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Background: Elder abuse is a global human rights issue, particularly in residential care settings where there is limited understanding of older people's experiences of this phenomenon. This scoping review aims to map and describe the existing literature on this phenomenon. Methods: Using Arksey and O'Malley's scoping review methodology, further developed by Levac et al. and the Joanna Briggs Institute, a systematic search of six databases was conducted to identify relevant studies published from inception to January 2023. Studies were included if they focused on older people's experience of abuse within residential care settings. A comprehensive data extraction process was employed to identify key themes from the included studies. Results: The initial search yielded a total of 3701 articles of which eight met the inclusion criteria. The findings revealed a range of abusive experiences encountered by older people living in residential care settings, including psychological, physical, financial, neglect and sexual abuse. The common attributes of residents vulnerable to abuse were evident throughout each of the studies. Finally, the theme of organizational neglect was apparent through the absence of effective safeguarding measures in the included studies. The findings revealed the insufficient implementation of safeguarding measures increases the risk of abuse among residents. Conclusion: This scoping review highlights the limited research on the experiences of older people who have encountered elder abuse in residential care settings. The findings stress the need for further research exploring the complex interplay of factors contributing to elder abuse within aged care settings. The insights gained from this scoping review can inform the development of comprehensive safeguarding strategies to prevent and address elder abuse in residential care settings, promoting the well‐being and safety of older people. Patient or Public Contribution: This project is a scoping review of the literature; therefore, no patient or public contribution was deemed necessary. What this paper contributes to the wider global community: Most research on elder abuse has been conducted in the community rather than in Residential Care Settings where there is a limited understanding of older people's experiences of abuse within the published literature.The scoping review highlights the presence of inadequate safeguarding strategies in Residential Care Settings within the reviewed studies, providing recommendations for developing and improving safeguarding measures in Residential Care Settings to prevent abuse, neglect, and harm in the future. [ABSTRACT FROM AUTHOR]

Since the tropopause was first identified, the quality and resolution of weather balloons has dramatically improved. NOAA Earth System Research Laboratories (ESRL) have provided high resolution and very high quality ozonesondes from eight locations: Fiji; American Samoa; Greenland; Antarctica; and several locations in USA (Hawai'i, Colorado, California and Alabama). These locations collectively cover polar regions, mid‐latitudes and tropics. Using this publicly archived data set, we studied the variability of the tropopause for all eight locations for one complete year (2016). Along with the standard estimates of the tropopause provided by NOAA ESRL, we developed four alternative tropopause definitions each based on changes in one of the following: (a) molar density; (b) temperature lapse rates; (c) water vapor content; (d) ozone content. These old and new tropopause definitions appear to hold over all eight locations—for all seasons and from the tropics to the poles. The cohesiveness between all five of these independent tropopause definitions is remarkable, although the NOAA ESRL estimates sometimes identify higher tropopause onsets than the other estimates. Therefore, each tropopause definition could potentially be used as proxies for other tropopause definitions. However, it also confirms that the troposphere/tropopause transition is a multi‐faceted physical and chemical phenomenon associated with more than just temperature changes. Finally, these high‐resolution results suggest that the original term "tropopause" might be a misnomer since they suggest increases in temperature lapse rate variability, rather than the "pausing" implied by lower resolution data or by lapse rates that are averaged over large distances. Plain Language Summary: In the lower atmosphere ("the troposphere"), the temperature decreases with height. This is why it is colder on mountaintops. Since 1902, it has been known that higher up in the atmosphere, in the region near where commercial airplanes fly, temperatures remain relatively constant with height. This region is called "the tropopause." In 1957, the World Meteorological Organization (WMO) defined the start of the tropopause in terms of a set of rules, that were complex, but designed to be applicable for all latitudes and seasons. However, these rules are often hard to implement and can give ambiguous results. So, other definitions have been developed for specific regions, such as the tropics, that are more straightforward and easier to interpret. In this paper, we have developed four new tropopause definitions that can be used with modern high resolution "ozonesondes" (weather balloons that also measure ozone). These four independent definitions describe different aspects of the atmosphere but each give very similar estimates of the tropopause. This reveals that the tropopause involves many different but synchronous changes in the atmosphere. It also shows that the name "tropopause" is confusing because it is a part of the atmosphere involving lots of changes instead of "pausing." Key Points: Four new tropopause definitions have been developed for use with high‐resolution ozonesondes that work for all latitudes and seasonsAll these definitions yield almost identical tropopause estimates yet are derived from independent physical or chemical metricsSurprisingly, the "tropopause" marks a region with increased lapse rate variability over short altitudes as opposed to long‐term averages [ABSTRACT FROM AUTHOR]

The rationale for the principles of effective school governance in England, as set out in government regulations, has never been made explicit. This article addresses that issue and develops and proposes such principles. We argue that effective school governance secures the legitimacy of schools as institutions. Such institutional legitimacy is achieved through the institutionalization processes in which the institutional primary task is central. Effective governance is therefore concerned with overseeing and ensuring the processes of institutionalization. We identify two general principles that relate to ensuring the school's legitimacy and ensuring that the school's institutionalization processes enable it to be a legitimate institution. We also distinguish six specific principles that relate to: the school's work on the institutional primary task, the resources required and deployed for work on the institutional primary task; the school's compliance with the rules and regulations that apply to the institution; the school's conformance to the norms expected of a school; the way the school operates on a day-to-day basis in relation to wider society's expectations; calling the headteacher or principal (HT/P) to account for the functioning of the school; and ensuring the HT/P's development. Our analysis is relevant to school governance in other countries. [ABSTRACT FROM AUTHOR]

