Family Presence Research Articles

Attitudes and Barriers of Emergency Nurses and Physicians Toward Family Presence During Resuscitation in Iran: A Cross-Sectional Study

IntroductionImplementing family presence during resuscitation poses many challenges in developing countries, especially in developing countries like Iran, where cultural and contextual factors play significant roles. This study examined the attitudes and barriers of Muslim emergency nurses and physicians toward family presence during resuscitation in Iran. MethodsA cross-sectional study included 300 physicians and 500 nurses. Data were analyzed using descriptive and analytic statistics. ResultsThe overall score of physicians’ attitudes toward family presence during resuscitation was higher than nurses’ (P = .001). Female nurses had a higher attitude score than male nurses (P = .001). Other demographic variables were not significant with nurses’ attitudes toward family presence during resuscitation. The most significant barriers to family presence during resuscitation included increased stress on staff and unwanted events during cardiopulmonary resuscitation. The attitude of Iranian physicians and nurses toward family presence during resuscitation is becoming more positive, with more than half of them agreeing with both the concept and the practice. DiscussionThe findings suggest that hospitals should develop and adopt policies to ensure consistent performance when implementing family presence during resuscitation and that the procedure is safe and effective.

Family presence during resuscitation: a survey of Japanese physicians’ views

Abstract Aim This study aimed to clarify physicians’ awareness of and attitudes toward family presence during resuscitation (FPDR) and related factors. Subject and methods A web-based questionnaire survey was conducted of 7859 physicians who were members of the Japanese Society of Intensive Care Medicine (survey period: October 12, 2022, to December 31, 2022). Focusing on cardiopulmonary arrest, the survey questioned their awareness and attitudes, with a comparison of exogenous and non-exogenous patients. Results The proportion of respondents who have family present during resuscitation was 100 (25.0%) for exogenous and 105 (29.2%) for non-exogenous. The proportion who believed that the family’s acceptance of death is greater with FPDR was 255 (61.7%) for exogenous and 245 (65.7%) for non-exogenous. The proportion who believed that the family’s acceptance of death is greater with FPDR included a significantly higher number of respondents who had family present than in the proportion who believed that FPDR has no effect. The proportion who believed that the family is emotionally traumatized by FPDR was 251 (60.8%) for exogenous and 217 (58.2%) for non-exogenous. The proportion who believed that families are emotionally traumatized by FPDR included a significantly higher number of respondents who do not have family present than the proportion who believed that FPDR has no effect. Conclusion Various international resuscitation guidelines have recommended FPDR from an early stage to alleviate grief and prevent mental disorders. However, these guidelines are not always followed in Japan.

Increasing High-Value, Cost-Conscious Care Family Rounding Discussions Via an Educational Rounding Tool.

Family-centered rounds (FCR) are an important time to engage in high-value, cost-conscious care (HV3C) discussions. However, research suggests HV3C conversations occur in a minority of FCRs. Best-practice support tools can improve provider performance, but no research has evaluated whether an HV3C-focused tool may increase pediatricians' HV3C FCR discussions. This study aimed to assess if an educational and practice-based HV3C Rounding Tool's introduction would increase providers' HV3C FCR performance and competence. This study involved a hospitalist teaching service at a tertiary-care hospital. Evidence-based HV3C Rounding Tool and Quick Reference interventions were designed for use on FCRs, using a validated tool to measure baseline and postintervention HV3C performance. Underlying family, nursing presence/participation, and other factors' impacts upon HV3C performance were also explored. Anonymous baseline and postintervention surveys compared providers' perceived competence and comfort engaging families in HV3C discussions, as well as the tools' usefulness. Out of the 197 baseline and 157 intervention encounters recorded, the tools respectively increased from 3.8 to 5.8 HV3C performance measures addressed (P < .001), with 80% of performance measures showing significant improvement (P < .002). Aside from family presence for select performance measures, the tools had an independent, significant, positive effect upon HV3C performance. Users generally reported the tools as helpful and easy to use, noting significant increases in faculty role-modeling and trainee competence practicing HV3C. Introduction of HV3C Rounding and Quick Reference tools were generally perceived as helpful and beneficial, resulting in an increase of providers' HV3C discussions and care delivery during FCRs.

