Adolescents' views on oral health care and promotion in Norway: everyday practices, recommendations, and future visions.

Introduction: In this study, we aimed to understand adolescents' perspectives on oral health care and promotion. Our research was conducted in the context of Norway's oral health care system, where societal factors like income and education influence health disparities. Despite free public dental care for all residents younger than 19 years, challenges persist in promoting oral health among adolescents, a group whose oral health behavior and literacy remain largely unexplored. Materials and methods: A thematic analysis of an anonymized dataset from 80 adolescents aged 12-20 years was conducted. Results: Five central themes were recognized: (1) Feeling fresh vs. feeling indifferent: A broad spectrum of attitudes; (2) Bridging gaps, building habits: Collaborative efforts in oral care; (3) "Create good experiences at the dentist so people come back again"; (4) Requested qualities in oral health promoting solutions; (5) Reminder tools for everyday use. Taken together, these themes highlight adolescents' oral health practices and resources, recommendations for dental clinics, and visions for future oral health promotion. Discussion: Based on the results, the discussion highlights a need for tailored oral health promotion and ideas to reach adolescents in meaningful and effective ways. Reflections on the theme of social inequalities are provided.

Visions for planetary health: Results from open-ended questions of survey participants after a virtual planetary health lecture series.

INTRODUCTION: A profound transformation of all areas of human activities is urgently needed for planetary health. Developing a shared vision of the future that is grounded in values aligned with planetary health is indispensable in this regard. The Planetary Health Academy is the first open online lecture series in Germany aiming for transformative planetary health education. As part of a recent evaluation of the impact of the lecture series, participants' visions for planetary health were also examined. METHODS: As part of a retrospective, cross-sectional, self-administered online survey, participants were asked to respond to an open-ended question on their visions for planetary health. Results were analysed using summarising qualitative content analysis according to Mayring. Sociodemographic details of those participants who provided a valid answer (n = 197) were calculated. RESULTS: Eight main categories were developed to summarise participants' visions for planetary health. These were: Awareness for planetary health - Planetary health integrated in all types of education - Establishment and development of the concept - A different understanding of health (care) - A transformative movement and global community - Transforming human activities - Planetary health as a guiding principle - The future state of planetary health. DISCUSSION: Broadly, the participants' visions were about planetary health as a goal and the means necessary to achieve this goal. Our findings can only be seen as a first explorative step in eliciting aspects of a common vision for planetary health, as our study design did not include a mechanism of building consensus towards one common vision. Besides the field of planetary health, similar concepts and associated movements exist or are emerging. Facilitating dialogue and exchange across disciplines and narratives about the prevailing future visions will be key to achieving what we call planetary health and what others might call Ubuntu or buen vivir. CONCLUSION: The results of this study provide first insights into the planetary health visions of those whom we would consider members of a movement aligned behind the idea of planetary health. In future editions, the Planetary Health Academy could integrate more discursive elements with a particular focus on negotiating future visions to support the creation of a critical mass of change agents within the health community and beyond.

Is This a Deceased Loved One That I See Before Me or Am I Only Dreaming?

This article makes a case for examining dying person's visions during wakefulness and their dreams during sleep as separate and unique phenomena. The reason being that the mode of experience, for example, being visited by a deceased loved one while awake and conscious vs having a deceased loved one appear in a dream while asleep, may have a different impact on the dying person. A better understanding of the content and impact of waking visions and sleeping dreams, respectively, may be beneficial to both dying persons and their families.

Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey study.

AIM: This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. DESIGN: A cross-sectional survey study was conducted from February 2023 to May 2023. SETTING/PARTICIPANTS: Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia. RESULTS: Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care. CONCLUSION: Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT: Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care. REPORTING METHOD: This study was reported using the STROBE Checklist for cross-sectional studies.

Aligning agri-environmental-climate public good supply and desire in a sustainable Dutch agricultural sector.

