End-of-life care in the intensive care unit : a systematic review of qualitative studies investigating the experiences and perceptions of the patient's family

Review question/objective The review objective is to synthesise the best available evidence on experiences and perceptions of family members of intensive care unit patients on the adequacy of end-of-life care, where life-support modalities have been withheld or withdrawn. Inclusion criteria Types of participants This review will consider studies that report on the experiences and perceptions of patients’ families on EOLC in the ICU, where life-support modalities have been withheld or withdrawn. The family is defined as “those who are closest to the patient... the family may include the biological family, family by acquisition, and the family of choice and friends”. Phenomena of interest The phenomena of interest for this review are the patients’ families experiences, perceptions or views on the adequacy of EOLC delivered in the ICU, where life-support modalities were withheld or withdrawn. These experiences may refer to the following views on domains of care considered important at the end-of-life in the ICU, which have been described already in the existing literature: timely, consistent, and compassionate communication, clinician availability, clinical decision making based on patients’ preferences, goals and values, physical care implemented to maintain patient comfort, holistic interdisciplinary care and bereavement care for families of patients who died.

The uber-assumption family

We offer an exposition of Boneh, Boyen, and Goh’s “uber-assumption” family for analyzing the validity and strength of pairing assumptions in the generic-group model, and augment the original BBG framework with a few simple but useful extensions.

The impact of funding deadlines on personal workloads, stress and family relationships : a qualitative study of Australian researchers

Objective To examine the impact of applying for funding on personal workloads, stress and family relationships. Design Qualitative study of researchers preparing grant proposals. Setting Web-based survey on applying for the annual National Health and Medical Research Council (NHMRC) Project Grant scheme. Participants Australian researchers (n=215). Results Almost all agreed that preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. Almost all researchers agreed that they became stressed by the workload (93%) and restricted their holidays during the grant writing season (88%). Most researchers agreed that they submitted proposals because chance is involved in being successful (75%), due to performance requirements at their institution (60%) and pressure from their colleagues to submit proposals (53%). Almost all researchers supported changes to the current processes to submit proposals (95%) and peer review (90%). Most researchers (59%) provided extensive comments on the impact of writing proposals on their work life and home life. Six major work life themes were: (1) top priority; (2) career development; (3) stress at work; (4) benefits at work; (5) time spent at work and (6) pressure from colleagues. Six major home life themes were: (1) restricting family holidays; (2) time spent on work at home; (3) impact on children; (4) stress at home; (5) impact on family and friends and (6) impact on partner. Additional impacts on the mental health and well-being of researchers were identified. Conclusions The process of preparing grant proposals for a single annual deadline is stressful, time consuming and conflicts with family responsibilities. The timing of the funding cycle could be shifted to minimise applicant burden, give Australian researchers more time to work on actual research and to be with their families.

Partial mediation role of self-efficacy between positive social interaction and mental health in family caregivers for dementia patients in Shanghai

We explored the mediation effect of caregiver self-efficacy on the influences of behavioral and psychological symptoms (BPSD) of dementia care recipients (CRs) or family caregivers’ (CGs) social supports (informational, tangible and affectionate support and positive social interaction) on CGs’ mental health. We interviewed 196 CGs, using a battery of measures including demographic data of the dyads, CRs’ dementia-related impairments, and CGs’ social support, self-efficacy and the Medical Outcome Study (MOS) Short-Form (SF-36) Health Survey. Multiple regression analyses showed that gathering information on self-efficacy and managing CG distress self-efficacy were the partial mediators of the relationship between positive social interaction and CG mental health. Managing caregiving distress self-efficacy also partial mediated the impact of BPSD on CG mental health. We discuss implications of the results for improving mental health of the target population in mainland China.

Cryptanalysis of the LAKE hash family

We analyse the security of the cryptographic hash function LAKE-256 proposed at FSE 2008 by Aumasson, Meier and Phan. By exploiting non-injectivity of some of the building primitives of LAKE, we show three different collision and near-collision attacks on the compression function. The first attack uses differences in the chaining values and the block counter and finds collisions with complexity 233. The second attack utilizes differences in the chaining values and salt and yields collisions with complexity 242. The final attack uses differences only in the chaining values to yield near-collisions with complexity 299. All our attacks are independent of the number of rounds in the compression function. We illustrate the first two attacks by showing examples of collisions and near-collisions.

