Patient and Team Experiences of Team-based Primary Care

Purpose: The purpose of this multi-sited, interpretive phenomenological study was to explore the team-based care experience for patients with type 2 diabetes and their primary care teams.Background: Over a decade ago, policy makers began to sound the alarm about an impending workforce crisis in primary care. This crisis endures today, as the supply of primary care providers has not kept up with the high demand from population growth, and an aging population with high rates of chronic disease. Primary care workforce and delivery issues are magnified in the care of patients with chronic conditions, particularly patients with type 2 diabetes. Consequently, patients report frustration with the care they receive, their inability to receive timely access to a primary care provider, and the rising costs that they increasingly share. As primary care workload complexity and demand increase, primary care practices are restructuring to team-based models of care by including interdisciplinary members such as registered nurses, pharmacists, behavioral health specialists, health educators, medical assistants, community health workers, and health coaches on the team. While there is ample and growing evidence of the benefits of team-based care, specifically for patients with type 2 diabetes, little is known about how patients experience team-based care or how it impacts engagement with their care.Methods: An interpretive phenomenological approach was used to explore this issue within a purposive sample of clinics (n=5) selected to represent different types of primary care and team settings. Forty-one participants from the 5 clinics were recruited, including 17 patients with diabetes, 6 primary care providers (physicians, nurse practitioners, physician assistants), 2 clinic administrators, 4 registered nurses, 2 health educators/wellness coaches, 8 medical assistants and 2 front desk representatives. Four data collection strategies were triangulated: individual semi-structured interviews with clinic patients, team focus groups, targeted observations of team-patient and team interactions; and clinic documents. Interviews were recorded, transcribed and analyzed using an interpretive approach.Results: The majority of patients experienced team-based care as an enhanced sensation of support: like a family, a net, a support, or a feeling of being surrounded. Team members provided an authentic, nurturing presence for patients to express their suffering, challenges, frustrations and confusions. Patients felt that they entered into a caring community where they felt understood and those caring for them were “there for them.” Team members felt equally supported by a team environment through mutual learning, a shared awareness of patient care responsibilities, and an enhanced sense of joy in practice. Barriers to patients’ engagement with teams include team conflict, poor team communication and organization, inadequate staff training and overly complex or large teams. Several critical practices of high-performing health care teams were revealed: shared commitment (to each other and to their patients), value and care of teammates, mutual learning, trust in each other to perform their roles in the team and strong inter-team communication.Conclusion: This research provides important insights into the experience of team-based care from within the teams’ and patients’ worlds to highlight what patients value in their health care experience, and how team-based primary care may provide a means to achieving greater patient engagement and satisfaction with their care, while sustaining a more fulfilled and joyful primary care workforce

A New Genus of Miniaturized and Pug-Nosed Gecko from South America (Sphaerodactylidae: Gekkota)

Sphaerodactyl geckos comprise five genera distributed across Central and South America and the Caribbean. We estimated phylogenetic relationships among sphaerodactyl genera using both separate and combined analyses of seven nuclear genes. Relationships among genera were incongruent at different loci and phylogenies were characterized by short, in some cases zero-length, internal branches and poor phylogenetic support at most nodes. We recovered a polyphyletic Coleodactylus, with Coleodactylus amazonicus being deeply divergent from the remaining Coleodactylus species sampled. The C. amazonicus lineage possessed unique codon deletions in the genes PTPN12 and RBMX while the remaining Coleodactylus species had unique codon deletions in RAG1. Topology tests could not reject a monophyletic Coleodactylus, but we show that short internal branch lengths decreased the accuracy of topology tests because there were not enough data along these short branches to support one phylogenetic hypothesis over another. Morphological data corroborated results of the molecular phylogeny, with Coleodactylus exhibiting substantial morphological heterogeneity. We identified a suite of unique craniofacial features that differentiate C. amazonicus not only from other Coleodactylus species, but also from all other geckos. We describe this novel sphaerodactyl lineage as a new genus, Chatogekko gen. nov. We present a detailed osteology of Chatogekko, characterizing osteological correlates of miniaturization that provide a framework for future studies in sphaerodactyl systematics and biology