European agricultural policies increasingly incorporate mechanisms for delivery of public goods. Sustainable public good delivery requires alignment between societal demand and landscape supply. However, the variation of demands or desires regarding future public good delivery among society is hardly known. We inventoried the desires for public goods across Dutch society, and projections of agricultural supply. A multi-method approach was used to find agreement levels between desired and expected change in good delivery. Most stakeholders expressed a desire for biodiversity and climate regulation from agriculture, whilst desire for natural heritage and recreation was less common. The utility of a public good to a stakeholder appears to influence its desire. Scenarios for agriculture focus on extensification, sustainable intensification, regionalization, or meadow bird conservation. Regionalized scenarios showed the highest agreement between public good supply and desire. Maximizing alignment between desire and supply thus requires a challenging transition towards region-specific agricultural sustainability strategies.

Patients' Dreams and Unreal Experiences During Intensive Care Unit (ICU) Hospitalization.

In the intensive care unit (ICU), patients often experience fragmented memories, primarily comprising dreams and illusions. These experiences can impact psychosocial well-being, correlating with post-traumatic stress symptoms and heightened anxiety. Understanding these phenomena is crucial for holistic care. To systematically explore patients' perspectives concerning the recollection of dreams and unreal encounters during their stay in the ICU, considering pertinent clinical conditions and potential influencing factors, we conducted a comprehensive search in the PubMed/MEDLINE, Web of Science, and Scopus databases until November 20, 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From an initial pool of 288 records, a thorough screening for eligibility resulted in the inclusion of nine studies for this systematic review. These selected studies underwent evaluation using either the Critical Appraisal Skills Programme (CASP) Qualitative Checklist or the Newcastle-Ottawa Scale (NOS). All studies categorized dreams into three main types: positive, distressing (including nightmares), and neutral experiences. These were further detailed based on aspects such as time, space, senses, emotions, and distinguishing between reality and unreality. Two studies found associations between dreams and conditions like Guillain-Barré syndrome (GBS), mental abnormalities, and delirium. In one study, GBS patients had more vivid dreams, hallucinations, and delusions compared to ICU control group patients; delirious patients tend to report more frequent frightening dreams. Patients in the ICU who recalled dreams often had more severe illness, longer stays, and higher ventilation frequency. Notably, a prolonged ICU stay significantly predicted the likelihood of dream recall, as consistently observed in three other studies. This suggests that patients with prolonged ICU stays, experiencing higher dream recall, underwent extended treatments. This systematic exploration of patients' perspectives on fragmented memories underscores the connections between these experiences, clinical conditions such as GBS and delirium, and extended ICU stays. Recognizing and attending to these psychological aspects in post-ICU care is critical for alleviating the enduring emotional consequences for patients.

Fully Memristive Elementary Motion Detectors for a Maneuver Prediction.

Insects can efficiently perform object motion detection via a specialized neural circuit, called an elementary motion detector (EMD). In contrast, conventional machine vision systems require significant computational resources for dynamic motion processing. Here, a fully memristive EMD (M-EMD) is presented that implements the Hassenstein-Reichardt (HR) correlator, a biological model of the EMD. The M-EMD consists of a simple Wye (Y) configuration, including a static resistor, a dynamic memristor, and a Mott memristor. The resistor and dynamic memristor introduce different signal delays, enabling spatio-temporal signal integration in the subsequent Mott memristor, resulting in a direction-selective response. In addition, a neuromorphic system is developed employing the M-EMDs to predict a lane-changing maneuver by vehicles on the road. The system achieved a high accuracy (> 87%) in predicting future lane-changing maneuvers on the Next Generation Simulation (NGSIM) dataset while reducing the computational cost by 92.9% compared to the conventional neuromorphic system without the M-EMD, suggesting its strong potential for edge-level computing.

Hospice Patients' End-of-Life Dreams and Visions: A Systematic Review of Qualitative Studies.

