Improving Communication in Adolescent Cancer Care: A Multiperspective Study.

BACKGROUND Professionals treating adolescents with cancer must communicate well with them and their parents. Evidence suggests that the communication needs of this population are rarely met. Skills training can improve professional communication, but has been criticized for not being based on the experience of the participants in the clinical encounter. We took a multiperspective approach, drawing on perspectives of former adolescents with cancer, patients' parents, physicians, and nurses with the aim to provide suggestions for improvement in communication in adolescent cancer care. METHODS Adolescent cancer survivors (n = 16), parents (n = 8), pediatric oncologists (n = 12), and pediatric oncology nurses (n = 18) participated in 11 focus groups. They discussed their experiences communicating with each other. Transcripts were analyzed by thematic analysis. RESULTS We identified themes within the following sections: (1) The framework in which professionals communicate with adolescents with cancer (regression in a time of detachment, adolescents' perception and knowledge of illness, cognitive versus legal maturity, "lost in transition" between pediatric and adult oncology); (2) communication difficulties between professionals and patients and parents (professionals and patients/parents identified the other party as the source of difficulties), and (3) effective professional communication (there was some overlap on how doctors and nurses should communicate, along with substantially different expectations for the two professions). CONCLUSIONS The framework within which professionals communicate, the different perspectives on the factors that make communication difficult, and the different expectations regarding good communication by doctors and nurses should be considered when communication skills training courses are developed for professionals who work in adolescent oncology.

Noise peaks influence communication in the operating room. An observational study

Noise peaks are powerful distractors. This study focuses on the impact of noise peaks on surgical teams' communication during 109 long abdominal surgeries. We related measured noise peaks during 5-min intervals to the amount of observed communication during the same interval. Results show that noise peaks are associated with less case-relevant communication; this effect is moderated by the level of surgical experience; case-relevant communications decrease under high noise peak conditions among junior, but not among senior surgeons. However, case-irrelevant communication did not decrease under high noise level conditions, rather there was a trend to more case-irrelevant communication under high noise peaks. The results support the hypothesis that noise peaks impair communication because they draw on attentional resources rather than impairing understanding of communication. As case-relevant communication is important for surgical performance, exposure to high noise peaks in the OR should be minimised especially for less experienced surgeons. Practitioner Summary: This study investigated whether noise during surgeries influenced the communication within surgical teams. During abdominal surgeries, noise levels were measured and communication was observed. Results showed that high noise peaks reduced the frequency of patient-related communication, but did not reduce patient-irrelevant communication. Noise may negatively affect team coordination in surgeries.

Investigator/IRB-led community communication in genetic research: A descriptive feasibility pilot study

This pilot study, conducted in the Houston, TX, area, established a structured dialogue among a university Institutional Review Board, its researchers, and its local community members (i.e. pool of potential research participants) for the purpose of further educating all three parties about genetic research and community concerns related to such research. An IRB-designed educational presentation aimed at assisting potential subjects in making an informed decision to participate in genetic research was provided to four community groups (n=54); this presentation also included a current example of genetic research being conducted in the community as explained by the researcher, and a question-and-answer session designed to assist the IRB and the researcher in understanding the community's concerns about genetic research. Comparisons of pre- and post- presentation community questionnaires indicate that the joint presentation was effective in increasing community knowledge about genetic research, most notably related to the risks and benefits of this research to the individual, as well as the understanding that protections are in place for research participants. While researchers are optimistic about the idea of a collaborative effort with the IRB and the community, the feasibility of such a program and the benefit to the participating researchers remain unclear; additional research is necessary to establish the most effective method of communication for all groups involved, as well as to obtain statistically significant results with regard to race/ethnicity, gender, and education levels of community participants. ^

Doctor-patient communication in the medical interaction: Context, implications, and practice