'Successfully' Aging 'Alone'?: Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally.

For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family tie. Such unprecedented shifts require a reevaluation of existing models of "successful aging", particularly in terms of long-term care policies. This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries. Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of "successful aging" opportunities in high income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated in higher income countries with lower within-country inequality. Aging "alone" is a risk factor in some contexts, yet a marker of privilege in others. Models of "successful aging" are largely unobtainable in lower income countries or high inequality countries, and therefore require a thorough incorporation of global realities, or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.

Screening for familial disease presence in first-degree relatives of Behçet's disease patients: Is measurement of common femoral vein wall thickness valuable for the diagnosis?

We aimed to assess first degree relatives (FDRs) of BD patients for the presence of clinical symptoms and signs of BD and evaluate common femoral vein (CFV) wall thickness measurement for the diagnosis. Patients with BD(n=129) and FDRs(n=230) of these patients were included. FDRs were questioned in terms of BD symptoms by phone. Pathergy test and CFV wall thickness measurement were performed among 111 FDRs who accepted the clinical assessment. Clinical assessment group were classified according to the criteria sets for BD. FDRs who did not meet the criteria sets and had at least one clinical finding in addition to oral aphthae(OA) were categorized as the "suspected BD". :We observed increased frequency of isolated BD manifestations in FDRs. Ten FDRs were diagnosed with BD during clinical evaluation. Significantly increased CFV wall thickness was observed in FDRs of BD patients fulfilling diagnostic BD criteria (p<0.001 for both sides) and also in those with suspected BD group (p<0.05 for both sides). Presence of OA, genital ulcer, folliculitis or erythema nodosum were associated with increased CFV wall thickness (p<0.05). . Our results suggest that CFV wall thickness measurement can be used in diagnosis of familial BD.

Family Presence During Resuscitation: Perspectives of Saudi Emergency Medicine Providers.

Background Family presence during resuscitation (FPDR) has been a long-debated topic in medical circles in the last 40 years. Studies usually concentrate on the opinions and responses of the family members of the patients being resuscitated. Only a handful of studies have focussed on the medical practitioner's opinions and beliefs on the topic. Hence, this study aimed to investigate opinions and beliefs regarding FPDR among emergency medicine practitioners (EMPs) in the Kingdom of Saudi Arabia. Methodology This was a self-filled, questionnaire-based study conducted among 450 EMPs across the Kingdom of Saudi Arabia. Proportions and subgroup analyses were conducted with respect to gender, experience, and seniority. EMPs were asked about the number of family members they would allow to attend the resuscitation of a patient under their care in different clinical scenarios. Results A total of 392 (87.1%) EMPs participated in this study. Overall, 64% (n = 250) of EMPs reported that they would not allow FPDR in cases that involved trauma, or if the patient being revived was female. This percentage dropped to about 33% (n = 129) when the patient being resuscitated was a child or in out-of-hospital arrest. The majority of EMPs believed that the decision to allow FPDR was the physician's decision (n = 251, 64.8%) and not the right of the family (n = 133, 34.7%). Moreover, emergency medicine board-certified physicians were more likely to allow FPDR in different cases with 19 (18.5%) in adult arrest cases, 18 (18%) in pediatric cases, and 16 (15.1%) in trauma cases, than non-board-certified practitioners (p = 0.001, 0.007, and 0.031, respectively). Female EMPs were more likely to refuse FPDR than their male counterparts (p < 0.001). Conclusions Approximately, 60-70% of EMPs allowed a member of the family to attend the resuscitation of their loved one. However, this percentage dropped in cases where the patient was a female, or the case was a trauma case instead of a medical case. Most Saudi EMPs believed that FPDR hurts the resuscitating team and might hinder the resuscitation efforts.