Coming to America: Multiple Origins of New World Geckos

Geckos in the Western Hemisphere provide an excellent model to study faunal assembly at a continental scale. We generated a time-calibrated phylogeny, including exemplars of all New World gecko genera, to produce a biogeographic scenario for the New World geckos. Patterns of New World gecko origins are consistent with almost every biogeographic scenario utilized by a terrestrial vertebrate with different New World lineages showing evidence of vicariance, dispersal via temporary land bridge, overseas dispersal, or anthropogenic introductions. We also recovered a strong relationship between clade age and species diversity, with older New World lineages having more species than more recently arrived lineages. Our data provide the first phylogenetic hypothesis for all New World geckos and highlight the intricate origins and ongoing organization of continental faunas. The phylogenetic and biogeographical hypotheses presented here provide an historical framework to further pursue research on the diversification and assembly of the New World herpetofauna

Moderate-depth benthic habitats of St. John, U.S. Virgin Islands

The National Oceanic and Atmospheric Administration’s (NOAA) Center for Coastal Monitoring and Assessment’s (CCMA) Biogeography Branch and the U.S. National Park Service (NPS) have completed mapping the moderate-depth marine environment south of St. John. This work is an expansion of ongoing mapping and monitoring efforts conducted by NOAA and NPS in the U.S. Caribbean. The standardized protocols used in this effort will enable scientists and managers to quantitatively compare moderate-depth coral reef ecosystems around St. John to those throughout the U.S. Territories. These protocols and products will also help support the effective management and conservation of the marine resources within the National Park system

WISE/NEOWISE observations of Active Bodies in the Main Belt

We report results based on mid-infrared photometry of 5 active main belt objects (AMBOs) detected by the Wide-field Infrared Survey Explorer (WISE) spacecraft. Four of these bodies, P/2010 R2 (La Sagra), 133P/Elst-Pizarro, (596) Scheila, and 176P/LINEAR, showed no signs of activity at the time of the observations, allowing the WISE detections to place firm constraints on their diameters and albedos. Geometric albedos were in the range of a few percent, and on the order of other measured comet nuclei. P/2010 A2 was observed on April 2-3, 2010, three months after its peak activity. Photometry of the coma at 12 and 22 {\mu}m combined with ground-based visible-wavelength measurements provides constraints on the dust particle mass distribution (PMD), dlogn/dlogm, yielding power-law slope values of {\alpha} = -0.5 +/- 0.1. This PMD is considerably more shallow than that found for other comets, in particular inbound particle fluence during the Stardust encounter of comet 81P/Wild 2. It is similar to the PMD seen for 9P/Tempel 1 in the immediate aftermath of the Deep Impact experiment. Upper limits for CO2 & CO production are also provided for each AMBO and compared with revised production numbers for WISE observations of 103P/Hartley 2.Comment: 32 Pages, including 5 Figure

Characterizing the Life Stressors of Children of Alcoholic Parents

The current study examined differences between children of alcoholic (COAs) and nonalcoholic parents in their experience of negative life events across 3 longitudinal studies together spanning the first 3 decades of life. The authors posited that COAs would differ from their peers in the life domains in which they are vulnerable to stressors, in the recurrence of stressors, and in the severity of stressors. Scale- and item-level analyses of adjusted odds ratios based on stressors across 7 life domains showed that COAs consistently reported greater risk for stressors in the family domain. COAs were also more likely to experience stressors repetitively and to rate their stressors as more severe (in adulthood). Implications for prevention and intervention programs targeting this risk group are discussed.This work was supported by Grants DA15398 to Hussong,DA13148 to Curran, AA016213 to Chassin, AA13987 to Sher, and AA07065 to Zucker.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64513/1/#158, Hussong 2008, Characterizing the life stressors of children of alcoholic parents, J Fy Psychol.pd

A Moderated Nonlinear Factor Model for the Development of Commensurate Measures in Integrative Data Analysis