Managing creativity on the margins : a comparative study of Beijing’s Songzhuang Art District and Hangzhou’s White Horse Lake Creative Eco-City

In the past decade the ‘creative cluster’ has become a driver of urban renewal in China. Many cluster developments attract human capital and investment to post-industrial spaces. This paper looks at two developments which are more post-agricultural than post-industrial: the first is Songzhuang, a large scale contemporary art community situated on the eastern fringe of Beijing, the second is Hangzhou’s White Horse Lake Creative Eco-City, a ‘mixed variety’ cluster model which integrates elements of art, fashion, design and animation. The common factor in both cases is how they came into existence. In both districts urban creative workers moved into a rural environment. Drawing on interviews with planners, officials, and residents we investigate the challenges of sustaining such fringe clusters.

Symbiotic relationships : saviour siblings, family rights and biomedicine

It is now possible to combine the use of preimplantation genetic diagnosis (PGD) and tissue matching to select an IVF embryo that will, after birth, be a compatible tissue donor for an existing individual. This article analyses the ethical issues and the regulatory frameworks that intersect around the creation of tissue compatible children.

CIB White Paper on IDDS Integrated Design & Delivery Solutions

CIB is developing a priority theme, now termed Improving Construction and Use through Integrated Design & Delivery Solutions (IDDS). The IDDS working group for this theme adopted the following definition: Integrated Design and Delivery Solutions use collaborative work processes and enhanced skills, with integrated data, information, and knowledge management to minimize structural and process inefficiencies and to enhance the value delivered during design, build, and operation, and across projects. The design, construction, and commissioning sectors have been repeatedly analysed as inefficient and may or may not be quite as bad as portrayed; however, there is unquestionably significant scope for IDDS to improve the delivery of value to clients, stakeholders (including occupants), and society in general, simultaneously driving down cost and time to deliver operational constructed facilities. Although various initiatives developed from computer‐aided design and manufacturing technologies, lean construction, modularization, prefabrication and integrated project delivery are currently being adopted by some sectors and specialisations in construction; IDDS provides the vision for a more holistic future transformation. Successful use of IDDS requires improvements in work processes, technology, and people’s capabilities to span the entire construction lifecycle from conception through design, construction, commissioning, operation, refurbishment/ retrofit and recycling, and considering the building’s interaction with its environment. This vision extends beyond new buildings to encompass modifications and upgrades, particularly those aimed at improved local and area sustainability goals. IDDS will facilitate greater flexibility of design options, work packaging strategies and collaboration with suppliers and trades, which will be essential to meet evolving sustainability targets. As knowledge capture and reuse become prevalent, IDDS best practice should become the norm, rather than the exception.

Genetic secrets and the family

The issue of how individual patients and their doctors should act in relation to the knowledge that the patient has a genetic condition— specifically, whether the patient and/or the doctor should or must inform relevant members of the patient’s family—is a looming area of medicolegal controversy. Over the last fifteen years or so, the issue of confidentiality versus disclosure has been particularly controversial in relation to HIV/AIDS patients.1 It has been argued that medical information about genetic disease gives rise to special problems vis-à-vis blood relatives. Because genetic disease is transmitted only by way of procreation, information about genetic disease is unique in that there is a propensity (which is highly variable and depends upon a variety of factors) for the condition to be shared by members of a family who are biologically related. Thus, genetic information about an individual may reveal information about relatives of that individual which is ‘specific (that the person has or will develop a genetic disease); or predictive (that the person has an unspecified risk of developing the disease)’

