We analyze a sample of older U.S. adults with religious backgrounds in order to examine the relationships among two types of divine forgiveness and three indicators of psychological well-being (PWB) ...as well as the moderating role of attachment to God. Results suggest that (a) feeling forgiven by God and transactional forgiveness from God are not associated with changes in PWB over time, (b) secure attachment to God at baseline is associated with increased optimism and self-esteem, (c) feeling forgiven by God and transactional forgiveness from God are more strongly associated with increased PWB among the securely attached, and (d) among the avoidantly attached, PWB is associated with consistency in one’s beliefs, that is, a decreased emphasis on forgiveness from God. Findings underscore the importance of subjective beliefs about God in the lives of many older adults in the United States.
Creutzfeldt-Jakob disease is a fatal neurological disease caused by abnormal infectious proteins called prions. Prions that are present on surgical instruments cannot be completely deactivated; ...therefore, patients who are subsequently operated on using these instruments may become infected. This can result in surgically transmitted Creutzfeldt-Jakob disease.
To update literature reviews, consultation with experts and economic modelling published in 2006, and to provide the cost-effectiveness of strategies to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease.
Eight systematic reviews were undertaken for clinical parameters. One review of cost-effectiveness was undertaken. Electronic databases including MEDLINE and EMBASE were searched from 2005 to 2017. Expert elicitation sessions were undertaken. An advisory committee, convened by the National Institute for Health and Care Excellence to produce guidance, provided an additional source of information. A mathematical model was updated focusing on brain and posterior eye surgery and neuroendoscopy. The model simulated both patients and instrument sets. Assuming that there were potentially 15 cases of surgically transmitted Creutzfeldt-Jakob disease between 2005 and 2018, approximate Bayesian computation was used to obtain samples from the posterior distribution of the model parameters to generate results. Heuristics were used to improve computational efficiency. The modelling conformed to the National Institute for Health and Care Excellence reference case. The strategies evaluated included neither keeping instruments moist nor prohibiting set migration; ensuring that instruments were kept moist; prohibiting instrument migration between sets; and employing single-use instruments. Threshold analyses were undertaken to establish prices at which single-use sets or completely effective decontamination solutions would be cost-effective.
A total of 169 papers were identified for the clinical review. The evidence from published literature was not deemed sufficiently strong to take precedence over the distributions obtained from expert elicitation. Forty-eight papers were identified in the review of cost-effectiveness. The previous modelling structure was revised to add the possibility of misclassifying surgically transmitted Creutzfeldt-Jakob disease as another neurodegenerative disease, and assuming that all patients were susceptible to infection. Keeping instruments moist was estimated to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease cases and associated costs. Based on probabilistic sensitivity analyses, keeping instruments moist was estimated to on average result in 2.36 (range 0-47) surgically transmitted Creutzfeldt-Jakob disease cases (across England) caused by infection occurring between 2019 and 2023. Prohibiting set migration or employing single-use instruments reduced the estimated risk of surgically transmitted Creutzfeldt-Jakob disease cases further, but at considerable cost. The estimated costs per quality-adjusted life-year gained of these strategies in addition to keeping instruments moist were in excess of £1M. It was estimated that single-use instrument sets (currently £350-500) or completely effective cleaning solutions would need to cost approximately £12 per patient to be cost-effective using a £30,000 per quality-adjusted life-year gained value.
As no direct published evidence to implicate surgery as a cause of Creutzfeldt-Jakob disease has been found since 2005, the estimations of potential cases from elicitation are still speculative. A particular source of uncertainty was in the number of potential surgically transmitted Creutzfeldt-Jakob disease cases that may have occurred between 2005 and 2018.
Keeping instruments moist is estimated to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease cases and associated costs. Further surgical management strategies can reduce the risks of surgically transmitted Creutzfeldt-Jakob disease but have considerable associated costs.
This study is registered as PROSPERO CRD42017071807.
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in
; Vol. 24, No. 11. See the NIHR Journals Library website for further project information.
Developing scalable methods for conversation analytics is essential for health care communication science and quality improvement.