Background: Most government efforts to control the COVID-19 pandemic revolved around non-pharmaceutical interventions (NPIs) and vaccination. However, many respiratory diseases show distinctive seasonal trends. In this manuscript, we examined the contribution of these three factors to the progression of the COVID-19 pandemic. Methods: Pearson correlation coefficients and time-lagged analysis were used to examine the relationship between NPIs, vaccinations and seasonality (using the average incidence of endemic human beta-coronaviruses in Sweden over a 10-year period as a proxy) and the progression of the COVID-19 pandemic as tracked by deaths; cases; hospitalisations; intensive care unit occupancy and testing positivity rates in six Northern European countries (population 99.12 million) using a population-based, observational, ecological study method. Findings: The waves of the pandemic correlated well with the seasonality of human beta-coronaviruses (HCoV-OC43 and HCoV-HKU1). In contrast, we could not find clear or consistent evidence that the stringency of NPIs or vaccination reduced the progression of the pandemic. However, these results are correlations and not causations. Implications: We hypothesise that the apparent influence of NPIs and vaccines might instead be an effect of coronavirus seasonality. We suggest that policymakers consider these results when assessing policy options for future pandemics. Limitations: The study is limited to six temperate Northern European countries with spatial and temporal variations in metrics used to track the progression of the COVID-19 pandemic. Caution should be exercised when extrapolating these findings. [ABSTRACT FROM AUTHOR]

The Equality Act 2010 was intended to extend its cover to perceived discrimination, such as dismissing a turbaned Sikh barista under pressure from customers mistaking him for a Muslim. Such mistakes are rooted in stereotyping, fear and prejudice. Disability discrimination is particularly prone to these attitudes, but the Act's inadequate drafting renders perceived disability discrimination claims exceptionally difficult. This paper suggests some innovative interpretive solutions, but ultimately recommends statutory reform. [ABSTRACT FROM AUTHOR]

The article focuses on gender disparity in nursing editorials, noting that while nursing is a primarily female profession, male voices dominate editorial discourse regarding future nursing policy, leadership, and research. The authors argue that women in nursing need to assert themselves strategically and confidently to take their rightful place at the table.

The standard worst-case normwise backward error bound for Householder QR factorization of an m x n matrix is proportional to mnu, where u is the unit roundoff. We prove that the bound can be replaced by one proportional to √mnu that holds with high probability if the rounding errors are mean independent and of mean zero and if the normwise backward errors in applying a sequence of m x m Householder matrices to a vector satisfy bounds proportional to √mu with probability 1. The proof makes use of a matrix concentration inequality. The same square rooting of the error constant applies to two-sided transformations by Householder matrices and hence to standard QR-type algorithms for computing eigenvalues and singular values. It also applies to Givens QR factorization. These results complement recent probabilistic rounding error analysis results for inner product-based algorithms and show that the square rooting effect is widespread in numerical linear algebra. Our numerical experiments, which make use of a new backward error formula for QR factorization, show that the probabilistic bounds give a much better indicator of the actual backward errors and their rate of growth than the worst-case bounds. [ABSTRACT FROM AUTHOR]

The aim of this review was to explore the evidence surrounding patients and families' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic from the perspective of nursing practice. While there is a plethora of research and publications related to COVID-19 and there are reports of increasing attention to nurses' psychological distress, there is little understanding of experiences related to patients' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic. A scoping review was conducted to search and select potential studies and undertake data extraction and synthesis. Twenty-one studies published between March 2020 and August 2021 were identified. Themes and subthemes that emerged from analysis of the studies included spiritual needs, new awareness of spiritual needs and spiritual interventions, chaplaincy referrals, and improved well-being. The potential requirement for spiritual care during these times has anecdotally never been greater. At the same time the existent ethical challenges persist, and nurses remain reticent about the topic of spirituality. This is evident from the clear lack of attention to this domain within the published nursing literature and a limited focus on spiritual care interventions or the experiences and spiritual needs of patients and their families. Greater attention is needed internationally to improve nurses' competence to provide spiritual care and to develop and advance nursing and research practice in the field of spiritual care. [ABSTRACT FROM AUTHOR]

Historically, there has be a close relationship between the nursing services and spiritual care provision to patients, arising due to the evolvement of many hospitals and nursing programmes from faith-based institutions and religious order nursing. With increasing secularism, these relationships are less entwined. Nonetheless, as nurses typically encounter patients at critical life events, such as receiving bad news or dying, nurses frequently understand the need and requirement for both spiritual support and religious for patients and families during these times. Yet there are uncertainties, and nurses can feel ill-equipped to deal with patients' spiritual needs. Little education or preparation is provided to these nurses, and they often report a lack of confidence within this area. The development of this confidence and the required competencies is important, especially so with increasingly multicultural societies with diverse spiritual and religious needs. In this manuscript, we discuss initial field work carried out in preparation for the development of an Erasmus Plus educational intervention, entitled from Cure to Care Digital Education and Spiritual Assistance in Healthcare. Referring specifically to post-COVID spirituality needs, this development will support nurses to respond to patients' spiritual needs in the hospital setting, using digital means. This preliminary study revealed that while nurses are actively supporting patients' spiritual needs, their education and training are limited, non-standardised and heterogeneous. Additionally, most spiritual support occurs within the context of a Judeo-Christian framework that may not be suitable for diverse faith and non-faith populations. Educational preparation for nurses to provide spiritual care is therefore urgently required. [ABSTRACT FROM AUTHOR]

Background: Special palliative care is provided in a range of settings including a patient's home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods: This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results: Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions: This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff. [ABSTRACT FROM AUTHOR]