Morphology of arthropods discovered in pitchers of Nepenthes at Aceh Singkil District, Indonesia

Abstract. Tarigan MRM, Faisal M, Manalu K, Khairuna, Tambunan EPS, Rahmadina, Asy’ari H, Ritonga YE. 2024. Morphology of arthropods discovered in pitchers of Nepenthes at Aceh Singkil District, Indonesia. Biodiversitas 25: 2888-2900. Nepenthes plants create unique microhabitats and are home to diverse arthropod communities. These plants, known for their complex and specialized structures, attract various species of arthropods and contribute to the region's biodiversity. The study of arthropod morphology is critical to understanding the complex interactions within these microhabitats as well as broader ecosystem dynamics. Although this plant has great ecological importance and conservation significance, detailed morphological studies of the arthropods living on it are still rare. This study aimed to identify the families of arthropods trapped in the upper and lower pitchers of Nepenthes. This study used descriptive methods to reveal the morphology of arthropods found in Nepenthes pitchers in Aceh Singkil District, Indonesia. Arthropods were obtained from the upper and lower pitchers of N. ampullaria, N. gracilis, N. mirabilis, N. rafflesiana, N. reinwardtiana, N. x hookeriana, and N. x trichocarpa. Samples were obtained through direct observations conducted between October to December 2023. The results showed the presence of arthropod families, namely Culicidae, Formicidae, Gryllidae, Calliphoridae, Coccinellidae, Curculionidae, Rhyaparochromidae, Blattellidae, Salticidae, and Araneidae. However, Culicidae and Formicidae were observed to be the most abundant and Gryllidae was observed to be the least abundant. A mutualistic symbiosis was established, in which ants used the tendrils of Nepenthes to lay eggs and collected nectar generated by the honey glands, while the egg-laying process helped in the breakdown of the pitcher. This discovery suggests that the plants provided a habitat for Culicidae and a conducive environment for Formicidae larvae. However, Araneidae, Rhyparochromidae, Salticidae, Curculionidae, and Coccinellidae are not attracted to petals and peristomes. Gryllidae and Blattellidae were present in Nepenthes pitchers as a result of their close association with the plant and UV color-trapping mechanism. The study of the morphology of arthropods found in Nepenthes pitchers has several overall implications. First, it contributes to our understanding of ecological interactions in Nepenthes plants, providing insight into predator-prey dynamics, nutrient cycling, and plant evolution. Second, it underscores the importance of Nepenthes plants as a microhabitat that supports diverse arthropod communities, and highlights the ecological role of arthropods in nutrient-poor environments. This research also informs conservation efforts, emphasizing the need to protect Nepenthes plant habitat to maintain biodiversity.

Simulation intervention related to family presence during resuscitation for physicians and medical students: A scoping review.

Family presence during resuscitation (FPDR) is known as part of family-centered care. However, it is unknown or how physicians are educated for FPDR. We aim to review the current status of simulation related FPDR for physicians and medical students. A scoping review of literature published from 1999 to May 5 2023 and written in English was undertaken. The articles were searched for using keyword combinations of the following words; family, resuscitation, and simulation-related words. Eight articles were included in the final review. This review of FPDR simulation for physicians and medical students revealed findings in three categories; measuring CPR quality, investigating participant responses after FPDR simulation, and extracting exemplar good communication elements. First, in four studies measuring resuscitation quality, physicians participated in adult resuscitation, and resuscitation quality was reduced with overt reaction family presence. Second, in three studies investigating the response to simulation training, interprofessional teams participating in pediatric resuscitation had negative responses to FPDR simulation. Third, in one study, good communication elements during FPDR were found in infant simulation, in which interprofessional teams participated. FPDR simulation training for medical students has not been reported. It highlighted a gap in FPDR simulations involving physicians and/or medical students. Physicians were more concerned with resuscitation quality than supporting families during resuscitation simulations. Medical students should be considered as the main participants for FPDR simulation. More high-evidence studies with interprofessional teams including physicians and/or medical students are needed to evaluate curriculum design and participant response changes following FPDR simulation.

A survey of nurses' experiences with patient visitation restrictions during the COVID-19 pandemic.

