The effects of isometric work on heart rate, blood pressure, and net oxygen cost

Isometric exercise effects on heart rate, blood pressure, and net oxygen cos

Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis

Polly H. Noel and Luci K. Leykum are with the South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA -- Polly H. Noel, Ray F. Palmer, Raquel L. Romero, Luci K. Leykum, Holly J. Lanham, and Krista W. Bowers are with the Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA -- Michael L. Parchman is with the MacColl Center for Healthcare Innovation, Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave 1600, Seattle, WA 98101, USA -- Holly J. Leykum is with the The McCombs School of Business, The University of Texas at Austin, 2110 Speedway, Stop B6000, Austin, TX 78712, USA -- John E. Zeber is with the Central Texas Veterans Health Care System, 1901 S. 1st St, Temple, TX 76504, USA and Scott and White Healthcare Center for Applied Health Research, 2401 S. 31st St, Temple, TX 76508, USABackground: Little is known as to whether primary care teams’ perceptions of how well they have implemented the Chronic Care Model (CCM) corresponds with their patients’ own experience of chronic illness care. We examined the extent to which practice members’ perceptions of how well they organized to deliver care consistent with the CCM were associated with their patients’ perceptions of the chronic illness care they have received. Methods: Analysis of baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM in small, community-based primary care practices. All practice “members” (i.e., physician providers, non-physician providers, and staff) completed the Assessment of Chronic Illness Care (ACIC) survey and adult patients with 1 or more chronic illnesses completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire. Results: Two sets of hierarchical linear regression models accounting for nesting of practice members (N = 283) and patients (N = 1,769) within 39 practices assessed the association between practice member perspectives of CCM implementation (ACIC scores) and patients’ perspectives of CCM (PACIC). ACIC summary score was not significantly associated with PACIC summary score or most of PACIC subscale scores, but four of the ACIC subscales were consistently associated with PACIC summary score and the majority of PACIC subscale scores after controlling for patient characteristics. The magnitude of the coefficients, however, indicates that the level of association is weak. Conclusions: The ACIC and PACIC scales appear to provide complementary and relatively unique assessments of how well clinical services are aligned with the CCM. Our findings underscore the importance of assessing both patient and practice member perspectives when evaluating quality of chronic illness care.Information, Risk, and Operations Management (IROM)[email protected]

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Aggressive behaviour is a critical issue for modern acute psychiatric services, not just because of the adverse impact it has on patients and staff, but also because it puts a financial strain on service providers. The aim of this study was to assess the relationship of patient violence to other variables: patient characteristics, features of the service and physical environment, patient routines, staff factors, the use of containment methods, and other patient behaviours. A multivariate cross sectional design was utilised. Data were collected for a six month period on 136 acute psychiatric wards in 26 NHS Trusts in England. Multilevel modelling was conducted to ascertain those factors most strongly associated with verbal aggression, aggression toward objects, and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Insufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence

What Is the Landscape of Early Childhood Coaching in Nebraska?

Background on Early Childhood Coaching in Nebraska Coaches have become an integral component of supporting teachers and adults working with young children and families nationally (Schachter, 2015). In the state of Nebraska, early childhood (EC) coaching has increasingly become important for this type of work (Jayaraman, Knoche, Marvin, & Bainter, 2014). Indeed, multiple initiatives within the state utilize coaches as a mechanism for supporting change in adult learners that leads to positive outcomes for young children and families. In general, coaching is a unique form of professional development that is relationship-based, whereby coaches work one-on-one or in small groups with adult learners to improve knowledge, skills, and dispositions (Aikens & Akers, 2011). Coaching can take place in adults’ immediate context and tends to be ongoing rather than a single, one-time training (Joyce & Showers, 1980; Rush & Shelden, 2005). As such, coaching has the potential to provide high-quality learning experiences for adults to support high-quality experiences in EC. Based on this growing use of coaching across the state, key stakeholders have collaborated to develop mechanisms that support coach training and development. Since this collaborative work began in 2009–10, a semiannual coach training was developed to provide foundational coaching skills and competencies relevant for all coaching initiatives, such as developing relationships and facilitating coaching conversations. The collaborative group also came to understand that coaches needed ongoing support and initiated the offering of regular “booster” sessions to support coaches’ professional development once they are in the field and actively serving coachees. In efforts to better understand who was coaching and perceptions of the training coaches received, stakeholders conducted an initial survey in 2014 (Jayaraman et al. 2014). Results of this survey (n = 35) revealed that coaches liked the work of coaching and, in particular, coaches commented that they enjoyed building relationships with coachees and observing positive changes. Although these coaches were generally positive about the training they received, myriad challenges were also reported, particularly with regards to the coaching process and their own training and professional development needs. Present Study Since the 2014 study, coaching in various EC initiatives has grown across the state. In 2018, the Nebraska Early Childhood Coach Collaboration team was interested in reassessing the process of coaching in Nebraska. This included understanding who is doing the work of coaching, what constitutes the coaching process, how coaches perceive their work, and how coaches were prepared to do their work. Thus, a new survey was created to understand more about coaching in the state of Nebraska. It contained a variety of questions consisting of both fixed-choice and open-response comments. Data collection was led by Dr. Schachter from the University of Nebraska–Lincoln and was reviewed by the Institutional Review Board. Participants were invited by email to complete an online survey that took approximately 20 minutes to complete. The survey was emailed to key stakeholders in the Spring of 2018 with requests that the survey be forwarded to anyone doing the work of EC coaching in Nebraska. In total, 101 individuals completed the survey. Importantly, all participants self-identified as a “coach.” Participants were able to enter into a raffle to win one of five iPad minis. Survey responses were analyzed descriptively. Next, we present our findings regarding who are the coaches, what is the content of coaching, how coaches perceive their work, how coaches know that coaching is working, and how coaches were prepared. We conclude with recommendations for advancing the work of coaching in the state of Nebraska

