The rise of the \u27silver surfer\u27 : online social networking and social inclusion for older adults

As the proportion of older adults continues to grow in many Western countries, there are increasing concerns about how to meet their needs. Ensuring social connectedness and inclusion is one way to support older adults&rsquo; wellbeing. Online social networking has become common place amongst younger age groups, suggesting its possible usefulness for older adults, in order to combat isolation and loneliness. Some quantitative studies have already explored the amount and degree of online social networking amongst older adults. To add further understanding of how older adults experience social inclusion via the internet, the current qualitative study aimed to explore older adults&rsquo; subjective experience of online social networking. Findings demonstrated a number of supports and barriers to social inclusion which reflect barriers to social inclusion of older adults in the non-virtual world. Recommendations to support social inclusion of isolated older adults via online social networking are suggested. <br /

Substance Use Disorder Treatment Confidentiality Boot Camp

[Excerpt]: INTRODUCTION: The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects. A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD) Treatment Confidentiality Boot Camp sessions providing technical assistance to assist each IDN partner with their SUD confidentiality project goals. The “boot camp” consisted of several guided meetings with assigned homework to follow, leading to the ultimate development of processes, plans, and draft forms and policies to implement Part 2 confidentiality. The process incorporated learning from the Citizens Health Initiative’s existing New Hampshire Behavioral Health Integration Learning Collaborative. The Project was implemented during half-day working sessions between May 15 – July 30, based upon the availability of IDN interdisciplinary teams and as arranged in collaboration with the IDNs. The IDNs committed to including project leaders with knowledge about and authority to investigate issues regarding projects, patient flow, and privacy. The project teams were multi-disciplinary. IDN participants were encouraged to review issues, forms, and ideas with their individual legal counsel at any point. The technical assistance provided as part of this project is not and does not take the place of legal advice

Made-in-Canada system ecology: Explorations of the garment industry

The contemporary Made-In-Canada (MIC) local garment system is a vast departure from what Canada had in place 40 years ago. In the 1970’s, 70% of the Canadian consumer clothing demand was met with domestic production [Wyman, 2009]. At the time, both production capacity and labour skills existed inside of Canada, whereas in today’s market, these skills are significantly outsourced by Canadian businesses. This shift - driven in part by the capabilities available from globalization - has shrunk the domestic manufacturing sector in Canada, carrying with it many long-term economic, environmental and social implications. This paper examines the MIC system as it pertains to the garment industry; understanding how the current consumer market interest in fashion-forward timeliness and focus on price are impacting the garment system in Canada. This research also explores the dominant stakeholders influencing consumers’ ability to make informed choices about their garment purchases, particularly those which label themselves, Made-In-Canada. Three findings were revealed through the research process: a) Globalization is a critical driver in the system as deregulation made it difficult for local manufacturers to stay competitive; b) Consumer perceptions of value are driving demand for cheap prices as they are limited by what they see in the market; c) The MIC system in the garment industry is a ‘black box’ for consumers who are challenged to make an informed choice with a lack of access to information. As a result of this examination, the research identified emerging opportunities and interventions to assist consumers in making choices about their MIC garments in the future. Due to scope, the interventions identified in this paper initiate from the government, a key stakeholder, with a emphasis on possible policy interventions

Death Management: A Cultural Exploration in Contemporary Canada

We are at a unique tipping point in our connection to and understanding of death and dying in contemporary Canada. This research exploration shines a light on the shifting ground of the culture of death and dying in Canada, including innovative services and the demographic context that are shifting our collective perspective. By reviewing past anthropological, sociological, philosophical, and psychological practices, the story of our modern ‘fear of death’ surfaces. Interviews with experts from a variety of domains within death management make known barriers, changes and innovations currently underway. Through use of the foresight model of causal layered analysis, deeply seeded cultural myths of repression and phobia are assessed in connection to the litany of current trends in death management. Application of the three horizons technique reveals a tangible vision of what radical shifts might occur in 10 to 20 years and provides a provocative awareness of how death might be perceived and handled differently in the future