To assess the feasibility of automating the identification of a ...conversational feature,
which is associated with important patient outcomes.
Using audio recordings from the Palliative Care Communication Research Initiative cohort study, we develop and test an automated measurement pipeline comprising three machine-learning (ML) tools-a random forest algorithm and a custom convolutional neural network that operate in parallel on audio recordings, and subsequently a natural language processing algorithm that uses brief excerpts of automated speech-to-text transcripts.
Our ML pipeline identified
with an overall sensitivity of 84% and specificity of 92%. For
and
subtypes, we observed sensitivities of 68% and 67%, and specificities of 95% and 97%, respectively.
These findings support the capacity for coordinated and complementary ML methods to fully automate the identification of
in natural hospital-based clinical conversations.
Floodplain reconnection and wetland restoration projects are increasingly implemented to enhance flood resiliency, and these nature-based solutions can also achieve co-benefits of nutrient storage ...and improved habitats. Considering the multiple and sometimes incompatible objectives of stakeholders for uses of riverside lands, a decision-support tool linked to a hydraulic model would enable planners to simulate floodplain restoration scenarios while also quantifying and assessing the trade-offs between the stakeholder objectives to arrive at optimal restoration designs. We illustrate a simple ranking approach using an n-dimensional objective function to represent key stakeholders engaged in restoration. We applied our approach in a watershed in central Vermont (USA) that has been identified by regional and state-level stakeholders as an important location to mitigate flooding damages but also to improve water quality – all within a context of increasing development pressures on riparian lands and limited financial resources to accomplish restoration. Eleven different floodplain reconnection and wetland restoration modifications were combined in six scenarios and simulated with 2D Hydrologic Engineering Center's River Analysis System (2D HEC-RAS), along with a baseline (no-action) scenario. Only modest attenuation of peak flows for 2-, 25-, 50- and 100-year design storms was achieved by the floodplain restoration scenarios due to the steep setting, and flashy nature of the watershed. Yet, several scenarios of floodplain reconnection projects more than met the necessary annual phosphorus load reductions targeted under a Total Maximum Daily Load implementation plan. Our approach provided planners with a ranking of restoration scenarios that best met multiple stakeholder objectives and allowed effectiveness of alternate design scenarios to be quantified, justified, and visualized to promote consensus decision-making.
Display omitted
•Floodplain reconnection design is a complex process considering many objectives.•We created an n-dimensional objective function to rank river restoration scenarios.•Quantified five flood resiliency, water quality, and socioeconomic objectives.•Case study modeled floodplain reconnection scenarios to determine best scenario.•Minor flood resiliency benefits but substantial water quality benefits were found.
Human connection can reduce suffering and facilitate meaningful decision-making amid the often terrifying experience of hospitalization for advanced cancer. Some conversational pauses indicate human ...connection, but we know little about their prevalence, distribution or association with outcomes.
To describe the epidemiology of Connectional Silence during serious illness conversations in advanced cancer.
We audio-recorded 226 inpatient palliative care consultations at two academic centers. We identified pauses lasting 2+ seconds and distinguished Connectional Silences from other pauses, sub-categorized as either Invitational (ICS) or Emotional (ECS). We identified treatment decisional status pre-consultation from medical records and post-consultation via clinicians. Patients self-reported quality-of-life before and one day after consultation.
Among all 6769 two-second silences, we observed 328 (4.8%) ECS and 240 (3.5%) ICS. ECS prevalence was associated with decisions favoring fewer disease-focused treatments (ORadj: 2.12; 95% CI: 1.12, 4.06). Earlier conversational ECS was associated with improved quality-of-life (p = 0.01). ICS prevalence was associated with clinicians' prognosis expectations.
Connectional Silences during specialist serious illness conversations are associated with decision-making and improved patient quality-of-life. Further work is necessary to evaluate potential causal relationships.
Pauses offer important opportunities to advance the science of human connection in serious illness decision-making.
•Connectional Silences are common in specialist serious illness conversations.•Connectional Silences are associated with markers of participatory decision-making.•Earlier timing of Emotional Connectional Silence is associated with improvement in quality-of-life.
