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BACKGROUND: The per diem financial structure of hospice care may lead agencies to consider patient-level factors when weighing admissions. OBJECTIVE: To investigate if treatment cost, disease complexity, and diagnosis are associated with hospice willingness to accept patients. DESIGN: In this 2019 online survey study, individuals involved in hospice admissions decisions were randomized to view one of six hypothetical patient vignettes: high-cost, high-complexity, low-cost, high-complexity, and low-cost, low-complexity within two diseases: heart failure and cystic fibrosis. Vignettes included demographics, prognoses, goals, and medications with costs. Respondents indicated their perceived likelihood of acceptance to their hospice; if likelihood was

Concerns over the supply of highly-skilled (HS) science, technology, engineering and maths (STEM) workers are well established and have been a feature of policy discourse in the UK for more than 50 years. Since the 2016 referendum on leaving the European Union, these concerns have been exacerbated by uncertainty about the movement of labour between UK and Europe. More recently, the COVID-19 pandemic has highlighted the importance of STEM skills in a wide range of areas. However, despite continued government investment in initiatives to address these concerns, the evidence base for shortages is neither well-established nor compatible with economic theories of labour supply. In order to fill a gap in the current evidence, we report on a unique analysis following the career destinations of STEM graduates from the 1970 British Cohort Study. While only a minority of STEM graduates ever work in highly-skilled STEM jobs, we identified three particular characteristics of the STEM labour market that may present challenges for employers: STEM employment appears to be predicated on early entry to the sector; a large proportion of STEM graduates are likely to never work in the sector; and there may be more movement out of HS STEM positions by older workers than in other sectors.

Increasing the number of women in the STEM labour market has been presented by policymakers and industry representatives as an opportunity to address purported skill shortages in the sector. National governments have spent considerable sums on initiatives aimed at increasing the proportion of girls and women who study science and work in STEM jobs, with a particular focus on increasing the number of female STEM graduates. Although there is a considerable literature on gendered patterns of STEM education, the employment of recent STEM graduates, and gender pay gaps in the STEM workforce, there are important gaps in our knowledge about the position of STEM graduates. We combine several high-quality large-scale data sets to provide a comprehensive overview of the relationship between gender, STEM degree subjects and employment destinations in the first decade of this century. We found that labour market destinations were closely linked to undergraduate STEM subject choice but that gendered differences persisted within subject areas. Throughout their early and mid-career years, women with STEM degrees were more likely than their male peers to be employed in 'caring' professions, such as health and education, be employed in 'lower status' associate professional positions, and less likely to hold managerial positions.

There is a longstanding imperative from both government and industry for a workforce with the skills needed to drive forward the scientific and technological advances that are considered so crucial to the economic prosperity of the nation. However, the skills of this workforce have purportedly been both in short supply and inadequate for many decades, leading to the well‐established narrative of Science, Technology, Engineering and Mathematics (STEM) skill shortages. One solution to this challenge has been to encourage, through myriad policies and initiatives, more young people, particularly young women, to study more science for longer. This paper contributes to the literature on the supply of STEM workers by documenting the long‐term trends in the participation and attainment of girls and women in STEM education: from school science through to graduate entry into the highly skilled STEM labour market. Using population datasets that extend across seven decades and include millions of students, it shows that gendered patterns of participation in science subjects have varied little in recent decades, suggesting that efforts to increase the number of women studying science in school have not resulted in a substantial increase in well‐qualified female graduates entering highly skilled STEM jobs. Furthermore, studying STEM appears to be generally advantageous for men, in terms of field‐related employment outcomes, but is not always associated with such higher status occupations among women. [ABSTRACT FROM AUTHOR]

Background: The majority of hospice patients are over the age of 65, and the majority of hospice deaths occur in private homes. As a hospice patient's disease progresses, death becomes imminent and family and friends gather around to say good-bye. These private vigils are the culmination of the hospice experience and reflect both the strengths and the challenges surrounding hospice care. The purpose of this study was to explore the stories and experiences of hospice staff with death vigils, unveiling the secrets of home deaths and identifying barriers to a good death. Methods: Qualitative analysis of interviews with 25 hospice staff representing 11 different hospice agencies explored the emotions and challenges of directing and managing the vigil experience. Based on Erving Goffman's dramaturgical model, the experience is explored in depth to unveil a private experience in hopes of enlightening the public on what death in the home looks and feels like. Co-coding of stories and validation of findings by hospice nurses and physicians assure the trustworthiness of the data. Results: Hospice staff share narratives related to family and caregiver burden, challenges with symptom management, frustrations with staffing shortages, and administrative burdens surrounding the experience of death vigils. Conclusions: The family and hospice clinician's experiences with the final act of dying at home are sometimes challenged by the intermittent nature of home care during the final days. [ABSTRACT FROM AUTHOR]

