1,068 research outputs found
Bridging Bays, Bridging Borders: Global Justice and Community Organizing in the San Francisco Bay Area
We offer this document as our own effort to build the inclusion and understandings that will help both communities and leaders recognize the grassroots wisdom and issues that could help us realize the positive impacts from globalization and minimize the negative aspects that have concerned us all. Another world is possible, but it is up to us to build it
Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study
Introduction:
Shared decision-making intends to align care provision with individuals’ preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners.//
Methods:
A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model.//
Results:
Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) ‘knowing the person and personalisation of care’, involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) ‘engaging and considering the perspectives of all involved in decision-making’ required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) ‘Training and support activities’ to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms.//
Conclusions:
The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work
Co-design of a theory-based implementation plan for a holistic eHealth assessment and decision support framework for people with dementia in care homes
Background:
Despite positive findings around the use of eHealth in dementia care, it is rarely translated into routine practice. This can be facilitated by early involvement of end-users in the development of an implementation plan. This study aimed to co-design strategies to implement an eHealth intervention, the EMBED-Care Framework, to support assessment and decision-making for people with dementia in care homes.//
Methods:
A qualitative co-design method was applied through a series of workshops. Participants included family carers and health and social care practitioners. People with dementia were included through a series of stakeholder engagement meetings. The workshops focused on co-developing strategies in response to identified determinants of implementation. A codebook thematic analytic approach was taken, guided by the Normalisation Process Theory (NPT).//
Results:
Three workshops were conducted from July 2021 to November 2021, attended by 39 participants. Three overarching phases of implementation were identified which aligned with the constructs of the NPT: (a) incentivising adoption of the Framework, which requires promotion of its benefits and alignment with recommendations for good quality dementia care to engage stakeholders, relating to ‘coherence’ and ‘cognitive participation’ constructs; (b) enabling its operation, which requires ensuring compatibility with care home processes, provision of training and support from ‘champions’, relating to ‘collective action’; (c) sustaining use of the Framework, which requires monitoring of implementation and appraisal of its effects, relating to ‘reflexive monitoring’.//
Conclusions:
We have developed a multi-strategy, theoretically driven plan to implement eHealth to support assessment and decision-making for people with dementia in care homes. Successful implementation requires incentivisation to adopt, ability to operate and motivation to sustain use of eHealth. The plan is strengthened through collaborating with end-users to increase its value, credibility and real-world relevance. The theoretically informed strategies target mechanisms of the NPT, demonstrated to shape the implementation process and outcomes, ready for testing
Suicide in trans populations:A systematic review of prevalence and correlates
Trans people experience high rates of attempted suicide and suicidal ideation. No study to date has collated the various findings concerning correlates of trans suicide. This systematic review aimed to summarize the available data and provide recommendations based on this evidence. Articles were included if they were published before November 2016, were in English, were peer reviewed, and presented data concerning trans people’s suicide attempts or ideation. Nine databases were searched, and 30 articles were selected. Discrimination emerged as strongly related to suicidal ideation and attempts, whereas positive social interactions and timely access to interventions appeared protective. Limitations included differences in how articles defined trans people or measured suicide and in their largely cross-sectional nature, making assumptions about causality in reference to lifetime ideation or attempts impossible. However, results clearly indicated a need to work at both individual and structural levels to reduce society- and service-level discrimination, enhance peer support, and ensure access to required interventions. The review highlights the need to explore suicidality in the trans population both in relation to general suicide models and in relation to models of minority stress. (PsycINFO Database Record (c) 2017 APA, all rights reserved