Aims Design Data Sources Results Conclusion Impact Patient or Public Contribution What this Paper Contributes to the Wider Body of Knowledge This article aimed to examine the concept of safeguarding adults and establish an operational definition for application to practice, research and policy.Rodgers' evolutionary and inductive method of concept analysis was used.A systematic search was conducted across four electronic databases, CINAHL, PsycINFO, Scopus and PubMed, covering the period from January 2014 to May 2023. This systematic database search aimed to gather a broad spectrum of research and scholarly literature to inform and support the concept analysis. A total of 10 peer‐reviewed articles were reviewed using a data chart to identify the context, definitions, antecedents, attributes and consequences of safeguarding adults.The analysis of the included articles helped to develop a better understanding of safeguarding adults by offering a practical operational definition tailored to the specific needs of practising nurses. The implications for practice, research and policy are discussed, highlighting the potential for improving the quality of care and ensuring the well‐being of adults at risk of abuse.By employing Rogers' evolutionary concept analysis method, we developed a deeper insight into safeguarding adults in health care. A synthesis of literature revealed the intricate layers and adaptations within safeguarding practices. This concept analysis lays the groundwork for future research, policy development and educational initiatives, enhancing the well‐being and safety of adults at risk of abuse within care.By undertaking a concept analysis of the term safeguarding adults' nurses can be more prepared to engage in and reinforce the key principles of safeguarding adults, providing guidance to ensure the protection and well‐being of adults at risk of abuse.Not applicable.This concept analysis helps to define and clarify the conceptual term ‘safeguarding adults’ promoting a shared understanding of the key components of adult protection and providing a comprehensive framework for assessment and management of adults at risk of abuse in this field of practice. [ABSTRACT FROM AUTHOR]

Stochastic rounding rounds a real number to the next larger or smaller floating-point number with probabilities 1 minus the relative distances to those numbers. It is gaining attention in deep learning because it can increase the success of low precision computations. We compare basic properties of stochastic rounding with those for round to nearest, finding properties in common as well as significant differences. We prove that for stochastic rounding the rounding errors are mean independent random variables with zero mean. We derive a new version of our probabilistic error analysis theorem from [N. J. Higham and T. Mary, SIAM J. Sci. Comput., 41 (2019), pp. A2815-- A2835], weakening the assumption of independence of the random variables to mean independence. These results imply that for a wide range of linear algebra computations the backward error for stochastic rounding is unconditionally bounded by a multiple of √nu to first order, with a certain probability, where n is the problem size and u is the unit roundoff. This is the first scenario where the rule of thumb that one can replace nu by √nu in a rounding error bound has been shown to hold without any additional assumptions on the rounding errors. We also explain how stochastic rounding avoids the phenomenon of stagnation in sums, whereby small addends are obliterated by round to nearest when they are too small relative to the sum. [ABSTRACT FROM AUTHOR]

Accepted definitions of educational leadership practice typically view it as influence to achieve organisational goals. Such definitions have been widely used over the last 30 years. During that time, the number of educational leadership theories/models has increased and cover the many aspects of educational leadership all of which implicitly or explicitly use the accepted definition. However, the accepted definition is open to critique in a range of important ways and we consider that a more robust definition is required. In this article, we reconceptualise and redefine educational leadership practice as 'legitimate interaction in an educational institution intended to enhance engagement with the institutional primary task'. We analyse the concepts underpinning the key aspects of that definition: the institutional context of educational leadership practice; legitimacy and educational leadership practice; the interactional nature of educational leadership practice; institutionalisation and institutions; the notion of engagement and the necessary conditions of capability, opportunity and motivation; and the institutional primary task. [ABSTRACT FROM AUTHOR]

Background: This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. Aim: The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. Method: This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. Findings: Four main themes emerged, revealing staff perceptions on the process of change and their own 'lightbulb moments' experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. Conclusion: Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops. [ABSTRACT FROM AUTHOR]

Background: palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit. Aim: the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis. Methods: a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses. Findings: the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education. Conclusion: nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of dual-energy (DE) virtual non-contrast computed tomography (vNCT) to non-contrast CT (NCT) for the diagnosis of adrenal adenomas.Methods: Search of multiple databases and grey literature was performed. Two reviewers independently applied inclusion criteria and extracted data. Risk of bias was assessed using QUADAS-2. Summary estimates of diagnostic accuracy were generated and sources of heterogeneity were assessed.Results: Five studies (170 patients; 192 adrenal masses) were included for diagnostic accuracy assessment; all used dual-source dual-energy CT. Pooled sensitivity for adrenal adenoma on vNCT was 54% (95% CI: 47-62%). Pooled sensitivity for NCT was 57% (95% CI: 45-69%). Pooling of specificity was not performed since no false positives were reported. There was a trend for overestimation of HU density on vNCT as compared to NCT which appeared related to contrast timing. Potential sources of bias were seen regarding the index test and reference standard for the included studies. Potential sources of heterogeneity between studies were seen in adenoma prevalence and intravenous contrast timing.Conclusions: vNCT images generated from dual-energy CT demonstrated comparable sensitivity to NCT for the diagnosis of adenomas; however the included studies are heterogeneous and at high risk for some types of bias.Key Points: • Similar sensitivity of vNCT to NCT for diagnosis of adenoma • Heterogeneity could be related to vNCT from early (<=60 sec) CECT studies • Could not pool specificity as there were no false positives • Small number of heterogeneous studies at high risk of bias. [ABSTRACT FROM AUTHOR]

Although being recognized by the World Health Organization as an essential domain of palliative care, spiritual care is still one of the most neglected component of the healthcare system. In this editorial, we set the context and invite contributions for a BMC Palliative Care Collection of articles titled 'Spirituality in Palliative Care'. [ABSTRACT FROM AUTHOR]