Problems with the supply of highly skilled science, technology, engineering and mathematics (STEM) workers have been reported by employers and governments for many decades, in the UK, the USA, and elsewhere. This paper presents some key findings from a project funded by the Nuffield Foundation that examined patterns of education and employment among STEM graduates in the UK. Five large-scale secondary datasets--comprising administrative, survey, cross-sectional and longitudinal data--were analysed in order to provide the most comprehensive account possible. The findings suggest that there is no overall shortage of STEM graduates but there is considerable variation in the career outcomes and trajectories of different groups. Recruitment to STEM degrees has stalled over the past 20 years but most STEM graduates never work in highly skilled STEM jobs--in any case, the majority of professional STEM workers do not have (or presumably need) degrees. Some groups of STEM graduates are currently under-represented in the highly skilled STEM workforce and increased recruitment from these groups could grow the numbers entering STEM occupations. However, employers may have to modify their views on exactly what constitutes a valuable or desirable employee and to what extent it is their responsibility to train their workers.

Whether enough highly qualified STEM workers are being educated and trained in the UK is an important question. The answer has implications not only for educators, employers and policymakers but also for individuals who are currently engaged in, or are considering entering, education or training in this area. Set against a policy backdrop that prioritises students studying more science for longer, this paper considers long-term patterns of participation in STEM education – from school science through to graduate entry into the highly skilled STEM labour market. Using a unique dataset that extends across seven decades and comprises many hundreds of thousands of students, the paper finds that patterns of participation in most STEM subjects have varied little over the period considered; suggesting that efforts to increase the numbers of students studying science in school has had limited impact on the throughput of students who study STEM, including the pure sciences, at university level and, subsequently, on the number of graduates who would be available to undertake highly skilled work in areas for which degree-level skills are a pre-requisite. [ABSTRACT FROM AUTHOR]

Objectives: Family members and close friends provide countless hours of care for patients enrolled in hospice care. They do so without pay, often sacrificing their own financial well-being and health in the process. This study asks 4 research questions: (1) What is the prevalence and severity of depressive symptoms among caregivers of hospice cancer patients? (2) What demographic and contextual factors (such as relationship with patient) are related to the severity of depressive symptoms among caregivers of hospice cancer patients? (3) Are caregiver quality of life and caregiver burden associated with depressive symptoms? and (4) Is baseline depression associated with change in depression over time? Methods: This was a secondary analysis of data collected in a cluster randomized controlled trial. Results: Thirty-five percent of caregivers reported depressive symptoms of moderate or greater severity. These depressive symptoms were found to increase depending on the relationship of the caregiver to the patient. Caregivers with higher reported burden and lower reported quality of life were also found to have higher depressive symptoms. Significance of Results: Hospice agencies are encouraged to assess caregiver depressive symptoms and have protocols in place to assist caregivers with high depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: The health of the gut microbiome is now recognized to be an important component of the gut–brain axis which itself appears to be implicated in pain perception. Antibiotics are known to create dysbiosis in the microbiome, so whether fibromyalgia is more commonly diagnosed after antibiotic prescriptions provides a means of exploring the role of the microbiome in the experience of chronic pain. Methods: A case–control study was carried out using electronic health records collected in the UK's Clinical Practice Research Datalink (CPRD), a comprehensive database of primary care consultations. For each case of diagnosed fibromyalgia, three controls were identified and matched by age, gender and GP practice. The exposure variable was the number and timing of antibiotic prescriptions over previous years. The analysis involved adjusting for a wide range of co‐variates that might be possible confounders. Results: A total of 44,674 cases of fibromyalgia were identified together with 133,513 controls. After adjusting for co‐variates, it was found that both the total number of prescriptions and their timing was associated with an FM diagnosis. For example, the quartile with the highest number of prescriptions and that with the longest exposure had a greater than three‐fold increase in FM diagnoses (number of prescriptions: odds ratio 3.92; 95% CIs: 3.71–4.13; exposure odds ratio 3.28; CIs: 3.13–3.43). Some antibiotics (such as tetracyclines and metronidazole) seemed to confer greater risk than others. Conclusions: The results lend support for prior antibiotics being an important risk factor for a diagnosis of FM. Significance: This study shows an association between the volume as well as timing of prior antibiotic prescriptions and of a subsequent diagnosis of fibromyalgia in primary care. [ABSTRACT FROM AUTHOR]