Effective communication; whether from an interpersonal, mass media, or global perspective, is a critical component in public health. It is an essential conduit in increasing public awareness of available health resources, potential health hazards and related disease prevention strategies, and in delivering better health care. Within this context, available literature asserts doctor-patient communication as central to healthcare delivery. It has been shown to affect patient health outcomes, satisfaction with care, adherence to treatment recommendations, and even understanding of medical information. While research supports the essential imperative of interventions aimed at teaching doctors and patients the communication skills necessary for a successful and meaningful medical interaction, most interventions to date, focus on teaching these communication skills to doctors and seem to rely, largely, on mass media for providing patients with the information needed to increase communication efficacy. This study sought to fill a significant gap in the doctor-patient communication literature by reviewing the context of the doctor-patient exchange in the medical interaction, the implications of this exchange in resulting care of the patient, and the potential improvements to practice through interventions aimed at improving the communication exchange. Closing with an evaluation of a patient-centered communication intervention, the “How to Talk to Your Doctor” (HTTTYD) program that combines previously identified optimal strategies for improving communication between doctors and patients, this study examined the patients’ perspective of their potential as better communicators in the medical interaction. ^ Specific Aims, Hypotheses or Questions (Aim I) To examine the context of health communication within a public health framework and its relation to health care delivery. (Aim II) To review doctor-patient communication as a central focus within health care delivery and the resulting implications to patient care. (Aim III) To assess the utility of interventions to improve doctor-patient communication. Specifically, to evaluate the effectiveness of a patient-centered community education intervention, the “How to Talk to Your Doctor” (HTTTYD) program, aimed at improving patient communication efficacy.^

Client-Provider Communication in Postabortion Care

Muchos trabajadores de la salud que tratan a las mujeres que sufren complicaciones de aborto inducido o espontáneo están dispuestos a admitir que estas mujeres necesitan asesoría, pero a menudo ven la consejería como una función no médica que requiere una formación específica, un tiempo especialmente designado, aparte de la prestación de servicios postaborto y otras instalaciones separadas y privadas. De este modo, los proveedores de servicios de atención postaborto a menudo creen que el asesoramiento no es una de sus responsabilidades de trabajo y que carecen de la formación y las instalaciones para hacerlo

Máquinas o atmósferas: La estética de la energía en la arquitectura, 1750-2000 = From Machines to Atmospheres: The Aesthetics of Energy in Architecture, 1750-2000