To characterize nurses' experiences of restrictive visitation during the COVID-19 pandemic. In early 2023, an exploratory study investigated professional RNs' perceptions of restrictive visitation policies and end-of-life care during the COVID-19 pandemic, focusing on experiences between March and September 2020. An 11-question online survey containing qualitative and quantitative elements was sent to postlicensure nursing students and alumni of American Public University System (American Military University/American Public University). Among the 41 survey respondents (response rate of 4%), 75.6% observed patients dying alone due to visitation restrictions during March-September 2020, with 87.8% noting strict no-visitation policies, yet only 10% found it effective. A majority (68.3%) supported allowing some family presence, reflecting negative sentiments toward strict policies; suggestions for enhancing family involvement included technology (78%) and employing volunteers or liaisons (34.1%) to improve patient/family well-being and alleviate nurse burden. The findings revealed insights into nurses' experiences and perspectives on end-of-life care and visitation limitations during the pandemic. While the isolation of patients during times of strict visitation restrictions has some merit, exploring options for modified family visitation at the end of life is critical.

From the waiting list to the transplanted heart: a qualitative approach to emotions, feelings, and coping strategies

Abstract Introduction Living with a complex disease such as heart failure (HF) can influence the functional and emotional capacity of individuals, compromising their quality of life. Furthermore, it is a progressive disease that can result in the final route of treatment, which is heart transplantation (HT), and the patient suffers an impactful change in health and disease status that can generate different emotions and feelings. A stressful factor can interfere with the way an individual deals with situations and this can result in negative behavior that harms themselves, their quality and meaning in life. Understanding emotions, and feelings and being able to deal with emotions are fundamental practices for coping with the disease and maintaining quality of life. Objective To identify the emotions, feelings, and coping strategies of patients who are on the waiting list for an HT and those who have already received the graft. Method Qualitative and exploratory research was conducted with 3 patients on the waiting list and 3 HT patients undergoing outpatient follow-up in a Brazilian public hospital. The Symbolic Interactionism was used as a theoretical framework. Data collection was carried out through a semi-structured interview with the following triggering questions: "How do you feel when you think about Heart Transplantation?", and "What do you usually do to deal with these emotions and feelings?", "Is the way you deal with these emotions ideal for you?" The interview was recorded in audio, and transcribed in full and the data was subjected to content analysis consisting of 03 phases: I) Pre-exploration; II) Selection of analysis units; III) Categorization and subcategorization. Results The emotions mentioned by patients on the HT waiting list were fear, anger, and surprise and the feelings were hope, melancholy, and disappointment. The coping strategies of this group were religious belief, support from family and friends, or even introspection and resignation to the disease. Heart transplant patients reported emotions such as joy and sadness, and feelings such as gratitude and loneliness. The beliefs, the presence of family and friends, psychiatric support, and carrying out work activities were reported as ways of dealing with loneliness and sadness. Regarding self-perception of emotional management, both groups reported an adequate approach when they can rely on beliefs/family/friends. Conclusion Patients on the waiting list or who have already undergone an HF experience a duality of emotions and feelings characterized by fear, anger, surprise, joy, sadness, hope, melancholy, disappointment, gratitude, and loneliness, respectively. These findings contribute to the development of new tools that enable specific management of these emotions and feelings that emerge in patients who experience the context of HF.

New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care.

In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days. The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC. This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units. The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.

Voices Unheard: A Reflective Lifeworld Research Study of Older Arabic-Speaking Female Migrants and Their Experience of Existential Loneliness.