Identification of Mendel's white flower character

Background The genetic regulation of flower color has been widely studied, notably as a character used by Mendel and his predecessors in the study of inheritance in pea. Methodology/Principal Findings We used the genome sequence of model legumes, together with their known synteny to the pea genome to identify candidate genes for the A and A2 loci in pea. We then used a combination of genetic mapping, fast neutron mutant analysis, allelic diversity, transcript quantification and transient expression complementation studies to confirm the identity of the candidates. Conclusions/Significance We have identified the pea genes A and A2. A is the factor determining anthocyanin pigmentation in pea that was used by Gregor Mendel 150 years ago in his study of inheritance. The A gene encodes a bHLH transcription factor. The white flowered mutant allele most likely used by Mendel is a simple G to A transition in a splice donor site that leads to a mis-spliced mRNA with a premature stop codon, and we have identified a second rare mutant allele. The A2 gene encodes a WD40 protein that is part of an evolutionarily conserved regulatory complex.

Physical activity levels among children attending family day care

Objective To objectively measure the physical activity (PA) levels of children attending family day care programs. Methods A total of 114 children from 47 family day care centers wore an accelerometer for the duration of their time in care. Time in moderate-to-vigorous PA (MVPA) and total PA was calculated using previously validated cut points. Results Children accumulated 5.8 ± 3.2 minutes of MVPA and 10.4 ± 4.4 minutes of total PA per hour of attendance. Boys exhibited significantly higher levels of PA than girls. Among healthy weight children, 4- and 5-year-olds exhibited significantly higher levels of PA than 2- and 3-year-olds. Overweight and obese 4- and 5-year-olds exhibited significantly lower levels of PA than their healthy weight counterparts. Conclusions and Implications Children attending family day care participate in low levels of PA during the child care day. The results highlight the need for effective programs to promote PA in family day care.

Validity of family child care providers' proxy reports on children's physical activity

Background Interventions to promote physical activity (PA) in children attending family child care homes (FCCHs) require valid, yet practical, measurement tools. The aim of this study was to assess the validity of two proxy report instruments designed to measure PA in children attending FCCHs. Methods A sample of 37 FCCH providers completed the Burdette parent proxy report, modified for the family child care setting for 107 children 3.4±1.2 years of age. A second sample of 42 FCCH providers completed the Harro parent and teacher proxy report, modified for the family child care setting, for 131 children 3.8±1.3 years of age. Both proxy reports were assessed for validity using accelerometry as a criterion measure. Results Significant positive correlations were observed between provider-reported PA scores from the modified Burdette proxy report and objectively measured total PA (r=0.30; p<0.01) and moderate-to-vigorous PA (MVPA; r=0.34; p<0.01). Across levels of provider-reported PA, both total PA and MVPA increased significantly in a linear dose-response fashion. The modified Harro proxy report was not associated with objectively measured PA. Conclusion Proxy PA reports completed by family child care providers may be a valid assessment option in studies where more burdensome objective measures are not feasible.

Nutrition and physical activity policies and practices in family child care homes

Background Family child care homes (FCCHs) are the second-largest provider of nonrelative care in the U.S. However, despite providing care for nearly 1.9 million children aged <5 years, little is known about the nutrition and physical activity practices of FCCHs. Purpose To address this gap, this study aims to describe policies and practices related to nutrition and physical activity in a representative sample of FCCHs. Methods A stratified random sample of registered FCCHs operating in Kansas (N=297) completed the Nutrition and Physical Activity Self Assessment for Child Care (NAPSACC) instrument. Prevalence estimates and 95% CIs for meeting or exceeding accepted child care standards were calculated using SAS PROC SURVEYFREQ. Results Most providers either met or exceeded child care standards related to serving fruit and vegetables and provision of daily physical activity. Very few providers reported serving fried meats or vegetables or unhealthy snack foods on a regular basis. Areas of concern included infrequent servings of low-fat milk, frequent use of unhealthy foods for celebrations, widespread use of TV and video games throughout the day, restricting physical activity for children who misbehave, and lack of appropriate indoor spaces for physical activity. Only a small percentage of providers reported receiving regular training in nutrition or physical activity. Relatively few providers had written guidelines on nutrition or physical activity. Conclusions Some strengths were exhibited by FCCHs, but substantial weaknesses were shown with respect to meeting established child care standards for nutrition and physical activity. Interventions to promote healthy eating and regular physical activity in FCCHs are thus warranted.