When conscious, about 50% to 60% of hospice patients report a "visitation" by someone who is not there while they dream or are awake: a phenomenon known as End-of-Life Dreams and Visions (ELDVs). Since the dying process is frequently complicated by delirium, ELDVs risk being misidentified as such by professionals and caregivers. To observe these phenomena from patients' perspectives, we conducted a systematic review to aggregate and synthesize the findings from the qualitative studies about ELDVs of patients assisted in hospices to indicate future directions for research and care. MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Scopus, and Web of Science databases were searched, yielding 293 documents after duplicates were removed. Six qualitative articles reporting on five unique studies conducted in hospice settings were included in the meta-synthesis. We generated three main categories: i) typologies of ELDVs reported, ii) emotional consequences, and iii) intersubjective meaning-making. The ELDVs reported were experiences that remained intimate and unsocialized and thus preventing participants from defining a shared sense in their relationships. Training healthcare professionals to recognize ELDVs and take advantage of them in the care relationship is desirable. We also encourage the patient's family members to listen and understand ELDVs when they occur actively. For caregivers to know how to interpret these phenomena may provide them with additional strategies for supporting, reassuring, and strengthening their relationships with their loved ones. The review allowed us to inform healthcare professionals and caregivers about how to help patients share their emotional and identity-related experiences and meaning-making in end-of-life.

Emerging Technologies for 6G Communication Networks: Machine Learning Approaches.

The fifth generation achieved tremendous success, which brings high hopes for the next generation, as evidenced by the sixth generation (6G) key performance indicators, which include ultra-reliable low latency communication (URLLC), extremely high data rate, high energy and spectral efficiency, ultra-dense connectivity, integrated sensing and communication, and secure communication. Emerging technologies such as intelligent reflecting surface (IRS), unmanned aerial vehicles (UAVs), non-orthogonal multiple access (NOMA), and others have the ability to provide communications for massive users, high overhead, and computational complexity. This will address concerns over the outrageous 6G requirements. However, optimizing system functionality with these new technologies was found to be hard for conventional mathematical solutions. Therefore, using the ML algorithm and its derivatives could be the right solution. The present study aims to offer a thorough and organized overview of the various machine learning (ML), deep learning (DL), and reinforcement learning (RL) algorithms concerning the emerging 6G technologies. This study is motivated by the fact that there is a lack of research on the significance of these algorithms in this specific context. This study examines the potential of ML algorithms and their derivatives in optimizing emerging technologies to align with the visions and requirements of the 6G network. It is crucial in ushering in a new era of communication marked by substantial advancements and requires grand improvement. This study highlights potential challenges for wireless communications in 6G networks and suggests insights into possible ML algorithms and their derivatives as possible solutions. Finally, the survey concludes that integrating Ml algorithms and emerging technologies will play a vital role in developing 6G networks.

Insights into the daily life of ventricular assist device coordinators: Outcome of an international questionnaire.

BACKGROUND: As the incidence of heart failure in developed countries is on the rise, mechanical circulatory support (MCS) often remains the only treatment option for patients with end-stage heart failure and is well established worldwide. Even though VAD coordinators play a key role in VAD programs, their responsibilities and daily duties are not clearly defined and characterized. Recently published data from the first 5-year multicenter clinical trial assessing experience with the HeartMate 3 left ventricular system (Abbott, Abbott Park, IL) show an overall survival of 61% at 5 years. When it comes to possible improvements to these systems, it is necessary for developers not only to know the status quo but also to determine and consider the visions and wishes of those individuals who take care of patients, provide education and deal with possible complications. This would be helpful a meaningful effort towards implementing a standard of care. METHODS: To fill this knowledge gap, we conducted an online survey using the SurveyMonkey tool, addressing representatives of programs implanting VADs worldwide. Representatives answered a standardized block of 14 questions and were asked to provide responses within 3 months. RESULTS: A total of 91 VAD coordinators from centers of various regions of the world completed the survey. The majority came from European countries. The numbers of patients followed up by the centers ranged from <20 to 390 patients. The majority of VAD coordinators had a nursing background (68%). Seventy-seven percent of the centers operate a 24-h hotline and 3-monthly visits to the outpatient department are most common. Fifty-nine percent of the centers do not use an infection scoring system for driveline wound care. The majority of the centers indicated that an optimized follow-up concept including wound care, medication, and social care is crucial and the key issue for an improved outcome. Smaller components and intensified psychosocial support ranked highest in questions about how to improve quality of life. Surprisingly, the future prospects of telemetric monitoring were not rated high in significance. CONCLUSIONS: There is a wide variability in the composition and tasks of VAD programs worldwide. Implementing a standard of care and improving psychosocial care as well as equipment is regarded most important to improve outcomes and quality of life. From the point of view of those responsible, the significance of telemetric monitoring seemed overrated.

