The use of protocol in breaking bad news: evidence and ethos

This article discusses health professionals use of protocol in the breaking of bad news, focusing particularly on the well-known SPIKES framework. The evidence of impact on the patient experience is examined and recommendations are made for further outcome-based research. Existing evidence suggests that the model as commonly interpreted may not fully meet the needs of patients or reflect the clinical experience of breaking bad news for some professionals and further guidance may be needed to support them in their practice. The ethos of the step-wise protocol is debated, questioning whether it helps or hinders individualised care and the formation of a genuine relationship between patient and professional. Finally, recommendations for practice are offered

Is there evidence of selection in the dopamine receptor D4 gene in Australian invasive starling populations?

 Although population genetic theory is largely based on the premise that loci under study are selectively neutral, it has been acknowledged that the study of DNA sequence data under the influence of selection can be useful. In some circumstances, these loci show increased population differentiation and gene diversity. Highly polymorphic loci may be especially useful when studying populations having low levels of diversity overall, such as is often the case with threatened or newly established invasive populations. Using common starlings Sturnus vulgaris sampled from invasive Australian populations, we investigated sequence data of the dopamine receptor D4 gene (DRD4), a locus suspected to be under selection for novelty-seeking behaviour in a range of taxa including humans and passerine birds. We hypothesised that such behaviour may be advantageous when species encounter novel environments, such as during invasion. In addition to analyses to detect the presence of selection, we also estimated population differentiation and gene diversity using DRD4 data and compared these estimates to those from microsatellite and mitochondrial DNA sequence data, using the same individuals. We found little evidence for selection on DRD4 in starlings. However, we did find elevated levels of within-population gene diversity when compared to microsatellites and mitochondrial DNA sequence, as well as a greater degree of population differentiation. We suggest that sequence data from putatively nonneutral loci are a useful addition to studies of invasive populations, where low genetic variability is expected

Job Satisfaction and Burnout Among VA and Community Mental Health Workers

Building on two independent studies, we compared burnout and job satisfaction of 66 VA staff and 86 community mental health center staff in the same city. VA staff reported significantly greater job satisfaction and accomplishment, less emotional exhaustion and lower likelihood of leaving their job. Sources of work satisfaction were similar (primarily working with clients, helping/witnessing change). VA staff reported fewer challenges with job-related aspects (e.g. flexibility, pay) but more challenges with administration. Community mental health administrators and policymakers may need to address job-related concerns (e.g. pay) whereas VA administrators may focus on reducing, and helping workers navigate, administrative policies

Benefits of Artificially Generated Gravity Gradients for Interferometric Gravitational-Wave Detectors

We present an approach to experimentally evaluate gravity gradient noise, a potentially limiting noise source in advanced interferometric gravitational wave (GW) detectors. In addition, the method can be used to provide sub-percent calibration in phase and amplitude of modern interferometric GW detectors. Knowledge of calibration to such certainties shall enhance the scientific output of the instruments in case of an eventual detection of GWs. The method relies on a rotating symmetrical two-body mass, a Dynamic gravity Field Generator (DFG). The placement of the DFG in the proximity of one of the interferometer's suspended test masses generates a change in the local gravitational field detectable with current interferometric GW detectors.Comment: 16 pages, 4 figure

Integrating Assertive Community Treatment and Illness Management and Recovery for Consumers with Severe Mental Illness

This study examined the integration of two evidence-based practices for adults with severe mental illness: Assertive community treatment (ACT) and illness management and recovery (IMR) with peer specialists as IMR practitioners. Two of four ACT teams were randomly assigned to implement IMR. Over 2 years, the ACT–IMR teams achieved moderate fidelity to the IMR model, but low penetration rates: 47 (25.7%) consumers participated in any IMR sessions and 7 (3.8%) completed the program during the study period. Overall, there were no differences in consumer outcomes at the ACT team level; however, consumers exposed to IMR showed reduced hospital use over time

Coping with Positive and Negative Symptoms of Schizophrenia

Objective: Although coping with positive symptoms of schizophrenia has been studied widely, few studies have examined coping with negative symptoms. This study compares the appraisal of stressfulness and coping patterns in response to positive and negative symptoms experienced by clients with schizophrenia attending a community mental health center. Methods: Clients were interviewed to assess symptom severity, appraisal of symptom stressfulness, and coping strategies used for selected symptoms rated as severe and reported as stressful. Open-ended responses from clients regarding coping strategies were coded according to an a priori coding scheme. Results: Clients reported negative symptoms as less stressful, and they used fewer coping strategies in response than they did for positive symptoms. Clients used some types of coping more than others: behavioral more than cognitive, nonsocial more than social, emotion-focused more than problem-focused, and avoidant more than nonavoidant. Conclusions: Clients more often report positive symptoms as stressful compared with negative symptoms, though negative symptoms are still reported as stressful to a certain degree, indicating a need to improve our ability to help clients cope with negative symptoms. Clients are less likely to use coping strategies to counteract negative symptoms compared with positive symptoms. Implications are discussed for developing interventions tailored to promoting awareness of and ways of coping with negative symptoms

Parametric Amplification of Nonlinear Response of Single Crystal Niobium

Giant enhancement of the nonlinear response of a single crystal Nb sample, placed in {\it a pumping ac magnetic field}, has been observed experimentally. The experimentally observed amplitude of the output signal is about three orders of magnitude higher than that seen without parametric pumping. The theoretical analysis based on the extended double well potential model provides a qualitative explanation of the experimental results as well as new predictions of two bifurcations for specific values of the pumping signal.Comment: 6 pages, 10 figure

Development of a lightweight cryogenic insulating system Final report, 30 Jun. 1964 - 31 May 1966

Lightweight external panel insulation systems for thermal protection of cryogenic launch vehicle propellant tank

Low energy polarization sensitivity of the Gas Pixel Detector

An X-ray photoelectric polarimeter based on the Gas Pixel Detector has been proposed to be included in many upcoming space missions to fill the gap of about 30 years from the first (and to date only) positive measurement of polarized X-ray emission from an astrophysical source. The estimated sensitivity of the current prototype peaks at an energy of about 3 keV, but the lack of readily available polarized sources in this energy range has prevented the measurement of detector polarimetric performances. In this paper we present the measurement of the Gas Pixel Detector polarimetric sensitivity at energies of a few keV and the new, light, compact and transportable polarized source that was devised and built to this aim. Polarized photons are produced, from unpolarized radiation generated with an X-ray tube, by means of Bragg diffraction at nearly 45 degrees. The employment of mosaic graphite and flat aluminum crystals allow the production of nearly completely polarized photons at 2.6, 3.7 and 5.2 keV from the diffraction of unpolarized continuum or line emission. The measured modulation factor of the Gas Pixel Detector at these energies is in good agreement with the estimates derived from a Monte Carlo software, which was up to now employed for driving the development of the instrument and for estimating its low energy sensitivity. In this paper we present the excellent polarimetric performance of the Gas Pixel Detector at energies where the peak sensitivity is expected. These measurements not only support our previous claims of high sensitivity but confirm the feasibility of astrophysical X-ray photoelectric polarimetry.Comment: 15 pages, 12 figures. Accepted for publication in NIM