Can We Institute Medical Trust? An exploratory case study of patient-staff relations at a community health center in the Mississippi Delta

The purpose of this study was to use the concept of the patient-centered medical home (PCMH) model and the case of the community health center (CHC) to explore social interaction and trust between patients and medical providers. While the PCMH model is being championed as revolutionizing and improving healthcare delivery, little evidence has yet to support the formation of basic social and health mechanisms, such as trust, that would result in positive health outcomes. The model’s guidelines focus more on healthcare organization and information technology than developing interpersonal relationships and adapting services to meet the specific needs of diverse populations. Utilizing participant observation and informal interviews, qualitative evidence suggests that context-specific details may have more impact on healthcare delivery than methods currently addressed in the PCMH guidelines themselves

Epistemic prejudice and geographies of innovation

This article seeks to understand how and why certain locations are excluded from or seen as foreclosed as places of innovation and knowledge production in health research and practice. Rooted in several years of collaborative ethnographic research in Mississippi, we develop this conceptual framework to understand the persistence of – and often ineffective response to – racialized and classed health disparities. We define our concept of epistemic prejudice as a structural inability or resistance to seeing certain places, bodies, and locations as capable of knowledge production and innovation. The history of the community health center movement, paired with the portrayal of Mississippi in contemporary media representations, helps us develop our concept. We use an interface ethnography method as Mississippi scholars to demonstrate the importance of this model of research in understanding persistent inequality in places of ‘lack’, noting that the challenges of addressing health problems in Mississippi stem in part from epistemic prejudice of scholars, health care practitioners, and policy-makers. Epistemic prejudice has broader implications for how global health initiatives are implemented, how postcolonial frameworks still shape knowledge production, and how knowledge is generated and taken as authoritative

Surface Laplacian of Central Scalp Electrical Signals is Insensitive to Muscle Contamination

Author version made available in accordance with the publisher's policy. "(c) 20xx IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works."Abstract—Objective: To investigate the effects of surface Laplacian processing on gross and persistent electromyographic (EMG) contamination of electroencephalographic (EEG) signals in electrical scalp recordings. Methods: We made scalp recordings during passive and active tasks, on awake subjects in the absence and in the presence of complete neuromuscular blockade. Three scalp surface Laplacian estimators were compared to left ear and common average reference (CAR). Contamination was quantified by comparing power after paralysis (brain signal, B) with power before paralysis (brain plus muscle signal, B+M). Brain:Muscle (B:M) ratios for the methods were calculated using B and differences in power after paralysis to represent muscle (M). Results: There were very small power differences after paralysis up to 600 Hz using surface Laplacian transforms (B:M> 6 above 30 Hz in central scalp leads). Conclusions: Scalp surface Laplacian transforms reduce muscle power in central and peri-central leads to less than one sixth of the brain signal, 2-3 times better signal detection than CAR. Significance: Scalp surface Laplacian transformations provide robust estimates for detecting high frequency (gamma) activity, for assessing electrophysiological correlates of disease, and also for providing a measure of brain electrical activity for use as a ‘standard’ in the development of brain/muscle signal separation methods

Constitutive spectral EEG peaks in the gamma range: suppressed by sleep, reduced by mental activity and resistant to sensory stimulation

This Document is Protected by copyright and was first published by Frontiers. All rights reserved. it is reproduced with permission. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Objective: In a systematic study of gamma activity in neuro-psychiatric disease, we unexpectedly observed distinctive, apparently persistent, electroencephalogram (EEG) spectral peaks in the gamma range (25–100 Hz). Our objective, therefore, was to examine the incidence, distribution and some of the characteristics of these peaks. Methods: High sample-rate, 128-channel, EEG was recorded in 603 volunteers (510 with neuropsychiatric disorders, 93 controls), whilst performing cognitive tasks, and converted to power spectra. Peaks of spectral power, including in the gamma range, were determined algorithmically for all electrodes. To determine if peaks were stable, 24-h ambulatory recordings were obtained from 16 subjects with peaks. In 10 subjects, steady-state responses to stimuli at peak frequency were compared with off-peak-frequency stimulation to determine if peaks were a feature of underlying network resonances and peaks were evaluated with easy and hard versions of oddball tasks to determine if peaks might be influenced by mental effort. Results: 57% of 603 subjects exhibited peaks >2 dB above trough power at or above 25 Hz. Larger peaks (>5 dB) were present in 13% of subjects. Peaks were distributed widely over the scalp, more frequent centrally. Peaks were present through the day and were suppressed by slow-wave-sleep. Steady-state responses were the same with on- or off-peak sensory stimulation. In contrast, mental effort resulted in reductions in power and frequency of gamma peaks, although the suppression did not correlate with level of effort. Conclusions: Gamma EEG can be expressed constitutively as concentrations of power in narrow or wide frequency bands that play an, as yet, unknown role in cognitive activity. Significance: These findings expand the described range of rhythmic EEG phenomena. In particular, in addition to evoked, induced and sustained gamma band activity, gamma activity can be present constitutively in spectral peaks

Negative parental responses to coming out and family functioning in a sample of lesbian and gay young adults

