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The present study examined chaplain reported plans for patient conversations regarding end-of-life (EOL) care through the lens of multiple goals. Chaplains (n = 69) were asked to curate a plan for engaging with a patient about EOL treatment options, including how they would engage in the conversation and what they would plan to discuss. Findings indicated that plans primarily consisted of relational and identity goals, with a majority navigating multiple goal orientations. Content overwhelmingly involved developing rapport with patients, eliciting patient preferences for care, and serving as a patient liaison. The current study addresses the paucity of research around the role a chaplain plays on the interdisciplinary team and their respective approach to EOL conversations. Examination of curated plans affords insight to what content is prioritized and which conversational goals are present. Integration of multiple goals offers preliminary evidence for conversational quality. Awareness of goal approach and content prioritized affords clarity on how chaplains can be called upon to support members of the interdisciplinary care team. [ABSTRACT FROM AUTHOR]

This paper discusses trends in recent academic literature on cumulative effects assessment (CEA) in the field of environmental impact assessment (IA). We performed an inductive, thematic analysis of peer-reviewed literature published between 2008 and 2018. We find that most academic research on CEA originates in North America, and much of it is situated in periodicals other than the leading IA journals. There is agreement that CEA is still not well understood conceptually and there remains a need for procedural guidance as support for practitioners. Support for regional and strategic approaches to CEA remains strong. Our review of the literature also shows that, increasingly, researchers advocate estimating relative ecosystem vulnerability to anthropogenic activities by aggregating stressors and differentiating the most heavily disturbed valued components and impact zones. The paper concludes with our suggestions to strengthen CEA scholarship globally. [ABSTRACT FROM AUTHOR]

Throughout history, African Americans have endured much, and their experiences with discrimination and racism continue today. Despite ongoing challenges, African Americans have also shown their resilience. Religion and spirituality are two of the largest resources of resilience that African Americans employ. However, little is known about the role of religion and spirituality within African American couple relationships. Using dyadic data from 292 married and 233 cohabiting African American couples, we examined the impact of sanctification of the couple relationship on communal coping within the Actor Partner Interdependence Model. Significant actor effects were found between relational sanctification and communal coping for both married and cohabiting men and women. There was a significant partner effect between married men's relational sanctification and married women's communal coping. However, no other significant partner effects were found. [ABSTRACT FROM AUTHOR]

Social workers play an integral role in end-of-life planning and patient outcomes, and yet how social workers approach such conversations with patients is not well understood. The current study employed a cross-sectional design to examine social worker planned communication about end-of-life care using a multiple goals framework. Recruited from online listservs, a content analysis was conducted with social worker curated plans (n = 20) for end-of-life conversations. Plans were coded for topics and content alignment with instrumental, identity, and relational goal types. Topics found were related to eliciting patient goals and the utilization of written resources. A substantial percentage of social workers also noted the inclusion of other parties in the conversation. Findings suggested that content was predominately instrumental (i.e. task-oriented) with an overwhelming majority adhering to multiple conversational goals. Plan content affords insight to occupational orientation and prioritization during conversations with patients. Further, identifying how the majority of planned responses integrate multiple goals simultaneously gives credence to existing research regarding enhanced conversational effectiveness when social workers are present on the palliative care team. [ABSTRACT FROM AUTHOR]

This study examined health-care provider planned responses to patient misunderstandings about end-of-life care using a multiple goals framework. Plan topics and content alignment with task, identity, and relational goal types were coded. Findings suggested that content was predominately task-oriented and concerned implications of treatment options such as choice outcomes and efficacy rates. A substantial percentage of providers planned to refer further discussion about the misunderstanding to another team member or occupational resource. Despite the prompt of patient misunderstanding, little attention was given to literacy and/or avoidance of medical jargon. Implications for these findings are discussed. [ABSTRACT FROM AUTHOR]