[End-of-Life Dreams and Visions]. / Traum- und Wachvisionen am Lebensende.

End-of-Life Dreams and Visions Abstract: End-of life dreams and visions (ELDVs) or so-called death bed phenomena are transcendent experiences at the end of life that can be visual, auditory and/or kinesthetic, and often include visions of (deceased) loved ones, close friends or perceptions of places, travels, bright lights, or music. ELDVs typically occur weeks to hours prior to death and may comfort the dying and prepare spiritually for the end of life. Such experiences are frequently reported by dying individuals, the prevalence varying between 30 and 80%, but in the clinical context ELDVs are usually neglected, but interpreted and treated as pathological changes in the brain that result in, and from, delirium. This article tries to enlighten the occurrence, the contents and meanings of ELDVs in dying persons as opposed to delirium and night dreams using findings from the literature and from clinical observations. Implications of these conclusions for palliative care and the therapeutic relevance of ELDVs when taking care of dying individuals and their loved ones will also be discussed.

Deathbed Visions: Hospice Palliative Care Volunteers' Experiences, Perspectives, and Responses.

11 female hospice palliative care volunteers who had either witnessed and/or had patients or patients' family members tell them about deathbed visions (DBVs) were interviewed about their experiences, perspectives, and responses. The volunteers responded to a series of guiding questions and shared stories about their patients' DBVs. During the interviews, the volunteers talked about, among other things, the impact of DBVs on their patients and themselves, how they responded to their patients' DBVs, and their explanations for them. The most common visitors appearing in the deathbed vision stories shared by the volunteers were their patients' deceased family members (parents, siblings). The volunteers described their patients' visions as having largely positive (e.g., comforting) effects on the patients as well as having a positive impact on themselves (e.g., lessening their own fear of death). The volunteers did not initiate conversations about DBVs with their patients, but responded appropriately by listening, asking questions, and not being dismissive if the patient brought it up first. All volunteers provided spiritual as opposed to medical or scientific explanations for DBVs. The implications and limitations of the findings are discussed.

How Neurotech Start-Ups Envision Ethical Futures: Demarcation, Deferral, Delegation.

Like many ethics debates surrounding emerging technologies, neuroethics is increasingly concerned with the private sector. Here, entrepreneurial visions and claims of how neurotechnology innovation will revolutionize society-from brain-computer-interfaces to neural enhancement and cognitive phenotyping-are confronted with public and policy concerns about the risks and ethical challenges related to such innovations. But while neuroethics frameworks have a longer track record in public sector research such as the U.S. BRAIN Initiative, much less is known about how businesses-and especially start-ups-address ethics in tech development. In this paper, we investigate how actors in the field frame and enact ethics as part of their innovative R&D processes and business models. Drawing on an empirical case study on direct-to-consumer (DTC) neurotechnology start-ups, we find that actors engage in careful boundary-work to anticipate and address public critique of their technologies, which allows them to delineate a manageable scope of their ethics integration. In particular, boundaries are drawn around four areas: the technology's actual capability, purpose, safety and evidence-base. By drawing such lines of demarcation, we suggest that start-ups make their visions of ethical neurotechnology in society more acceptable, plausible and desirable, favoring their innovations while at the same time assigning discrete responsibilities for ethics. These visions establish a link from the present into the future, mobilizing the latter as promissory place where a technology's benefits will materialize and to which certain ethical issues can be deferred. In turn, the present is constructed as a moment in which ethical engagement could be delegated to permissive regulatory standards and scientific authority. Our empirical tracing of the construction of 'ethical realities' in and by start-ups offers new inroads for ethics research and governance in tech industries beyond neurotechnology.