Existential loneliness (EL) is an unavoidable, deeper sense of loneliness. EL has been described as disconnection from life and the universe, experienced even in the presence of family and friends. Meaninglessness, loss of health and significant others seem to trigger older persons EL. Older Arabic-speaking women are a large migrant group in Sweden and there is a lack in knowledge about their experience of EL. Therefore, this study aimed to describe the phenomenon of EL as experienced by older Arabic-speaking female migrants. This study was based on a phenomenological approach known as reflective lifeworld research (RLR). Ten older migrated Arabic-speaking women were included in the study. Lifeworld interviews were conducted to collect data. The data were analysed in accordance with the phenomenological RLR principles of openness, flexibility and bridling. This study shows that EL is experienced when there is a lack of attachment to place and people. EL is experienced more distinctively in the beginning of the migration process. It was difficult sharing feelings of EL with anyone. Feelings of meaninglessness occurred when entering a new lifeworld and triggered EL. EL was however attenuated when being able to practise their religion. Lack of attachment to place and people as well as feelings of meaninglessness brought existential loneliness to the fore for the older Arabic-speaking female migrants. There was a collision of lifeworlds not at least by the fact moving as a Muslim woman to one of the most secular countries in the world. Practising their religion attenuated their EL. To promote better health for this group of women, it is of importance to be aware of EL and its mode of expression. It is crucial to let the voice of older Arabic-speaking female migrants be heard and to be aware of their experience of EL and its mode of expression in order to promote better health. Further, educational training for nursing professionals and nursing students needs to be provided to develop skills how to be aware of and address EL.

Factors Associated With Quality-of-Dying-and-Death Classes Among Critically Ill Patients

Improving end-of-life care in the intensive care unit (ICU) is a priority, but clinically modifiable factors of quality of dying and death (QODD) are seldom identified. To comprehensively identify factors associated with QODD classes of dying ICU patients, emphasizing clinically modifiable factors based on the integrative framework of factors associated with for bereavement outcomes. This observational cohort study was conducted at medical ICUs of 2 Taiwanese medical centers from January 2018 to March 2020 with follow-up through December 2022. Eligible participants included primary family surrogates responsible for decision making for critically ill ICU patients at high risk of death (Acute Physiology and Chronic Health Evaluation II score >20) but who survived more than 3 days after ICU admission. Data analysis was conducted from July to September 2023. QODD was measured by the 23-item ICU-QODD questionnaire. Factors associated with patient membership in 4 previously determined QODD classes (high, moderate, poor to uncertain, and worst) were examined using a 3-step approach for latent class modeling with the high QODD class as the reference category. A total of 309 family surrogates (mean [SD] age, 49.83 [12.55] years; 184 women [59.5%] and 125 men [40.5%]) were included in the study. Of all surrogates, 91 (29.4%) were the patients' spouse and 66 (53.7%) were the patients' adult child. Patient demographics were not associated with QODD class. Two family demographics (age and gender), relationship with the patient (spousal or adult-child), and length of ICU stay were associated with QODD classes. Patients of surrogates perceiving greater social support were less likely to be in the poor to uncertain (adjusted odds ratio [aOR], 0.89; 95% CI, 0.83-0.94) and worst (aOR, 0.92; 95% CI, 0.87-0.96) QODD classes. Family meetings were associated with the poor to uncertain QODD class (aOR, 8.61; 95% CI, 2.49-29.74) and worst QODD class (aOR, 7.28; 95% CI, 1.37-38.71). Death with cardiopulmonary resuscitation was associated with the worst QODD class (aOR, 7.51; 95% CI, 1.12-50.25). Family presence at patient death was uniformly negatively associated with the moderate QODD class (aOR, 0.16; 95% CI, 0.05-0.54), poor to uncertain QODD class (aOR, 0.21; 95% CI, 0.05-0.82), and worst QODD class (aOR, 0.08; 95% CI, 0.02-0.38). Higher family satisfaction with ICU care was negatively associated with the poor to uncertain QODD class (aOR, 0.93; 95% CI, 0.87-0.98) and worst QODD class (aOR, 0.86; 95% CI, 0.81-0.92). In this cohort study of critically ill patients and their family surrogates, modifiable end-of-life ICU-care characteristics played a more significant role in associations with patient QODD class than did immutable family demographics, preexisting family health conditions, patient demographics, and patient clinical characteristics, thereby illuminating actionable opportunities to improve end-of-life ICU care.

