Treating patients as persons : a capabilities approach to support delivery of person-centered care

Peer reviewedPublisher PD

Discovering and Predicting Temporal Patterns of WiFi-interactive Social Populations

Extensive efforts have been devoted to characterizing the rich connectivity patterns among the nodes (components) of such complex networks (systems), and in the course of development of research in this area, people have been prompted to address on a fundamental question: How does the fascinating yet complex topological features of a network affect or determine the collective behavior and performance of the networked system? While elegant attempts to address this core issue have been made, for example, from the viewpoints of synchronization, epidemics, evolutionary cooperation, and the control of complex networks, theoretically or empirically, this widely concerned key question still remains open in the newly emergent field of network science. Such fruitful advances also push the desire to understand (mobile) social networks and characterize human social populations with the interdependent collective dynamics as well as the behavioral patterns. Nowadays, a great deal of digital technologies are unobtrusively embedded into the physical world of human daily activities, which offer unparalleled opportunities to explosively digitize human physical interactions, who is contacting with whom at what time. Such powerful technologies include the Bluetooth, the active Radio Frequency Identification (RFID) technology, wireless sensors and, more close to our interest in this paper, the WiFi technology. As a snapshot of the modern society, a university is in the coverage of WiFi signals, where the WiFi system records the digital access logs of the authorized WiFi users when they access the campus wireless services. Such WiFi access records, as the indirect proxy data, work as the effective proxy of a large-scale population's social interactions.Comment: 11 pages, 10 page

Diagnostic and cost utility of whole exome sequencing in peripheral neuropathy.

OBJECTIVE: To explore the diagnostic utility and cost effectiveness of whole exome sequencing (WES) in a cohort of individuals with peripheral neuropathy. METHODS: Singleton WES was performed in individuals recruited though one pediatric and one adult tertiary center between February 2014 and December 2015. Initial analysis was restricted to a virtual panel of 55 genes associated with peripheral neuropathies. Patients with uninformative results underwent expanded analysis of the WES data. Data on the cost of prior investigations and assessments performed for diagnostic purposes in each patient was collected. RESULTS: Fifty patients with a peripheral neuropathy were recruited (median age 18 years; range 2-68 years). The median time from initial presentation to study enrollment was 6 years 9 months (range 2 months-62 years), and the average cost of prior investigations and assessments for diagnostic purposes AU$4013 per patient. Eleven individuals received a diagnosis from the virtual panel. Eight individuals received a diagnosis following expanded analysis of the WES data, increasing the overall diagnostic yield to 38%. Two additional individuals were diagnosed with pathogenic copy number variants through SNP microarray. CONCLUSIONS: This study provides evidence that WES has a high diagnostic utility and is cost effective in patients with a peripheral neuropathy. Expanded analysis of WES data significantly improves the diagnostic yield in patients in whom a diagnosis is not found on the initial targeted analysis. This is primarily due to diagnosis of conditions caused by newly discovered genes and the resolution of complex and atypical phenotypes

Improving energy efficiency in private rented housing : what makes landlords act?

The private rented sector in England contains some of the least energy efficient properties in the country and houses more vulnerable households than any other sector. Occupants endure dangerously cold homes and fuel poverty but have no direct influence over the energy performance of their homes. The choices that occupants make regarding energy are constrained by the material characteristics of a property: something only the landlord can alter. Enduringly poor conditions in the sector indicate that an initiative that convinces landlords of the benefits of improving energy efficiency remains elusive. Based on a review of existing research and 30 interviews with landlords, this paper identifies factors which deter landlords from acting to improve energy efficiency. Factors include lack of knowledge regarding the consequences of energy inefficiency and possible solutions, the absence of direct financial incentives (the principal–agent problem), local housing market and cultural factors. It also identifies a number of motivating factors that may encourage landlords to invest in energy efficiency. It is argued that policies to tackle energy inefficiency in the sector should take account of these factors in order to improve effectiveness. Keywords Private rented sector, Domestic energy efficiency, Principal–agent, The Green Deal, Private landlords, Split incentiv

Researching the use of force: The background to the international project

This article provides the background to an international project on use of force by the police that was carried out in eight countries. Force is often considered to be the defining characteristic of policing and much research has been conducted on the determinants, prevalence and control of the use of force, particularly in the United States. However, little work has looked at police officers’ own views on the use of force, in particular the way in which they justify it. Using a hypothetical encounter developed for this project, researchers in each country conducted focus groups with police officers in which they were encouraged to talk about the use of force. The results show interesting similarities and differences across countries and demonstrate the value of using this kind of research focus and methodology

The reach of citizenship: Locating the politics of industrial air pollution in Durban and beyond

This paper develops a relational understanding of the geographies of citizenship action, using the example of environmental activism in Durban as an empirical reference point. We argue that citizenship involves an interactive dynamic shaped by different actors' capacities to project authority and influence over distance by enacting different modalities of spatial reach. Post-apartheid environmental politics illustrates how the relationship between the subjects of environmental rights and agents of obligation is both de-territorialised and re-territorialised by the activities of environmental activists. We examine the politics of attributing responsibility for urban industrial pollution in Durban, and identify two modalities of spatial reach through which environmental rights have been given weight. We conclude by emphasising that forms of transnational activism, while indicative in some respects of emergent styles of cosmopolitan citizenship, remain oriented by the goals of realizing national citizenship rights

