Patients’ experiences of and roles in interprofessional collaborative practice in primary care: a constructivist grounded theory study

Aim:This constructivist grounded theory study aimed to (1) explore patients’ experiences of and roles in interprofessional collaborative practice for chronic conditions in primary care and (2) consider the relevance and alignment of an existing theoretical framework on patients’ roles and based on the experiences of patient advocates.Background:High-quality management of chronic conditions requires an interprofessional collaborative practice model of care considering an individual’s mental, physical, and social health situation. Patients’ experiences of this model in the primary care setting are relatively unknown.Methods:A constructivist grounded theory approach was taken. Interview data were collected from primary care patients with chronic conditions across Australia in August 2020 – February 2022. Interviews were recorded, transcribed verbatim, and thematically analysed by (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation, and (5) theme and sub-theme development. Themes and sub-themes were mapped against an existing theoretical framework to expand and confirm the results from a previous study with a similar research aim.Findings:Twenty adults with chronic conditions spanning physical disability, diabetes, heart disease, cancer, autoimmune, and mental health conditions participated. Two themes were developed: (1) Adapting to Change with two sub-themes describing how patients adapt to interprofessional team care and (2) Shifting across the spectrum of roles, with five sub-themes outlining the roles patients enact while receiving care. The findings suggest that patients’ roles are highly variable and fluid in interprofessional collaborative practice, and further work is recommended to develop a resource to support greater patient engagement in interprofessional collaborative practice

Family carers' experiences and perceived roles in interprofessional collaborative practice in primary care: A constructivist grounded theory study

Abstract Background Chronic conditions can lead to physical, cognitive and social decline; thus, increasing an individual's dependence on family who assist with activities of daily living. Interprofessional collaborative practice (IPCP), involving two or more health professionals working with the patient and their family, is one model of care for the high‐quality management of individuals with chronic conditions in primary care. Nevertheless, family carers have reported a disconnect between themselves and healthcare providers in previous research. This study aimed to explore the experiences and perspectives of family carers for individuals with chronic conditions, regarding their involvement in IPCP. Methods Aspects of constructivist grounded theory methodology were used. Family carers of individuals with chronic conditions were invited to participate in a one‐on‐one, semistructured interview about their experiences with IPCP in the care of their loved one. Interview transcripts were analysed using Charmaz's four‐step iterative process: (1) line‐by‐line coding, (2) focused coding, (3) categorisation of codes and (4) potential theme and subtheme development with memo writing to support each phase of analysis. The research team collaborated on reflexivity exercises, the conceptualisation of categories and the development of themes. Results Constructivist data analysis of interviews (average 40 min) with 10 family carers resulted in two themes. (1) Stepping in for my loved one represents the notion that carers take on external roles on behalf of their loved ones (subthemes: working with interprofessional teams, supporting independence and learning as I go). (2) Taking on the carer role, represents the internal factors that influence the external roles described in theme 1 (subthemes: feeling obligated to be involved and changing relationship dynamics). Conclusion This study outlines the external actions and internal influences on family carer involvement in an interprofessional team. The required knowledge and support to care for their loved ones is currently learned in an ad hoc manner, and carers' resources should be better promoted by health professionals. Additionally, the relationship dynamics between a carer and their loved one change as the carer becomes more involved in IPCP and influences how and the extent health professionals involve family carers. Patient or Public Contribution Carers were the study population involved in this qualitative study. Patient advocates who have chronic conditions, and are informal family carers, were involved in the creation and design of this study, including a review of the research question, participant information sheet and the interview guide

Carbonate Assimilation at Merapi Volcano, Java, Indonesia: Insights from Crystal Isotope Stratigraphy

Recent basaltic andesite lavas from Merapi volcano contain abundant, complexly zoned, plagioclase phenocrysts, analysed here for their petrographic textures, major element composition and Sr isotope composition. Anorthite (An) content in individual crystals can vary by as much as 55 mol% (An40-95) across internal resorption surfaces with a negative correlation between high An mol% (>70), MgO wt% and FeO wt%. In situ Sr isotope analyses of zoned plagioclase phenocrysts show that the 87Sr/86Sr ratios of individual zones range from 0·70568 to 0·70627. The upper end of this range is notably more radiogenic than the host basaltic andesite whole-rocks (< 0·70574). Crystal zones with the highest An content have the highest 87Sr/86Sr values, requiring a source or melt with elevated radiogenic Sr, rich in Ca and with lower Mg and Fe. Recent Merapi eruptive rocks contain abundant xenoliths, including metamorphosed volcanoclastic sediment and carbonate country rock (calc-silicate skarns) analysed here for petrographic textures, mineralogy, major element composition and Sr isotope composition. The xenoliths contain extremely calcic plagioclase (up to An100) and have whole-rock 87Sr/86Sr ratios of 0·70584 to 0·70786. The presence of these xenoliths and their mineralogy and geochemistry, coupled with the 87Sr/86Sr ratios observed in different zones of individual phenocrysts, indicate that magma-crust interaction at Merapi is potentially more significant than previously thought, as numerous crystal cores in the phenocrysts appear to be inherited from a metamorphosed sedimentary crustal source. This has potentially significant consequences for geochemical mass-balance calculations, volatile saturation and flux and eruptive behaviour at Merapi and similar island arc volcanic systems elsewher

Physical restraint in residential child care : the experiences of young people and residential workers

There have long been concerns about the use of physical restraint in residential care. This paper presents the findings of a qualitative study which explores the experiences of children, young people and residential workers about physical restraint. The research identifies the dilemmas and ambiguities for both staff and young people, and participants discuss the situations where they feel physical restraint is appropriate as well as their concerns about unjustified or painful restraints. They describe the negative emotions involved in restraint but also those situations where, through positive relationships and trust, restraint can help young people through unsafe situations

Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis.