La energía es ya un tema arquitectónico, pero su incorporación al proyecto ha sido hasta ahora fundamentalmente técnica, dando pie a una especie de funcionalismo ecológico cuyo destino es acaso repetir los errores de los viejos funcionalismos en su confianza de encontrar modos ‘objetivos’ de transmutar la energía en forma construida, pero sin que en tal proceso parezca haber hueco para mediaciones de tipo estético. Sin embargo, son precisamente tales mediaciones las que necesitan analizarse para que la adopción de los temas energéticos resulte fructífera en la arquitectura, y asimismo para dar cuenta de otras perspectivas complementarias —filosóficas, científicas, artísticas— que hoy forman el complejo campo semántico de la energía. Partiendo de la fecha de 1750 —que da comienzo simbólicamente al proceso de contaminaciones ‘modernas’ entre la arquitectura y otras disciplinas—, esta tesis analiza los diferentes modos con los que proyectos y edificios han expresado literal y analógicamente ciertos temas o ideales energéticos, demostrando la existencia de una ‘estética de la energía’ en la arquitectura y también de una tradición proyectual e intelectual sostenida en ella. Con este fin, se han seleccionados siete metáforas que vinculan tanto técnica como ideológicamente a la arquitectura con la energía: la metáfora de la máquina, asociada al ideal de movimiento y la autorregulación; las metáforas del arabesco, del cristal y del organismo, afines entre sí en su modo de dar cuenta del principio de la morfogénesis o energía creadora de la naturaleza; la metáfora de la actividad interna de los materiales; la metáfora del gradiente, que expresa la condición térmica y climática de la arquitectura, y, finalmente, la de la atmósfera que, recogiendo los sentidos anteriores, los actualiza en el contexto de la estética contemporánea. La selección de estas siete metáforas se ha llevado a cabo después de un barrido exhaustivo de la bibliografía precedente, y ha estructurado un relato cuyo método combina la perspectiva general —que permite cartografiar las continuidades históricas— con la cercana —que atiende a las problemas específicos de cada tema o metáfora—, complementándolas con una aproximación de sesgo iconográfico cuyo propósito es incidir en los vínculos que se dan entre lo ideológico y lo morfológico. El análisis ha puesto de manifiesto cómo detrás de cada una de estas metáforas se oculta un principio ideológico común —la justificación de la arquitectura desde planteamientos externos procedentes de la ciencia, la filosofía y el arte—, y cómo en cada uno de los casos estudiados las asimilaciones más fructíferas de la energía se han producido según mecanismos de mímesis analógica que inciden más en los procesos que en las formas que estos generan, y que en último término son de índole estética, lo cual constituye un indicio de los métodos de la arquitectura por venir. ABSTRACT Although it is already an architectural theme, the matter of incorporating energy into projects has up to now been mainly technical, giving rise to a kind of ecological functionalism which may be bound to old funcionalist mistakes in hopes of finding “objective” ways of transmuting energy into built forms without aesthetic considerations. However, it is precisely such considerations that need to be analyzed if the adoption of energy issues in architecture is to bear fruit and also to account for other complementary perspectives – philosophical, scientific, artistic – which today form the complex fabric of the energy semantic field. Beginning in 1750 – symbolic start of ‘modern’ contaminations between architecture and other disciplines –, this thesis analyzes the different ways in which projects and buildings have literally and analogically expressed certain subjects or ideals on energy, and demonstrates the existence of an “aesthetics of energy” in architecture, as well as of an intellectual and design tradition based on such aesthetics. For this purpose, seven metaphors are selected to link energy to architecture both technically and ideologically: the machine’s metaphor, associated with the ideal of mouvement and self-regulation; the arabesque, glass and the organism’s metaphors, which account for the morphogenesis principle, i.e. creative energy of nature; the metaphor linked to matter and the ideal of internal activity; the gradient’s metaphor, which expressed the thermal and climatic condition of architecture, and, finally, that of the atmosphere which, collecting the above meanings, updates them in the context of contemporary aesthetics. The selection of these seven metaphors was carried out after a thorough scan of the preceding literature, and has structured a reasoning that combines the overview method – which accounts for historical continuities – with the nearby one – which meets the specifics problems of each theme or metaphor –, both supplemented with an iconographic bias, the purpose of which is to visually express the links existing between the ideological and the morphological. So presented, the analysis shows how, behind each of these metaphors, lies a common ideological principle – the justification of architecture from scientific, philosophical and artistic “external” angles –, and how in each of the studied cases the most successful assimilation of energy were those produced by aesthetic mechanisms of analogical mimesis not focused in forms but in processes that generate them: an indication of the methods of architecture to come.

MNEMOSYNE VS MIMESIS, On Memory in Architecture = MNEMOSINE VS MIMESIS, De la memoria en la arquitectura

Memory is an indispensable tool for all architects. An architect without memory is worthless or less than worthless.

Feo, inútil, inestable: pensamiento crítico contemporáneo y procesos proyectivos en arquitectura = Ugly, useless, unstable: contemporary critical thought and projective processes in architecture