Background: Developing conversational plans can potentially help ameliorate some of the apprehension that medical providers feel when approaching end-of-life conversations. The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. With specific interest in the POLST, this study assessed the sources that providers draw upon in their plan construction, perceptions of domain knowledge, prioritization and the relative impact such factors had on plan complexity. Method: Respondents (n = 297) were asked to design a plan to communicate to the patient about their options for life-sustaining treatment. Following the plan generation, questions concerning prioritization, domain specific knowledge, as well as the resources that are drawn upon to engage in such conversations were elicited. Results: Health care providers most commonly reported reliance on personal experience in plan development with limited utilization of the POLST. Increased prioritization and domain knowledge were associated with greater plan complexity. Conclusions: The findings suggest that with greater experience, providers are better able to articulate in detail what needs to be considered in conversational engagement with patients regarding end-of-life treatment options. [ABSTRACT FROM AUTHOR]

As college students are particularly vulnerable to weight struggles, understanding how weight-related communication impacts behavior can have important implications for overall health. This study investigated memorable messages regarding weight using the theoretical lens of control theory. Control theory provides a guiding framework to predict how memorable messages impact subsequent behavior when an individual senses a discrepancy between their ideal and actual weight. Participants were asked to report whether they had experienced a weight-associated discrepancy and if they recalled a memorable message about this issue. For those with a memorable message, characteristics and outcomes of the message were solicited. The prevalence of weight-associated discrepancies, associated memorable messages, topics, sources, and perceived intentions of the memorable messages and the reported outcomes of message recall were identified. Findings address the relationship between interpersonal communication and weight and offer insight to the role of memorable messages in both construction and achievement of individuals’ ideal states. [ABSTRACT FROM PUBLISHER]

Objective: Approaches to improve earlier diagnosis of cancer often focus on symptom awareness as a key driver of help‐seeking behaviour and other psychological influences are less well understood. This is the first study to explore the role of patient enablement on help‐seeking for people experiencing potential blood cancer symptoms. Methods: A cross‐sectional, nationally representative survey was completed by 434 respondents (>18 years). Questions asked about symptom experiences, medical help‐seeking and re‐consultation. Existing patient enablement items were included in the newly developed Blood Cancer Awareness Measure. We collected data on patient socio‐demographic characteristics. Results: Of those responding to the survey 224/434 (51.6%) reported experiencing at least one potential blood cancer symptom. Half of those experiencing symptoms (112/224) had sought medical help. Results from logistic regression analysis showed that higher scores on patient enablement were associated with being less likely to seek help (Odds Ratio [OR] 0.89, Confidence Interval [CI] 0.81–0.98) after controlling for socio‐demographics. Separate analyses showed that higher enablement was associated with being more comfortable to re‐consult if symptoms didn't go away or got worse (OR 1.31, CI 1.16–1.48); after a test result suggested there was nothing to worry about, but symptoms persisted (OR 1.23, CI 1.12–1.34) or to request further tests, scans or investigations (OR 1.31, CI 1.19–1.44). Conclusions: Contrary to our hypotheses, patient enablement was associated with lower likelihood of help‐seeking for potential blood cancer symptoms. Yet enablement appears to play an important role in likelihood of re‐consulting when symptoms persist, get worse or need further investigation. [ABSTRACT FROM AUTHOR]

The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) × 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals. Findings suggested that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggested that the utility of the POLST surfaced with provider responses to patient misunderstanding, in which differences in conditions were identified. Significant differences in goals reported as most important in driving conversational engagement emerged. Implications for findings are discussed. [ABSTRACT FROM AUTHOR]

This experiment builds upon previous research on the legitimization of paltry favors (LPF) technique by probing the conditions that explain the effectiveness of the technique. Specifically, impression management as a potential mediator was explored. Subjects were randomly exposed to one of eight solicitation conditions where cause (highly prosocial, less prosocial) and social comparison (No C [confederate], C does not donate, C donated $1.00, C donated $10.00) were varied. The robustness of the LPF technique was assessed by examining the impact of the extent to which the cause was prosocial and by the magnitude of the pledge made by another on the probability of targets' compliance as well as on the magnitude of the pledges. Results indicated that both factors influenced the effectiveness of the LPF technique. [ABSTRACT FROM AUTHOR]