Educational management and educational leadership are central concepts in understanding organising in educational institutions but their meaning, the difference between them and their value in educational organising remain the subject of debate. In this article, we analyse and contrast the two concepts. We conclude that educational management entails carrying the responsibility for the proper functioning of a system in an educational institution in which others participate. Carrying a responsibility of this kind is a state of mind and does not necessitate actions, though it typically and frequently does. In contrast, educational leadership is the act of influencing others in educational settings to achieve goals and necessitates actions of some kind. When those carrying a delegated responsibility act in relation to that responsibility, they influence and are therefore leading. Although educational leadership is ideally undertaken responsibly, in practice it does not necessarily entail carrying the responsibility for the functioning of the educational system in which the influence is exercised. Through our analysis, the notion of responsibility, which is underplayed in considerations of organising in educational institutions, comes to the fore. Educational responsibility is an important notion and it should play a more prominent role in analyses of organising in educational institutions. [ABSTRACT FROM AUTHOR]

The article discusses the court case Lee v Ashers. It mentions bakery's refusal to supply a cake iced with the words ‘Support Gay Marriage' concerned discrimination on the grounds of political opinion and sexual orientation. It mentions that claim raised issues relevant to ‘indissociable' and associative discrimination, indirect discrimination.

During routine blood work, a 53-year-old female patient was noted to have asymptomatic hypercalcemia and subsequently found to have hyperparathyroidism. Localization studies for a suspected parathyroid adenoma included 99mTc Sestamibi scintigraphy, Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) study, and ultrasound of the neck, which were initially read as negative for parathyroid adenoma. A contrast-enhanced CT scan of the neck was performed to locate the suspected parathyroid adenoma and demonstrated a soft tissue lesion within the right piriform sinus. Flexible fiber optic nasolaryngoscopy revealed a submucosal lesion in the right piriform sinus. Following these findings, the initial 99mTc Sestamibi scintigraphy and SPECT/CT were reviewed with confirmation of a focal area of increased activity superior to the right thyroid lobe, corresponding to a nodule in the right piriform sinus that demonstrated increased activity on SPECT/CT. The patient was brought to the operating room for surgical management where a laryngoscope and operating microscope were utilized. The encapsulated lesion was dissected and excised in total. The parathyroid hormone and ionized calcium levels normalized postoperatively. Pathology confirmed a parathyroid adenoma. Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Sixteen percent of parathyroid adenomas can be situated in an ectopic location. Ectopic parathyroid adenomas in the piriform sinus are rare with only a few previously documented cases. We document a rare case of ectopic parathyroid adenoma in the piriform sinus overlooked on initial imaging studies. These lesions can be challenging to localize, however, an understanding of embryology, close scrutiny of possible ectopic locations, and the application of complementary imaging techniques may prove useful for surgeons and clinicians. [ABSTRACT FROM AUTHOR]

Background: A key aspect to the provision of palliative care is maintaining the dignity of the individual being cared for. Nurses working in the community setting need knowledge and skills to meet the needs of individuals who need palliative care and their families. Dignity Care Intervention Ireland is a community-based pilot project designed to implement a dignity care intervention for individuals with a life-limiting condition living in their own home. As part of the overall intervention, an education programme was developed for nurses working in the community. Method: Completion of a locally-designed questionnaire pre- and post-education. Results: Nurses working in the community setting welcomed and highly valued the Dignity Care Intervention Ireland education programme. There was an overall improvement in the understanding of palliative care for both groups and improved understanding of the principles of palliative care, with self-evaluated competence to apply these principles in daily clinical practice. Conclusion: The importance of education about palliative care to support the delivery of dignity-preserving care cannot be underestimated. Ensuring nurses have the requisite knowledge will enhance future practice development and subsequently improve care for patients with life-limiting conditions and their families. [ABSTRACT FROM AUTHOR]

This article analyses recent developments in school governance in Ireland. The context for school governance in Ireland is changing. Features of this new context include increased population diversity partly because of immigration; an increasingly negative attitude to religion; a decline in religious observance; economic growth; the school performance compared with other countries; increasing population size; the nature of the electoral system, which brings local issues to the fore; and the unionization of the teaching profession, which affects system change. This changing context is set against the embedded and strong influence of organised religion. Disquiet at the church's influence on educational policy and practice is increasing. The government's intention to address this influence is slow to impact but evidence indicates that the role of religious institutions in school governing in Ireland is declining. Because the present situation is unsustainable, a crisis in school patronage is looming. [ABSTRACT FROM AUTHOR]

Aims and Objectives To evaluate a dignity care intervention provided by community nurses seeking to address dignity concerns for people with advanced and life-limiting conditions. Background Evidence would suggest that dying people fear a loss of dignity and a central focus of palliative care is to assist people to die with dignity. Whilst community nurses have a key role to play in the delivery of palliative care, specific interventions for dignity are lacking. Design A mixed methods study using online survey and focus group interviews and thematic analysis to examine data. Methods Twenty four community nurses implemented the dignity care intervention for people with advanced and life-limiting conditions were recruited from four pilot sites across Ireland. Four focus group interviews and on line survey were conducted between March-June 2015. Results The community nurses found the dignity care intervention useful. It helped the nurses to provide holistic end-of-life care and assisted in the overall assessment of palliative care patients, identifying areas that might not otherwise have been noted. Whilst it was a useful tool for communication, they noted that it stimulated some emotionally sensitive conversations for which they felt unprepared. Conclusions Implementing the dignity care intervention in practice was challenging . However, the dignity care intervention facilitated holistic assessment and identified patient dignity-related concerns that may not have been otherwise identified. Further support is required to overcome barriers and enable dignity-conserving care. Relevance to clinical practice Ensuring dignity is a key aspect of palliative and end-of-life care; however, community nurses may not feel equipped to address this aspect of care. Implementing a dignity care intervention can assist in identifying patient dignity-related concerns and provision of holistic care. Community nurses need more training to assist in difficult conversations relating to dignity and end-of-life care. [ABSTRACT FROM AUTHOR]

