Mixed methods study of a new model of care for chronic disease: co-design and sustainable implementation of group consultations into clinical practice

Objectives: Group consultations are used for chronic conditions, such as inflammatory arthritis, but evidence of efficacy for treatment to target or achieving tight control is lacking. Our aim was to establish whether group consultation is a sustainable, co-designed routine care option and to explore factors supporting spread. Methods: The study used mixed methods, observational process/outcome data, plus qualitative exploration of enabling themes. It was set in two community hospitals, in 2008-19, with a third hospital from 2016, and was triangulated with primary care qualitative data. There was a total of 3363 arthritis patient attendances at 183 clinics during 2008-19. The early arthritis cohort comprised 46 patients, followed monthly until the treatment target was achieved, during 2016-19. Focus groups included 15 arthritis and 11 osteoporosis group attendees. Intervention was a 2 h group consultation, attended monthly for early/active disease and annually for stable disease. Measurements included attendance, DAS, satisfaction and enabling themes. Results: There was a mean number of 18.4 patients per clinic ( n  = 16, 2010-15; n  = 18, 2016; n  = 20, 2017; n  = 23, 2018-19). Forty per cent (1161/2874) of patients with DAS data reached low disease activity (DAS < 3.2) or remission (DAS < 2.6). Forty-six early arthritis patients followed monthly until they achieved remission responded even better: 50% remission; and 89% low disease activity/remission by 6 months. Qualitative analysis derived five main enabling themes (efficiency, empathy, education, engagement and empowerment) and five promotors to translate these themes into practice (prioritization, personalization, participation, personality and pedagogy). Limitations included the prospectively collected observational data and pragmatic design susceptible to bias. Conclusion: Co-designed group consultations can be sustainable, clinically effective and efficient for monthly review of early active disease and annual review of stable disease. Promoting factors may support effective training for chronic disease group consultations

Geochemical Data on Waters, gases, scales, and rocks from the Dixie Valley Region, Nevada (1996-1999)

This report tabulates an extensive geochemical database on waters, gases, scales, rocks, and hot-spring deposits from the Dixie Valley region, Nevada. The samples from which the data were obtained were collected and analyzed during 1996 to 1999. These data provide useful information for ongoing and future investigations on geothermal energy, volcanism, ore deposits, environmental issues, and groundwater quality in this region

Regional hydrology of the Dixie Valley geothermal field, Nevada: preliminary interpretations of chemical and isotopic data

Chemical and isotopic analyses of Dixie Valley regional waters indicate several distinct groups ranging in recharge age from Pleistocene (&lt;20 ka) to recent (&lt;50a). Valley groundwater is older than water from perennial springs and artesian wells in adjacent ranges, with Clan Alpine range (east) much younger (most &lt;50a) than Stillwater range (west; most &gt;1000a). Geothermal field fluids ({approximately}12-14 ka) appear derived from water similar in composition to non-thermal groundwater observed today in valley artesian wells (also -14 ka). Geothermal fluid interaction with mafic rocks (Humboldt Lopolith) appears to be common, and significant reaction with granodiorite may also occur. Despite widespread occurrence of carbonate rocks, large scale chemical interaction appears minor. Age asymmetry of the ranges, more extensive interaction with deep-seated waters in the west, and distribution of springs and artesian wells suggest the existence of a regional upward hydrologic gradient with an axis in proximity to the Stillwater range

Informe del muestreo geoquímico de gases en sistemas geotermales en el sur del Perú (6 al 18 de julio del 2007)

La recolección y análisis de las muestras de gas se realizaron en el marco de un proyecto de cooperación entre el Instituto Geológico Minero y Metalúrgico (INGEMMET) y la Universidad Nacional Autónoma de México (UNAM). Teniendo como participantes al Dr. Claus Siebe de la UNAM – México; y los Drs. Fraser y Cathy Goff del Laboratorio Los Álamos de Estados Unidos, especialistas en campos geotermales y el Lic. Pablo Masías, Químico del INGEMMET. Los trabajos se realizaron del 6 al 18 de julio del 2007, en 17 zonas geotermales en 4 departamentos del sur del Perú (Puno, Arequipa, Moquegua y Tacna), las que se pueden apreciar en la fig. 1 y 2. Estas se caracterizaron por presentar agua caliente, en algunos casos se encontraron fuentes saturadas con vapor, además de geisers, solfataras y fumarolas. En algunas zonas se tomaron más de un punto de muestreo. El muestreo de gases se realizó utilizando las botellas de Giggenbach con el método que se describirá más adelante, además se tomaron muestras de agua para realizarle análisis químicos e isotópicos, se midieron parámetros como la temperatura, pH, Conductividad y los sólidos totales disueltos