Background: The burden of caregiving for family members is significant and becomes particularly challenging at end of life, with negative effects on mental health, including anxiety and depression. Research has shown caregivers need better communication with their health care team. Objectives: To evaluate the relationship between hospice team communication with caregivers and caregiver involvement in care. Methods: The purpose of this secondary analysis of data collected from a U.S.-based cluster crossover randomized trial was to evaluate whether caregiver-centered communication (Caregiver-Centered Communication Questionnaire) is associated with a caregiver's perceptions of involvement in care (Perceived Involved in Care Scale). A block-wise approach was used to estimate linear models, which were created using total scores and subscale scores. Results: Caregiver-centered communication was positively associated with perceptions of involvement in care. Conclusion: Skilled communication between hospice clinicians and family caregivers is critical in helping family members perception they are involved in the care of their loved one. There could be similar benefit in caregiver-centered communication during cancer treatment as well. [ABSTRACT FROM AUTHOR]

The hundreds of tidewater glaciers found in the Canadian Arctic Archipelago have the potential to enhance delivery of nutrients and other material to the surface ocean. Despite this, their influence on marine ecosystems, specifically phytoplankton, is poorly characterized. Here we developed and applied a quantitative mass spectrometry‐based approach to measure phytoplankton ribulose‐1,5‐bisphosphate carboxylase/oxygenase (Rubisco) concentrations to examine differences in productivity in glacierized and non‐glacierized marine systems in Jones Sound, Nunavut, within Inuit Nunangat. Comparisons to chloroplast 16S rRNA gene amplicon sequencing data suggested that these measurements detect the majority of Rubisco produced in Jones Sound. Because Rubisco catalyzes carbon fixation, we used these measurements to estimate total and group‐specific primary production potential, which were within the range of historical primary production measurements made using classical methods in this region. Our measurements also revealed that up to 2% of total protein in the water column is Rubisco, and that Rubisco concentrations are correlated with chlorophyll fluorescence, with maxima near the nitracline. Rubisco produced by diatom genera Chaetoceros and Thalassiosira were higher in marine regions influenced by glaciers, while Rubisco from Micromonas (Chlorophyta) was greater in non‐glacierized regions. This suggests that future climate scenarios may favor smaller phytoplankton groups, like Micromonas, with consequences for food webs and carbon cycling. This study broadens our understanding of how tidewater glaciers will impact phytoplankton communities, now and in a warmer future, and lays the foundation for using this mass spectrometry‐based approach to quantify phytoplankton group‐specific carbon fixation potential in other marine regions. [ABSTRACT FROM AUTHOR]

Measuring seasonal productivity is difficult in multi‐brooded species without labour‐intensive ringing studies. Individual‐based (IB) models have been used to estimate seasonal productivity with no direct knowledge of number of nesting attempts, but they are often based on simplified re‐nesting probability (φR) step‐functions instead of observed or more biologically plausible ones. We present a new, open‐source IB seasonal productivity model parameterized from studies of Black Redstart Phoenicurus ochruros and Yellowhammer Emberiza citrinella. We examined how the φR function shape (empirical versus simplified) influenced (1) model performance, (2) re‐nesting compensation and (3) population‐level predictions of a simulated management intervention. Population‐level predictions were made only for Yellowhammer as we had more detailed demographic data, such as survival rates, available. Pattern‐oriented modelling revealed that IB models produced realistic within‐population distributions of breeding parameters, and those specified with an observed or empirically derived φR function generally outperformed those specified with simpler step functions. Strength of re‐nesting compensation differed depending on the φR function used. For Yellowhammers, type of φR function in IB models marginally influenced population‐level predictions of a simulated management intervention (potential population growth rate increased between 23% and 29% relative to no management intervention). In contrast, a simple deterministic productivity model, which did not simulate re‐nesting compensation, predicted a 41% increase in potential population growth. At a population level, choice of φR function may have less influence on IB model predictions, but choice of model itself (IB versus deterministic) may have substantial impact. We discuss how more biologically plausible φR functions might either be observed directly, derived from nest data, or estimated from proxy information such as moult or brood patch changes. [ABSTRACT FROM AUTHOR]