Parents of children with complex care needs are generally willing to participate in research studies about their experiences; however, they are often challenged in their capacity to participate as they struggle to find time for family life. In our research with parents to explore their experience of transitioning to home, we deliberately sought an approach that would reduce the imposition on parents, while gaining insightful interpretations of their experiences. This article reflects on our experience of the process of discovering, analyzing, and interpreting parents’ perspectives of their journey to home, when interviewed by telephone. Applying the voice-centered relational method of qualitative analysis, accounts from parents were explored by the research team using 4 perspectives: the plot and evaluator responses to the narrative; the voice of the “I”; relationships; and placing people within cultural contexts and social structures. Parents interviewed were very receptive to being interviewed by phone. We found that this enhanced their trust in the interview process and subsequently led to our ability to gather rich data. The use of multiple lenses of analysis gave insightful interpretations of their journey to home. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this scoping review is to appraise the published literature on taste disturbance in patients with advanced cancer, with the specific objectives being to determine its prevalence, clinical features and complications. Methods: This scoping review was conducted using the recommended methodological framework. A detailed search of databases (Medline, Embase, CINAHL and PsycInfo) was conducted to identify eligible studies: eligible studies needed to include patients with advanced cancer and needed to include details of clinical features and/or complications of taste disturbance. Standard bibliographic/systematic review software was used to store the records and manage the review process, respectively. Results: Twenty-five studies were identified from the database searches. The studies identified included eight physical and/or psychological symptom studies, six symptom cluster studies, five oral symptom studies and six taste and/or smell specific studies. Detailed data is presented on the clinical features and complications of taste disturbance and on the symptom clusters involving taste disturbance in this cohort of patients. Conclusion: This scoping review identified a relatively small number of relevant studies involving a relatively small number of participants. Nevertheless, it confirms that taste disturbance is a common problem in patients with advanced cancer and is associated with significant morbidity because of the primary condition and the associated complications. [ABSTRACT FROM AUTHOR]

A new seasonal and annual dataset describing Arctic sea ice extents for 1901–2015 was constructed by individually re-calibrating sea ice data sources from the three Arctic regions (North American, Nordic and Siberian) using the corresponding surface air temperature trends for the pre-satellite era (1901–1978), so that the strong relationship between seasonal sea ice extent and surface air temperature observed for the satellite era (1979-present) also applies to the pre-satellite era. According to this new dataset, the recent period of Arctic sea ice retreat since the 1970s followed a period of sea ice growth after the mid-1940s, which in turn followed a period of sea ice retreat after the 1910s. Arctic sea ice is a key component of the Arctic hydrological cycle, through both its freshwater storage role and its influence on oceanic and atmospheric circulation. Therefore, these new insights have significance for our understanding of Arctic hydrology.EDITOR D. KoutsoyiannisASSOCIATE EDITOR not assigned [ABSTRACT FROM PUBLISHER]

This article analyses the stakeholder model of boards that is widely used in public and third sector institutions in England and Wales. The central tenet of this model is that such institutions should be strategically led by individuals who are representative of and from the groups that have an interest in them. The article focuses in particular on the operation of the stakeholder model of governing bodies of schools in England and Wales where a range of stakeholders including teachers, parents and the community are represented. The issues that arise from this stakeholder model of governing are analysed and the alternatives to it are considered. A significant alternative is the skills-based model, where boards are constituted on the basis of their expertise and not their interest in the institution. This skills-based model is becoming more prominent in the way governing bodies of academy schools in England are constituted and this is certainly the direction of travel outlined in the 2015 regulations. The article reviews the stakeholder model for the governance of schools at a time when there is much interest in the skills-based approach. The wider implications of shifting from a stakeholder to a skills-based model of public board membership are considered. [ABSTRACT FROM AUTHOR]

On 14 July 2016 Ireland reported an extraordinary increase in GDP of 26.3% for 2015. This paper explores the rationale for this result in the context of the new statistical standards of SNA 2008 (ESA 2010) and BPM6 that had been recently introduced. The primary focus is on the recording of research and development activities now inside the production boundary and included for the first time in the Macro Economic accounts together with the related contract manufacturing activities. There is particular reference to the impact of economic globalisation, together with initiatives linked to application of the Base Erosion and Profit Shifting (BEPS) recommendations of OECD. The large corporate relocations in 2015 together with transactions in intangible assets and the associated depreciation are explained and their impact on the economic accounts is illustrated. Some unintended consequences of the application of the new statistical standards is discussed and an alternate approach to the recording in particular of cross border transactions in Intellectual Property products is outlined. [ABSTRACT FROM AUTHOR]

Using panel data from 1995 to 2011 for 34 OECD countries, we examine the effects of government consumption spending, public social spending, and public investment on economic growth. We use a generalized method of moments estimation technique to solve inconsistency problems with fixed effects and random effects panel estimation. We find that an increase in public social spending has a significant negative effect on subsequent economic growth. Government consumption spending and public investment have no significant effect on subsequent economic growth. [ABSTRACT FROM AUTHOR]