Two studies are reported that test a model in which job-search self-efficacy mediates the relationship between received esteem support and job-search behavior. Esteem support refers to messages intended to enhance how recipients feel about themselves and their attributes, abilities, and/or accomplishments. New-entrant job seekers (N = 208, Study 1), as well as unemployed, underemployed, and/or displaced workers (N = 254, Study 2) completed a survey assessing their reception of esteem support messages, job-search self-efficacy, and job-search behavior. Both studies revealed that job-search self-efficacy mediated the relationship between esteem support and job-search behavior, but the effects were more pronounced among new-entrant job seekers. [ABSTRACT FROM PUBLISHER]

The current study assessed the role of health care provider constraints and perceived consequences on plan complexity for conversations with patients about end-of-life care. Meta-goal constraints, perceived consequences associated with conversational engagement and planning theory provides the basis for research questions and hypotheses posed. Findings suggested that while the meta-goals of efficiency and politeness were each recognized as important, providers indicated greater concern for politeness during patient interactions concerning treatment options. Reported constraints had no impact on plan complexity. Perceived consequences of conversational engagement were predominantly positive and concerned the patient. Findings may enhance the understanding of social workers in their educational role regarding the potential training needs of health care team members in palliative care contexts. [ABSTRACT FROM AUTHOR]

Abstract: Recent empirical research about the influence of built environments on individual health behaviors and health conditions focuses on people of all ages or youth subgroups (such as children and adolescents) but infrequently on older adults. To address the gap, the impact of built environment characteristics—such as population density, land use arrangements, and access to public transit—on body mass index (BMI) is assessed for 207 older adults (age 50 and older) in Erie County, New York. A particular focus of inquiry is how frequency of driving and access to public transportation—and the degree to which various urban forms provide support for these mode choices—relate to BMI for older adults. Socio-demographic data and information about individuals'' health is collected using a random survey of older adults; data about the built environment is calculated for the surroundings of each respondent''s home using Geographic Information Systems (GIS). Results from ordinary least squares regression models suggest that BMI of older adults may be more influenced by personal characteristics—age, sex, physical functionality—and neighborhood socioeconomic factors—share of population within the respondents'' census tract that is white, and median household income—than by neighborhood land use and frequency of driving. Access to public transportation—measured by the density of nearby bus stops—exhibits an inverse and statistically significant relationship with BMI among older adults, suggesting that transportation access may play a greater role in the overall activity levels and BMI of older adults. [Copyright &y& Elsevier]

The author examined the role of narratives used by unemployed, underemployed, and displaced workers seeking job training assistance through a government-funded One-Stop Career Center. Interviews with employees of a One-Stop Career Center provided insight on client rate of disclosure of personal narratives and how client narratives are used to facilitate the job search process. Specifically, data from the interviews suggest that narratives give career center employees insight on job seekers' background, barriers, and reemployment mind-set. Furthermore, the act of listening was seen as legitimizing job seekers' experiences. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: There is limited qualitative research focussed specifically on what it is like for children and young people with intellectual disabilities coming into hospital, with much of the evidence‐base being about those with Autism Spectrum Condition or adults with intellectual disabilities. Aim: To share rich detail of the emotional and physical impact on children and young people with intellectual disabilities of attending hospital, from their own and their parent's perspective. Methods: Talking Mats interviews, sticker survey and photography with children and young people with intellectual disabilities, and in‐depth interviews, hospital diaries and photography with their parents. Results and Conclusions: The multiple and compounding layers of complexity surrounding hospital care of children and young people with intellectual disabilities resulted in challenges associated with loss of familiarity and routine, undergoing procedures, managing sensory overload, managing pain and having a lack of safety awareness. An individualised approach to their care is needed. [ABSTRACT FROM AUTHOR]

