Building on Julian Tudor Hart's example of anticipatory care

The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and longterm relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome

UK emergency preparedness: a holistic local response?

Purpose – This paper aims to argue that to address the consequences of climate change and variability a greater focus on pre-emergency planning that engages a wider stakeholder group must be adopted. Design/methodology/approach – The paper discusses UK emergency management and approaches to climate change and climate variability risk. Findings – The internal focus of UK emergency management inhibits the contribution that it can make to societal resilience and public preparedness. Effective risk reduction requires that all actors, including the public, are engaged in the social learning process. From a UK emergency management perspective this requires a culture shift to an outward proactive focus. Originality/value – This paper offers insights into emergency preparedness in the UK

Anticipatory Mobile Computing: A Survey of the State of the Art and Research Challenges

Today's mobile phones are far from mere communication devices they were ten years ago. Equipped with sophisticated sensors and advanced computing hardware, phones can be used to infer users' location, activity, social setting and more. As devices become increasingly intelligent, their capabilities evolve beyond inferring context to predicting it, and then reasoning and acting upon the predicted context. This article provides an overview of the current state of the art in mobile sensing and context prediction paving the way for full-fledged anticipatory mobile computing. We present a survey of phenomena that mobile phones can infer and predict, and offer a description of machine learning techniques used for such predictions. We then discuss proactive decision making and decision delivery via the user-device feedback loop. Finally, we discuss the challenges and opportunities of anticipatory mobile computing.Comment: 29 pages, 5 figure

Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria

Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Results Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment – the Dying with Dignity Victoria Advance Healthcare Directive. Conclusions More research is needed to understand how online resources can optimally elicit and record consumers’ individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement

Respiratory, postural and spatio-kinetic motor stabilization, internal models, top-down timed motor coordination and expanded cerebello-cerebral circuitry: a review

Human dexterity, bipedality, and song/speech vocalization in Homo are reviewed within a motor evolution perspective in regard to 

(i) brain expansion in cerebello-cerebral circuitry, 
(ii) enhanced predictive internal modeling of body kinematics, body kinetics and action organization, 
(iii) motor mastery due to prolonged practice, 
(iv) task-determined top-down, and accurately timed feedforward motor adjustment of multiple-body/artifact elements, and 
(v) reduction in automatic preflex/spinal reflex mechanisms that would otherwise restrict such top-down processes. 

Dual-task interference and developmental neuroimaging research argues that such internal modeling based motor capabilities are concomitant with the evolution of 
(vi) enhanced attentional, executive function and other high-level cognitive processes, and that 
(vii) these provide dexterity, bipedality and vocalization with effector nonspecific neural resources. 

The possibility is also raised that such neural resources could 
(viii) underlie human internal model based nonmotor cognitions. 
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Evaluation of the advance/anticipatory care planning (ACP) facilitators training programme

This report presents an overview of the findings of the three phases of the study and assesses the degree to which the Facilitator Training Programme and Resource Pack have prepared the cohort of facilitators with the knowledge, skills and tools to deliver training initiatives in ACP to address local and regional needs