OBJECTIVE: Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients. METHOD: A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases ( n = 9), reference tracking, hand-searching of selected journals ( n = 2), grey literature searching, and expert consultation ( n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel. RESULTS: In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders. CONCLUSIONS: Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923

Changing times in England: the influence on geography teachers’ professional practice

School geography in England has been characterised as a pendulum swinging between policies that emphasise curriculum and pedagogy alternately. In this paper, I illustrate the influence of these shifts on geography teacher's professional practice, by drawing on three “moments” from my experience as a student, teacher and teacher educator. Barnett's description of teacher professionalism as a continuous project of “being” illuminates how geography teachers can adapt to competing influences. It reflects teacher professionalism as an unfinished project, which is responsive, but not beholden, to shifting trends, and is informed by how teachers frame and enact policies. I argue that recognising these contextual factors is key to supporting geography teachers in “being” geography education professionals. As education becomes increasingly competitive on a global scale, individual governments are looking internationally for “solutions” to improve educational rankings. In this climate, the future of geography education will rest on how teachers react locally to international trends. Geography teacher educators can support this process by continuing to inform the field through meaningful geography education research, in particular in making the contextual factors of their research explicit. This can be supported through continued successful international collaboration in geography education research

MS4A1 Dysregulation in Asbestos-Related Lung Squamous Cell Carcinoma Is Due to CD20 Stromal Lymphocyte Expression

Asbestos-related lung cancer accounts for 4–12% of lung cancers worldwide. We have previously identified ADAM28 as a putative oncogene involved in asbestos-related lung adenocarcinoma (ARLC-AC). We hypothesised that similarly gene expression profiling of asbestos-related lung squamous cell carcinomas (ARLC-SCC) may identify candidate oncogenes for ARLC-SCC. We undertook a microarray gene expression study in 56 subjects; 26 ARLC-SCC (defined as lung asbestos body (AB) counts >20AB/gram wet weight (gww) and 30 non-asbestos related lung squamous cell carcinoma (NARLC-SCC; no detectable lung asbestos bodies; 0AB/gww). Microarray and bioinformatics analysis identified six candidate genes differentially expressed between ARLC-SCC and NARLC-SCC based on statistical significance (p<0.001) and fold change (FC) of >2-fold. Two genes MS4A1 and CARD18, were technically replicated by qRT-PCR and showed consistent directional changes. As we also found MS4A1 to be overexpressed in ARLC-ACs, we selected this gene for biological validation in independent test sets (one internal, and one external dataset (2 primary tumor sets)). MS4A1 RNA expression dysregulation was validated in the external dataset but not in our internal dataset, likely due to the small sample size in the test set as immunohistochemical (IHC) staining for MS4A1 (CD20) showed that protein expression localized predominantly to stromal lymphocytes rather than tumor cells in ARLC-SCC. We conclude that differential expression of MS4A1 in this comparative gene expression study of ARLC-SCC versus NARLC-SCC is a stromal signal of uncertain significance, and an example of the rationale for tumor cell enrichment in preparation for gene expression studies where the aim is to identify markers of particular tumor phenotypes. Finally, our study failed to identify any strong gene candidates whose expression serves as a marker of asbestos etiology. Future research is required to determine the role of stromal lymphocyte MS4A1 dysregulation in pulmonary SCCs caused by asbestos

The standard model at low energies

The hadronic sector of the standard model at low energies is described by a non--decoupling effective field theory, chiral perturbation theory. An introduction is given to the construction of effective chiral Lagrangians, both in the purely mesonic sector and with inclusion of baryons. The connection between the relativistic formulation and the heavy baryon approach to chiral perturbation theory with baryons is reviewed.Comment: Lectures given at the 6th Indian-Summer School on Intermediate Energy Physics, Prague, Aug. 1993, Latex, 26 pages (with a4.sty), UWThPh-1993-3

The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities

The prevalence, and incidence, of mental ill-health in adults with intellectual disabilities and autism were compared with the whole population with intellectual disabilities, and with controls, matched individually for age, gender, ability-level, and Down syndrome. Although the adults with autism had a higher point prevalence of problem behaviours compared with the whole adult population with intellectual disabilities, compared with individually matched controls there was no difference in prevalence, or incidence of either problem behaviours or other mental ill-health. Adults with autism who had problem behaviours were less likely to recover over a two-year period than were their matched controls. Apparent differences in rates of mental ill-health are accounted for by factors other than autism, including Down syndrome and ability level