Murray Valley Encephalitis virus (MVEV) is a mosquito-borne Flavivirus. Clinical presentation is rare but severe, with a case fatality rate of 15–30%. Here we report a case of MVEV from the cerebrospinal fluid (CSF) of a patient in the Northern Territory in Australia. Initial diagnosis was performed using both MVEV-specific real-time, and Pan-Flavivirus conventional, Polymerase Chain Reaction (PCR), with confirmation by Sanger sequencing. Subsequent isolation, the first from CSF, was conducted in Vero cells and the observed cytopathic effect was confirmed by increasing viral titre in the real-time PCR. Isolation allowed for full genome sequencing using the Scriptseq V2 RNASeq library preparation kit. A consensus genome for VIDRL-MVE was generated and phylogenetic analysis identified it as Genotype 2. This is the first reported isolation, and full genome sequencing of MVEV from CSF. It is also the first time Genotype 2 has been identified in humans. As such, this case has significant implications for public health surveillance, epidemiology, and the understanding of MVEV evolution. [ABSTRACT FROM AUTHOR]

Recovery Colleges aim to assist people with mental health difficulties in the journey to recovery through education. They bring together professional and lived experience of mental health challenges in a non‐stigmatising college environment and operate on college principles. All courses are designed to contribute towards well‐being and recovery. Despite the ever‐growing number of Recovery Colleges (both in the UK and internationally), the evaluative evidence is limited; comprising mostly non‐peer‐reviewed evaluations, audits and case studies. The present article comprises a mixed‐methods evaluation of a newly established Recovery College in South East Essex, UK. The evaluation comprised questionnaires of mental well‐being and social inclusion at baseline and 3 and 6 month follow‐up, in addition to three focus groups. There were significant improvements in both mental well‐being and social inclusion from baseline to 6 month follow‐up (25 participants completed the measure of well‐being at both time points and 19 completed the measure of social inclusion). This was supported by additional free‐text questionnaire comments and focus group findings (17 participants participated across the focus groups), with reports of increased confidence, reduced anxiety and increased social inclusion/reduced social isolation. Additionally, at 6 month follow‐up a majority of respondents were planning on attending courses external to the Recovery College, volunteering and/or gaining paid employment. Challenges and recommendations identified through the focus groups indicate the importance for standardisation of processes (which is particularly important when multiple organisations are involved in the running of a Recovery College), as well as consideration of longer‐running courses. Funders should continue to invest in the Recovery College movement as the growing evidence‐base is demonstrating how these colleges can help address the high prevalence of mental health difficulties, by promoting mental well‐being and social inclusion. [ABSTRACT FROM AUTHOR]

The granulate ambrosia beetle (GAB) Xylosandrus crassiusculus, was first formally detected in New Zealand in 2019. Since then, GAB has subsequently been found infesting numerous tree species in the Auckland region.Flight intercept traps baited with ethanol lures were deployed from October 2019 to May 2021 at three sites in the Auckland region to ascertain the phenology of GAB in New Zealand. Two distinct peak flight periods were identified in early and late summer, while a smaller and inconsistent third peak was detected in early autumn. Logistical analysis of GAB captures in the ethanol‐lured traps and degree‐day (DD) accumulation indicated that 90% of flight activity is completed by 800 DD.To assess monitoring tactics, flight intercept traps were baited with three different ethanol lures with varying release rates or ethanol‐soaked or non‐soaked wood bolts from three species of trees. A lure releasing 2 g ethanol per day was most effective at capturing GAB. Ethanol‐soaked bolts were less effective than the lures.Xylosandrus crassiusculus represents a significant risk for shrubs and trees native to New Zealand, as well as commercial horticultural and forestry trees. We recommend using ethanol‐lured panel traps for monitoring purposes. [ABSTRACT FROM AUTHOR]