Prevalence of multisensory hallucinations in people at risk of transition to psychosis.

Hallucinations can occur in single or multiple sensory modalities. Greater attention has been paid to single sensory experiences with a comparative neglect of hallucinations that occur across two or more sensory modalities (multisensory hallucinations). This study explored how common these experiences were in people at risk of transition to psychosis (n=105) and considered whether a greater number of hallucinatory experiences increased delusional ideation and reduced functioning, both of which are associated with a greater risk of transition to psychosis. Participants reported a range of unusual sensory experiences, with two or three being common. However, when a strict definition of hallucinations was applied, in which the experience has the quality of a real perception and in which the person believes them to be real experiences, then multisensory experiences were rare and when reported, single sensory hallucinations in the auditory domain were most common. The number of unusual sensory experiences or hallucinations was not significantly associated with greater delusional ideation or poorer functioning. Theoretical and clinical implications are discussed.

End-of-Life Dreams and Visions: Initial Guidelines and Recommendations to Support Dreams and Visions at the End of Life.

Background: End-of-life dreams and visions (ELDVs) are a common phenomenon in which dying patients experience dreams/visions often of deceased loved ones before death. Past research has highlighted the need for education and awareness to improve clinical engagement at the bedside in response to ELDVs. Objectives: To explore the perspectives of multidisciplinary hospice care providers who are ELDV subject matter experts. Design/Methods: Semi-structured interviews with 13 multidisciplinary hospice providers were conducted and analyzed using thematic qualitative analysis. Results: Analysis revealed six themes: Normalization, Rapport Building, Active Listening, Individualized Meaning Making, Barriers, and Education. A secondary thematic analysis focused on defining/describing ELDVs and resulted in two themes: Natural Part of Dying and ELDV Properties. Conclusions: Findings identified facilitators and barriers encountered when caring for a patient with ELDVs. Based on this, an initial set of recommendations for meaningful clinical engagement regarding ELDVs and initial operationalized definition has been proposed.

Distressing Deathbed Visions: Rare, Misunderstood, or Underreported?

Studies reporting distressing deathbed visions (DBVs) are reviewed to determine whether these experiences are rare, misunderstood, or underreported. Possible explanations for distressing DBVs are explored and possible reasons why distressing DBVs might be underreported are offered. Given the paucity of information on distressing DBVs, more research is needed to determine their prevalence, types, meaning, and impact on dying persons and their families.

Metaphors in End-of-Life Dreams in Patients Receiving Palliative Care: A Secondary Qualitative Study.

Background: Metaphors are used by patients and professionals in the discourse of disease and can facilitate conversations about difficult topics. There is little information about metaphors present in patients' end-of-life dreams. Objective: Identify and interpret metaphors in end-of-life dreams, directly reported by patients in palliative care. Design: A qualitative study with a secondary analysis of transcribed face-to-face interviews with patients. Setting/Participants: The study includes 25 patients with end-stage disease receiving advanced end-of-life palliative care. In total, 41 interviews were performed. Results: Metaphors applicable to 3 themes were found: the journey toward death, the inevitability of death and death itself. The underlying meaning of the metaphors is often related to topics and emotions commonly relevant in dialogue with patients near death. Patients, however, often seemed unaware of the meaning of their dream metaphors. Conclusion: Metaphors pertaining to death are present in end-of-life dreams in patients with end-stage disease. We hypothesize that encouraging patients to talk about their dreams can expose metaphors that could facilitate end-of-life discussions.

