Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Background: Frequent and potentially avoidable hospital admission amongst older patients with ambulatory care sensitive (ACS) chronic conditions is a major topic for research internationally, driven by the imperative to understand and therefore reduce hospital admissions. Research to date has mostly focused on analysis of routine data using ACS as a proxy for 'potentially avoidable'. There has been less research on the antecedents of frequent and/or avoidable admission from the perspectives of patients or those offering community based care and support for these patients. This study aimed to explore community based service providers' perspectives on the factors contributing to admission among older patients with chronic disease and a history of frequent and potentially avoidable admission. Methods. 15 semi-structured interviews with community based providers of health care and other services, and an emergency department physician were conducted. Summary documents were produced and thematic analysis undertaken. Results: A range of complex barriers which limit or inhibit access to services were reported. We classified these as external and internal barriers. Important external barriers included: complexity of provision of services, patients' limited awareness of different services and their inexperience in accessing services, patients needing a higher level or longer length of service than they currently have access to, or an actual lack of available services, patient poverty, rurality, and transport. Important internal barriers included: fear (of change for example), a 'stoic' attitude to life, and for some, the difficulty of accepting their changed health status. Conclusions: The factors underlying frequent and/or potentially avoidable admission are numerous and complex. Identifying strategies to improve services or interventions for this group requires understanding patient, carer and service providers' perspectives. Improving accessibility of services is also complex, and includes consideration of patients' social, emotional and psychological ability and willingness to use services as well as those services being available and easily accessed

Serum amyloid A primes microglia for ATP-dependent interleukin-1\u3b2 release

Acute-phase response is a systemic reaction to environmental/inflammatory insults and involves production of acute-phase proteins, including serum amyloid A (SAA). Interleukin-1\u3b2 (IL-1\u3b2), a master regulator of neuroinflammation produced by activated inflammatory cells of the myeloid lineage, in particular microglia, plays a key role in the pathogenesis of acute and chronic diseases of the peripheral nervous system and CNS. IL-1\u3b2 release is promoted by ATP acting at the purinergic P2X7 receptor (P2X7R) in cells primed with toll-like receptor (TLR) ligands

Effects of Global Warming on Ancient Mammalian Communities and Their Environments

Current global warming affects the composition and dynamics of mammalian communities and can increase extinction risk; however, long-term effects of warming on mammals are less understood. Dietary reconstructions inferred from stable isotopes of fossil herbivorous mammalian tooth enamel document environmental and climatic changes in ancient ecosystems, including C(3)/C(4) transitions and relative seasonality.Here, we use stable carbon and oxygen isotopes preserved in fossil teeth to document the magnitude of mammalian dietary shifts and ancient floral change during geologically documented glacial and interglacial periods during the Pliocene (approximately 1.9 million years ago) and Pleistocene (approximately 1.3 million years ago) in Florida. Stable isotope data demonstrate increased aridity, increased C(4) grass consumption, inter-faunal dietary partitioning, increased isotopic niche breadth of mixed feeders, niche partitioning of phylogenetically similar taxa, and differences in relative seasonality with warming.Our data show that global warming resulted in dramatic vegetation and dietary changes even at lower latitudes (approximately 28 degrees N). Our results also question the use of models that predict the long term decline and extinction of species based on the assumption that niches are conserved over time. These findings have immediate relevance to clarifying possible biotic responses to current global warming in modern ecosystems

Technology‐enhanced learning:Rethinking the term, the concept and its theoretical background

This theoretical paper is concerned with problematising the rethinking of theoretical backgrounds associated with one of the commonly used educational technology terms (fields)—technology‐enhanced learning—in the wider context of scholarship. Examples will show that the term itself is now used beyond its apparent, stated scope, that it is used in a number of varied ways, and that this is in itself problematic. The ways in which the term is used will be identified, and from these a strategic categorisation to rethink the use of the single term in areas of scholarship (particularly research and teaching) will be proposed, offering terms specifically encompassing the realms in which technologies are being used. From this categorisation, it will be shown that each specific category is based on different conceptions related to or arising from practice. Consequently, ways that theoretical backgrounds should be considered will be explored in each case. While existing theoretical backgrounds enable conceptual underpinnings in some of those cases, in other cases it will be shown that there are currently no fully developed theories or limited theoretical frameworks available. The paper will conclude by identifying key research areas needed if we are to develop and take pertinent aspects of scholarship further forward