Background: Low levels of cancer awareness may contribute to delays in seeking medical help and subsequent delays in diagnosis. For blood cancer this may be a particularly prominent problem due to the high prevalence of undifferentiated symptoms such as bodily pain, weakness, nausea and weight loss, resulting in low symptom awareness. The delay is exacerbated by the dismissal of similar symptoms which are often interpreted as mild disease, resulting in multiple consultations prior to diagnosis. This study describes the development of a Cancer Awareness Measure for Blood Cancer (Blood CAM) and presents results from a population-representative survey using the measure. Methods: A rapid systematic review identified constructs relevant to blood cancer. Items were taken from previous awareness measures and other literature and reviewed by expert groups including health care professionals and patients. Cognitive interviews were conducted with ten members of the public to check comprehension and clarity. A total sample of 434 participants completed the survey at Time 1 and n = 302 at Time 2 (two weeks later). Results: Internal reliability was high across the different constructs included in the questionnaire (> 0.70) and test-retest reliability was moderate to good (0.49–0.79). The most commonly recognised blood cancer symptoms were unexplained weight loss (68.9%) and unexplained bleeding (64.9%) and the least commonly recognised symptoms were night sweats (31.3%) breathlessness and rash/itchy skin (both 44%). In terms of symptom experience, fatigue was the most commonly reported symptom (26.7%) followed by night sweats (25.4%). Exploratory factor analysis of barriers to presenting at primary care revealed three distinct categories of barriers; emotional, external/practical and service/healthcare professional related. Service and emotional barriers were most common. Conclusions: We developed a valid and reliable tool to assess blood cancer awareness and showed variable awareness of blood cancer symptoms which can help target public health campaigns. We also incorporated additional measures (e.g. confidence to re-consult, ability to understand symptoms) that could be used to tailor public messaging for blood cancer and for other harder to suspect and diagnose cancers. [ABSTRACT FROM AUTHOR]

Evidence regarding possible environmental causes of breast cancer is advancing. Often, however, the public is not informed about these advances in a manner that is easily understandable. This research translates findings from biologists into messages at two literacy levels about perfluorooctanoic acid (PFOA), a possible environmental contributor to breast cancer. The Heuristic Systematic Model (HSM) was used to investigate how ability, motivation, and systematic and heuristic processing lead to risk beliefs and, ultimately, to negative attitudes for individuals receiving translated scientific messages about PFOA. Participants (N = 1,389) came from the Dr. Susan Love Research Foundation’s Army of Women. Findings indicated that ability, in the form of translated messages, predicted systematic processing, operationalized as knowledge gain, which was negatively associated with formation of risk beliefs that led to negative attitudes toward PFOA. Heuristic processing cues, operationalized as perceived message quality and source credibility, were positively associated with risk beliefs, which predicted negative attitudes about PFOA. Overall, more knowledge and lower literacy messages led to lower perceived risk, while greater involvement and ratings of heuristic cues led to greater risk perceptions. This is an example of a research, translation, and dissemination team effort in which biologists created knowledge, communication scholars translated and tested messages, and advocates were participants and those who disseminated messages. [ABSTRACT FROM PUBLISHER]

Introduction: The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of 'personality disorder') is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim: To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods: Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results: Twenty-nine papers were eligible for inclusion, most with samples given a 'personality disorder' diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion: Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support. [ABSTRACT FROM AUTHOR]

The Cognitive-Emotional Theory of Esteem Support Messages posits that messages intended to enhance recipients' state self-esteem focus on cognitions and/or behaviors. In the current studies, problem-focused message content (i.e., content focused on enacting behavior to alleviate the esteem threat) was of particular interest. College students (Study 1, n= 227) applying for postgraduation jobs and unemployed, underemployed, and/or displaced workers recruited from a government one-stop career center (Study 2, n = 292) rated esteem support messages varying in degree of focus on behaviors vs. cognitions relevant to the job search process. Messages focused on behavior were rated as less effective than those focusing on cognitions relevant to the esteem threat, although support for this result was stronger in Study 2. [ABSTRACT FROM AUTHOR]