Prevalence and nature of multi-sensory and multi-modal hallucinations in people with first episode psychosis.

Hallucinations can occur in single or multiple sensory modalities. This study explored how common these experiences were in people with first episode of psychosis (n = 82). Particular attention was paid to the number of modalities reported and whether the experiences were seen to be linked temporally and thematically. It was predicted that those people reporting a greater number of hallucinations would report more delusional ideation, greater levels of distress generally and lower functioning. All participants reported hallucinations in the auditory domain, given the nature of the recruitment. The participants also reported a range of other unusual sensory experiences, with visual and tactile hallucinations being reported by over half. Moreover, single sensory experiences or unimodal hallucinations were less common than two or more hallucination modalities which was reported by 78% of the participants. The number of hallucinations was significantly associated with greater delusional ideation and higher levels of general distress, but not with reduced functioning. It is clear there is a need to refine psychological treatments so that they are better matched to the actual experiences reported by people with psychosis. Theoretical implications are also considered.

The Promissory Visions of DIYbio: Reimaging Science from the Fringe.

Recent years have seen a proliferation of do-it-yourself biology (DIYbio) initiatives, consisting of people undertaking a range of bioscience activities outside traditional research environments. DIYbio initiatives, while diverse, exist at the fringes of institutionalised science, which enables them to advance different promissory visions about what science, especially bioscience, could or should become in the future, including how it should be governed. These visions reconfigure conventional delineations of science in politically and normatively loaded ways that can simultaneously reaffirm, contest, and shift the traditional epistemic foundations of science. They put forth alternative science futures in ways that highlight the performative force of promissory visions in shaping not only mainstream but also fringe science activity. DIYbio offers a fruitful lens for understanding how science is currently being reconfigured by unconventional actors to encompass new meanings and domains. It offers a different angle on the wider sociology of expectations engagement with the future as an analytical object, by showing how the future of science is constructed and managed from the fringe. Yet, DIYbio initiatives' promissory visions are also embedded within neoliberal ideals of productive and entrepreneurial citizens, highlighting how the wider socio-economic context constrains the alternative futures manufactured by these initiatives.

End-of-life dreams and visions: A systematic integrative review.

OBJECTIVES: End-of-life dreams and visions (ELDVs) have been reported throughout history. We aimed to synthesize the research literature on ELDVs to determine the proportions of patients, bereaved families, healthcare professionals, and volunteers reporting ELDVs; ELDV content, timing, and interpretation; and any evidence-based approaches to ELDV-related care. METHODS: A systematic review protocol was registered with PROSPERO (CRD4021282929). CINAHL, Medline, Embase, Emcare, and APA PsycInfo were searched for peer-reviewed English language articles reporting qualitative, quantitative, or mixed methods studies that explored reports of ELDVs by patients, bereaved families, healthcare professionals, or volunteers. Synthesis used both meta-analysis and a narrative approach. RESULTS: Of 2,045 papers identified by searches, 22 were included, describing 18 studies in a variety of settings. Meta-analyses indicated that 77% (95% confidence intervals [CIs] 69-84%) of patients (n = 119) reported an ELDV compared with 32% (95% CIs 21-44%) of bereaved relatives (n = 2,444) and that 80% (95% CIs 59-94%) of healthcare professionals (n = 171) reported either witnessing or being told of an ELDV in the preceding 5 years. Studies of volunteers reported 34% (95% CIs 20-48%) (n = 45) either witnessing or being told of an ELDV over their entire period of service, with 49% of volunteers (95% CIs 33-64%) (n = 39) reporting events occurring in the preceding year. ELDVs reported by patients, bereaved families, healthcare professionals, and volunteers were perceived as being a source of comfort. Healthcare professionals and volunteers expressed a need for further education on how to support patients experiencing ELDVs and their families. SIGNIFICANCE OF RESULTS: ELDVs are experienced by the majority of dying patients and need consideration in delivering holistic end-of-life care. Little if any research has been conducted in acute care facilities.