Improving Adolescent Health Care Transition: Piloting the Transition Readiness Assessment Questionnaire

Purpose. Successful adolescent health care transition (HCT) is a vital process in providing developmentally appropriate care and minimizing negative outcomes, especially in adolescents with special health care needs. The purpose of this mixed-methods quality improvement project was to pilot the Transition Readiness Assessment Questionnaire (TRAQ) tool in a pediatric rheumatology clinic and assess its utility as a transition tool as well as to inquire about specific patient and family-based transition needs. Methods. The TRAQ tool and follow-up survey were administered in dyads to all established pediatric rheumatology patients between the ages of 12-18, and one caregiver, who presented to the clinic during the two-month intervention period. A post-intervention interview with the treating team was also conducted to assess provider experience. Results. 29/30 paired TRAQ and surveys returned with overall acceptance of the tool across adolescents, caregivers and providers. 84% of adolescents and 91.3% of caregivers agreed that they were seeking greater independence for themselves or their child and the skills listed on TRAQ would help them take care of themselves. Caregivers found the TRAQ easier to fill out, understand and more helpful as a transition tool than the adolescents. The treatment team reported the TRAQ was useful in starting a conversation about transition and highlighted the need for a structured transition process. Conclusions.The TRAQ is an accepted and valuable HCT tool for adolescents, caregivers and providers. Future projects could be aimed at piloting the TRAQ or other readiness assessment tools in other sub-specialty clinics, building a transition framework to support utilization of transitional tools and addressing the transition themes identified by adolescents and their caregivers

Active absorption of electromagnetic pulses in a cavity

7 pages, 4 figuresAuthor version of the article. The version of record is available from the publisher via: http://dx.doi.org/10.1088/1367-2630/17/5/053050 and is an open access article.© 2015 IOP Publishing Ltd and Deutsche Physikalische GesellschaftWe show that a pulse of electromagnetic radiation launched into a cavity can be completely absorbed into an infinitesimal region of space, provided one has a high degree of control over the current flowing through this region. We work out explicit examples of this effect in a cubic cavity and a cylindrical one, and experimentally demonstrate the effect in the microwave regime.Engineering and Physical Sciences Research Council (EPSRC)Czech Science Foundatio

Innovative Collaborative Practice: A Journey to Interinstitutional Transformation

What happens when university educators interested in improving health care partner with health care clinicians interested in improving education? Findings Why is collaboration important? -Brings new value to both institutions -Grounds research and theory in contemporary context -Power of bringing different expertise togethe

The long-term impact of COVID-19 on nursing: An e-panel discussion from the International Network for Child and Family Centred Care

Aim To explore the International Network for Child and Family Centred Care (INCFCC) members\u27 experiences and views on the long-term impact of COVID-19 on the nursing workforce. Background On the 11 March 2020, the World Health Organization declared COVID-19 a global pandemic. While some countries adopted a herd immunity approach, others imposed stricter measures to reduce the transmission of the virus. Hospitals in some countries faced an avalanche of extremely sick admissions, whereas others experienced an early surge in cases or were able to control the spread. Design Discursive paper. Methods A web-based survey was e-mailed to 63 INCFCC members from 28 March to 30 April 2022, as an invitation to share their experience concerning the long-term impact of COVID-19 on their role as a nurse educator, clinician or researcher. Results Sixteen members responded, and the responses were grouped under the themes stress and anxiety, safe staffing and pay, doing things differently, impact on research, impact on teaching and learning, impact on clinical practice, nursing made visible and lessons for the future. Conclusion The INCFCC members provided their views and highlighted the impact on their role in nursing education, administration, research and/or practice. This discussion of international perspectives on the similarities and differences imposed by COVID-19 found that the impact was wide-ranging and prolonged. The overarching theme revealed the resilience of the participating members in the face of COVID-19. Relevance to Clinical Practice This study highlights the importance of all areas of nursing, be it in academia or in clinical practice, to work together to learn from the present and to plan for the future. Future work should focus on supporting organizational and personal resiliency and effective interventions to support the nursing workforce both during a disaster and in the recovery phase. Nursing workforce resilience in the face of COVID-19

Effects of Understory Vegetation Management on Plant Communities in Oil Palm Plantations in Sumatra, Indonesia

Oil palm plantations have expanded rapidly in recent decades, and are causing substantial impacts on tropical habitats and biodiversity. However, owing to its long lifespan (25-30 years), oil palm forms a much more varied and structurally-complex habitat than many other crops. This can include abundant understory vegetation and also epiphytes on palm trunks. However, the diversity of this plantation vegetation has been poorly studied, and there has been little consideration of the impacts of common plantation vegetation management practices on plant communities. We conducted a long-term vegetation management experiment that forms part of the Biodiversity and Ecosystem Function in Tropical Agriculture (BEFTA) Programme in Riau, Indonesia. We manipulated herbicide and manual cutting regimes within mature oil palm plantations to create three different understory complexity treatments (Reduced, Normal, and Enhanced vegetation) across replicated sets of plots. Plant communities were surveyed before and after experimental understory vegetation treatments began in three different microhabitats: within the middle of the plantation block (core), on the road edge (edge) and on oil palm trunks (trunk). Part of the sampling was also conducted during a drought event. We recorded 120 plant species, which comprised a mixture of native, non-native, ‘beneficial’, and ‘problem’ species. We found substantial variation in plant communities between edge, core, and trunk microhabitats, indicating high levels of heterogeneity within the plantation. There were significant effects of varying understory treatment within both core and edge microhabitats, but no spillover of impacts into the trunk microhabitat. We also observed substantial impacts of drought on plant communities, with declines in either biomass, percentage cover, or richness seen across core, edge, and trunk microhabitats during low-rainfall periods. Our findings highlight the diversity of plant communities that can be supported within oil palm plantations, and the substantial impacts that management decisions, and also drought, can have on them. Given the role that diverse plant communities can have in supporting species in other groups, this is likely to have a significant impact on the wider plantation biodiversity. We suggest that plantation management strategies give greater consideration to within-plantation understory plant communities and choose more wildlife-friendly options where possible.This work was funded by The Isaac Newton Trust Cambridge, Golden Agri Resources, and the Natural Environment Research Council [grant number NE/P00458X/1]