Background: Parents commonly report a significant improvement in quality of life following the provision of hospice and supportive care and have identified a need for such a service in the home. The purpose of this study was to understand the experiences of families receiving a nurse led pilot hospice at home programme and the experiences of healthcare professionals delivering and engaging with the programme. Methods: An exploratory, qualitative study was conducted, including telephone interviews with parents and focus groups and individual interviews with healthcare professionals. All parents of families who received the programme of care between June 2014 and September 2015 and healthcare professionals delivering and engaging with the programme were invited to participate. Results: Seven parents participated in telephone interviews. Four focus groups took place, two with external stakeholders (18 participants in total), one with in-patient hospice staff (13 participants) and one with the hospice at home team (8 participants). Two additional interviews took place with individual stakeholders who were unable to attend a scheduled focus group. Themes from interviews with parents focused on the value of having consistent and expert care. The findings from healthcare professionals centred on communication within and across services, education and training and lone working. Conclusions: The pilot hospice at home programme was welcomed by all those who took part in the study. The programme may be improved by enhanced clarification of roles, enhanced access to multi-disciplinary services, greater communication across services and improved information provision to families. [ABSTRACT FROM AUTHOR]

Aim: This paper provides an overview of the research methodologies of systematic review and meta-analysis and uses a commentary on the analysis of data from a previously published study to illustrate the procedures and decision-making involved for consumers and those who may be considering carrying out a systematic review. Rationale: Systematic review and meta-analysis are located within a hierarchy of evidence-based practice, and their underlying epistemological and theoretical basis considered. The advantages of systematic review over traditional narrative reviews are discussed, together with the case for the use of meta-analysis to synthesise research findings. The feasibility of the use of these methodologies by educational psychologists is also considered. Findings: The worked example details the steps necessary to carry out a systematic review and meta-analysis and the commentary addresses key issues such as specifying inclusion/exclusion criteria and determining relevance; specifying the literature search strategy and coping with the 'grey' literature; extracting and coding data from the included studies and the importance of reliability checks; study quality; selecting the most appropriate effect size; selecting the most appropriate model for meta-analysis (fixed-effect versus random-effect), combining and averaging effect sizes across studies; running weighted ANOVAs or meta-regression analyses to investigate heterogeneity; checks for publication bias; and sensitivity analysis to deal with outliers. Conclusions: Future developments in these methodologies, details of available software and resources, and implications for educational psychologists who may wish to carry out systematic reviews and meta-analysis are discussed. [ABSTRACT FROM AUTHOR]

Stigma is a common characteristic among lesbian, gay and bisexual (LGB) people's lives. The LGB population faces a challenge in finding ways to adapt to its stigmatised identity. Stigma and its related processes can have an isolating and negative affect on the LGB individual, who is seen as and often perceives themselves as different. Stigma can also have a negative effect on health and wellbeing and can influence the type of care received from health and social care professionals, including those working in palliative care. This paper presents a discussion of the impact that stigma has on LGB people who access and receive palliative and end-of-life care. [ABSTRACT FROM AUTHOR]

Allergies caused by Japanese Red Cedar (JRC) pollen affect up to a third of Japanese people, necessitating development of an effective therapeutic. We utilized the lysosomal targeting property of lysosomal-associated membrane protein-1 (LAMP-1) to make DNA vaccines that encode LAMP-1 and the sequences of immunodominant allergen CryJ1 or CryJ2 from the JRC pollen. This novel strategy is designed to skew the CD4 T cell responses to the target allergens towards a nonallergenic Th1 response. CryJ1-LAMP and CryJ2-LAMP were administrated to BALB/c mice and antigen-specific Th1-type IgG2a and Th2-type IgG1 antibodies, as well as IgE antibodies, were assayed longitudinally. We also isolated different T cell populations from immunized mice and adoptively transferred them into naïve mice followed by CryJ1/CryJ2 protein boosts. We demonstrated that CryJ-LAMP immunized mice produce high levels of IFN-γ and anti-CryJ1 or anti-CryJ2 IgG2a antibodies and low levels of IgE antibodies, suggesting that a Th1 response was induced. In addition, we found that CD4(+) T cells are the immunological effectors of DNA vaccination in this allergy model. Together, our results suggest the CryJ-LAMP Vaccine has a potential as an effective therapeutic for JRC induced allergy by skewing Th1/Th2 responses. [ABSTRACT FROM AUTHOR]

Introduction: The clinical application of robotic surgery is increasing. The skills necessary to perform robotic surgery are unique from those required in open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (Fundamentals of Laparoscopic Surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool for robotic surgery. Our research group previously developed and validated a robotic training curriculum in a virtual reality (VR) simulator. We hypothesized that novice robotic surgeons could achieve proficiency levels defined by more experienced robotic surgeons on the VR robotic curriculum, and that this would result in improved performance on the actual daVinci Surgical System™. Methods: 25 medical students with no prior robotic surgery experience were recruited. Prior to VR training, subjects performed 2 FLS tasks 3 times each (Peg Transfer, Intracorporeal Knot Tying) using the daVinci Surgical System™ docked to a video trainer box. Task performance for the FLS tasks was scored objectively. Subjects then practiced on the VR simulator (daVinci Skills Simulator) until proficiency levels on all 5 tasks were achieved before completing a post-training assessment of the 2 FLS tasks on the daVinci Surgical System™ in the video trainer box. Results: All subjects to complete the study (1 dropped out) reached proficiency levels on all VR tasks in an average of 71 (± 21.7) attempts, accumulating 164.3 (± 55.7) minutes of console training time. There was a significant improvement in performance on the robotic FLS tasks following completion of the VR training curriculum. Conclusions: Novice robotic surgeons are able to attain proficiency levels on a VR simulator. This leads to improved performance in the daVinci surgical platform on simulated tasks. Training to proficiency on a VR robotic surgery simulator is an efficient and viable method for acquiring robotic surgical skills. [ABSTRACT FROM AUTHOR]