Background: There is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users' views and co-production initiatives have had little impact on the development of interventions and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs. Methods: A co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data. Results: Participants reported some experiences of good practice but also of experiences of severely stigmatising interventions, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised and compassionate way and care that is trauma-informed. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs. Conclusions: Relational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with people with relevant lived experience, their carers and the professionals who support them. [ABSTRACT FROM AUTHOR]

This study presents data from a content analysis of original research articles published in Health Communication and Journal of Health Communication from 2000 to 2009. The authors coded 776 articles using categories that identified health topics, theory, population characteristics, and methods used in each study. Distinctions between the published research in Health Communication and Journal of Health Communication are highlighted. Across both journals, findings demonstrated articles sometimes lack racial demographic information, primarily perform research in the United States, rely heavily on survey data, and often lack a theoretical framework. The top physical health topic addressed across both journals was cancer, and the top non–physical health topic addressed was the role of media in health. Journals displayed differences in several areas and those differences often mirrored each journal's stated objectives. Results are discussed in terms of their implications for expanding health communication research to be reflective of issues salient to public health within the United States and around the world. [ABSTRACT FROM AUTHOR]

Background: There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a "personality disorder" diagnosis. Services should be informed by the views of people with these experiences. Aims: To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. Methods: We searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist "personality disorder" services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes. Results: Forty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of 'personality disorder' diagnosis. Themes tended to recur across studies from different countries and years. Discussion: Recurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist "personality disorder" services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with "personality disorders" throughout the mental health care system. [ABSTRACT FROM AUTHOR]

Background: Children and young people with learning disabilities experience poor health outcomes and lengthier hospital admissions than those without learning disabilities. No consistently applied, systematic approach exists across the NHS to identify and record this population. This paper describes practices in English hospitals to identify children and young people with learning disabilities. Method: Interviews: 65 NHS staff. Questionnaire: 2,261 NHS staff. Conducted across 24 NHS hospitals in England. Results: No standardized approach exists to identify children or young people with a learning disability or for this information to be consistently recorded, communicated to relevant parties within a hospital, Trust or across NHS services. Staff reported a reliance on parents to inform them about their child's needs but concerns about "flagging" patients might be a significant barrier. Discussion: Without an integrated systematic way across the NHS to identify children with learning disabilities, their individual needs will not be identified. [ABSTRACT FROM AUTHOR]

In this study, we designed emulsions with an oil-water interface consisting of a composite layer of whey protein isolate (WPI, 1 wt%) and cellulose nanocrystals (CNCs) (1–3 wt%). The hypothesis was that a secondary layer of CNCs at the WPI-stabilized oil-water interface could protect the interfacial protein layer against in vitro gastric digestion by pepsin at 37 °C. A combination of transmission electron microscopy, ζ -potential measurements, interfacial shear viscosity measurements and theoretical surface coverage considerations suggested the presence of CNCs and WPI together at the O/W interface, owing to the electrostatic attraction between complementarily charged WPI and CNCs at pH 3. Microstructural analysis and droplet sizing revealed that the presence of CNCs increased the resistance of the interfacial protein film to rupture by pepsin, thus inhibiting droplet coalescence in the gastric phase, which occurs rapidly in an emulsion stabilized by WPI alone. It appeared that there was an optimum concentration of CNCs at the interface for such barrier effects. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) results further confirmed that the presence of 3 wt% of CNCs reduced the rate and extent of proteolysis of protein at the interface. Besides, evidence of adsorption of CNCs to the protein-coated droplets to form more rigid layers, there is also the possibility that network formation by the CNCs in the bulk (continuous) phase reduced the kinetics of proteolysis. Nevertheless, structuring emulsions with mixed protein-particle layers could be an effective strategy to tune and control interfacial barrier properties during gastric passage of emulsions. [ABSTRACT FROM AUTHOR]

