Multimorbidity:will it stand the test of time?

The concept of multimorbidity has risen in popularity over the past few years. It is use has led to, or coincided with, an increased recognition that patients often have more than one health problem which should not be treated in isolation. The motivation for more holistic, person-centred care that lies behind multimorbidity is to be welcomed. The 2016 National Institute for Health and Care Excellence multimorbidity management guideline helpfully makes recommendations in key areas that are important in the care of patients with complicated medical problems.However, we question the sustainability of the term for the following four reasons: (i) it is doctor and researcher centred rather than patient centred, focusing upon the number of diagnoses rather than the patient's lived experience, (ii) it is not a positive term for patients and is at odds with the move towards promoting active and healthy ageing, (iii) its non-specific nature means it holds little value in daily clinical practice and (iv) most definitions apply to a large segment of the population making it of limited use for health care planners. We argue that the complementary concepts of complexity and frailty would fit better with the delivery of patient centred care for people with multiple co-existing health problems and would be more useful to clinicians, commissioners and researchers

Adolescent Stress As It Relates To Stepfamily Living

The purpose of this study was to ascertain what adolescents who become stepchildren between the ages of 13 and 18 believe to be the stressful and non-stressful aspects of stepfamily living. This study also attempted to determine if the level of stress for adolescent stepchildren does diminish over time when comparing subjects living in a stepfamily less than two years, two to three years, three to four years, and four to six years. The 63 volunteer subjects responded to a 41-item questionnaire from which the data for this study were obtained. The Pearson Product-Moment Correlation yielded a reliability coefficient of .89 between the test and retest. The questionnaire items represented 12 areas suggested as stressful by the current literature. These areas were: (1) discipline; (2) biological parent elsewhere; (3) compounded loss; (4) parent\u27s and stepparent\u27s understanding of the stepchild\u27s feelings about the stepfamily; (5) pseudomutuality; (6) living with one parent before the remarriage; (7) unrealistic expectations; (8) divided loyalty; (9) family constellation; (10) desire for natural parents to reunite; (11) member of two households; and (12) social issues. A mean stress score for each of the 12 categories was computed from the subjects\u27 responses. The possible responses for each question were: (1) 1 = not stressful; (2) 2 = slightly stressful; (3) 3 = somewhat stressful; and (4) 4 = very stressful. The category of discipline (mean stress score = 2.52) had the highest mean stress score of the 12 categories. The category pertaining to social issues (mean stress score = 1.50) had the lowest mean stress score of the 12 categories. Frequency counts were also computed for the following demographic data: (1) present age of the subjects; (2) sex; (3) the age at which the subjects became members of a stepfamily; (4) the number of years that the subjects had lived in a stepfamily; (5) the number of years that the subjects have lived with one parent prior to the remarriage; (6) the reason for the dissolution of the nuclear family; (7) the presence of stepsiblings; (8) the presence of half siblings; and (9) the presence of stepmother or stepfather. This study attempted to measure stress that adolescent stepchildren experience as a result of stepfamily living. One stress experienced by the subjects was computed to be just above slightly stressful (overall mean stress score = 2.21). This study also attempted to determine if the stress for adolescent stepchildren does diminish over time spent in the stepfamily. The results of this study indicate that those subjects living in a stepfamily two to three years experienced more stress (mean stress score = 2.49) than those subjects living in a stepfamily zero to two years (mean stress score = 1.96). This study also attempted to ascertain if those subjects who had spent a longer period of time with a single parent before the remarriage experienced more stress in stepfamily living. The results indicate that those subjects who had lived nine years or more with a single parent experienced the least amount of stress (mean stress score = 1.63). Those subjects who had lived zero to three years with a single parent experienced the highest amount of stress (mean stress score = 2.27). One filler item, Feeling that your opinion as a teenager is not taken seriously (mean stress score = 2.87) received the highest mean stress score of the 41 items on the questionnaire. The implications of the study suggest that stepfamily living may not be particularly stressful for adolescent stepchildren. Much of the stress experienced by adolescent stepchildren may be the result of their struggle through the developmental stage of adolescence

