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Dementia as a Critical Lens on The Role of Narrative in Medical Training and Practice
No full textNarrative holds an important place within medicine and medical education, but an uncritical use of narrative can have troubling consequences for the care of patients who have limited or no capacity for self-narration, such as those living with dementia. We argue that the guiding principles in the use of narrative within medicine and medical education must be inclusivity and opportunity. We illustrate how medical training can benefit from a more inclusive definition of narrative, and we present a selection of innovative approaches to narrative coming out of literary studies, narrative gerontology, and medical and health humanities that focus on metaphor, embodied selfhood, and critical methods for teaching narrative in medical education. These approaches provide opportunities for medical and health humanities to shape the use of narrative in clinical spaces in critical ways that include and empower more individuals, including medical professionals
TRUE-BSG: A True Random Bit-Stream Generator for Fast and Efficient Stochastic Computing
Full text linkStochastic computing (SC) leverages random bitstreams to perform arithmetic operations, offering ultra-lowcost, fault-tolerant, and highly parallelizable computations. The quality of these bit-streams is crucial for the accuracy and reliability of SC. This paper introduces TRUE-BSG, a novel true random bit-stream generator designed for fast and energyefficient SC. Unlike state-of-the-art (SoTA) pseudo-random and quasi-random bit-stream generators, TRUE-BSG utilizes a highquality true random number generator (TRNG), capable of producing random bits at a rate of 1 Gigabit per second. Our TRNG ensures high entropy and minimal correlation. TRUE-BSG shows comparable accuracy to software-based generators and better energy efficiency than SoTA bit-stream generators, making it an ideal solution for resource-constrained devices
An Experimental Investigation on the Effect of Laser Energy Deposition in an Over-Expanded Jet
Full text linkThis experimental investigation focuses on understanding the influence of perturbations due to short-duration energy deposition on the shock train structure and flow dynamics in an axisymmetric over-expanded Mach 2.52 jet. The flow is perturbed by localized laser-induced breakdown at various locations within the jet, creating a shock wave and a high-temperature plasma zone in the shock train. A high-speed self-aligning focusing schlieren system is used to visualize the flow and characterize the shock train dynamics and the flow structure recovery process by measuring the distance to the first shock reflection point from the nozzle exit. The response of the jet flow is similar for cases with the perturbation at the nozzle exit and the pre-reflection point across a range of jet total pressures, but the response is qualitatively different when the perturbation occurs downstream of the first shock reflection in the jet, with the flow structures being forced upstream toward the nozzle. The frequency of the oscillations of the shock height is found to be the same for all cases, approximately 10 kHz, independent of the jet total pressure, laser energy, and deposition location. The oscillations reduce in magnitude over time, and the damping ratio for cases with the energy deposition at the pre-reflection point and nozzle exit is found to be nearly constant with respect to jet total pressure and deposition energy, varying within the range of 0.06–0.12, whereas it is dependent on the jet chamber pressure for the post-reflection case, varying from 0.07 to 0.14
Engaged Employees Deliver Returns: Evidence on Financial Performance from Spain
Full text linkDoes investing in your employees create long-term value? Although many firms pursue employee-focused policies, studies show little agreement on which specific dimensions of employee satisfaction yield sustainable financial performance. Building on Edmans (2011), who linked employee satisfaction to superior stock performance in the United States, this study turns to the Spanish market. Using 15 years of data from Actualidad Económica—Spain’s most recognized benchmark for employee satisfaction—we apply Herzberg’s (1968) two-factor theory to distinguish between motivators, such as sense of belonging, talent management, and training, and hygiene factors, like compensation and work environment. Applying a Carhart (1997) four-factor model, we find that only motivator dimensions are consistently associated with significant risk-adjusted excess returns. Notably, companies scoring highest in sense of belonging deliver annual excess returns exceeding 10%, reinforcing the financial materiality of employee beliefs and identification with the organization. This result is consistent with findings by Gartenberg et al. (2019). In contrast, hygiene factors (i.e., compensation and work environment) show limited effects on long-term performance. These findings suggest that the path to sustained financial value lies in fostering cultural alignment, meaningful connection, and developmental opportunities at work, rather than focusing on buying talent or having the most employee-friendly policies