Background Early engagement in advance care planning ( ACP) is seen as fundamental for ensuring the highest standard of care for children and young people with a life-limiting condition ( LLC). However, most families have little knowledge or experience of ACP. Objective To investigate how parents of children and young people with LLCs approach and experience ACP. Methods Open-ended, semi-structured interviews were conducted with parents of 18 children; nine children who were currently receiving palliative care services, and nine children who had received palliative care and died. Verbatim transcripts of audiotaped interviews were analysed following principles of grounded theory while acknowledging the use of deductive strategies, taking account of both the child's condition, and the timing and nature of decisions made. Results Parents reported having discussions and making decisions about the place of care, place of death and the limitation of treatment. Most decisions were made relatively late in the illness and by parents who wished to keep their options open. Parents reported different levels of involvement in a range of decisions; many wished to be involved in decision making but did not always feel able to do so. Discussion This study highlights that parents' approaches to decision making vary by the type of decision required. Their views may change over time, and it is important to allow them to keep their options open. We recommend that clinicians have regular discussions over the course of the illness in an effort to understand parents' approaches to particular decisions rather than to drive to closure prematurely. [ABSTRACT FROM AUTHOR]

The heuristic systematic model is used to investigate how ability, motivation, and heuristic message cues predict knowledge scores for individuals receiving messages written for different literacy levels about 3 environmental risk factors for breast cancer. The 3 risk factors were the roles of genetics, progesterone, and ingesting perfluorooctanoic acid in breast cancer risk. In this study, more than 4,000 women participated in an online survey. The results showed support for the hypotheses that ability (measured as education, number of science courses, and confidence in scientific ability) predict knowledge gain and that those individuals who presented with the lower literacy level message had significantly higher knowledge scores across all 3 message topics. There was little support for motivation or heuristic cues as direct predictors of knowledge gain across the 3 message topics, although they served as moderators for the perfluorooctanoic acid topic. The authors provide implications for health communication practitioners. [ABSTRACT FROM PUBLISHER]

This manuscript details an investigation of memorable messages that help students navigate college life using a control theory framework. Researchers conducted face-to-face interviews with 61 undergraduate students who recalled a specific memorable message that helped them as they navigated college. Results of this formative study show the majority of participants' memorable messages were academic, and approximately 70% reported changing their behavior when recalling the message. Findings include categories of messages, challenges and topics, message sources, and changes in behavior and attitudes as a result of recalling the message. Additionally, the authors discuss responses to the study findings by college personnel that highlight the applicability of the research. [ABSTRACT FROM AUTHOR]

Background: Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. The Care Quality Commission's (CQC) view of best practice for this group of patients includes: access to senior LD nurse provision; a clearly visible flagging system for identifying them; the use of hospital passports; and defined communication strategies (Glasper, Comp Child Adolesc Nurs 40:63-67, 2017). What remains unclear is whether these recommendations are being applied and if so, what difference they are making. Furthermore, what we do not know is whether parental concerns of CYP with LD differ from parents of other children with long-term conditions. The aims of this study were to 1) describe the organisational context for healthcare delivery to CYP with LD and their families and 2) compare staff perceptions of their ability to identify the needs of CYP with and without LD and their families and provide high quality care to effectively meet these needs.Methods: Individual interviews (n = 65) and anonymised online survey (n = 2261) were conducted with hospital staff working with CYP in 15 children's and 9 non-children's hospitals in England. The majority of interviews were conducted over the telephone and recorded and transcribed verbatim. Health Research Authority was obtained and verbal or written consent for data collection was obtained from all interview participants.Results: The nature and extent of organisational policies, systems and practices in place within hospitals to support the care of CYP with LD differs across England and some uncertainty exists within and across hospitals as to what is currently available and accessed. Staff perceived that those with LD were included less, valued less, and less safe than CYP without LD. They also reported having less confidence, capability and capacity to meet the needs of this population compared to those without LD.Conclusion: Findings indicate inequality with regards the provision of high quality hospital care to children and young people with LD that meets their needs. There is a pressing need to understand the impact this has on them and their families.Trial Registration: The study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4). [ABSTRACT FROM AUTHOR]