

This thesis sets out to understand better how chaplains can support bereaved parents following the death of their baby. Running parallel to this, with increasing demand for evidence-based practice, it aims to evidence the benefit of chaplaincy support and the unique skills of chaplains. The thesis is based on twelve semi-structured interviews with sixteen parents. These were analysed using a form of grounded theory and compared with the findings of related research. I argue that the root of all other spiritual need is the loss of control parents experienced. Alongside this theme I identify a loss of meaning, a loss of self worth, and a desire to do something in response to their loss. Although there is not a one size fits all response, the liturgy and ritual provided by chaplains helped counter spiritual distress. I propose that, alongside the ability to perform liturgy and ritual, chaplains are viewed as having authority in both religious and spiritual matters. As liturgy and ritual was appreciated in conjunction with the presence of the chaplain, I explore a virtue-based approach to chaplaincy and recommend the increased use of shadowing and mentoring. Drawing on Fowler’s Stages of Faith, I describe how some parents found greater religious faith or increased spiritual awareness as a result of their experience. I speculate that, in order to provide the best possible support to parents, chaplains need to exhibit the characteristics of Fowler’s stage 5. Chaplains have a richness of reflection and experience and I appeal to churches to engage more profoundly with them. I also recommend the continued employment of chaplains within hospitals and argue for the narrative voice to be valued in research. Contra to current NICE guidelines, I contend that parents should be offered the opportunity to see and hold their dead baby

Toward Uniform Implementation Of Parametric Map Digital Imaging And Communication In Medicine Standard In Multisite Quantitative Diffusion Imaging Studies

This paper reports on results of a multisite collaborative project launched by the MRI subgroup of Quantitative Imaging Network to assess current capability and provide future guidelines for generating a standard parametric diffusion map Digital Imaging and Communication in Medicine (DICOM) in clinical trials that utilize quantitative diffusion-weighted imaging (DWI). Participating sites used a multivendor DWI DICOM dataset of a single phantom to generate parametric maps (PMs) of the apparent diffusion coefficient (ADC) based on two models. The results were evaluated for numerical consistency among models and true phantom ADC values, as well as for consistency of metadata with attributes required by the DICOM standards. This analysis identified missing metadata descriptive of the sources for detected numerical discrepancies among ADC models. Instead of the DICOM PM object, all sites stored ADC maps as DICOM MR objects, generally lacking designated attributes and coded terms for quantitative DWI modeling. Source-image reference, model parameters, ADC units and scale, deemed important for numerical consistency, were either missing or stored using nonstandard conventions. Guided by the identified limitations, the DICOM PM standard has been amended to include coded terms for the relevant diffusion models. Open-source software has been developed to support conversion of site-specific formats into the standard representation

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Abstract Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline

Predicting breast cancer response to neoadjuvant treatment using multi-feature MRI: results from the I-SPY 2 TRIAL.

Dynamic contrast-enhanced (DCE) MRI provides both morphological and functional information regarding breast tumor response to neoadjuvant chemotherapy (NAC). The purpose of this retrospective study is to test if prediction models combining multiple MRI features outperform models with single features. Four features were quantitatively calculated in each MRI exam: functional tumor volume, longest diameter, sphericity, and contralateral background parenchymal enhancement. Logistic regression analysis was used to study the relationship between MRI variables and pathologic complete response (pCR). Predictive performance was estimated using the area under the receiver operating characteristic curve (AUC). The full cohort was stratified by hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status (positive or negative). A total of 384 patients (median age: 49 y/o) were included. Results showed analysis with combined features achieved higher AUCs than analysis with any feature alone. AUCs estimated for the combined versus highest AUCs among single features were 0.81 (95% confidence interval [CI]: 0.76, 0.86) versus 0.79 (95% CI: 0.73, 0.85) in the full cohort, 0.83 (95% CI: 0.77, 0.92) versus 0.73 (95% CI: 0.61, 0.84) in HR-positive/HER2-negative, 0.88 (95% CI: 0.79, 0.97) versus 0.78 (95% CI: 0.63, 0.89) in HR-positive/HER2-positive, 0.83 (95% CI not available) versus 0.75 (95% CI: 0.46, 0.81) in HR-negative/HER2-positive, and 0.82 (95% CI: 0.74, 0.91) versus 0.75 (95% CI: 0.64, 0.83) in triple negatives. Multi-feature MRI analysis improved pCR prediction over analysis of any individual feature that we examined. Additionally, the improvements in prediction were more notable when analysis was conducted according to cancer subtype