•Conversational storytelling is a scalable conceptual framework for uncertainty measurement in serious illness conversations.•Natural language processing of uncertainty lexicon can identify ..."uncertainty story arcs" in serious illness conversations.•A Self-Organizing Map provides an intuitive machine learning interface for qualitative exploration of uncertainty story types.
Understanding uncertainty in participatory decision-making requires scientific attention to interaction between what actually happens when patients, families and clinicians engage one another in conversation and the multi-level contexts in which these occur. Achieving this understanding will require conceptually grounded and scalable methods for use in large samples of people representing diversity in cultures, speaking and decision-making norms, and clinical situations.
Here, we focus on serious illness and describe Conversational Stories as a scalable and conceptually grounded framework for characterizing uncertainty expression in these clinical contexts. Using actual conversations from a large direct-observation cohort study, we demonstrate how natural language processing and unsupervised machine learning methods can reveal underlying types of uncertainty stories in serious illness conversations.
Conversational Storytelling offers a meaningful analytic framework for scalable computational methods to study uncertainty in healthcare conversations.
Ichthyosaurs rapidly diversified and colonised a wide range of ecological niches during the Early and Middle Triassic period, but experienced a major decline in diversity near the end of the ...Triassic. Timing and causes of this demise and the subsequent rapid radiation of the diverse, but less disparate, parvipelvian ichthyosaurs are still unknown, notably because of inadequate sampling in strata of latest Triassic age. Here, we describe an exceptionally large radius from Lower Jurassic deposits at Penarth near Cardiff, south Wales (UK) the morphology of which places it within the giant Triassic shastasaurids. A tentative total body size estimate, based on a regression analysis of various complete ichthyosaur skeletons, yields a value of 12–15 m. The specimen is substantially younger than any previously reported last known occurrences of shastasaurids and implies a Lazarus range in the lowermost Jurassic for this ichthyosaur morphotype.
1. Participants will be able to define the concept of connectional silence (CS) and identify the criteria used to subcategorize CS in the context of telemedicine palliative care consultations.
2. ...Participants will understand the differences in telemedicine versus in person connectional silence (CS) and the impact on measurement of CS with human coding and computer algorithms.
Despite its significance, research on connectional silence (CS) in telepalliative care is limited. This study addresses this gap. Combining human coding and machine learning, it explores CS prevalence and subtypes in telehealth, offering insights into enhancing empathetic care delivery.
Connectional silence (CS) in palliative care conversations fosters comfort and trust and is linked to better quality of life and decision-making. COVID-19 highlighted the role of telehealth however it is unclear if CS is present or different in telehealth compared to in-person communication.
We sought to determine the prevalence of CS in telepalliative care using dual human and computer approaches.
We studied participants from the “Telemedicine facilitated palliative care consultations in rural dialysis study,” who were recruited between 2018-20 from five dialysis units. A human coder identified silence defined as pauses of ≥ 2 seconds with no utterances from audio files. Pauses were double-coded as CS and sub-categorized as invitational, emotional, or compassionate. Next, CS were identified using an established computer algorithm based on convolutional neural networks and random forest machine learning methods.
39 participants (90% non-Hispanic White, 56% male) were recruited and 34 participants completed a telepalliative care consultation recorded via Zoom. Intra-rater reliability for CS was 93.5%. Human coding identified 666 pauses of ≥ 2 seconds and computer coding identified 360 pauses of ≥ 2 seconds, with 151 pauses identified by both methods. Among human-identified pauses, 57 (8.6%) were CS. There were 43 (75.4%) invitational CS and 10 (17.5%) emotional CS.
CS was identified using human and established computer algorithms during telehealth palliative care consultations with patients receiving dialysis. The prevalence of CS in these teleconsults was similar to a reported prevalence for in-person palliative care. Invitational CS was more common in televideos than in prior work, which may be due to the conversational and technical aspects of telehealth.
We confirm the presence of CS in telepalliative care conversations using human and computer coding approaches, which supports the use of telehealth for palliative care delivery in rural settings.
Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of ...fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.
PDF