Coherent control of enrichment and conversion of molecular spin isomers

A theoretical model of nuclear spin conversion in molecules controlled by an external electromagnetic radiation resonant to rotational transition has been developed. It has been shown that one can produce an enrichment of spin isomers and influence their conversion rates in two ways, through coherences and through level population change induced by radiation. Influence of conversion is ranged from significant speed up to almost complete inhibition of the process by proper choice of frequency and intensity of the external field.Comment: REVTEX, 13 pages + 6 eps figure

Thermoelectric effects in submicron heterostructure barriers

Nonisothermal electron transport in thin barrier heterostructures is investigated using Monte Carlo techniques. Particular attention is paid to the energy balance in thermionic emission, and the Joule heating in the barrier region. By introducing an energy relaxation length, an equation for the temperature distribution inside the device is derived. Conditions for creating a steady-state temperature gradient and for integrated cooling of electronic components are examined

A Mi\u27kmaq First Nation cosmology: investigating the practice of contemporary Aboriginal Traditional Medicine in dialogue with counselling – toward an Indigenous therapeutics

This paper explores from a Mi’kmaq and Aboriginal standpoint foundational knowledge in Indigenous therapeutics. Based on an eco-social-psycho-spiritual way of working, the article proposes Indigenous cultural models that open a window to a rich cultural repository of meanings associated with Indigenous cosmology, ontology and epistemology. The three layers of meaning, theory and practice within the symbolic ‘Medicine Lodge’ or ‘Place of The Dreaming’ give rise to ways of working that are deeply integrative and wholistic. These forms of Indigenous theory and practice have much to offer the counselling and complimentary health professions

The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards

Contains fulltext : 99818.pdf (publisher's version ) (Open Access)Background: Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards in their rates of these behaviours, and that structure (ward organisation, rules and daily routines) might be the most critical of these. This paper describes the exploration of a large dataset to assess the relationship between structure and other staff variables. Methods: A multivariate cross-sectional design was utilised. Data were collected from staff on 136 acute psychiatric wards in 26 NHS Trusts in England, measuring leadership, teamwork, structure, burnout and attitudes towards difficult patients. Relationships between these variables were explored through principal components analysis (PCA), structural equation modelling and cluster analysis. Results: Principal components analysis resulted in the identification of each questionnaire as a separate factor, indicating that the selected instruments assessed a number of non-overlapping items relevant for ward functioning. Structural equation modelling suggested a linear model in which leadership influenced teamwork, teamwork structure; structure burnout; and burnout feelings about difficult patients. Finally, cluster analysis identified two significantly distinct groups of wards: the larger of which had particularly good leadership, teamwork, structure, attitudes towards patients and low burnout; and the second smaller proportion which was poor on all variables and high on burnout. The better functioning cluster of wards had significantly lower rates of containment events. Conclusion: The overall performance of staff teams is associated with differing rates of containment on wards. Interventions to reduce rates of containment on wards may need to address staff issues at every level, from leadership through to staff attitudes