Background: The clinical application of robotic-assisted surgery (RAS) is rapidly increasing. The da Vinci Surgical System™ is currently the only commercially available RAS system. The skills necessary to perform robotic surgery are unique from those required for open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (fundamentals of laparoscopic surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool specific for robotic surgery. Based on previously published data and expert opinion, we developed a robotic skills curriculum. We sought to evaluate this curriculum for evidence of construct validity (ability to discriminate between users of different skill levels). Methods: Four experienced surgeons (>20 RAS) and 20 novice surgeons (first-year medical students with no surgical or RAS experience) were evaluated. The curriculum comprised five tasks utilizing the da Vinci™ Skills Simulator (Pick and Place, Camera Targeting 2, Peg Board 2, Matchboard 2, and Suture Sponge 3). After an orientation to the robot and a period of acclimation in the simulator, all subjects completed three consecutive repetitions of each task. Computer-derived performance metrics included time, economy of motion, master work space, instrument collisions, excessive force, distance of instruments out of view, drops, missed targets, and overall scores (a composite of all metrics). Results: Experienced surgeons significantly outperformed novice surgeons in most metrics. Statistically significant differences were detected for each task in regards to mean overall scores and mean time (seconds) to completion. Conclusions: The curriculum we propose is a valid method of assessing and distinguishing robotic surgical skill levels on the da Vinci Si™ Surgical System. Further study is needed to establish proficiency levels and to demonstrate that training on the simulator with the proposed curriculum leads to improved robotic surgical performance in the operating room. [ABSTRACT FROM AUTHOR]

In England, governing bodies continue to be responsible for the conduct of publicly funded schools. This article compares the governing of publicly funded primary schools (for 5–11 year olds) and secondary schools (for 11–18 year olds). The research analysed policy documents and the governing of 16 primary and 14 secondary schools. The main governance mode for both primary schools and secondary schools is hierarchical and similar in nature, and the governing bodies of primary and secondary schools use broadly similar governing instruments. However, they differ in significant ways. In primary schools, governing is smaller in scale and less complex. Primary school governing is closer to the school and children, and the images held by governors of the system to be governed are better developed in primary schools. Functional knowledge was more useful in primary school governing, and the use of informal meetings as instruments of governance was more widespread in primary school governing. The findings and their implications need to be taken into account in the analysis of and policy making for school governing. [ABSTRACT FROM PUBLISHER]

Introduction The 'SAGE & THYME Foundation Level Workshop' delivers evidence-based communication skills training to 30 health care workers in 3 hours. It teaches a structured approach (the SAGE & THYME model) to discuss patient/carer concerns. The aim of this study was to determine whether the workshop had a positive outcome on factors that influence communication skills. Methods The study had a pragmatic, mixed methods design. Workshops were run in an acute hospital. One hundred seventy health care workers completed questionnaires pre- and post-workshop; 141 were sent follow-up questionnaires at 2 weeks and 2 months; and 9 were filmed talking to a simulated patient pre- and post-workshop. Results From pre- to post-workshop, there was a significant increase in knowledge ( p < 0.001), self-efficacy ( p < 0.001), and outcome expectancy ( p < 0.001). An expert's rating of behavior with the simulated patient also significantly increased after the training ( p = 0.011). Motivation to use the training, and the perceived usefulness of the SAGE & THYME model, were high post-workshop. There was a poor response rate in the follow-up period; hence, the quantitative data are not reported. The qualitative data are described, however, as they give an insight into the impact of the training on staff and their patients. Discussion The SAGE & THYME Foundation Level Workshop significantly increases communication skills knowledge, self-efficacy, and outcome expectancy of hospital health care workers who are predominantly white, female, nursing, or nonclinical staff. This suggests that the workshop may have a positive impact on some factors influencing communication skills in this group. [ABSTRACT FROM AUTHOR]

This study examined beliefs of mental health nurses about smoking by clients, nurses, and visitors in inpatient facilities and identified the influence of years of experience, smoke-free status, and workplace on these beliefs. Data were collected by a survey, distributed via a nursing newsletter with approximately 600 members. Descriptive statistics and cross-tabulations explored the data. A total of 104 responses were received. Smoke-free status made significant differences to nurses' beliefs relating to prohibition of smoking for clients, staff, and visitors; concern about the effects of passive smoking; the role of smoking in the development of therapeutic relationships; smoking as a source of patient pleasure; and the role of smoking in symptom management. That half of the nurses who responded believe that smoking is helpful in the creation of therapeutic relationships is of concern. The nurse plays an important role model in promoting smoke-free lifestyles amongst clients, and the effects of positive role modelling could be lost if nurses continue to smoke with clients. The negative impacts of smoking on the physical health of mental health inpatients is considerable and well documented, and the creation of smoke-free inpatient mental health services can help to address these. [ABSTRACT FROM AUTHOR]

In recent decades, efforts to investigate atmospheric circulation patterns have predominantly relied on either semi-empirical datasets (i.e., reanalyses) or modeled output (i.e., global climate models, GCMs). While both approaches can provide important insights, there is a need for more empirical data to supplement these approaches. In this paper, we demonstrate how the application of relatively simple calculations to the basic measurements from a standard weather balloon radiosonde can provide a vertical profile of the horizontal atmospheric mass fluxes. These mass fluxes can be resolved into their meridional (north/south) and zonal (east/west) components. This provides a new useful empirical tool for analyzing atmospheric circulations. As a case study, we analyze the results for a selected five stations along a fairly constant meridian in the North Atlantic sector from 2015–2019. For each station, we find the atmospheric mass flux profiles from the lower troposphere to mid-stratosphere are surprisingly coherent, suggesting stronger interconnection between the troposphere and stratosphere than previously thought. Although our five stations span a region nominally covered by the classical polar, Ferrel and Hadley meridional circulation cells, the results are inconsistent with those expected for polar and Ferrel cells and only partially consistent with that of a Hadley cell. However, the region is marked by very strong prevailing westerly (west to east) mass fluxes for most of the atmosphere except for the equatorial surface easterlies ("trade winds"). We suggest that the extension of the techniques of this case study to other stations and time periods could improve our understanding of atmospheric circulation patterns and their time variations. [ABSTRACT FROM AUTHOR]

