The Defining Characteristics of the Buurtzorg Nederland Model of Home Care from the Perspective of Buurtzorg Nurses

In the summer of 2015, I spent nine weeks in the Netherlands conducting qualitative research on the Buurtzorg model, an award-winning home healthcare organization, whose name translates to “neighborhood care.” I focused my research on the Buurtzorg nurses’ perspectives on the characteristics of the model. I conducted informal interviews with seventeen nurses, accompanied more on their home visits, and attended team meetings in several cities and towns. I also visited the headquarters of Buurtzorg in Almelo, where I spoke with Jos de Blok, the co-founder of the Buurtzorg model. In my collected data, I found four common themes in how the nurses perceived their work and the organization. The model for home care presented by Buurtzorg offers possibilities for the U.S. to lower homecare costs and increase patient and nurse satisfaction

The legal role of medical professionals in decisions to withhold or withdraw life sustaining treatment: Part 3 (Victoria)

This is the final article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Victoria. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training that medical professionals receive on issues such as refusal of treatment certificates and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Victoria. The article also draws together themes from the series as a whole, including conclusions about the need for more and better medical education and about law reform generally

IT Asset Disposition

In 2008, we generated 3.16 million tons of electronic waste in the U.S. alone. It is estimated that between twenty to fifty metric tons of e-waste is disposed of worldwide on an annual basis. As technology rapidly changes, there will be more and more technology e-waste. This paper presents what to do to help solve the e-waste problems; a survey of e-waste disposal; and methods of fully cleaning hard drives to avoid potential identify theft

Doctors' knowledge of the law on withholding and withdrawing life-sustaining medical treatment

Objectives To examine the level of knowledge of doctors about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity, and factors associated with a higher level of knowledge. Design, setting and participants Postal survey of all specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in New South Wales, Victoria and Queensland. Survey initially posted to participants on 18 July 2012 and closed on 31 January 2013. Main outcome measures Medical specialists’ levels of knowledge about the law, based on their responses to two survey questions. Results Overall response rate was 32%. For the seven statements contained in the two questions about the law, the mean knowledge score was 3.26 out of 7. State and specialty were the strongest predictors of legal knowledge. Conclusions Among doctors who practise in the end-of-life field, there are some significant knowledge gaps about the law on withholding and withdrawing life-sustaining treatment from adults who lack decision-making capacity. Significant consequences for both patients and doctors can flow from a failure to comply with the law. Steps should be taken to improve doctors’ legal knowledge in this area and to harmonise the law across Australia

Towards water literacy: an interdisciplinary analysis of standards for teaching and learning about humans and Water

Water is critical to sustain human existence. Water literacy involves understanding the interactions within and between natural and human dimensions of water systems to support informed decision-making, an important outcome for learners of all ages. It is therefore critical to foster water literacy in today’s global citizens, particularly through formal education. The purpose of this study, in tandem with a parallel study focusing on natural dimensions of water systems (Mostacedo-Marasovic et al., in press), is to examine water-related K-12 standards for teaching and learning about human dimensions of water systems to develop a comprehensive and transdisciplinary perspective on water education. Our overarching question is, “What do disciplinary standards specify as outcomes for students’ learning about water and humans?”. Our research questions are: i) “To what extent do these water-related standards address recognized domains of learning?” and ii) “What thematic outcomes for students’ learning are apparent across grades in these water-related standards?”. We use chi-square statistics and a conventional qualitative content analysis method complemented by processes from grounded theory to analyze water-related education standards (N = 341) from 12 education-oriented, governmental and non-governmental organizations based in the United States. Our results indicate that first, water-related standards emphasize the cognitive domain, including declarative and procedural knowledge. The affective domain and its social and emotional components are much less prevalent. Second, the water-related standards illustrate five categories which encompass human dimensions of water spanning K-12 grade bands, including human settlements; the nexus between water, food, and energy; public health; impacts of human activities on water quality and quantity; and water resources management. Overall, the study contributes to a more holistic and comprehensive perspective of water and human systems that can help inform teaching and learning to cultivate water literacy, including curriculum development and classroom pedagogy

Risk of death or hospital admission among community-dwelling older adults living with dementia in Australia

Background: Older people living with dementia prefer to stay at home to receive support. But they are at high risk of death and/or hospital admissions. This study primarily aimed to determine risk factors for time to death or hospital admission (combined) in a sample of community-dwelling older people living with dementia in Australia. As a secondary study purpose, risk factors for time to death were also examined. Methods. This study used the data of a previous project which had been implemented during September 2007 and February 2009. The original project had recruited 354 eligible clients (aged 70 and over, and living with dementia) for Extended Aged Care At home Dementia program services during September 2007 and 2008. Client information and carer stress had been collected from their case managers through a baseline survey and three-monthly follow-up surveys (up to four in total). The principal data collection tools included Global Deterioration Scale, Modified Barthel Index, Instrumental-Dependency OARS, Adapted Cohen-Mansfield Agitation Inventory, as well as measures of clients' socio-demographic characteristics, service use and diseases diagnoses. The sample of our study included 284 clients with at least one follow-up survey. The outcome variable was death or hospital admission, and death during six, nine and 16-month study periods. Stepwise backwards multivariate Cox proportional hazards analysis was employed, and Kaplan-Meier survival analysis using censored data was displayed. Results: Having previous hospital admissions was a consistent risk factor for time to death or hospital admission (six-month: HR = 3.12; nine-month: HR = 2.80; 16-month: HR = 2.93) and for time to death (six-month: HR = 2.27; 16-month: HR = 2.12) over time. Previously worse cognitive status was a consistent risk factor over time (six- and nine-month: HR = 0.58; 16-month: HR = 0.65), but no previous use of community care was only a short-term risk factor (six-month: HR = 0.42) for time to death or hospital admission. Conclusions: Previous hospital admissions and previously worse cognitive status are target intervention areas for reducing dementia clients' risk of time to death or hospital admission, and/or death. Having previous use of community care as a short-term protective factor for dementia clients' time to death or hospital admission is noteworthy