Chaplain Development in Clinical Pastoral Education (CPE) in Healthcare Settings in England: A Mixed Methods Study

Clinical Pastoral Education (CPE) is the predominant specialised training for healthcare chaplains in several national contexts. CPE is spiritual care education that uses experiential and action-reflection learning methods to train diverse participants. However, CPE is not established for chaplaincy training in England. Currently, chaplaincy education in England lacks standardisation, leading to inequalities in entry into the profession and inconsistent training and career pathways. CPE has the potential to address these issues. We examined changes associated with participating in CPE and participants’ perceptions about their learning experience. We sought to evaluate the effectiveness of CPE as a viable chaplaincy education model in healthcare settings in England. Convergent mixed methods involved pre-post surveys and focus group sessions to examine the experiences and development of seven chaplains, with diverse experience levels and backgrounds, who participated in the pilot CPE unit in NHS England. We integrated thematic analysis and survey results. We identified four overarching themes: Development pathways, Catalysts for development, Advantages of CPE for chaplaincy education, and Experiences with CPE course structure. Participants developed along various pathways: confidence, reflective practice, emotional intelligence, listening and attending skills, diversity in chaplaincy care, and spiritual assessment. Survey results confirmed several themes, indicating gains in chaplaincy capabilities, emotional intelligence, and counselling self-efficacy. Participants emphasised the advantages and effectiveness of the CPE model. Quantitative and qualitative findings converged to provide rich evidence that CPE generated personal and professional development, improving chaplaincy practice. General learning pathways moved from personal development, through the interpersonal learning context, and translated into chaplain competency. Participants endorsed CPE, as a robust and effective training model for chaplaincy in the English context, for those entering the profession and experienced chaplains alike. We conceptualised preliminary models for chaplain development and learning pathways in CPE that need validation and refinement by future research

Is ″Portuguese-speaking″ Africa Comparable to ″Latin″ America? Voyaging in the Midst of Colonialities of Power

Établir une comparaison entre lesdites Amérique "latine" et Afrique "de langue portugaise" peut s'avérer utile pour souligner certaines différences majeures entre ces pays d'Amérique et d'Afrique issus de colonisations précoces. Mais la principale différence ne concernera pas les 150 années entre les indépendances du début du XIX e siècle et celles de la fin (1974-1975) du XXe siècle. Elle sera relative à la nature même des États créés d'une part par des indépendances sans décolonisation - des États coloniaux (latins) - et d'autre part par des indépendances avec décolonisation - des États décolonisés (africains) -: c'est-à-dire des États qui ont été façonnés par des colonialités du pouvoir différentes. Une telle comparaison peut aider aussi à problématiser certaines caractéristiques communes issues de la longue durée des colonisations ibériques. L'une d'elle, toute proportion gardée, est la question créole: la persistance et l'importance politique, aujourd'hui, de milieux sociaux issus du premier âge de la colonisation. Bien que ces vieilles élites coloniales eussent été pré-capitalistes - au sens où leur accumulation ne procédait pas du mode de production capitaliste -, elles étaient cependant, pleinement intégrées au système-monde du capitalisme marchand.Establishing a comparison between so-called "Latin" America and "Portuguese-speaking" Africa may well prove useful in highlighting certain major differences between those countries of America and Africa having undergone early colonization. But the main difference will not concern the hundred and fifty years between the independences of the early nineteenth and those of the late (1974-1975) twentieth century. It will lie in the very nature of the states created, on the one hand, by independences without decolonization - the colonial (Latin) states - and, on the other hand, by independence with decolonization - the decolonized (African) states: states, that is, which are differently embedded into colonialities of power. But such a comparison will also help to bring out certain common features stemming from the "longue durée" of Iberian colonizations. One such feature, despite the distance involved, is the Creole issue: the persistence and political importance of social milieus stemming from the first age of colonization. Although those old colonial elites were pre-capitalist - in the sense of not accumulating via the capitalist mode of production - they were, however, fully integrated into the merchant capitalist world-system