La presente tesis doctoral persigue dos objetivos simultáneos: Determinar el alcance de los criterios clásicos para la evaluación de arquitectura y poner en crisis la prevalencia de esos mismos criterios dentro del marco crítico y productivo actual. En concreto, esta tesis se interroga sobre la posible contribución de determinadas corrientes del pensamiento post-estructuralista y neo-materialista a las tareas de expansión y transformación de los criterios clásicos antes mencionados. Asimismo, se plantea la oportunidad de formalizar estas incorporaciones conceptuales como metodologías para el proyectar arquitectónico. La tesis emplea un análisis pormenorizado de las cualidades implícitas en la triada Firmitas, Utilitas, Venustas elaborada por Vitruvio como vehículo para calibrar la influencia de los paradigmas de pensamiento clásico en nuestras posiciones críticas contemporáneas. Como reacción al carácter dominante de dichos paradigmas, y con la ayuda de una compilación selectiva de ejemplos procedentes de los campos artístico y arquitectónico, la presente tesis procede a examinar y clasificar diversas estrategias arquitectónicas basadas en la no conformidad con los criterios clásicos de evaluación de la disciplina. A la hora de realizar esta tarea, y con el objetivo de superar el dualismo trascendental que caracteriza la gran mayoría de dichos criterios clásicos, se propone un modelo analítico y multidimensional que formula las instancias arquitectónicas como posibles posiciones dentro de un extenso continuo combinatorio de cualidades formales, estructurales y organizativas. Este modelo conceptual permite replantear el aparente antagonismo entre los principios de Vitruvio y sus opuestos, estableciendo en su lugar un dominio operativo continuo de producción arquitectónica. Esta operación abre una ventana de oportunidad para expandir los límites del marco crítico actual más allá de las fronteras establecidas por nuestra herencia clásica. En consecuencia con esta voluntad, la presente tesis pretende habilitar un ámbito para el análisis crítico de las estrategias que caracterizan ciertas corrientes del proyectar contemporáneo, pero también contribuir a informar nuevas aproximaciones metodológicas al proceso de proyecto, desplazando progresivamente su foco desde lo descriptivo hacia lo proyectivo. ABSTRACT This doctoral thesis attempts to simultaneously determine the scope of the classical criteria for the evaluation of architecture and challenge their prevalence within the current framework of architectural production and criticism. It examines how specific strands of post-structuralism and neo-materialism may contribute to both the expansion and the transformation of these criteria and, in doing so, sets itself the goal of mobilising these conceptual incorporations as explicit design methodologies. A detailed analysis of the formal, structural and organisational qualities implicit in Vitruvius’ triad Firmitas, Utilitas, Venustas is used as a starting point to determine the influence of classical paradigms in our current critical positions. As a reaction to this critical pervasiveness, and supported by a curated collection of artistic and architectural works, diverse approaches to non-compliance with the classical criteria of assessment are examined and classified. In order to facilitate this endeavour -and to overcome the transcendental dualism of most classical critical approaches in architecture- this thesis puts forward an analytical, multidimensional model that formulates architectural instances as possible positions within a larger combinatory continuum of formal, structural and organisational qualities. Using this conceptual model, the apparent antagonism between Vitruvius’ principles and its non-compliant opposites is reframed as a continuous operative domain of architectural production, which in turn opens up a window of opportunity to expand the limits of our critical framework beyond the boundaries of classical paradigms. In doing so, this thesis attempts not only to foster a better understanding of some of the strategic approaches that characterise contemporary systems of architectural production, but also to inform future methodological approaches to architectural design, hence situating itself beyond the domain of the descriptive and moving towards the projective.

Simulation of thermal performance of glazing in architecture using scale models = Simulación del comportamiento térmico de los acristalamientos en la arquitectura mediante modelos a escala

