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Most if not all of end-of-life care for people living in long-term care facilities is provided within the facility. This type of care is likely to increase with population ageing. This paper presents a literature review of the published literature on end-of-life care in long-term care facilities such as nursing homes, aged care facilities, residential care homes and continuing care settings, published between 2000 and 2004. A subset of literature that focuses on the development of practice and the identification of interventions to promote the provision of end-of-life care in care homes is examined in detail. Twenty-five papers are identified and these address modes of service delivery, the introduction of ‘interventions’ that facilitate care for individuals, and the development of tools. This work remains largely descriptive. Small-scale work dominates, reflecting the initial stages of knowledge development in this area of work. Suggestions for ways to expand the scope of the end-of-life care development work in long-term care settings are presented, as it is time to expand the horizons of these initiatives to become more rigorous and responsive to the needs of older people and their families in this care setting. [ABSTRACT FROM AUTHOR]

Objective: To develop a clinically sensitive test of social perception for people with traumatic brain injury (TBI). Design: An assessment toot comprising videotaped vignettes and response probes was developed in successive stages and tested on both normal participants and those with TBI. Subjects: A total of 169 normal adults and 7 adults with severe TBI (pilot studies), 283 normal adults, and 12 people with severe TBI (main studies). Main outcome measures: 'The Awareness of Social Inference Test' (TASIT) comprises videotaped vignettes of everyday social interactionsand has three-parts ; each with alternate forms. The Emotion Evaluation Test (EET) assesses recognition of spontaneous emotional expression (happy, surprised, sad, anxious, angry, disgusted, and neutral). The Social Inference-Minimal (SI-M) test assesses comprehension of sincere versus sarcastic exchanges, whereas the Social Inference-Enriched test (SI-E) assesses lies versus sarcasm. In both SI-M and SI-E speaker demeanor (voice, facial expression) indicate the intended meaning of the exchange. In addition, the SI-E vignettes have other contextual clues that reveal the speakers' intentions. Performance on SUE and SI-E is assessed via four standard questions per item probing for understanding of the emotions, intentions, beliefs, and meanings of the speakers and their exchanges. Results: Groups taken from the pool of 283 normal adults achieved a high level of performance on all aspects of the test with some influence from both education and intelligence. The 12 people with TBI were poorer at judging emotions than were matched controls, with particular difficulties recognizing neutral items, fear, and disgust. They were as capable as matched controls when understanding sincere exchanges and lies but had difficulty with sarcasm. Conclusions: TASIT is straightforward for people with a normal range of social skills while being sensitive to social perception deficits after traumatic brain injury. [ABSTRACT FROM AUTHOR]

Wood cores were taken at breast height of mature sugar maple (Acer Saccharum Marsh.) trees of approximately the same age from four sites in Ontario, Canada differing in soil characteristics and general treehealth. The soils of two of the sites were acidic (podzols), while the soils of the other two sites were calcareous (brunisols). Selectedelemental analyses using Neutron Activation Analysis were conducted on the soils and the xylem wood of the sugar maple trees, and the results were compared relative to tree-health. Aluminum in stem xylem was found to be significantly higher in declining trees (mean 7.7 ppm) relative to the healthy trees (mean 4.0) from the acidic sites, wherealuminum was freely available in the soil. Soil extractable aluminumwas also significantly higher in the soil adjacent to the declining trees (mean 5.10) compared to the healthy trees (mean 3.20). These results show that xylem aluminum contents reflect the increased availability of aluminum in acidifying soils and provide additional evidencethat dendrochemistry may be used as a proxy environmental monitoringtool. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Background: Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program., Purpose: A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot., Methods: Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate., Results: Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program., Implications for Practice: Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2020 American Association of Nurse Practitioners.)

A checklist of the marine and estuarine fishes of New Ireland Province is presented, with special emphasis on Kavieng District, combining both previous and new records. After the recent KAVIENG 2014 expedition, a total of 1325 species in 153 families were recorded from the region. The largest families are the Gobiidae, Pomacentridae, Labridae, Serranidae, Apogonidae, Lutjanidae, Chaetodontidae, Blenniidae, Carangidae, Acanthuridae, Scaridae, Holocentridae, Syn-gnathidae, Lethrinidae and Scorpaenidae. A total of 810 fish species (61.1 % of the total marine and estuarine fish fauna) are recorded from New Ireland for the first time.The fish fauna of New Ireland includes 142 species in transitional waters and 1264 species in marine habitats, and 54 species species in freshwater habitats. Zoogeographically, 1179 species have a wide distribution range, most frequently a broad Indo-West Pacific distribution. Among the remaining species, just 12 are endemic to New Ireland.

A thorough understanding of livelihoods is necessary to ensure development policies are compatible with both resource conservation and the social and economic goals of development. Few studies, however, focus on value-adding activities occurring post-harvest in artisanal fisheries. The transformation of mollusc shells and skeletal remains of other marine taxa into artistic jewellery and decorative items is becoming an increasingly important livelihood activity for rural, coastal communities across the Pacific. We examine the potential challenges facing the shell-based handicraft sector and opportunities for overcoming these challenges using a quantitative study of artisans among the Tigak Islands of Papua New Guinea. The major challenges facing this livelihood sector are perceptions of marine resource declines and a lack of livelihood flexibility, attributed to the specialisation of material assets and skills. Improving market heterogeneity and developing coastal aquaculture may facilitate sustainable development of this livelihood sector.