Defects in cell spreading and ERK1/2 activation in fibroblasts with lamin A/C mutations
AbstractIn-frame mutations in nuclear lamin A/C lead to a multitude of tissue-specific degenerative diseases known as the ‘laminopathies’. Previous studies have demonstrated that lamin A/C-null mouse fibroblasts have defects in cell polarisation, suggesting a role for lamin A/C in nucleo-cytoskeletal-cell surface cross-talk. However, this has not been examined in patient fibroblasts expressing modified forms of lamin A/C. Here, we analysed skin fibroblasts from 3 patients with Emery–Dreifuss muscular dystrophy and from 1 with dilated cardiomyopathy. The emerin–lamin A/C interaction was impaired in each mutant cell line. Mutant cells exhibited enhanced cell proliferation, collagen-dependent adhesion, larger numbers of filopodia and smaller cell spread size, compared with control cells. Furthermore, cell migration, speed and polarization were elevated. Mutant cells also showed an enhanced ability to contract collagen gels at early time points, compared with control cells. Phosphotyrosine measurements during cell spreading indicated an initial temporal lag in ERK1/2 activation in our mutant cells, followed by hyper-activation of ERK1/2 at 2 h post cell attachment. Deregulated ERK1/2 activation is linked with cardiomyopathy, cell spreading and proliferation defects. We conclude that a functional emerin–lamin A/C complex is required for cell spreading and proliferation, possibly acting through ERK1/2 signalling
Diversity Of Diagnoses And Student Learning Experiences In An On-Campus School Psychology Assessment Center: Future Directions And Focus
School Psychology Assessment Centers (SPAC) developed at the University-level are crucial in developing competent school psychologists. While many models on how to develop mental health centers are in existence, a new model exists for creating a SPAC on a University campus that is specifically designed to serve the diverse surrounding community and postsecondary students (see Ellis-Hervey et al., 2016). The community’s needs were reviewed, including missing service links in the region, and identification of potential clients who would benefit most from services provided. Senior students who work with clients in the SPAC gain assessment skills and build supervision skills through close interactions and consultation with junior students. New goals of the SPAC is to develop and implement academic, behavioral, social skills and therapy/counseling services
The RODAM study
Background Although the prevalence of smoking is low in Ghana, little is known
about the effect of migration on smoking. Comparing Ghanaians living in their
country of origin to those living in Europe offers an opportunity to
investigate smoking by location of residence and the associations between
smoking behaviours and migration-related factors. Methods Data on a relatively
homogenous group of Ghanaians living in London (n = 949), Amsterdam (n =
1400), Berlin (n = 543), rural Ghana (n = 973) and urban Ghana (n = 1400) from
the cross-sectional RODAM (Research on Obesity & Diabetes in African Migrants)
study were used. Age-standardized prevalence rates of smoking by location of
residence and factors associated with smoking among Ghanaian men were
estimated using prevalence ratios (PR: 95% CIs). Results Current smoking was
non-existent among women in rural and urban Ghana and London but was 3.2% and
3.3% in women in Amsterdam and Berlin, respectively. Smoking prevalence was
higher in men in Europe (7.8%) than in both rural and urban Ghana (4.8%): PR
1.91: 95% CI 1.27, 2.88, adjusted for age, marital status, education and
employment. Factors associated with a higher prevalence of smoking among
Ghanaian men included European residence, being divorced or widowed, living
alone, Islam religion, infrequent attendance at religious services,
assimilation (cultural orientation), and low education. Conclusion Ghanaians
living in Europe are more likely to smoke than their counterparts in Ghana,
suggesting convergence to European populations, although prevalence rates are
still far below those in the host populations
Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders
Background: Understanding how best to provide palliative care for frail older people with non-malignant conditions is an international priority. We aimed to develop a community-based episodic model of short-term integrated palliative and supportive care (SIPS) based on the views of service users and other key stakeholders in the United Kingdom.
Method: Transparent expert consultations with health professionals, voluntary sector and carer representatives including a consensus survey; and focus groups with older people and carers were used to generate recommendations for the SIPS model. Discussions focused on three key components of the model: potential benefit of SIPS; timing of delivery; and processes of integrated working between specialist palliative care and generalist practitioners. Content and descriptive analysis was employed and findings integrated across the data sources.