Development of a Self-Management Tool for Individuals With Seizure Clusters: Trial Design and Methodological Report
No full textBackground: Despite advances in anti-seizure medications (ASMs) for people with epilepsy (PWE), adverse outcomes, negative health events (NHEs), and breakthrough seizures remain common. Rescue medication (RM) can better manage repetitive seizures, but barriers to RM use persist. Self-management for PWE and a history of NHEs (SMART) is an evidence-based epilepsy self-management program aimed at reducing barriers and maximizing facilitators to self-care in high-risk PWE. Methods: This 2-phase, ongoing clinical trial adapts SMART to integrate RM support for PWE with repetitive seizures. Phase 1, now completed, used input from an advisory board (AB) of PWE, caregivers, and clinicians to adapt the SMART curriculum to include diazepam nasal spray, an RM. Phase 2 will test the adapted curriculum (SMART-RM) in a 6-month prospective trial among adult PWE, measuring seizure counts from baseline to 6-month follow-up. Secondary outcomes include changes in quality of life, NHEs, functional status, and depression severity. Results: The AB for Phase 1 enrolled 6 individuals: 2 PWE, 2 caregivers, and 2 clinicians. Participants endorsed the need for evidence-based epilepsy self-management curricula that include RM support and positively reviewed the SMART curriculum\u27s format and duration. Additional content requests included: 1) A seizure action plan with RM, 2) RM education for caregivers, 3) Customized care plans for PWE to support caregivers, 4) An RM-specific goal template, and 5) A template for RM-related discussion topics with care providers. Conclusions: Integrating RM into an evidence-based epilepsy self-management curriculum offers a comprehensive care package with potential to improve care for PWE with seizure clusters
Super-Resolution Imaging Reveals Resistance to Mass Transfer in Functionalized Stationary Phases
No full textChemical separations are costly in terms of energy, time, and money. Separation methods are optimized with inefficient trial-and-error approaches that lack insight into the molecular dynamics that lead to the success or failure of a separation and, hence, ways to improve the process. We perform super-resolution imaging of fluorescent analytes in five different commercial liquid chromatography materials. Unexpectedly, we observe that chemical functionalization can block more than 50% of the material’s porous interior, rendering it inaccessible to small-molecule analytes. Only in situ imaging unveils the inaccessibility when compared to the industry-accepted ex situ characterization methods. Selectively removing some of the functionalization with solvent restores pore access without substantially altering the single-molecule kinetics that underlie the separation and agree with bulk chromatography measurements. Our molecular results determine that commercial “fully porous” stationary phases are overfunctionalized and provide an alternative avenue to characterize and direct separation material design from the bottom up
Electrochemically-Assisted Low Power Density Laser Writing on Stainless Steel via Enrichment of Chromium Oxides
No full textLaser color marking produces nearly permanent, environmentally friendly, vibrant colors on surfaces. However, previous work has used high-power-density pulsed lasers to induce the physicochemical reactions for marking. Here, laser color marking on stainless steel 304 (SS304) is performed with a less expensive continuous wave (CW) laser and a power density five orders of magnitude below that previously reported by combining an electrochemical cell with a fluorescence microscope. Using a combination of optical microscopy, x-ray photoelectron spectroscopy, and bulk electrochemistry, it is demonstrated that the laser-induced luminescence and colors are due to enrichment (32 ± 9% increase) of Cr2O3 in the SS304 passive film. It is shown that the enrichment proceeds by a different chemical mechanism than the oxygen pyrolysis that occurs in typical laser color marking. The technique provides a new pathway for laser color marking of metals in industrial settings with applications as diverse as solar absorbers or corrosion prevention
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