Assessing Palliative Care Knowledge Among Medicine/Pulmonary Intensive Care Unit Staff to Identify Barriers and Increase Palliative Care Referrals

Background: To conduct a needs assessment to identify areas of opportunity for increased awareness of the interdisciplinary medicine/pulmonary intensive care unit (MICU) staffs’ knowledge of palliative care and identify potential barriers to initiating referrals for palliative care consultations. Then provide an educational intervention and assess effectiveness with a post interventions assessment of referrals. The goal of this project is to increase referrals for palliative care consults. Methods: A pre-/post-survey design will be utilized to assess palliative care knowledge to identify barriers to palliative care consultation referrals. An educational intervention that addresses palliative care knowledge deficits and addresses barriers will be provided between the pre- and post-survey. A prospective and retrospective chart review will also be performed to determine whether the educational intervention results in any change in palliative care referrals for consultations. Results: Statistical significance was noted in the overall knowledge scores between pre and post survey groups (p \u3c .001). Among the pre and post samples, there was a significant association between intubation status and palliative care initiation (p = 0.047). Statistical significance was noted between initiation of palliative care services among the pre and post groups (p = .036). Conclusion: Identifying and addressing palliative care barriers with targeted education can be an effective solution. This intervention was effective at increasing palliative care knowledge, initiation, and comfort with patient/family discussions. Addressing how to accomplish greater provider inclusion in future studies will be an integral component to improving palliative care services utilization

A Conductor\u27s Analysis of Gabriel Faure\u27s Requiem, Op. 48

Gabriel Fauré’s Requiem, Op. 48 was an evolving work, which he continued to revise from its inception in 1887 until the published version of 1900. The focus and intent of this paper is to present a detailed analysis of Requiem, Op. 48 as well as historical background to aid conductors in the preparation and performance of this work. Discussions include the history of the requiem mass as a liturgical form, the evolution of Requiem, Op. 48, the John Rutter edition (1984) and his research, and a conductor’s analysis addressing issues of harmony, form, and style

Comparing the Relative Strengths of EEG and Low-Cost Physiological Devices in Modeling Attention Allocation in Semiautonomous Vehicles

As semiautonomous driving systems are becoming prevalent in late model vehicles, it is important to understand how such systems affect driver attention. This study investigated whether measures from low-cost devices monitoring peripheral physiological state were comparable to standard EEG in predicting lapses in attention to system failures. Twenty-five participants were equipped with a low-fidelity eye-tracker and heart rate monitor and with a high-fidelity NuAmps 32-channel quick-gel EEG system and asked to detect the presence of potential system failure while engaged in a fully autonomous lane changing driving task. To encourage participant attention to the road and to assess engagement in the lane changing task, participants were required to: (a) answer questions about that task; and (b) keep a running count of the type and number of billboards presented throughout the driving task. Linear mixed effects analyses were conducted to model the latency of responses reaction time (RT) to automation signals using the physiological metrics and time period. Alpha-band activity at the midline parietal region in conjunction with heart rate variability (HRV) was important in modeling RT over time. Results suggest that current low-fidelity technologies are not sensitive enough by themselves to reliably model RT to critical signals. However, that HRV interacted with EEG to significantly model RT points to the importance of further developing heart rate metrics for use in environments where it is not practical to use EEG