Recent concerns about a shortage of capacity for statistical and numerical analysis skills among social science students and researchers have prompted a range of initiatives aiming to improve teaching in this area. However, these projects have rarely re-evaluated the content of what is taught to students and have instead focussed primarily on delivery. The emphasis has generally been on increased use of complex techniques, specialist software and, most importantly in the context of this paper, a continued focus on inferential statistical tests, often at the expense of other types of analysis. We argue that this "business as usual" approach to the content of statistics teaching is problematic for several reasons. First, the assumptions underlying inferential statistical tests are rarely met, meaning that students are being taught analyses that should only be used very rarely. Secondly, all of the most common outputs of inferential statistical tests--p-values, standard errors and confidence intervals--suffer from a similar logical problem that renders them at best useless and at worst misleading. Eliminating inferential statistical tests from statistics teaching (and practice) would avoid the creation of another generation of researchers who either do not understand, or knowingly misuse, these techniques. It would also have the benefit of removing one of the key barriers to students' understanding of statistical analysis. [For a response to this article, "A Response to White and Gorard: against Inferential Statistics: How and Why Current Statistics Teaching Gets It Wrong," see EJ1152509. For the rejoinder, "Still against Inferential Statistics: Rejoinder to Nicholson and Ridgway," see EJ1152510.]

In their response to our paper, Nicholson and Ridgway agree with the majority of what we wrote. They echo our concerns about the misuse of inferential statistics and NHST in particular. Very little of their response explicitly challenges the points we made but where it does their defence of the use of inferential techniques does not stand up to scrutiny. Their statements are either contradictory, agreement 'dressed up' as disagreement, appeals to authority, semantic slights of hand, or irrelevant to our original claims. It is not clear why such a response was needed. [For the original article, "Against Inferential Statistics: How and Why Current Statistics Teaching Gets It Wrong," see EJ1152511. For the response, "A Response to White and Gorard: against Inferential Statistics: How and Why Current Statistics Teaching Gets It Wrong," see EJ1152509.]

Concerns about a shortage of highly skilled workers in the science, technology, engineering and mathematics (STEM) sector have been expressed frequently since the late 1940s. Although these claims have been challenged as being insufficiently grounded in evidence, they have formed the basis of policies directing considerable resources to STEM education, particularly in the university sector. This paper uses data from the Higher Education Statistical Agency from 1994 to 2010, covering more than three million UK graduates, to contribute to the existing research into the purported skills gap in the STEM sector. It examines their destinations six months after graduation to establish the proportion of graduates from different subject areas that enter graduate careers, with a particular focus on STEM graduates and highly skilled STEM occupations. The findings show that only a minority of graduates enter "graduate" positions within six months of finishing their degree and many find themselves unemployed or underemployed. Overall, STEM graduates fare little better than non-STEM graduates and while graduates in some STEM subjects fare slightly better than average, those with other STEM degrees fare worse than those with non-STEM degrees. The findings appear incompatible with a true shortage of potential STEM workers and raise questions about employers' expectations and the continued subsidisation of STEM degrees.

This paper contributes to the empirical evidence on participation and attainment in higher education by reviewing the patterns of entry and success of undergraduate students. It examines the characteristics of entrants to different subjects and considers the role that subject studied plays in determining the likelihood of graduating with a "good" degree. The data used were drawn from the administrative records of over 38,000 UK-domiciled undergraduate students from one "elite" British university. Despite considerable between-subject variation in degree outcomes, multivariate analysis of the relationship between students' social and academic characteristics and achievement at university revealed that once social background and prior attainment had been controlled for, the subject students studied added little explanatory power to models predicting final degree classifications. Differences in degree outcome were most strongly related to attainment on entry to higher education, sex and ethnicity. In contrast with attainment during the earlier phases of education, the relationship with occupational class was relatively weak. Disparities between the proportion of higher level classifications awarded in different subjects can be largely explained by the background characteristics of the students who choose (and are accepted) to study on these degrees. This finding has particular implications for policies aimed at increasing both the number and quality of Science, Technology, Engineering and Mathematics (STEM) graduates in what is often argued to be a "shortage" or "priority" area.