Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

Background: Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific unmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. Method: A mixed method study was conducted. A standardised survey (n = 92) of experts in chronic care using mail responses to open-ended questions was conducted to analyse existing chronic care programs focusing on effective, problematic and missing components. An expert workshop (n = 22) of professionals and scientists of a European funded research project MANAGE CARE was used to define a limited number of unmet needs and priorities of elderly patients with type 2 diabetes mellitus and comorbidities. This list was validated and ranked using a multilingual online survey (n = 650). Participants of the online survey included patients, health care professionals and other stakeholders from 56 countries. Results: The survey indicated that current care models need to be improved in terms of financial support, case management and the consideration of social care. The expert workshop identified 150 patient needs which were summarised in 13 needs dimensions. The online survey of these pre-defined dimensions revealed that financial issues, education of both patients and professionals, availability of services as well as health promotion are the most important unmet needs for both patients and professionals. Conclusion: The study uncovered competing demands which are not limited to medical conditions. The findings emphasise that future care models need to focus stronger on individual patient needs and promote their active involvement in co-design and implementation. Future research is needed to develop new chronic care models providing evidence-based and practical implications for the regional care setting

Turbulence-driven magnetic reconnection and the magnetic correlation length: observations from magnetospheric multiscale in Earth's magnetosheath

Turbulent plasmas generate a multitude of thin current structures that can be sites for magnetic reconnection. The Magnetospheric Multiscale (MMS) mission has recently enabled the detailed examination of such turbulent current structures in Earth's magnetosheath and revealed that a novel type of reconnection, known as electron-only reconnection, can occur. In electron-only reconnection, ions do not have enough space to couple to the newly reconnected magnetic fields, suppressing ion jet formation and resulting in thinner sub-proton-scale current structures with faster super-Alfvénic electron jets. In this study, MMS observations are used to examine how the magnetic correlation length (λC) of the turbulence, which characterizes the size of the large-scale magnetic structures and constrains the length of the current sheets formed, influences the nature of turbulence-driven reconnection. We systematically identify 256 reconnection events across 60 intervals of magnetosheath turbulence. Most events do not appear to have ion jets; however, 18 events are identified with ion jets that are at least partially coupled to the reconnected magnetic field. The current sheet thickness and electron jet speed have a weak anti-correlation, with faster electron jets at thinner current sheets. When ≲20 ion inertial lengths, as is typical near the sub-solar magnetosheath, a tendency for thinner current sheets and potentially faster electron jets is present. The results are consistent with electron-only reconnection being more prevalent for turbulent plasmas with relatively short λC and may be relevant to the nonlinear dynamics and energy dissipation in turbulent plasmas

Observations of whistler mode waves with nonlinear parallel electric fields near the dayside magnetic reconnection separatrix by the Magnetospheric Multiscale mission

We show observations from the Magnetospheric Multiscale (MMS) mission of whistler mode waves in the Earth's low-latitude boundary layer (LLBL) during a magnetic reconnection event. The waves propagated obliquely to the magnetic field toward the X line and were confined to the edge of a southward jet in the LLBL. Bipolar parallel electric fields interpreted as electrostatic solitary waves (ESW) are observed intermittently and appear to be in phase with the parallel component of the whistler oscillations. The polarity of the ESWs suggests that if they propagate with the waves, they are electron enhancements as opposed to electron holes. The reduced electron distribution shows a shoulder in the distribution for parallel velocities between 17,000 and 22,000 km/s, which persisted during the interval when ESWs were observed, and is near the phase velocity of the whistlers. This shoulder can drive Langmuir waves, which were observed in the high-frequency parallel electric field data

Electron scale structures and magnetic reconnection signatures in the turbulent magnetosheath

Collisionless space plasma turbulence can generate reconnecting thin current sheets as suggested by recent results of numerical magnetohydrodynamic simulations. The MMS mission provides the first serious opportunity to check if small ion-electron-scale reconnection, generated by turbulence, resembles the reconnection events frequently observed in the magnetotail or at the magnetopause. Here we investigate field and particle observations obtained by the MMS fleet in the turbulent terrestrial magnetosheath behind quasi-parallel bow shock geometry. We observe multiple small-scale current sheets during the event and present a detailed look of one of the detected structures. The emergence of thin current sheets can lead to electron scale structures where ions are demagnetized. Within the selected structure we see signatures of ion demagnetization, electron jets, electron heating and agyrotropy suggesting that MMS spacecraft observe reconnection at these scales

HD 51106 and HD 50747: an ellipsoidal binary and a triple system observed with CoRoT

We present an analysis of the observations of HD 51106 and HD 50747 by the satellite CoRoT, obtained during its initial run, and of the spectroscopic preparatory observations. AIMS: We complete an analysis of the light curve, extract the main frequencies observed, and discuss some preliminary interpretations about the stars. Methods: We used standard Fourier transform and pre-whitening methods to extract information about the periodicities of the stars. Results: HD 51106 is an ellipsoidal binary, the light curve of which can be completely explained by the tidal deformation of the star and smaller secondary effects. HD 50747 is a triple system containing a variable star, which exhibits many modes of oscillation with periods in the range of a few hours. On the basis of this period range and the analysis of the physical parameters of the star, we conclude that HD 50747 is a Gamma-Doradus star.Comment: 7 pages, 8 figures, use (Astronomy-Astrophysics format/macro LAtex

Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort

Sistemes d'informació, Atenció integrada; Ictus; Atenció domiciliàriaSistemas de información; Atención integrada; Ictus; Atención domiciliariaInformation systems; Integrated care; Stroke; Domiciliary carePurpose: to assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. Design/methodology/approach: the RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. Findings: the study included 92 stroke patients attended within the RHP program and the patients’ matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group