El propósito de esta tesis es estudiar la aproximación a los fenómenos de transporte térmico en edificación acristalada a través de sus réplicas a escala. La tarea central de esta tesis es, por lo tanto, la comparación del comportamiento térmico de modelos a escala con el correspondiente comportamiento térmico del prototipo a escala real. Los datos principales de comparación entre modelo y prototipo serán las temperaturas. En el primer capítulo del Estado del Arte de esta tesis se hará un recorrido histórico por los usos de los modelos a escala desde la antigüedad hasta nuestro días. Dentro de éste, en el Estado de la Técnica, se expondrán los beneficios que tiene su empleo y las dificultades que conllevan. A continuación, en el Estado de la Investigación de los modelos a escala, se analizarán artículos científicos y tesis. Precisamente, nos centraremos en aquellos modelos a escala que son funcionales. Los modelos a escala funcionales son modelos a escala que replican, además, una o algunas de las funciones de sus prototipos. Los modelos a escala pueden estar distorsionados o no. Los modelos a escala distorsionados son aquellos con cambios intencionados en las dimensiones o en las características constructivas para la obtención de una respuesta específica por ejemplo, replicar el comportamiento térmico. Los modelos a escala sin distorsión, o no distorsionados, son aquellos que mantienen, en la medida de lo posible, las proporciones dimensionales y características constructivas de sus prototipos de referencia. Estos modelos a escala funcionales y no distorsionados son especialmente útiles para los arquitectos ya que permiten a la vez ser empleados como elementos funcionales de análisis y como elementos de toma de decisiones en el diseño constructivo. A pesar de su versatilidad, en general, se observará que se han utilizado muy poco estos modelos a escala funcionales sin distorsión para el estudio del comportamiento térmico de la edificación. Posteriormente, se expondrán las teorías para el análisis de los datos térmicos recogidos de los modelos a escala y su aplicabilidad a los correspondientes prototipos a escala real. Se explicarán los experimentos llevados a cabo, tanto en laboratorio como a intemperie. Se han realizado experimentos con modelos sencillos cúbicos a diferentes escalas y sometidos a las mismas condiciones ambientales. De estos modelos sencillos hemos dado el salto a un modelo reducido de una edificación acristalada relativamente sencilla. Los experimentos consisten en ensayos simultáneos a intemperie del prototipo a escala real y su modelo reducido del Taller de Prototipos de la Escuela Técnica Superior de Arquitectura de Madrid (ETSAM). Para el análisis de los datos experimentales hemos aplicado las teorías conocidas, tanto comparaciones directas como el empleo del análisis dimensional. Finalmente, las simulaciones nos permiten comparaciones flexibles con los datos experimentales, por ese motivo, hemos utilizado tanto programas comerciales como un algoritmo de simulación desarrollado ad hoc para esta investigación. Finalmente, exponemos la discusión y las conclusiones de esta investigación. Abstract The purpose of this thesis is to study the approximation to phenomena of heat transfer in glazed buildings through their scale replicas. The central task of this thesis is, therefore, the comparison of the thermal performance of scale models without distortion with the corresponding thermal performance of their full-scale prototypes. Indoor air temperatures of the scale model and the corresponding prototype are the data to be compared. In the first chapter on the State of the Art, it will be shown a broad vision, consisting of a historic review of uses of scale models, from antiquity to our days. In the section State of the Technique, the benefits and difficulties associated with their implementation are presented. Additionally, in the section State of the Research, current scientific papers and theses on scale models are reviewed. Specifically, we focus on functional scale models. Functional scale models are scale models that replicate, additionally, one or some of the functions of their corresponding prototypes. Scale models can be distorted or not. Scale models with distortion are considered scale models with intentional changes, on one hand, in dimensions scaled unevenly and, on the other hand, in constructive characteristics or materials, in order to get a specific performance for instance, a specific thermal performance. Consequently, scale models without distortion, or undistorted scale models scaled evenly, are those replicating, to the extent possible, without distortion, the dimensional proportions and constructive configurations of their prototypes of reference. These undistorted and functional scale models are especially useful for architects because they can be used, simultaneously, as functional elements of analysis and as decision-making elements during the design. Although they are versatile, in general, it is remarkable that these types of models are used very little for the study of the thermal performance of buildings. Subsequently, the theories related to the analysis of the experimental thermal data collected from the scale models and their applicability to the corresponding full-scale prototypes, will be explained. Thereafter, the experiments in laboratory and at outdoor conditions are detailed. Firstly, experiments carried out with simple cube models at different scales are explained. The prototype larger in size and the corresponding undistorted scale model have been subjected to same environmental conditions in every experimental test. Secondly, a step forward is taken carrying out some simultaneous experimental tests of an undistorted scale model, replica of a relatively simple lightweight and glazed building construction. This experiment consists of monitoring the undistorted scale model of the prototype workshop located in the School of Architecture (ETSAM) of the Technical University of Madrid (UPM). For the analysis of experimental data, known related theories and resources are applied, such as, direct comparisons, statistical analyses, Dimensional Analysis and last, but not least important, simulations. Simulations allow us, specifically, flexible comparisons with experimental data. Here, apart the use of the simulation software EnergyPlus, a simulation algorithm is developed ad hoc for this research. Finally, the discussion and conclusions of this research are exposed.