Synthesis of photoacid crosslinkable hydrogels for the fabrication of soft, biomimetic microlens arrays

Soft, biomimetic microlens arrays were fabricated by interference lithography from the copolymers of poly(2-hydroxyethyl methacrylate), whose hydroxyl groups were crosslinked by photoacids and external crosslinkers

Brewing with Unmalted Cereal Adjuncts: Sensory and Analytical Impacts on Beer Quality

Citation: Yorke, J.; Cook, D.; Ford, R. Brewing with Unmalted Cereal Adjuncts: Sensory and Analytical Impacts on Beer Quality. Beverages 2021, 7, 4. https://doi

Downtown Providence Farmers Market Design

This market essentially combines a marketplace with an existing or new industrial building. The hybrid created results in space that has daily retail sales and hours, as well as other goods available at other times. The industrial aspect typically acts as the anchor, as the market’s activities help attract a different group of consumers at other business times. An example of this would be a seafood supply warehouse that also provides dining and entertainment as a nightlife destination

Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study.

BACKGROUND: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. OBJECTIVE: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. METHODS: This study involved 2 iterative design feedback cycles-an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. RESULTS: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. CONCLUSIONS: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools.Medical Research Council Confidence in Concept award (MC_PC_18042)

“I will try anything” the experience of working age stroke survivors living with chronic post-stroke pain: an interpretative phenomenological analysis

Purpose: To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). Methods: Semi-structured interviews were conducted with eight working age (46–64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. Results: The analysis led to three Group Experiential Themes: “The Solitude of the Pain Experience,” “Unsatisfactory Healthcare and the Need for Self-Care” and “The Development of Pain Acceptance.” Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. Conclusions: The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions

Mechanical thrombectomy in patients with acute ischemic stroke: a cost-effectiveness and value of implementation analysis

Background: Recent clinical trials have demonstrated the efficacy of mechanical thrombectomy in acute ischemic stroke. Aims: To determine the cost-effectiveness, value of future research, and value of implementation of mechanical thrombectomy. Methods: Using UK clinical and cost data from the Pragmatic Ischemic Stroke Thrombectomy Evaluation (PISTE) trial, we estimated the cost-effectiveness of mechanical thrombectomy over time horizons of 90-days and lifetime, based on a decision-analytic model, using all existing evidence. We performed a meta-analysis of seven clinical trials to estimate treatment effects. We used sensitivity analysis to address uncertainty. Value of implementation analysis was used to estimate the potential value of additional implementation activities to support routine delivery of mechanical thrombectomy. Results: Over the trial period (90 days), compared with best medical care alone, mechanical thrombectomy incurred an incremental cost of £5207 and 0.025 gain in QALY (incremental cost-effectiveness ratio (ICER) £205,279), which would not be considered cost-effective. However, mechanical thrombectomy was shown to be cost-effective over a lifetime horizon, with an ICER of £3466 per QALY gained. The expected value of perfect information per patient eligible for mechanical thrombectomy in the UK is estimated at £3178. The expected value of full implementation of mechanical thrombectomy is estimated at £1.3 billion over five years. Conclusion: Mechanical thrombectomy was cost-effective compared with best medical care alone over a patient’s lifetime. On the assumption of 30% implementation being achieved throughout the UK healthcare system, we estimate that the population health benefits obtained from this treatment are greater than the cost of implementation. Trial registration: NCT01745692

Fluphenazine dihydro­chloride dimethanol solvate

In the title compound {systematic name: 1-(2-hy­droxy­eth­yl)-4-[3-(2-trifluoro­methyl-10H-phenothia­zin-10-yl)prop­yl]piperazine-1,4-diium dichloride dimethanol disolvate}, C22H28F3N3OS2+·2Cl−·2CH3OH, the dihedral angle between the planes of the two outer benzene rings of the tricyclic phenothia­zine system is 46.91 (13)°. The piperazine ring adopts a chair conformation. The crystal structure is stabilized by O—H⋯Cl, N—H⋯Cl, C—H⋯O, C—H⋯Cl and C—H⋯F hydrogen bonds and contacts