Psychological distress, self-harm and suicide attempts in gender minority compared with cisgender adolescents in the UK

Background Few population-based studies have compared the mental health of gender minority and cisgender adolescents. Aims To compare reports of psychological distress, behavioural and emotional difficulties, self-harm and suicide attempts between gender minority and cisgender adolescents. Method Data came from the Millennium Cohort Study (n = 10 247), a large nationally representative birth cohort in the UK. At a 17-year follow-up, we assessed gender identity, psychological distress (Kessler K6 scale), behavioural and emotional difficulties (parent and child reports on the Strengths and Difficulties Questionnaire), self-harm in the previous year, suicide attempts, substance use, and victimisation including harassment and physical and sexual assaults. Multivariable modified Poisson and linear regression models were used. Attenuation after the inclusion of victimisation and substance use was used to explore mediation. Results Of the 10 247 participants, 113 (1.1%) reported that they were a gender minority. Gender minority participants reported more psychological distress (coefficient 5.81, 95% CI 4.87–6.74), behavioural and emotional difficulties (child report: coefficient 5.60; 95% CI 4.54–6.67; parent/carer report: coefficient 2.60; 95% CI 1.47–3.73), self-harm including cutting or stabbing (relative risk (RR) 4.38; 95% CI 3.55–5.40), burning (RR 3.81; 95% CI 2.49–5.82), taking an overdose (RR 5.25; 95% CI 3.35–8.23) and suicide attempts (RR 3.42; 95% CI 2.45–4.78) than cisgender youth. These associations were partially explained by differences in exposure to victimisation. Conclusions Gender minority adolescents experience a disproportionate burden of mental health problems. Policies are needed to reduce victimisation and services should be adapted to better support the mental health of gender minority adolescents

Ichthyophonus irregularis sp. nov. from the yellowtail flounder Limanda ferruginea from the Nova Scotia shelf

A previously described unusual form of the protistan parasite Ichthyophonus, differing in morphological and developmental features from I. hoferi sensu Plehn & Mulsow, was recovered from yellowtail flounder Limanda ferruginea Storer from the Brown's Bank area of the Nova Scotia shelf. The nuclear gene encoding the rRNA of the small ribosomal subunit was amplified from this unusual form of Ichthyophonus using the polymerase chain reaction, sequenced and aligned with other eukaryote small subunit (ssu)-rDNAs. Inferred phylogenetic trees clearly show that its ssu-rDNA is distinct from those of 2 isolates of I. hoferi sensu Plehn & Mulsow from different hosts and geographical locations (herring in the North Sea, and yellowtail flounder from the Nova Scotia shelf). We consider the unusual form to be a separate species, I. irregularis. The occurrence of a second, distinct type of Ichthyophonus within a single host species raises the possibility that ichthyophoniasis could be produced by different (although related) pathogens, and in some cases, by concurrent infections of the two

Factors that promote a positive childbearing experience : a qualitative study

Introduction: Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn. This study aimed to understand the health system factors that promote a positive childbearing experience. Methods: Women who had a positive experience and had given birth in Australia in the previous 12 months were recruited for individual semistructured interviews. The interview guide focused on health system factors that participants credited with contributing to their positive experience of perinatal care. Interviews were conducted until data saturation was reached. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis. Results: Data from 36 interviews were thematically analyzed, and 4 major themes were generated: health care provider attributes, health system attributes, communication and decision-making, and experience of care. The salient factors that promoted positive experiences included care that was respectful and individualized with effective communication, access to midwifery continuity of care models, and good integration between services. Competent and professional health care providers who facilitated shared decision-making were also essential. Discussion: Although women often sought out care that promoted physiologic birth, they emphasized that the way they were cared for was more important than fulfilling specific birth aspirations. Quality maternity care has the capacity to support a woman's confidence in her own abilities and promote a positive, and sometimes transformative, childbearing experience. © 2022 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM)

Quantitative Soil Descriptions for Ecoregions of the United States

Researchers have defined and mapped ecological regions of the United States based on similar patterns of ecosystems such as deserts, forests, and croplands. These studies are useful in regional research, monitoring, and environmental management because data can be more readily extrapolated within the same ecoregion and to regions with similar characteristics. The description of ecoregions is largely holistic and qualitative. Conversely, quantitative information for soil are abundant and soil is an important ecosystem component related to many ecoregion properties. We used the nationwide State Soil Geographic database(STATSGO) to describe the soils of 84 Level III ecoregions in the United States. Among the 24 soil characteristics studied were texture, rock fragments, available water capacity, bulk density, and organic matter content. For each ecoregion we developed ranks to describe (i) its similarity to the U.S. average soil characteristics, (ii) the accuracy of predicting those characteristics, (iii) how well the soil map unit boundaries fit within ecoregion boundaries, (iv) the spatial relationship of soils across neighboring ecoregion boundaries, and (v) the homogeneity of texture-rock patterns. We present a national map of soil texture and rock fragments and five soil ranks for each ecoregion, and examine relationship between soils and other ecological components for selected ecoregions. Because soils relate to other ecosystem components such as vegetation, geology, and land use, the soil ranks complement and enrich the qualitative ecoregion descriptions. Similar analyses of physical or biological components of ecoregions will expand the understanding of the ecosystem patterns