Provider connectedness and communication patterns: extending continuity of care in the context of the circle of care

BACKGROUND: Continuity is an important aspect of quality of care, especially for complex patients in the community. We explored provider perceptions of continuity through a system’s lens. The circle of care was used as the system. METHODS: Soft systems methodology was used to understand and improve continuity for end of life patients in two communities. Participants: Physicians, nurses, pharmacists in two communities in British Columbia, involved in end of life care. Two debates/discussion groups were completed after the interviews and initial analysis to confirm findings. Interview recordings were qualitatively analyzed to extract components and enablers of continuity. RESULTS: 32 provider interviews were completed. Findings from this study support the three types of continuity described by Haggerty and Reid (information, management, and relationship continuity). This work extends their model by adding features of the circle of care that influence and enable continuity: Provider Connectedness the sense of knowing and trust between providers who share care of a patient; a set of ten communication patterns that are used to support continuity across the circle of care; and environmental factors outside the circle that can indirectly influence continuity. CONCLUSIONS: We present an extended model of continuity of care. The components in the model can support health planners consider how health care is organized to promote continuity and by researchers when considering future continuity research

Adam Smith and the theory of punishment

A distinctive theory of punishment plays a central role in Smith's moral and legal theory. According to this theory, we regard the punishment of a crime as deserved only to the extent that an impartial spectator would go along with the actual or supposed resentment of the victim. The first part of this paper argues that Smith's theory deserves serious consideration and relates it to other theories such as utilitarianism and more orthodox forms of retributivism. The second part considers the objection that, because Smith's theory implies that punishment is justified only when there is some person or persons who is the victim of the crime, it cannot explain the many cases where punishment is imposed purely for the public good. It is argued that Smith's theory could be extended to cover such cases. The third part defends Smith's theory against the objection that, because it relies on our natural feelings, it cannot provide an adequate moral justification of punishment

Distinctive and pervasive alterations in aqueous humor protein composition following different types of glaucoma surgery

PURPOSE: To investigate whether specific glaucoma surgeries are associated with differences in aqueous humor protein concentrations compared to eyes without filters. METHODS: In this cross-sectional study, aqueous humor samples were prospectively collected from control subjects who underwent routine cataract surgery (n=14) and from patients who had different glaucoma filters: Baerveldt aqueous shunt (n=6), Ahmed aqueous shunt (n=6), trabeculectomy (n=5), and Ex-Press trabeculectomy (n=3). Total protein concentrations were determined with Bradford assay. Tryptic digests were analyzed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Proteins were identified with high confidence using stringent criteria and were quantitatively compared with a label-free platform. Relative protein quantities were compared across groups with ANOVA. Post hoc pair-wise comparisons were adjusted for multiple comparisons. RESULTS: Compared to the control eyes, the aqueous humor protein concentration was increased approximately tenfold in the Ahmed and Baerveldt eyes and fivefold in the trabeculectomy and Ex-Press eyes. Overall, 718 unique proteins, splice variants, or isoforms were identified. No differences in the protein concentrations were detected between the Baerveldt and Ahmed groups. Likewise, the trabeculectomy and Ex-Press groups were remarkably similar. Therefore, the aqueous shunt groups were pooled, and the trabeculectomy groups were pooled for a three-way comparison with the controls. More than 500 proteins differed significantly in relative abundance (ANOVA p<0.01) among the control, aqueous shunt, and trabeculectomy groups. Functional analyses suggested these alterations in relative protein abundance affected dozens of signaling pathways. CONCLUSIONS: Different glaucoma surgical procedures were associated with marked increases in the aqueous humor protein concentration and distinctive changes in the relative abundance of numerous proteins involved in multiple signaling pathways

Characterising latency for AO optical sensors: An implementation

The latency of electro-optical components is of high importance in the design of Adaptive Optics systems, as it limits the performance of the control loop. There exists a need for a latency measurement method that can be constructed with simple components found in most Adaptive Optics labs that still provides a measurement accurate to sub-microseconds. Through a combination of research and experimentation, potential methodologies were investigated with the aim of producing reliable latency measurements. This document will discuss one such method, involving coupling a LED pulse output and detected pulse input signals to the same clock for easy comparison. For this method, a proof-of-concept was developed using MATLAB and small analogue electronics, and the performance characterised. This characterisation showed that although there is some merit to the method, improvements are necessary to increase the precision of the measurement to a level usable in Adaptive Optics systems

Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients

Objective To investigate the effects on cardiovascular outcomes of drug interventions that increase high density lipoprotein levels. Design Meta-analysis. Studies reviewed Therapeutic benefit of niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors on cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke). Results 117 411 patients were randomised in a total of 39 trials. All interventions increased the levels of high density lipoprotein cholesterol. No significant effect was seen on all cause mortality for niacin (odds ratio 1.03, 95% confidence interval 0.92 to 1.15, P=0.59), fibrates (0.98, 0.89 to 1.08, P=0.66), or CETP inhibitors (1.16, 0.93 to 1.44, P=0.19); on coronary heart disease mortality for niacin (0.93, 0.76 to 1.12, P=0.44), fibrates (0.92, 0.81 to 1.04, P=0.19), or CETP inhibitors (1.00, 0.80 to 1.24, P=0.99); or on stroke outcomes for niacin (0.96, 0.75 to 1.22, P=0.72), fibrates (1.01, 0.90 to 1.13, P=0.84), or CETP inhibitors (1.14, 0.90 to 1.45, P=0.29). In studies with patients not receiving statins (before the statin era), niacin was associated with a significant reduction in non-fatal myocardial infarction (0.69, 0.56 to 0.85, P=0.0004). However, in studies where statins were already being taken, niacin showed no significant effect (0.96, 0.85 to 1.09, P=0.52). A significant difference was seen between these subgroups (P=0.007). A similar trend relating to non-fatal myocardial infarction was seen with fibrates: without statin treatment (0.78, 0.71 to 0.86, P<0.001) and with all or some patients taking statins (0.83, 0.69 to 1.01, P=0.07); P=0.58 for difference. Conclusions Neither niacin, fibrates, nor CETP inhibitors, three highly effective agents for increasing high density lipoprotein levels, reduced all cause mortality, coronary heart disease mortality, myocardial infarction, or stroke in patients treated with statins. Although observational studies might suggest a simplistic hypothesis for high density lipoprotein cholesterol, that increasing the levels pharmacologically would generally reduce cardiovascular events, in the current era of widespread use of statins in dyslipidaemia, substantial trials of these three agents do not support this concept

Archeota, Spring 2019

This is the Spring 2019 issue of Archeota, the official publication of SJSU SAASC. Archeota is a platform for students to contribute to the archival conversation. It is written BY students, FOR students. It provides substantive content on archival concerns and issues, and promotes career development in the field of archival studies. Archeota upholds the core values of the archival profession. It is a semiannual publication of the Student Chapter of the Society of American Archivists at the San Jose State University School of Information.https://scholarworks.sjsu.edu/saasc_archeota/1009/thumbnail.jp

Seasonal effects to metallothionein responses to metal exposure in a naturalised population of Ruditapes philippinarum in a semi-enclosed estuarine environment

The Manila clam (Ruditapes philippinarum), an invasive species in Northern Europe, can be used as a bioindicator of metal pollution. Seasonal effects on metallothionein (MT) production have not been considered in this species at the northernmost extent of its European distribution. This study assesses the annual seasonal effects on MT and metal concentrations in R. philippinarum from Poole Harbour, UK. R. philippinarum were collected in winter, spring, summer, and autumn throughout 2015, and MT and metal concentrations, as well as biotic and abiotic variables, were quantified. During winter, linear regression analysis showed significant positive relationships between tissue metal and MT concentrations. However, during spring and summer, these relationships were mostly insignificant. MT concentrations during spring had significant positive relationships with tissue and whole weight. Significant positive relationships were also observed between MT and condition index, during summer. During spring and summer, biotic factors seem to override the role of MT as a detoxification mechanism for metal exposure in this species. This is probably due to an increase in MT concentration in spring caused by gametogenesis, associated with increased tissue weight as the gonads expand. A depletion of energy resources, or physical stressors such as heat, may be attributed to the reduced MT production in clams of poor body condition in summer. The evidence from this study suggests that MT may only be a useful biomarker of metal pollution during winter in R. philippinarum in the UK. This verifies the natural variability of MT in this species at high latitudes, and highlights the potential and limits to a widely available bioindicator of metal pollution

Access issues: Transportation Challenges and healthcare delivery in rural settings

The aim of the work in this paper is to present the results from a study of how the quality of life in remote locations and rural settings of Bayelsa State, Nigeria can be enhanced through improvement in healthcare accessibility. The methodology comprised desktop study, questionnaire survey, participant observations and interviews. A survey comprising 2,000 distributed questionnaires was conducted between July 2016 and July 2017 within seven selected states in the Niger Delta region of Nigeria. A total of 1,800 questionnaires were completed and returned. Informal interviews were conducted with respondents from the public and health sectors within Bayelsa State; the focus state for the study. Data from most of the respondents revealed that physical barriers such as nature of terrain and transportation significantly influenced health services accessibility. Further analysis of the data revealed that lapses in the health policies and lack of initiatives were paramount drivers to the challenges around accessibility. Based on these findings a guide was developed to aid improvement on access to healthcare services. The guide provides recommendations for development of better transportation mechanisms that will resolve the long-standing logistics challenges that have impacted the healthcare needs of the rural population. Government action or involvement is a key influence on the actual outcomes from execution of the guid