Integrative data analysis (IDA) is a methodological framework that allows for the fitting of models to data that have been pooled across two or more independent sources. IDA offers many potential advantages including increased statistical power, greater subject heterogeneity, higher observed frequencies of low base-rate behaviors, and longer developmental periods of study. However, a core challenge is the estimation of valid and reliable psychometric scores that are based on potentially different items with different response options drawn from different studies. In Bauer and Hussong (2009) we proposed a method for obtaining scores within an IDA called moderated nonlinear factor analysis (MNLFA). Here we move significantly beyond this work in the development of a general framework for estimating MNLFA models and obtaining scale scores across a variety of settings. We propose a five step procedure and demonstrate this approach using data drawn from n=1972 individuals ranging in age from 11 to 34 years pooled across three independent studies to examine the factor structure of 17 binary items assessing depressive symptomatology. We offer substantive conclusions about the factor structure of depression, use this structure to compute individual-specific scale scores, and make recommendations for the use of these methods in practice

Advanced backcross-QTL analysis in spring barley (H. vulgare ssp. spontaneum) comparing a REML versus a Bayesian model in multi-environmental field trials

A common difficulty in mapping quantitative trait loci (QTLs) is that QTL effects may show environment specificity and thus differ across environments. Furthermore, quantitative traits are likely to be influenced by multiple QTLs or genes having different effect sizes. There is currently a need for efficient mapping strategies to account for both multiple QTLs and marker-by-environment interactions. Thus, the objective of our study was to develop a Bayesian multi-locus multi-environmental method of QTL analysis. This strategy is compared to (1) Bayesian multi-locus mapping, where each environment is analysed separately, (2) Restricted Maximum Likelihood (REML) single-locus method using a mixed hierarchical model, and (3) REML forward selection applying a mixed hierarchical model. For this study, we used data on multi-environmental field trials of 301 BC2DH lines derived from a cross between the spring barley elite cultivar Scarlett and the wild donor ISR42-8 from Israel. The lines were genotyped by 98 SSR markers and measured for the agronomic traits “ears per m²,” “days until heading,” “plant height,” “thousand grain weight,” and “grain yield”. Additionally, a simulation study was performed to verify the QTL results obtained in the spring barley population. In general, the results of Bayesian QTL mapping are in accordance with REML methods. In this study, Bayesian multi-locus multi-environmental analysis is a valuable method that is particularly suitable if lines are cultivated in multi-environmental field trials

Identification of key risk factors related to serious road injuries and their health impacts, deliverable 7.4 of the H2020 project SafetyCube

Because of their high number and slower reduction compared to fatalities, serious road injuries are increasingly being adopted as an additional indicator for road safety, next to fatalities. Reducing the number of serious road injuries is one of the key priorities in the EU road safety programme 2011- 2020. In 2013, the EU Member States agreed on the following definition of serious road traffic injuries: a serious road traffic injury is a road traffic casualty with a Maximum AIS level of 3 or higher (MAIS3+). One recommendation created by the EU SUSTAIN project was to conduct “A more detailed study of the causes of serious road injuries, [which] could reveal more specific keys to reduce the number of serious injuries in the EU”. This recommendation is addressed through the identification of crashrelated causation and contributory factors for selected groups of casualties with relatively many MAIS3+ casualties compared to fatalities and groups with a relatively high burden of injury of MAIS3+ casualties. This deliverable is made up of two parts brought together in order to determine the main contributory factors detailed above. This two-step approach initially identifies groups of casualties that are specifically relevant from a serious injury perspective using national level collision and hospital datasets from 6 countries. Following the determination of groups of interest a detailed analysis of the selected groups using indepth data was conducted. On the basis of in-depth data from 4 European countries the main contributory and causal factors are determined for the selected MAIS3+ casualty groups. Alongside the three proceeding deliverables that have formed the major outputs of WP7, deliverable D7.4 is aimed at addressing serious injury policy at an EU levels. As such this report is broadly aimed at policy makers although the inclusion of results from in-depth data analysis also provides information relevant to stakeholders, particularly those working in vehicle design and manufacture or road user behaviour

Physical and psychological consequences of serious road traffic injuries, deliverable 7.2 of the H2020 project SafetyCube

SafetyCube aims to develop an innovative road safety Decision Support System (DSS) that will enable policy-makers and stakeholders to select the most appropriate strategies, measures and cost-effective approaches to reduce casualties of all road user types and all severities. Work Package 7 of SafetyCube is dedicated to serious road traffic injuries, their health impacts and their costs. This Deliverable discusses health impacts of (serious) road traffic injuries