Functional Characterization of the Mammalian TRPV4 Channel: Yeast Screen Reveals Gain-of-Function Mutations

Transient receptor potential (TRP) channels are a class of six-transmembrane (6-TM) cation-permeable channels that mediate flux of calcium and sodium into cells, leading to depolarization as well as activation of calcium-mediated second-messenger signaling pathways. The TRP channel family is large and diverse in terms of tissue expression, mechanism, and function; therefore, sub-classification is primarily through amino acid homology. A general role has emerged for TRP channels, though, in the processing of sensory stimuli at both the cellular and organismal level. The goal of this study was to perform mutagenesis screens of mammalian TRP channels to reveal key structural determinants of channel activity (such as gating, permeation, and selectivity). We screened for gain-of-function alleles of TRP channels by their ability to rescue growth deficiency of a strain of the yeast Saccharomyces cerevisiae caused by lack of ion efflux. Channels were further characterized through electrophysiological analysis of their activity when heterologously expressed in Xenopus laevis oocytes. Of the subset of mammalian TRP channels tested, only wild type TRPV4 rescued the ability of the yeast strain trk1Δ trk2Δ to grow on low potassium media. The TRPV4 channel is important in thermosensitive, osmosensitive, and mechanosensitive processes; recently, mutations of TRPV4 have been linked to human skeletal and neurodegenerative disorders. We obtained a loss-of-function variant of TRPV4 containing the substitutions K70E (N-terminal tail) and M605T (intracellular linker between transmembrane helices S4 and S5) that failed to rescue low potassium growth of trk1Δ trk2Δ. Therefore, we screened for compensatory mutations that would restore the ability of the V4-K70E/M605T channel to rescue the yeast growth phenotype. Five gain-of-function clones were isolated, containing a total of seven mutations: three substitutions in the N-terminal tail (R151W, P152S, L154F), one substitution in the pore-lining S5 transmembrane helix (M625I), one substitution in the C-terminal tail (H787Y), and two truncations of the C-terminal tail (N789Δ and Q790Δ). Each of these mutations was assayed, in both the variant V4-K70E/M605T and the wild type TRPV4 background, for effect on rescue of trk1Δ trk2Δ yeast low-potassium growth, as well as degree of salt sensitivity conferred on wild type yeast. We also performed two-electrode voltage-clamp (TEVC) recordings of the mutant channels expressed in Xenopus oocytes, obtaining preliminary data on the ability of the mutations to restore a calcium-activated sodium current to V4-K70E/M605T that was present in wild type TRPV4. Given the known importance of the S5 helix in gating, the mutation M625I most likely has an effect on gating of the intracellular pore. This mutation showed strong rescue of low potassium growth and salt sensitivity in yeast, and preliminary data showed strong rescue of calcium-activated current in oocytes. An autoinhibitory channel structure is formed by binding of the C-terminal calmodulin-binding domain to a portion of the N-terminus, which is disrupted by the binding of calcium-calmodulin to the C-terminal domain. The point mutations we isolated in the N- and C-termini lie just outside these respective regions, leading us to believe that the gain-of-function phenotype could be due to disruption of this autoinhibitory structure. Although the C-terminal truncations were isolated with a gain-of-function phenotype in V4-K70E/M605T (rescue of low-potassium yeast growth), introduction of the truncations into wild type TRPV4 led to a loss-of-function phenotype: truncated channels no longer induced yeast salt sensitivity and exhibited no calcium-activated current in oocytes. This phenotype could be due to the loss of the calmodulin-binding domain, suggesting that the potentiation of channel activity by calcium involves mechanisms other than simply the disruption of the autoinhibitory domain. However, it is also possible that the phenotype is merely the result of reduced membrane expression: some studies indicate that truncation of the C-terminal tail leads to ER retention of the protein. Taken together, the results of our three assays provide insight into the mechanisms of TRP channel function. Combined with what is already known about these channel regions, we are able to draw conclusions as to the potential contribution of these residues on channel activity and add to the body of evidence regarding mechanisms of function of the TRPV4 channel

Sub-optimal pain control in patients with rheumatic disease.