Findings: We conducted two expert consultations (n=63), a consensus survey (n=42) and three focus groups (n=17). Potential benefits of SIPS included holistic assessment, opportunity for end of life discussion, symptom management, and carer reassurance. Older people and carers advocated early access to SIPS, while other stakeholders proposed delivery based on complex symptom burden. A priority for integrated working was the assignment of a key worker to coordinate care, but the assignment criteria remain uncertain.
Interpretation: Key stakeholders agree that a model of SIPS for frail older people with non-malignant conditions has potential benefits within community settings, but differ in opinion on the optimal timing and indications for this service. Our findings highlight the importance of consulting all key stakeholders in model development prior to feasibility evaluation
Uncoordinated Transcription and Compromised Muscle Function in the Lmna-Null Mouse Model of Emery-Dreifuss Muscular Dystrophy
LMNA encodes both lamin A and C: major components of the nuclear lamina. Mutations in LMNA underlie a range of tissue-specific degenerative diseases, including those that affect skeletal muscle, such as autosomal-Emery-Dreifuss muscular dystrophy (A-EDMD) and limb girdle muscular dystrophy 1B. Here, we examine the morphology and transcriptional activity of myonuclei, the structure of the myotendinous junction and the muscle contraction dynamics in the lmna-null mouse model of A-EDMD. We found that there were fewer myonuclei in lmna-null mice, of which ∼50% had morphological abnormalities. Assaying transcriptional activity by examining acetylated histone H3 and PABPN1 levels indicated that there was a lack of coordinated transcription between myonuclei lacking lamin A/C. Myonuclei with abnormal morphology and transcriptional activity were distributed along the length of the myofibre, but accumulated at the myotendinous junction. Indeed, in addition to the presence of abnormal myonuclei, the structure of the myotendinous junction was perturbed, with disorganised sarcomeres and reduced interdigitation with the tendon, together with lipid and collagen deposition. Functionally, muscle contraction became severely affected within weeks of birth, with specific force generation dropping as low as ∼65% and ∼27% of control values in the extensor digitorum longus and soleus muscles respectively. These observations illustrate the importance of lamin A/C for correct myonuclear function, which likely acts synergistically with myotendinous junction disorganisation in the development of A-EDMD, and the consequential reduction in force generation and muscle wasting
Smoking prevalence differs by location of residence among Ghanaians in Africa and Europe: The RODAM study.
BACKGROUND: Although the prevalence of smoking is low in Ghana, little is known about the effect of migration on smoking. Comparing Ghanaians living in their country of origin to those living in Europe offers an opportunity to investigate smoking by location of residence and the associations between smoking behaviours and migration-related factors. METHODS: Data on a relatively homogenous group of Ghanaians living in London (n = 949), Amsterdam (n = 1400), Berlin (n = 543), rural Ghana (n = 973) and urban Ghana (n = 1400) from the cross-sectional RODAM (Research on Obesity & Diabetes in African Migrants) study were used. Age-standardized prevalence rates of smoking by location of residence and factors associated with smoking among Ghanaian men were estimated using prevalence ratios (PR: 95% CIs). RESULTS: Current smoking was non-existent among women in rural and urban Ghana and London but was 3.2% and 3.3% in women in Amsterdam and Berlin, respectively. Smoking prevalence was higher in men in Europe (7.8%) than in both rural and urban Ghana (4.8%): PR 1.91: 95% CI 1.27, 2.88, adjusted for age, marital status, education and employment. Factors associated with a higher prevalence of smoking among Ghanaian men included European residence, being divorced or widowed, living alone, Islam religion, infrequent attendance at religious services, assimilation (cultural orientation), and low education. CONCLUSION: Ghanaians living in Europe are more likely to smoke than their counterparts in Ghana, suggesting convergence to European populations, although prevalence rates are still far below those in the host populations
- …