Volcanic CO 2 seeps were successfully used to predict coral reef response to ocean acidification, although toxic elements, often characteristic of hydrothermal vents were rarely reported. We measured the physicochemical conditions, seawater carbonate chemistry and trace elements in Tutum Bay, Papua New Guinea. There, intense emission of hydrothermal fluids and CO 2 expose the coral reef to a seawater pH T between 7.6 and 7.7. Arsenic and silica were enriched by up to six times in surface seawater, while bottom concentrations were lower and thus similar to coral reefs worldwide. Manganese, cesium, iron and zinc concentrations fell into the range of other coastal environments. Our measurements suggest that Tutum Bay is a suitable site to study the response of coral reefs to high pCO 2 . Considering that arsenic is a common metal in hydrothermal fluids, its characterization should be included in any study that uses volcanic CO 2 seeps as natural laboratories for ocean acidification., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

A major difficulty in managing live organism wildlife trade is often the reliance on trade data to monitor exploitation of wild populations. Harvested organisms that die or are discarded before a point of sale are regularly not reported. For the global marine aquarium trade, identifying supply-chain losses is necessary to more accurately assess exploitation from trade data. We examined quality control rejections and mortality of marine invertebrates (Asteroidea, Gastropoda, Malacostraca, Ophiuroidea) moving through the Papua New Guinea marine aquarium supply-chain, from fisher to importer. Utilizing catch invoices and exporter mortality records we determined that, over a 160 day period, 38.6% of the total invertebrate catch (n = 13,299 individuals) was lost before export. Supply-chain losses were divided among invertebrates rejected in the quality control process (11.5%) and mortality of the accepted catch in transit to, and during holding at, an export facility (30.6%). A further 0.3% died during international transit to importers. We quantified supply-chain losses for the ten most fished species which accounted for 96.4% of the catch. Quality control rejections (n = 1533) were primarily explained by rejections of oversized invertebrates (83.2% of rejections). We suggest that enforceable size limits on species prone to size-based rejections and elimination of village-based holding of invertebrates would reduce losses along the Papua New Guinea supply-chain. This case study underscores that low mortality during international transit may mask large losses along supply-chains prior to export and exemplifies the limitations of trade data to accurately monitor exploitation.

Breast cancer, the most common cancer among Arab women in Qatar, significantly affects the morbidity and mortality of Arab women largely because of low participation rates in breast cancer screening. We used a critical ethnographic approach to uncover and describe factors that influence Arab women's breast cancer screening practices. We conducted semistructured interviews with 15 health care practitioners in Qatar. Through thematic analysis of the data, we found three major factors influencing breast cancer screening practices: (a) beliefs, attitudes, and practices regarding women's bodies, health, and illness; (b) religious beliefs and a culturally sensitive health care structure; and (c) culturally specific gender relations and roles. Arab women's health practices cannot be understood in isolation from the sociocultural environment. The problem of low rates of breast cancer screening practices and supportive interventions must be addressed within the context and not be limited to the individual.

A major difficulty in managing wildlife trade is the reliance on trade data (rather than capture data) to monitor exploitation of wild populations. Collected organisms that die or are rejected before a point of sale often go unreported. For the global marine aquarium trade, identifying the loss of collected fish from rejection, prior to export, is a first step in assessing true collection levels. This study takes a detailed look at fish rejections by buyers before export using the Papua New Guinea marine aquarium fishery as a case study. Utilizing collection invoices detailing the species and quantity of fish (Actinopteri and Elasmobranchii) accepted or rejected by the exporting company it was determined that, over a six month period, 24.2% of the total fish catch reported (n = 13,886) was rejected. Of the ten most collected fish families, rejection frequency was highest for the Apogonidae (54.2%), Chaetodontidae (26.3%), and Acanthuridae (18.2%) and lowest for Labridae (6.6%) and Hemiscylliidae (0.7%). The most frequently cited reasons for rejection were fin damage (45.6% of cases), undersized fish (21.8%), and fish deemed too thin (11.1%). Despite fishers receiving feedback on invoices explaining rejections, there was no improvement in rejection frequencies over time (r = -0.33, P = 0.15) with weekly rejection frequencies being highly inconsistent (range: 2.8% to 79.4%; s = 16.3%). These findings suggest that export/import statistics can greatly underestimate collection for the marine aquarium trade as additional factors such as fisher discards, escapees, post-collection mortalities, and unregulated domestic trade would further contribute to this disparity.

Right ventricular infarction complicates up to half of inferior left ventricular infarctions. The term represents a spectrum of disease from mild, asymptomatic right ventricular dysfunction to cardiogenic shock, and it includes transient ischemic myocardial dysfunction as well as myocardial necrosis. Right ventricular infarction is associated with considerable morbidity and mortality, and its presence defines a high-risk subgroup of patients with inferior left ventricular infarction. Diagnosis of this condition requires a high degree of suspicion based on clinical findings and the early recording of the electrocardiogram through right precordial leads, as well as elevated right-sided filling pressures out of proportion to left-sided filling pressures. The proper management of right ventricular infarction requires sustaining adequate right ventricular preload with volume loading and maintenance of atrioventricular synchrony, reduction of right ventricular afterload (particularly when left ventricular dysfunction is present), and inotropic support of the right ventricle. Early reperfusion with fibrinolytic therapy or direct angioplasty is also warranted. Survivors of right ventricular infarction generally have a restoration of normal right ventricular function with resolution of hemodynamic abnormalities.

The isolated lamprey spinal cord, when bathed in 2 millimolar D-glutamic acid, will generate a pattern of motor neuron discharge that has generally been assumed to represent the central motor program for swimming. Motion pictures of behaving lampreys were analyzed by a computer algorithm to estimate undulatory movement parameters that could be directly compared with those generated during D-glutamate--induced undulations. The D-glutamate--induced movement parameters were significantly different from those observed during normal behaviors, including swimming, but accurately predicted the undulations produced by spinally transected adult lampreys.