The Unspeakable Nature of Death & Dying During Childhood: A Silenced Phenomenon in Pediatric Care

In pediatric settings, the concept of hope is frequently positioned as a fundamental aspect of care and at odds with the possibility and proximity of death. This arguably fosters silence about death and dying in childhood despite evidence indicating the benefits of open communication at the end of life. In this paper, we describe the unspeakable nature of death and dying in childhood, including its conceptual and clinical causes and dimensions, its persistence, and the associated challenges for children and youth facing critical illnesses, their families, and society. We explore how the tension between hope and death can be reframed and apply our analysis to the context of medical assistance in dying for mature minors in Canada. Considering the lack of related literature, this paper offers initial reflections to form a framework for the unspeakable nature of death and dying in childhood and to advance the crucial need for research.

Derived blockchain architecture for security-conscious data dissemination in edge-envisioned Internet of Drones ecosystem

Internet of Drones (IoD) facilitates the autonomous operations of drones into every application (warfare, surveillance, photography, etc) across the world. The transmission of data (to and fro) related to these applications occur between the drones and the other infrastructure over wireless channels that must abide to the stringent latency restrictions. However, relaying this data to the core cloud infrastructure may lead to a higher round trip delay. Thus, we utilize the cloud close to the ground, i.e., edge computing to realize an edge-envisioned IoD ecosystem. However, as this data is relayed over an open communication channel, it is often prone to different types of attacks due to it wider attack surface. Thus, we need to find a robust solution that can maintain the confidentiality, integrity, and authenticity of the data while providing desired services. Blockchain technology is capable to handle these challenges owing to the distributed ledger that store the data immutably. However, the conventional block architecture pose several challenges because of limited computational capabilities of drones. As the size of blockchain increases, the data flow also increases and so does the associated challenges. Hence, to overcome these challenges, in this work, we have proposed a derived blockchain architecture that decouples the data part (or block ledger) from the block header and shifts it to off-chain storage. In our approach, the registration of a new drone is performed to enable legitimate access control thus ensuring identity management and traceability. Further, the interactions happen in the form of transactions of the blockchain. We propose a lightweight consensus mechanism based on the stochastic selection followed by a transaction signing process to ensure that each drone is in control of its block. The proposed scheme also handles the expanding storage requirements with the help of data compression using a shrinking block mechanism. Lastly, the problem of additional delay anticipated due to drone mobility is handled using a multi-level caching mechanism. The proposed work has been validated in a simulated Gazebo environment and the results are promising in terms of different metrics. We have also provided numerical validations in context of complexity, communication overheads and computation costs.

Case Report: Stem cell therapy in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease leading to loss of upper and lower motor neurons at both spinal and bulbar levels. For patients with ALS rehabilitation is important to maintain functional independence, ensure safety and optimize quality of life but is not curative. Stem cell therapy (SCT) provides a new approach to treat previously incurable diseases although peer reviewed published evidence has shown no benefit in ALS for slowing disease progression or functional loss. This case report presents a patient with ALS who underwent SCT but deteriorated rapidly after the procedure. Whether the deterioration was due to the natural progress of the disease or expedited by SCT remains unknown. The ethical considerations of how marketing influences healthcare and individuals’ decisions in desperate situations along with reasons for taking desperate measures are discussed. Patient education and open communication with ALS patients are imperative in gaining patient satisfaction and overcoming ill effects that marketing could have on unconventional methods of intervention. Raising awareness about the availability and access to multidisciplinary care, the timing of decisions with regards to symptom management and end of life care have proven to enhance the quality of life for such patients.

Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities

Background and Objectives Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. Research Design and Methods Descriptive qualitative study using framework analysis applied to open-ended semi-structured interviews (n=28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from three SNFs in the Eastern U.S. (Massachusetts and North Carolina). Results Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. Discussion and Implications Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.