Alcohol Consumption and Incident Cataract Surgery in Two Large UK Cohorts

PURPOSE: To examine the association of alcohol consumption and type of alcoholic beverage with incident cataract surgery in two large cohorts. DESIGN: Longitudinal observational study PARTICIPANTS: We included 469,387 participants of UK Biobank with a mean age of 56 years, and 23,162 participants of EPIC-Norfolk with a mean age of 59 years. METHODS: Self-reported alcohol consumption at baseline was ascertained by a touchscreen questionnaire in UK Biobank and a food-frequency questionnaire in EPIC-Norfolk. Cases were defined as participants undergoing cataract surgery in either eye as ascertained via data linkage to National Health Service procedure statistics. We excluded participants with cataract surgery up to 1 year after the baseline assessment visit or those with self-reported cataract at baseline. Cox proportional hazards models were used to examine the associations of alcohol consumption with incident cataract surgery, adjusted for age, sex, ethnicity, Townsend deprivation index, body mass index, smoking and diabetes status. MAIN OUTCOME MEASURES: Incident cataract surgery RESULTS: There were 19,011 (mean cohort follow-up of 95 months) and 4,573 (mean cohort follow-up of 193 months) incident cases of cataract surgery in UK Biobank and EPIC-Norfolk, respectively. Compared to non-drinkers, drinkers were less likely to undergo cataract surgery in UK Biobank (HR 0.89, 95% CI 0.85-0.93) and EPIC-Norfolk (HR 0.90, 95% CI 0.84-0.97) after adjusting for covariables. Among alcohol consumers, greater alcohol consumption was associated with a reduced risk of undergoing cataract surgery in EPIC-Norfolk (P<0.001), while a U-shaped association was observed in the UK Biobank. Compared with non-drinkers, sub-group analysis by type of alcohol beverage showed the strongest protective association with wine consumption; the risk of incident cataract surgery was 23% and 14% lower among those in the highest category of wine consumption in EPIC-Norfolk and UK Biobank, respectively. CONCLUSION: Our findings suggest a lower risk of undergoing cataract surgery with low to moderate alcohol consumption. The association was particularly apparent with wine consumption. We cannot exclude the possibility of residual confounding and further studies are required to determine whether this association is causal in nature

Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia

White matter hyperintensities as seen on brain T2-weighted magnetic resonance imaging are associated with varying degrees of cognitive dysfunction in stroke, cerebral small vessel disease and dementia. The pathophysiological mechanisms within the white matter accounting for cognitive dysfunction remain unclear. With the hypothesis that gliovascular interactions are impaired in subjects with high burdens of white matter hyperintensities, we performed clinicopathological studies in post-stroke survivors, who had exhibited greater frontal white matter hyperintensities volumes that predicted shorter time to dementia onset. Histopathological methods were used to identify substrates in the white matter that would distinguish post-stroke demented from post-stroke non-demented subjects. We focused on the reactive cell marker glial fibrillary acidic protein (GFAP) to study the incidence and location of clasmatodendrosis, a morphological attribute of irreversibly injured astrocytes. In contrast to normal appearing GFAP + astrocytes, clasmatodendrocytes were swollen and had vacuolated cell bodies. Other markers such as aldehydedehydrogenase 1 family, member L1 (ALDH1L1) showed cytoplasmic disintegration of the astrocytes. Total GFAP + cells in both the frontal and temporal white matter were not greater in post-stroke demented versus post-stroke non-demented subjects. However, the percentage of clasmatodendrocytes was increased by 42-fold in subjects with post-stroke demented compared to post-stroke non-demented subjects (P = 0.026) and by 11-fold in older controls versus young controls (P50.023) in the frontal white matter. High ratios of clasmotodendrocytes to total astrocytes in the frontal white matter were consistent with lower Mini-Mental State Examination and the revised Cambridge Cognition Examination scores in post-stroke demented subjects. Double immunofluorescent staining showed aberrant co-localization of aquaporin 4 (AQP4) in retracted GFAP + astrocytes with disrupted end-feet juxtaposed to microvessels. To explore whether this was associated with the disrupted gliovascular interactions or blood–brain barrier damage, we assessed the co-localization of GFAP and AQP4 immunoreactivities in post-mortem brains from adult baboons with cerebral hypoperfusive injury, induced by occlusion of three major vessels supplying blood to the brain. Analysis of the frontal white matter in perfused brains from the animals surviving 1–28 days after occlusion revealed that the highest intensity of fibrinogen immunoreactivity was at 14 days. At this survival time point, we also noted strikingly similar redistribution of AQP4 and GFAP + astrocytes transformed into clasmatodendrocytes. Our findings suggest novel associations between irreversible astrocyte injury and disruption of gliovascular interactions at the blood–brain barrier in the frontal white matter and cognitive impairment in elderly post-stroke survivors. We propose that clasmatodendrosis is another pathological substrate, linked to white matter hyperintensities and frontal white matter changes, which may contribute to post-stroke or small vessel disease dementia