Parental responses to youths' coming out (CO) are crucial to the subsequent adjustment of children and family. The present study investigated the negative parental reaction to the disclosure of same-sex attraction and the differences between maternal and paternal responses, as reported by their homosexual daughters and sons. Participants' perceptions of their parents' reactions (evaluated through the Perceived Parental Reactions Scale, PPRS), age at coming out, gender, parental political orientation, and religiosity involvement, the family functioning (assessed through the Family Adaptability and Cohesion Evaluation Scales, FACES IV), were assessed in 164 Italian gay and lesbian young adults. Pearson correlation coefficients were calculated to assess the relation between family functioning and parental reaction to CO. The paired sample t-test was used to compare mothers and fathers' scores on the PPRS. Hierarchical multiple regression was conducted to analyze the relevance of each variable. No differences were found between mothers and fathers in their reaction to the disclosure. The analysis showed that a negative reaction to coming out was predicted by parents' right-wing political conservatism, strong religious beliefs, and higher scores in the scales Rigid and Enmeshed. Findings confirm that a negative parental reaction is the result of poor family resources to face a stressful situation and a strong belief in traditional values. These results have important implications in both clinical and social fields

The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers:Protocol for a 3-Phase Support Group Evaluation

BACKGROUND: People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. OBJECTIVE: We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. METHODS: We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. RESULTS: The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. CONCLUSIONS: The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/3537

The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation

BACKGROUND: People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. OBJECTIVE: We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. METHODS: We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. RESULTS: The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. CONCLUSIONS: The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population

La mariée mise à nu par ses célibataires, même

OVERTIME was an exhibition that explored the differences between office spaces and the artists’ studio. SEIZE Leeds invited 26 artists to respond to an office space – to explore the tools and working methods common to such spaces through making art. Occupying a disused floor of Wellington Park House, in Leeds’ busy financial district, the exhibition brought together a diverse range of artists in order to showcase both emerging and more established practitioners from across the UK. SEIZE Leeds is an artist-led organisation that works to engage and support emerging and mid-career artists both regionally and nationally through a programme of ambitious art shows and events. They work with vacant spaces in situ to produce exciting and accessible exhibitions that explore ideas relevant to each location and promote talent

Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis.

Multiple sclerosis is a common disease of the central nervous system in which the interplay between inflammatory and neurodegenerative processes typically results in intermittent neurological disturbance followed by progressive accumulation of disability. Epidemiological studies have shown that genetic factors are primarily responsible for the substantially increased frequency of the disease seen in the relatives of affected individuals, and systematic attempts to identify linkage in multiplex families have confirmed that variation within the major histocompatibility complex (MHC) exerts the greatest individual effect on risk. Modestly powered genome-wide association studies (GWAS) have enabled more than 20 additional risk loci to be identified and have shown that multiple variants exerting modest individual effects have a key role in disease susceptibility. Most of the genetic architecture underlying susceptibility to the disease remains to be defined and is anticipated to require the analysis of sample sizes that are beyond the numbers currently available to individual research groups. In a collaborative GWAS involving 9,772 cases of European descent collected by 23 research groups working in 15 different countries, we have replicated almost all of the previously suggested associations and identified at least a further 29 novel susceptibility loci. Within the MHC we have refined the identity of the HLA-DRB1 risk alleles and confirmed that variation in the HLA-A gene underlies the independent protective effect attributable to the class I region. Immunologically relevant genes are significantly overrepresented among those mapping close to the identified loci and particularly implicate T-helper-cell differentiation in the pathogenesis of multiple sclerosis

Imaging of moving fiducial markers during radiotherapy using a fast, efficient active pixel sensor based EPID

Purpose: The purpose of this work was to investigate the use of an experimental complementary metal‐oxide‐semiconductor (CMOS) active pixel sensor (APS) for tracking of moving fiducial markers during radiotherapy. Methods: The APS has an active area of 5.4 × 5.4 cm and maximum full frame read‐out rate of 20 frame s−1, with the option to read out a region‐of‐interest (ROI) at an increased rate. It was coupled to a 4 mm thick ZnWO4 scintillator which provided a quantum efficiency (QE) of 8% for a 6 MV x‐ray treatment beam. The APS was compared with a standard iViewGT flat panel amorphous Silicon (a‐Si) electronic portal imaging device (EPID), with a QE of 0.34% and a frame‐rate of 2.5 frame s−1. To investigate the ability of the two systems to image markers, four gold cylinders of length 8 mm and diameter 0.8, 1.2, 1.6, and 2 mm were placed on a motion‐platform. Images of the stationary markers were acquired using the APS at a frame‐rate of 20 frame s−1, and a dose‐rate of 143 MU min−1 to avoid saturation. EPID images were acquired at the maximum frame‐rate of 2.5 frame s−1, and a reduced dose‐rate of 19 MU min−1 to provide a similar dose per frame to the APS. Signal‐to‐noise ratio (SNR) of the background signal and contrast‐to‐noise ratio (CNR) of the marker signal relative to the background were evaluated for both imagers at doses of 0.125 to 2 MU. Results: Image quality and marker visibility was found to be greater in the APS with SNR ∼5 times greater than in the EPID and CNR up to an order of magnitude greater for all four markers. To investigate the ability to image and track moving markers the motion‐platform was moved to simulate a breathing cycle with period 6 s, amplitude 20 mm and maximum speed 13.2 mm s−1. At the minimum integration time of 50 ms a tracking algorithm applied to the APS data found all four markers with a success rate of ≥92% and positional error ≤90 μm. At an integration time of 400 ms the smallest marker became difficult to detect when moving. The detection of moving markers using the a‐Si EPID was difficult even at the maximum dose‐rate of 592 MU min−1 due to the lower QE and longer integration time of 400 ms. Conclusions: This work demonstrates that a fast read‐out, high QE APS may be useful in the tracking of moving fiducial markers during radiotherapy. Further study is required to investigate the tracking of markers moving in 3D in a treatment beam attenuated by moving patient anatomy. This will require a larger sensor with ROI read‐out to maintain speed and a manageable data‐rate