Analytical performance specifications for the measurement uncertainty of 24,25-dihydroxyvitamin D examinations

Objectives: The exploration of the metabolites in the degradation pathways of vitamin D (VTD) has gained importance in recent years and simultaneous quantitation of twenty-five-hydroxy vitamin D (25(OH)D) mass concentration together with 24,25-dihydroxyvitamin D (24,25(OH)2D) has been proposed as a newer approach to define VTD deficiency. Yet, no data are available on 24,25(OH)2D biological variation (BV). In this study, we evaluated 24,25(OH)2D's BV on the European Biological Variation Study (EuBIVAS) cohort samples to determine if analytical performance specifications (APS) for 24,25(OH)2D could be generated. Methods: Six European laboratories recruited 91 healthy participants. 25(OH)D and 24,25(OH)2D concentrations in K3-EDTA plasma were examined weekly for up to 10 weeks in duplicate with a validated LC-MS/MS method. The Vitamin D Metabolite Ratio (24,25(OH)2D divided by 25(OH)D × 100) was also calculated at each time point. Results: Linear regression of the mean 24,25(OH)2D concentrations at each blood collection showed participants were not in steady state. Variations of 24,25(OH)2D over time were significantly positively associated with the slopes of 25(OH)D concentrations over time and the concentration of 25(OH)D of the participant at inclusion, and negatively associated with body mass index (BMI), but not with age, gender, or location of the participant. The variation of the 24,25(OH)2D concentration in participants over a 10 weeks period was 34.6%. Methods that would detect a significant change linked to the natural production of 24,25(OH)2D over this period at p&lt;0.05 would need a relative measurement uncertainty (u%)&lt;14.9% while at p&lt;0.01, relative measurement uncertainty should be &lt;10.5%. Conclusions: We have defined for the first time APS for 24,25(OH)2D examinations. According to the growing interest in this metabolite, several laboratories and manufacturers might aim to develop specific methods for its determination. The results presented in this paper are thus necessary prerequisites for the validation of such methods.</p

Rethinking the concept of labour

Is labour a useful concept for anthropology today? This essay attempts to respond theoretically to the challenge that the contributions to this special issue empirically pose. The essay rethinks the concept of labour by addressing three questions that deal with the relation of human work effort and capital accumulation: the first refers to alienation; the second to the difference between abstract and concrete labour; and the third to ambiguity. Over the years, these issues have addressed particular aspects of social reproduction, helping define labour as a concept, albeit a heterogeneous one, that is relationally linked to capital. Dislocation, together with the parallel concepts of dispossession, disorganization, disconnection, and differentiation, emerges prominently in the analyses of contemporary labour transformations and specificities. Finally, the essay engages with seemingly disappearing labour futures and what this means for the concept of labour. What is the value of work for capital and, conversely, the value of labouring for people today

Monitoring guidance for patients with hypophosphatasia treated with asfotase alfa.

Hypophosphatasia (HPP) is a rare, inherited, systemic, metabolic disorder caused by autosomal recessive mutations or a single dominant-negative mutation in the gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). The disease is associated with a broad range of signs, symptoms, and complications, including impaired skeletal mineralization, altered calcium and phosphate metabolism, recurrent fractures, pain, respiratory problems, impaired growth and mobility, premature tooth loss, developmental delay, and seizures. Asfotase alfa is a human, recombinant enzyme replacement therapy that is approved in many countries for the treatment of patients with HPP. To address the unmet need for guidance in the monitoring of patients receiving asfotase alfa, an international panel of physicians with experience in diagnosing and managing HPP convened in May 2016 to discuss treatment monitoring parameters. The panel discussions focused on recommendations for assessing and monitoring patients after the decision to treat with asfotase alfa had been made and did not include recommendations for whom to treat. Based on the consensus of panel members, this review provides guidance on the monitoring of patients with HPP during treatment with asfotase alfa, including recommendations for laboratory, efficacy, and safety assessments and the frequency with which these should be performed during the course of treatment. Recommended assessments are based on patient age and include regular monitoring of biochemistry, skeletal radiographs, respiratory function, growth, pain, mobility and motor function, and quality of life. Because of the systemic presentation of HPP, a coordinated, multidisciplinary, team-based, patient-focused approach is recommended in the management of patients receiving asfotase alfa. Monitoring of efficacy and safety outcomes must be tailored to the individual patient, depending on medical history, clinical manifestations, availability of resources in the clinical setting, and the clinician's professional judgment