The visual analog scale (VAS) of pain is a ubiquitous clinical and research tool with widespread application in the rheumatic diseases. The objectives of this study were to assess if patients report pain differently to doctors or nurses, to determine reproducibility of this test for diagnosis, age, gender, and treatment, and to ascertain the level of pain in patients attending general rheumatology clinics. Using a standardized line of exactly 100 mm and instructions with identical wording, consecutive patients attending general rheumatology clinics were asked to score their perceived level of pain in the preceding week. Two assessments were carried out, one before and one after the clinic visit, and each patient was questioned by both a doctor and a nurse. Differences between the first and second VAS scores (VAS1 and VAS2) were recorded. One hundred and eight patients completed the study (69 female). VAS1 and VAS2 scores were administered by a similar number of doctors and nurses. There was no significant difference between mean VAS1 and VAS2 scores (41.1 vs. 41.4 mm, p = 0.78). VAS1 and VAS2 differed by \u3c4 mm in\u3e59% of patients. Age, gender, or diagnosis did not influence VAS1 or VAS2. Differences in scores were independent of which health professional administered the scale (p = 0.19). Patients taking painkillers had higher mean VAS scores (49 mm) compared with those not on analgesia (27 mm; p \u3c 0.001). Anti-rheumatic treatment did not influence pain scores (p = 0.13). The VAS is a reliable and effective method of pain assessment. Results are independent of which health professional administers the scale. Patients with rheumatic disease report their pain similarly regardless of diagnosis. However, pain control is sub-optimal in patients taking analgesia. Specific assessment of pain is, thus, important in patients attending rheumatology clinics

Telehealth and Mobile Health Applied To IntegratedBehavioral Care: OpportunitiesFor Progress In New Hampshire

This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizens Health Initiative (Initiative). As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health (mHealth) have the opportunity to help achieve this while delivering a robust, empowered patient experience. The promise of video-based technology was first made in 1964 as Bell Telephone shared its Picturephone® with the world. This was the first device with audio and video delivered in an integrated technology platform. Fast-forward to today with Skype, FaceTime, and webinar tools being ubiquitous in our personal and business lives, but often slow to be adopted in the delivery of medicine. Combining technology-savvy consumers with New Hampshire’s high rate of electronic health record (EHR) technology adoption, a fairly robust telecommunications infrastructure, and a predominately rural setting, there is strong foundation for telehealth and mHealth expansion in New Hampshire’s integrated health continuum

Evaluating the impact of an intervention to increase uptake of modern contraceptives among adolescent girls (15-19 years) in Nigeria, Ethiopia and Tanzania: the Adolescents 360 quasi-experimental study protocol.

INTRODUCTION: Nigeria, Ethiopia and Tanzania have some of the highest teenage pregnancy rates and lowest rates of modern contraceptive use among adolescents. The transdisciplinary Adolescents 360 (A360) initiative being rolled out across these three countries uses human-centred design to create context-specific multicomponent interventions with the aim of increasing voluntary modern contraceptive use among girls aged 15-19 years. METHODS: The primary objective of the outcome evaluation is to assess the impact of A360 on the modern contraceptive prevalence rate (mCPR) among sexually active girls aged 15-19 years. A360 targets different subpopulations of adolescent girls in the three countries. In Northern Nigeria and Ethiopia, the study population is married girls aged 15-19 years. In Southern Nigeria, the study population is unmarried girls aged 15-19 years. In Tanzania, both married and unmarried girls aged 15-19 years will be included in the study. In all settings, we will use a prepopulation and postpopulation-based cross-sectional survey design. In Nigeria, the study design will also include a comparison group. A one-stage sampling design will be used in Nigeria and Ethiopia. A two-stage sampling design will be used in Tanzania. Questionnaires will be administered face-to-face by female interviewers aged between 18 and 26 years. Study outcomes will be assessed before the start of A360 implementation in late 2017 and approximately 24 months after implementation in late 2019. ETHICS AND DISSEMINATION: Findings of this study will be widely disseminated through workshops, conference presentations, reports, briefings, factsheets and academic publications