Barriers, Solutions, and Opportunities for Adapting Critical Care Clinical Trials in the COVID-19 Pandemic

The COVID-19 pandemic created unprecedented challenges for clinical trials worldwide, threatening premature closure and trial integrity. Every phase of research operations was affected, often requiring modifications to protocol design and implementation. To identify the barriers, solutions, and opportunities associated with continuing critical care trials that were interrupted during the pandemic, and to generate suggestions for future trials. This mixed-methods study performed an explanatory sequential analysis involving a self-administered electronic survey and focus groups of principal investigators (PIs) and project coordinators (PCs) conducting adult and pediatric individual-patient randomized trials of the Canadian Critical Care Trials Group during the COVID-19 pandemic. Eligible trials were actively enrolling patients on March 11, 2020. Data were analyzed between September 2023 and January 2024. Importance ratings of barriers to trial conduct and completion, solutions employed, opportunities arising, and suggested strategies for future trials. Quantitative data examining barriers were analyzed using descriptive statistics. Data addressing solutions, opportunities, and suggestions were analyzed by qualitative content analysis. Integration involved triangulation of data sources and perspectives about 13 trials, synthesized by an interprofessional team incorporating reflexivity and member-checking. A total of 13 trials run by 29 PIs and PCs (100% participation rate) were included. The highest-rated barriers (on a 5-point scale) to ongoing conduct during the pandemic were decisions to pause all clinical research (mean [SD] score, 4.7 [0.8]), focus on COVID-19 studies (mean [SD] score, 4.6 [0.8]), and restricted family presence in hospitals (mean [SD] score, 4.1 [0.8]). Suggestions to enable trial progress and completion included providing scientific leadership, implementing technology for communication and data management, facilitating the informed consent process, adapting the protocol as necessary, fostering site engagement, initiating new sites, streamlining ethics and contract review, and designing nested studies. The pandemic necessitated new funding opportunities to sustain trial enrollment. It increased public awareness of critical illness and the importance of randomized trial evidence. While underscoring the vital role of research in society and drawing the scientific community together with a common purpose, the pandemic signaled the need for innovation to ensure the rigor and completion of ongoing trials. Lessons learned to optimize research procedures will help to ensure a vibrant clinical trials enterprise in the future.

The effect of multisector integration communication on empowerment in rural areas

Background: Empowering impoverished communities has been a long-standing endeavor. However, the persistent prevalence of poverty still affects approximately 25 million individuals (BPS, 2023). Nevertheless, the government continues its relentless efforts to minimize the presence of impoverished families. One of the strategies employed is the implementation of the Family Hope Program (PKH). PKH stands as a program that has effectively fulfilled its mission. Various research studies have been conducted to comprehend the processes, mechanisms, impacts, and societal implications. However, research exploring the cross-sectoral communication aspects, elaborating on the involvement of stakeholders and PKH implementers spanning multiple institutions, remains lacking. Purpose: This research aims to measure the level of influence of multi-sectoral integration communication on the performance of individual PKH implementers. Methods: The employed methodology is an explanatory survey. The surveyed population comprises civil servants engaged in PKH. The population size consists of 80 individuals. Probability sampling is utilized as the sampling technique, with a sample size of 44 respondents, determined using the Slovin method. Hypothesis testing employs Path Analysis. Results: The research findings indicate a significant influence of cross-sectoral communication factors, encompassing organizational member perceptions, organizational strategies, communication climate, media quality, information accessibility, information dissemination, information accuracy, and organizational culture, on the performance of individual PKH implementers. Conclusion: Organizational member performance emerges as a critical aspect for the success of PKH implementation. The research results demonstrate that this performance is influenced by several factors, including information accessibility, media quality, information accuracy, organizational communication climate, organizational culture, information dissemination, and organizational strategies in the execution of the PKH program. Implications: The success of PKH is contingent upon the performance of individual members from collaborating institutions. Enhancing the effectiveness and efficiency of individual performance factors can be achieved by synergizing with cross-sectoral communication components.

Identification of a biomarker for Bacillus thuringiensis strains with high toxicity against Spodoptera frugiperda based on insecticidal gene linkage analysis.