Domain–domain communication in a miniature archaebacterial tRNA synthetase

The three-dimensional structure of tRNA is organized into two domains—the acceptor-TΨC minihelix with the amino acid attachment site and a second, anticodon-containing, stem–loop domain. Aminoacyl-tRNA synthetases have a structural organization that roughly recapitulates the two-domain organization of tRNAs—an older primary domain that contains the catalytic center and interacts with the minihelix and a secondary, more recent, domain that makes contacts with the anticodon-containing arm. The latter contacts typically are essential for enhancement of the catalytic constant kcat through domain–domain communication. Methanococcus jannaschii tyrosyl-tRNA synthetase is a miniature synthetase with a tiny secondary domain suggestive of an early synthetase evolving from a one-domain to a two-domain structure. Here we demonstrate functional interactions with the anticodon-containing arm of tRNA that involve the miniaturized secondary domain. These interactions appear not to include direct contacts with the anticodon triplet but nonetheless lead to domain–domain communication. Thus, interdomain communication may have been established early in the evolution from one-domain to two-domain structures.

Folliculostellate cell network: A route for long-distance communication in the anterior pituitary

All higher life forms critically depend on hormones being rhythmically released by the anterior pituitary. The proper functioning of this master gland is dynamically controlled by a complex set of regulatory mechanisms that ultimately determine the fine tuning of the excitable endocrine cells, all of them heterogeneously distributed throughout the gland. Here, we provide evidence for an intrapituitary communication system by which information is transferred via the network of nonendocrine folliculostellate (FS) cells. Local electrical stimulation of FS cells in acute pituitary slices triggered cytosolic calcium waves, which propagated to other FS cells by signaling through gap junctions. Calcium wave initiation was because of the membrane excitability of FS cells, hitherto classified as silent cells. FS cell coupling could relay information between opposite regions of the gland. Because FS cells respond to central and peripheral stimuli and dialogue with endocrine cells, the form of large-scale intrapituitary communication described here may provide an efficient mechanism that orchestrates anterior pituitary functioning in response to physiological needs.

Chemical communication in scarab beetles: reciprocal behavioral agonist-antagonist activities of chiral pheromones.

A novel mechanism of reciprocal behavioral agonist-antagonist activities of enantiomeric pheromones plays a pivotal role in overcoming the signal-to-noise problem derived from the use of a single-constituent pheromone system in scarab beetles. Female Anomala osakana produce (S, Z)-5-(+)-(1-decenyl)oxacyclopentan-2-one, which is highly attractive to males; the response is completely inhibited even by 5% of its antipode. These two enantiomers have reverse roles in the Popillia japonica sex pheromone system. Chiral GC-electroantennographic detector experiments suggest that A. osakana and P. japonica have both R and S receptors that are responsible for behavioral agonist and antagonist responses.

Introduction of asymmetry in the naturally symmetric restriction endonuclease EcoRV to investigate intersubunit communication in the homodimeric protein.

Type II restriction endonucleases are dimers of two identical subunits that together form one binding site for the double-stranded DNA substrate. Cleavage within the palindromic recognition site occurs in the two strands of the duplex in a concerted manner, due to the action of two catalytic centers, one per subunit. To investigate how the two identical subunits of the restriction endonuclease EcoRV cooperate in binding and cleaving their substrate, heterodimeric versions of EcoRV with different amino acid substitutions in the two subunits were constructed. For this purpose, the ecorV gene was fused to the coding region for the glutathione-binding domain of the glutathione S-transferase and a His6-tag, respectively. Upon cotransformation of Escherichia coli cells with both gene fusions stable homo- and heterodimers of the EcoRV variants are produced, which can be separated and purified to homogeneity by affinity chromatography over Ni-nitrilotriacetic acid and glutathione columns. A steady-state kinetic analysis shows that the activity of a heterodimeric variant with one inactive catalytic center is decreased by 2-fold, demonstrating that the two catalytic centers operate independently from each other. In contrast, heterodimeric variants with a defect in one DNA-binding site have a 30- to 50-fold lower activity, indicating that the two subunits of EcoRV cooperate in the recognition of the palindromic DNA sequence. By combining a subunit with an inactive catalytic center with a subunit with a defect in the DNA-binding site, EcoRV heterodimers were produced that only nick DNA specifically within the EcoRV recognition sequence.