The article investigates the effects of the increased use of monetary policy guidance during the financial crisis on the response of asset prices to the policy. It analyzes the changes in the U.S. Federal Open Market Committee's (FOMC) response to future monetary policy decision. It describes the quantification of forward guidance on monetary policy and estimates changes in market expectations of future monetary policy due to announcements.

Why you should read this article: • To understand the policies and procedures related to safeguarding nursing home residents at risk of abuse • To be aware of the categories and possible indicators of elder abuse • To learn about the role of nurses in the assessment and management of suspected incidents of elder abuse Elder abuse is a growing concern for nurses who work with older people, and safeguarding incidents can be challenging and complex to manage. In the Republic of Ireland, safeguarding agencies claim there is a lack of reporting of abuse to the authorities, raising questions as to whether nurses know how, when and where to report safeguarding concerns. Despite varying strategies and laws concerning the reporting of elder abuse worldwide, the principles of recognising and responding to abuse are similar. However, to date, there is no specific legislation governing safeguarding for adults in Ireland. This article discusses elder abuse and safeguarding nursing home residents from an Irish perspective, explaining the process of managing concerns in practice using an analysis of a case study. [ABSTRACT FROM AUTHOR]

Constipation can cause unnecessary discomfort and suffering for patients, and there appears to be a lack of awareness among nurses and doctors about its cause, impact and management. A large proportion of the evidence for the assessment and management of constipation in the context of palliative care is derived from the perspective of advanced cancer and from guidelines developed at a European level. Although constipation remains a problem for palliative care patients, early intervention combined with continuous and impeccable assessment can assist in its management and improve patient comfort at the end of life. [ABSTRACT FROM AUTHOR]

Constipation can cause unnecessary discomfort and suffering for patients, and there appears to be a lack of awareness among nurses and doctors about its cause, impact and management. A large proportion of the evidence for the assessment and management of constipation in the context of palliative care is derived from the perspective of advanced cancer and from guidelines developed at a European level. Although constipation remains a problem for palliative care patients, early intervention combined with continuous and impeccable assessment can assist in its management and improve patient comfort at the end of life. [ABSTRACT FROM AUTHOR]

Population studies have shown a positive correlation between diets rich in whole grains and a reduced risk of developing metabolic diseases, like diabetes, cardiovascular disease, and certain cancers. However, little is known about the mechanisms of action, particularly the impact different fermentable components of whole grains have on the human intestinal microbiota. The modulation of microbial populations by whole grain wheat flakes and the effects of toasting on digestion and subsequent fermentation profile were evaluated. Raw, partially toasted, and toasted wheat flakes were digested using simulated gastric and small intestinal conditions and then fermented using 24-hour, pH-controlled, anaerobic batch cultures inoculated with human feces. Major bacterial groups and production of short-chain fatty acids were compared with those for the prebiotic oligofructose and weakly fermented cellulose. Within treatments, a significant increase ( P<.05) in bifidobacteria numbers was observed upon fermentation of all test carbohydrates, with the exception of cellulose. Toasting appeared to have an effect on growth of lactobacilli as only fermentation of raw wheat flakes resulted in a significant increase in levels of this group. [ABSTRACT FROM AUTHOR]

Debates about governance, across the public sector, including education, continue to generate a substantial literature. The intention of this article is to engage with these debates by reviewing the articles in this special edition. In this review article, we first consider the wider context of the articles by revisiting some of the central debates in the governance literature. We then consider some of the themes that emerge from the articles, which are: the significance of improving school performance and pupil attainment; the dynamic nature of governance and the problematic nature of managing change in school governance; difference and variety; the contested territory of school governing and the conflicting roles and responsibilities; the complexity of school governing especially the complexity wrought by diversity of provision; the complex and demanding capabilities required for, and participation in, governing; micro—macro issues; and joint modes of institutional governance. [ABSTRACT FROM AUTHOR]

Discharge preparation is a multiprofessional activity that is not always conducted efficiently. Perspectives of staff provide an insight into challenges and solutions for this organizational process. The study aimed to examine current discharge practice in one hospital and to compare perceptions of this activity between healthcare workers from different professions. A questionnaire was sent to 1344 staff in an English hospital. It consisted of items related to discharge, which were rated on a Likert scale, and included space for free text. Data were analyzed using descriptive and inferential statistics. The survey method has a number of limitations and conclusions must be considered with caution. A total of 455 usable questionnaires were returned from nurses/midwives, doctors and therapists/allied health professionals. Although respondents showed agreement on a number of areas, differences did arise, which could be linked, in part, to values and roles associated with specific healthcare disciplines. Tensions between professional groups were evident, especially between social workers, nurses and medics. Differences of opinion also appeared between practitioners, patients and carers. Different views among practitioners of discharge preparation could impede efficient joint working. Better understanding of the roles and expertise of team members might improve this process. Factors affecting discharge preparation need to be understood to reduce staff and consumer dissatisfaction and to avoid potential readmissions. [ABSTRACT FROM AUTHOR]