Grand Field Challenges for Cognitive Neuroergonomics in the Coming Decade

Neuroergonomics as defined by Raja Parasuraman is the study of “the brain at work and in everyday life” (Parasuraman, 2003). This rapidly growing research field aims at understanding human brain function underlying the many facets of human interaction with technical systems (Dehais et al., 2020). The term “cognition” is used to describe different processes (e.g., attention, memory, decision making) relevant to human-technology interaction. Cognitive neuroergonomics, then, can be defined as a section of neuroergonomics concerned with the investigation of the neural bases of those cognitive processes involved in the user's interaction with a technical system at work or during everyday life. One of the defining aspects of cognitive neuroergonomics is that it uses insights from analyzing neural dynamics in these settings to inform cognitive theory and models, as well as to improve our understanding of human brain function underlying cognition, in general. To this end, new imaging methods are continuously adapted and used in a wide range of experimental scenarios that cover the entire area of ergonomics from highly controlled laboratory research protocols, to less controlled translational research, to research in the real world with little control over the factors of interest (Parada, 2018). This decreasing level of control is accompanied by an increasing level of ecological validity. Laboratory experiments provide very good control over experimental factors with high internal validity of the investigated constructs but often suffer from low levels of ecological validity. In contrast, real-world experiments might show low internal validity and lack of experimental control but provide high ecological validity that cannot be further improved. Here, the real world is the laboratory (Gramann et al., 2017). Furthermore, with increasing ecological validity, inter-acting with technical systems often involves expanding physical activity of the user. System interactions range from very low input (e.g., interaction with mobile devices; McKendrick, 2019) to larger scale interaction (e.g., Human-Robot Interaction, HRI; Tsarouchi et al., 2016) to very large scale interactions (e.g., assisted navigation; Wunderlich and Gramann, 2020). Active behavior is the basis for physically demanding workplaces as well as less physically challenging tasks that, nonetheless, require body, head and eye movements when users actively seek information or respond to external stimuli (Doshi and Trivedi, 2009). Traditionally, however, active behavior is not allowed in brain imaging protocols because established imaging modalities are usually too heavy to follow participants' movements and movement-related artifacts render the analyses of neural activity difficult (Makeig et al., 2009; Gramann et al., 2011). With cognitive neuroergonomics maturing into a new research area with widespread research questions and methods, the focus should be put back into theory-driven studies of the human brain at work and in everyday life. Good scientific practices have to be adapted to allow for replicable science including the integration of new mobile imaging methods into the existing range of established imaging protocols. New findings have to be related to parameters known from established laboratory protocols and integrated into larger theoretical frameworks that allow for systematic replication as well as the development of robust parameters reflecting cognitive processes. From this perspective, it is our belief that the following challenges will have to be met to further develop this scientific field

Transcranial direct current stimulation facilitates cognitive multi-task performance differentially depending on anode location and subtask

There is a need to facilitate acquisition of real world cognitive multi-tasks that require long periods of training (e.g., air traffic control, intelligence analysis, medicine). Non-invasive brain stimulation—specifically transcranial Direct Current Stimulation (tDCS)—has promise as a method to speed multi-task training. We hypothesized that during acquisition of the complex multi-task Space Fortress, subtasks that require focused attention on ship control would benefit from tDCS aimed at the dorsal attention network while subtasks that require redirection of attention would benefit from tDCS aimed at the right hemisphere ventral attention network. We compared effects of 30 min prefrontal and parietal stimulation to right and left hemispheres on subtask performance during the first 45 min of training. The strongest effects both overall and for ship flying (control and velocity subtasks) were seen with a right parietal (C4, reference to left shoulder) montage, shown by modeling to induce an electric field that includes nodes in both dorsal and ventral attention networks. This is consistent with the re-orienting hypothesis that the ventral attention network is activated along with the dorsal attention network if a new, task-relevant event occurs while visuospatial attention is focused (Corbetta et al., 2008). No effects were seen with anodes over sites that stimulated only dorsal (C3) or only ventral (F10) attention networks. The speed subtask (update memory for symbols) benefited from an F9 anode over left prefrontal cortex. These results argue for development of tDCS as a training aid in real world settings where multi-tasking is critical

FAIR Data Pipeline: provenance-driven data management for traceable scientific workflows

Modern epidemiological analyses to understand and combat the spread of disease depend critically on access to, and use of, data. Rapidly evolving data, such as data streams changing during a disease outbreak, are particularly challenging. Data management is further complicated by data being imprecisely identified when used. Public trust in policy decisions resulting from such analyses is easily damaged and is often low, with cynicism arising where claims of "following the science" are made without accompanying evidence. Tracing the provenance of such decisions back through open software to primary data would clarify this evidence, enhancing the transparency of the decision-making process. Here, we demonstrate a Findable, Accessible, Interoperable and Reusable (FAIR) data pipeline developed during the COVID-19 pandemic that allows easy annotation of data as they are consumed by analyses, while tracing the provenance of scientific outputs back through the analytical source code to data sources. Such a tool provides a mechanism for the public, and fellow scientists, to better assess the trust that should be placed in scientific evidence, while allowing scientists to support policy-makers in openly justifying their decisions. We believe that tools such as this should be promoted for use across all areas of policy-facing research

Weber and church governance: religious practice and economic activity

The debate about the relationship between religion and economic activity in the wake of Weber has been cast largely in terms of belief and values. This article suggests an alternative focus on practice. It argues that taken for granted practices of church governance formed to-hand resources for the organization of economic activity. The argument is developed through an examination of the historical development of church governance practices in the Presbyterian Church of Scotland, with particular emphasis on the way in which theological belief gave rise to practices of accountability and record keeping. In turn such practices contributed to a ‘culture of organization’ which had implications for economic activity. A focus on governance practices can help to illuminate enduring patterns of difference in the organization of economic activity