Place Brand Co-Creation through Storytelling: Benefits, Risks and Preconditions

Co-creation in place branding is used as an umbrella term for the complex brand meaning emerging through stakeholders’ participation in place activities, their contribution, collaborations and interchange of ideas and resources. Co-creation is often an aspiration for places to create and promote their brands collectively. In this context, storytelling—an old technique used in corporate marketing to instigate brand stakeholders’ participation—serves as a method which facilitates place brand co-creation through shared place stories. With the rise of online interactions, the chances of place stakeholders’ participation in brand meaning creation increase, and place stories are effective in allowing diverse place meanings to emerge from various stakeholders. However, when storytelling emerges as a marketing tactic, mostly from a top-down campaign, the stories are not always accepted by all place stakeholders, and they create contrasting brand meanings. The paper aims to investigate the benefits and risks of participation in “Many Voices One Town” (2018), a top-down campaign from Luton, UK, which used storytelling to instigate place brand co-creation. The campaign was created by the Luton Council with an external advertising agency. The campaign attempted to tackle the town’s segregation issues and foster community cohesion through the promotion of seven selected Lutonians’ stories about their diverse and multicultural experiences of living in Luton. The study employs a qualitative methodology to analyse the MVOT case study. Interviews with the council and participants in the campaign and netnographic data from Twitter, Facebook and Instagram were used to gain an insight into residents’ participation in a top-down approach and examine the outcomes of co-creation. Residents’ participation in such a campaign shows numerous benefits but also risks for the place brand. The findings show that participation can sometimes intensify disputes about the town if people’s needs are not properly addressed. The study highlights the importance of open communication between all parties involved in the process, bringing into focus the need for careful coordination of top-down initiatives in line with stakeholders’ needs. It also demonstrates the ‘power of the people’ in the sense that stakeholder engagement with the shared stories led to negative outcomes that were not predicted by the Council.

Novel use of a sequential standardized oral board exam to assess PGY1 resident progression

Purpose A standardized oral board exam was created to longitudinally assess postgraduate year 1 (PGY1) pharmacy residents in key domains. Summary We provide a descriptive review of a novel oral board exam administered quarterly to our PGY1 pharmacy residents. Preceptors from our core rotations (internal medicine/infectious diseases, adult critical care, oncology, pediatrics, and administration/health policy and outcomes) developed questions based on situations commonly encountered by PGY1 residents to assess residents’ communication; the content of their response, assessment, and plan; and coachability. Over the 4-year history of this assessment, scoring has matured to consider whether a resident has or has not met or has exceeded expectations for a PGY1 resident at a given stage in their training. Our comprehensive feedback and action planning approach included residents’ self-assessment, feedback from the exam committee, development and implementation of a customized training plan for execution, and dissemination to our preceptors. Systematically assessing our PGY1 residents with this innovative method provided a process for tracking their performance and served as a baseline for those who completed additional training at our institution. Conclusion A standardized quarterly oral board exam was developed to identify residents’ strengths and areas for improvement at established periods during the PGY1 residency training program. This standardized assessment, paired with individualized action plans and open communication with key stakeholders, stimulated development in residents’ performance, communication, and interpersonal skills. We aim to expand this system’s application to identify predictors of success for candidates we interview for our postgraduate training programs.

THE ECOLOGICAL COMPONENT OF POLITICAL COMMUNICATION OF MODERN STUDENTS

The article analyzes the process of formation in the academic environment of a higher educational institution of the desire to expand and diversify communication channels, which is significant from the standpoint of achieving the goals of sustainable development in the field of education. It is shown that one of the most accessible and open communication channels is ecological. This is due to the peculiarities of the very ecological approach to education and upbringing, which contributes to the involvement of students in the protection of nature, as well as the fact that this channel opens up opportunities for transition to other areas, including political communication.

Family Strength During the COVID-19 Pandemic in Indonesia

Research on family strength is growing. Limited work has been studied about family strength during the COVID-19 pandemic in Indonesia. This qualitative online survey studied on 65 participants, aged 27–57 years (M = 40.85, SD = 6.8), to explore the characters of Indonesian family strength during the COVID-19 pandemic. Qualitative data were analyzed thematically. This research discovered eight characters of Indonesian family strength, namely:(1) intense and open communication, (2) intimacy and time together, (3) cooperation and division of roles, (4) finding solutions to problems, (5) implementing health protocols, (6) financial stability, (7) religiosity/spiritual well-being, and (8) grateful and optimistic. These eight characters coupled with two other areas, (9) self-development, and (10) concern for the needs of others, become 10 areas that growing up in families during the pandemic. These findings highlight the importance of focusing on characters of family strength when facing crises and uncertainties.

Komunikasi Interpersonal Keluarga sebagai Penunjang Kesehatan Mental Mahasiswa Rantau Asal Papua-Papua Barat

In this study, the researcher aims to find out how interpersonal communication in the family can support a person's mental health, especially overseas students. This study uses a qualitative method with a phenomenological approach, which focuses on telling the phenomenon of the role of family communication on student mentality, which is experienced directly by overseas students from Papua-West Papua. The results of this study show that communication plays a very important role in supporting one's mental health, especially overseas students who now have to study in a pandemic situation. Communication that supports this in the form of open communication and willing to listen. During this pandemic, some students chose to return to their hometowns, but some had to stay overseas due to certain conditions. Each student told a different experience, but more or less had something in common, namely feeling pressured or stressed with lectures. Through communication, students tend to feel their burden is reduced. Parental responses also build enthusiasm in students and provide strength, which reduces stress and helps students' mental health. The willingness of parents to hear stories and give positive words turned out to give students a feeling of comfort and relief.