Choice in the context of informal care-giving

Extending choice and control for social care service users is a central feature of current English policies. However, these have comparatively little to say about choice in relation to the informal carers of relatives, friends or older people who are disabled or sick. To explore the realities of choice as experienced by carers, the present paper reviews research published in English since 1985 about three situations in which carers are likely to face choices: receiving social services; the entry of an older person to long-term care; and combining paid work and care. Thirteen electronic databases were searched, covering both the health and social care fields. Databases included: ASSIA; IBSS; Social Care Online; ISI Web of Knowledge; Medline; HMIC Sociological Abstracts; INGENTA; ZETOC; and the National Research Register. The search strategy combined terms that: (1) identified individuals with care-giving responsibilities; (2) identified people receiving help and support; and (3) described the process of interest (e.g. choice, decision-making and self-determination). The search identified comparatively few relevant studies, and so was supplemented by the findings from another recent review of empirical research on carers' choices about combining work and care. The research evidence suggests that carers' choices are shaped by two sets of factors: one relates to the nature of the care-giving relationship; and the second consists of wider organisational factors. A number of reasons may explain the invisibility of choice for carers in current policy proposals for increasing choice. In particular, it is suggested that underpinning conceptual models of the relationship between carers and formal service providers shape the extent to which carers can be offered choice and control on similar terms to service users. In particular, the exercise of choice by carers is likely to be highly problematic if it involves relinquishing some unpaid care-giving activities

COL4A3 is degraded in allergic asthma and degradation predicts response to anti-IgE therapy.

BACKGROUND: Asthma is a heterogeneous syndrome substantiating the urgent requirement for endotype-specific biomarkers. Dysbalance of fibrosis and fibrolysis in asthmatic lung tissue leads to reduced levels of the inflammation-protective collagen 4 (COL4A3). OBJECTIVE: To delineate the degradation of COL4A3 in allergic airway inflammation and evaluate the resultant product as a biomarker for anti-IgE therapy response. METHODS: The serological COL4A3 degradation marker C4Ma3 (Nordic Bioscience, Denmark) and serum cytokines were measured in the ALLIANCE cohort (paediatric cases/controls: n=134/n=35; adult cases/controls: n=149/n=31). Exacerbation of allergic airway disease in mice was induced by sensitising to ovalbumin (OVA), challenge with OVA aerosol and instillation of poly(cytidylic-inosinic). Fulacimstat (chymase inhibitor; Bayer) was used to determine the role of mast cell chymase in COL4A3 degradation. Patients with cystic fibrosis (n=14) and cystic fibrosis with allergic bronchopulmonary aspergillosis (ABPA; n=9) as well as patients with severe allergic uncontrolled asthma (n=19) were tested for COL4A3 degradation. Omalizumab (anti-IgE) treatment was assessed using the Asthma Control Test. RESULTS: Serum levels of C4Ma3 were increased in asthma in adults and children alike and linked to a more severe, exacerbating allergic asthma phenotype. In an experimental asthma mouse model, C4Ma3 was dependent on mast cell chymase. Serum C4Ma3 was significantly elevated in cystic fibrosis plus ABPA and at baseline predicted the success of the anti-IgE therapy in allergic, uncontrolled asthmatics (diagnostic OR 31.5). CONCLUSION: C4Ma3 levels depend on lung mast cell chymase and are increased in a severe, exacerbating allergic asthma phenotype. C4Ma3 may serve as a novel biomarker to predict anti-IgE therapy response

Managing and resisting ‘degeneration’ in employee-owned businesses: a comparative study of two large retailers in Spain and the UK

Employee-owned businesses have recently enjoyed a resurgence of interest as possible ‘alternatives’ to the somewhat tarnished image of conventional investor-owned capitalist firms. Within the context of global economic crisis, such alternatives seem newly attractive. This is somewhat ironic because, for more than a century, academic literature on employee-owned businesses has been dominated by the ‘degeneration thesis’. This suggested that these businesses tend towards failure – they either fail commercially, or they relinquish their democratic characters. Bucking this trend and offering a beacon - especially in the UK - has been the commercially successful, co-owned enterprise of the John Lewis Partnership (JLP) whose virtues have seemingly been rewarded with favourable and sustainable outcomes. This paper makes comparisons between JLP and its Spanish equivalent Eroski – the supermarket group which is part of the Mondragon cooperatives. The contribution of this paper is to examine in a comparative way how the managers in JLP and Eroski have constructed and accomplished their alternative scenarios. Using longitudinal data and detailed interviews with senior managers in both enterprises it explores the ways in which two large, employee-owned, enterprises reconcile apparently conflicting principles and objectives. The paper thus puts some new flesh on the ‘regeneration thesis’

What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community?

Background: Workforce shortages in Australia are occurring across a range of health disciplines but are most acute in general practice. Skill mix change such as task substitution is one solution to workforce shortages. The aim of this systematic review was to explore the evidence for the effectiveness of task substitution between GPs and pharmacists and GPs and nurses for the care of older people with chronic disease. Published, peer reviewed (black) and non-peer reviewed (grey) literature were included in the review if they met the inclusion criteria. Results: Forty-six articles were included in the review. Task substitution between pharmacists and GPs and nurses and GPs resulted in an improved process of care and patient outcomes, such as improved disease control. The interventions were either health promotion or disease management according to guidelines or use of protocols, or a mixture of both. The results of this review indicate that pharmacists and nurses can effectively provide disease management and/or health promotion for older people with chronic disease in primary care. While there were improvements in patient outcomes no reduction in health service use was evident. Conclusion: When implementing skill mix changes such as task substitution it is important that the health professionals' roles are complementary otherwise they may simply duplicate the task performed by other health professionals. This has implications for the way in which multidisciplinary teams are organised in initiatives such as the GP Super Clinics