Bacillus thuringiensis (Bt) is a Gram-positive bacterium that produces various insecticidal proteins used to control insect pests. Spodoptera frugiperda is a global insect pest which causes serious damage to crops, but bio-insecticides currently available to control this pest have limited activity and so new ones are always being sought. In this study we have tested the hypothesis that a biomarker for strain toxicity could be found that would greatly facilitate the identification of new potential products. Using genomic sequencing data we constructed a linkage network of insecticidal genes from 1957 Bt genomes and found that four gene families, namely cry1A, cry1I, cry2A and vip3A, showed strong linkage. For 95 strains isolated from soil samples we assayed them for toxicity towards S. frugiperda and for the presence of the above gene families. All of the strains that showed high toxicity also contained a member of the vip3A gene family. Two of them were more toxic than a commercially available strain and genomic sequencing identified a number of potentially novel toxin-encoding genes. The presence of a vip3A gene in the genome of a Bt strain proved to be a strong indicator of toxicity towards S. frugiperda validating this biomarker approach as a strategy for future discovery programs. © 2024 Society of Chemical Industry.

Psychological Distress Among High School Students in Bangkok Thailand.

This study investigated psychological distress among high school students in Thailand.A sample of 8,345 students from thirty-five Bangkok schools voluntarily participated, responding to a questionnaire and undergoing stress assessments. Socio-demographic factors including grade level, school scale, hometown, parental marital status, presence of siblings, gender, health conditions, online classes, and family monthly income were analyzed. Of the participants, 1,087 (13.02%) experienced psychological distress. Grade level, school scale, hometown, parental marital status, and siblings' presence showed no significant associations with distress. However, being female or transgender correlated with higher distress levels. Students with health issues and those in online classes also experienced elevated distress. Additionally, a family monthly income below 10,000 Thai Baht was associated with distress. This study sheds light on factors contributing to psychological distress in high school students. It highlights the need for tailored support for vulnerable groups within the student population, emphasizing the role of educators, policymakers, and mental health professionals in addressing these challenges.

Exploring the Botanical Origins of Bee-Collected Pollen: A Comprehensive Historical and Contemporary Analysis.

Bee-collected pollen is one of the most important bee products. In order to predict its chemical composition and nutritional value botanical origin of pollen plays a crucial role. This review intended to collect all available data published about botanical origin of pollen collected all around the world. Due to enourmous amount of data and variables nonlinear principal component analysis (NLPCA), by applying Categorical Principal Component Analysis (CATPCA), was conducted in order to try to determine any specifity and/or differences among samples. Also, importance of some plant families/genera/species for bees was monitored. Based on CATPCA results families can serve in order to distinct samples from North/South America. Also, some samples from Europe (Turkey and Serbia) were characterized with presence of some specific families. Genera were excellent tool to distinguish samples from different parts of Brazil as well as Australia, Asia and Africa. Due to high and specific biodiversity pollen samples obtained from Sonoran desert (USA) completely were separated during analysis. This review presents the first attempt to summarize and classify a large number of data about botanical sources of bee-collected pollen.

Fair play in family firms: examining the perceived justice of performance management systems

PurposeThis study examines the intricate relationship between family influence and perceived justice in performance management systems within family firms. Recognizing the unique dynamics that family ownership brings to human resource practices, the research aims to delineate how family presence affects both the process and the perception of fairness in performance evaluations.Design/methodology/approachUsing a conceptual framework, the research adopts a dual-method approach, combining a comprehensive literature review with theoretical modeling. The study synthesizes existing research and theoretical insights to explore the effects of family influence on the perceived fairness of performance management practices.FindingsThe findings reveal that family influence profoundly shapes fairness perceptions in performance management, impacting family and non-family employees. It affects systems' design, implementation and reception, with mechanisms including resource distribution and criteria alignment. Specifically, family influence molds fairness perceptions within the performance management process, enhancing organizational performance and fostering trust in family businesses, thus supporting sustainable growth.Originality/valueThis study contributes to the family business and human resource management literature by providing a nuanced understanding of how family dynamics influence perceptions of justice in performance management. It underscores the dual role of family influence in enhancing and complicating fairness perceptions, thus offering a balanced view that can inform academic research and practical HR management in family firms.

Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019-2020.

To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices. A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168). Six PICUs in the United States. One thousand sixty-four patients who were admitted to a PICU for 3 or more days. None. Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates. In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.