Metabolic syndrome in rural Australia:An opportunity for primary health care

Objective: To measure the impact of a 6-month home-based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas. Design: A two-arm randomised controlled trial of rural adults. Setting: The rural town of Albany in the Great Southern region of Western Australia. Participants: Participants (n = 401) aged 50-69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group. Interventions: A 6-month intervention program incorporating goal setting, self-monitoring and feedback, with motivational interviewing was conducted. Main outcome measures: Change in metabolic syndrome status and cardiovascular risk. Results: Significant improvements in metabolic syndrome status and cardiovascular disease risk score (−0.82) were observed for the intervention group relative to control group from baseline to post-test. Conclusion: This home-based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long-term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered

The personal and national costs of mental health conditions: impacts on income, taxes, government support payments due to lost labour force participation

<p>Abstract</p> <p>Background</p> <p>Mental health conditions have the ability to interrupt an individual's ability to participate in the labour force, and this can have considerable follow on impacts to both the individual and the state.</p> <p>Method</p> <p>Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' <it>Survey of Disability, Ageing and Carers </it>and STINMOD, an income and savings microsimulation model was used to quantify the personal cost of lost income and the cost to the state from lost income taxation, increased benefits payments and lost GDP as a result of early retirement due to mental health conditions in Australians aged 45-64 in 2009.</p> <p>Results</p> <p>Individuals aged 45 to 64 years who have retired early due to depression personally have 73% lower income then their full time employed counterparts and those retired early due to other mental health conditions have 78% lower incomes. The national aggregate cost to government due to early retirement from these conditions equated to $278 million (£152.9 million) in lost income taxation revenue,$407 million (£223.9 million) in additional transfer payments and around $1.7 billion in GDP in 2009 alone.</p> <p>Conclusions</p> <p>The costs of mental health conditions to the individuals and the state are considerable. While individuals has to bear the economic costs of lost income in addition to the burden of the conditions itself, the impact on the state is loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments - in addition to direct health care costs.</p

S100P enhances the motility and invasion of human trophoblast cell lines

S100P has been shown to be a marker for carcinogenesis where its expression in solid tumours correlates with metastasis and a poor patient prognosis. This protein’s role in any physiological process is, however, unknown. Here we first show that S100P is expressed both in trophoblasts in vivo as well as in some corresponding cell lines in culture. We demonstrate that S100P is predominantly expressed during the early stage of placental formation with its highest expression levels occurring during the first trimester of gestation, particularly in the invading columns and anchoring villi. Using gain or loss of function studies through overexpression or knockdown of S100P expression respectively, our work shows that S100P stimulates both cell motility and cellular invasion in different trophoblastic and first trimester EVT cell lines. Interestingly, cell invasion was seen to be more dramatically affected than cell migration. Our results suggest that S100P may be acting as an important regulator of trophoblast invasion during placentation. This finding sheds new light on a hitherto uncharacterized molecular mechanism which may, in turn, lead to the identification of novel targets that may explain why significant numbers of confirmed human pregnancies suffer complications through poor placental implantation

Basaltic Dyke with Specific Volcanogenic Structures and its geomorphic evolution: Unique Geoheritage of the Faroe Islands (North Atlantic Ocean)

Volcanic landforms resulting from Cenozoic volcanism represent the most peculiar features of global geodiversity and provide eminent narratives for geoeducation. Among them, however, relict volcanic forms and site-specific landforms in remote areas have received less attention. In this paper, we provide the first description of unique volcanogenic features (hereinafter referred to as pseudo-hieroglyphs) developed on a summit rock wall at the Sandfelli ridge near the village of Gjógv in the N Eysturoy Island (Faroe Islands). The geomorphic evolution of the ridge and rock wall during the Quaternary is described and detailed petrographic analyses of the volcanogenic features are provided. Based on observed petrographical features, we interpret the pseudo-hieroglyphs to probably represent unique examples of chaotic horizontal columnar jointing. Following the geomorphological and petrographic examination of the study site, we analyse current Faroese legislation aiming at nature conservation and use this case to discuss broader implications of geoheritage conservation and geotourism in distant regions.Vulkanická krajina vzniklá kenozoickým vulkanismem představuje nejpodivnější rysy globální geodiversity a poskytuje vynikající příběhy pro geovzdělávání. Méně pozornosti se však dostává reliktním vulkanickým formám a lokálním tvarům reliéfu v odlehlých oblastech. V tomto článku přinášíme první popis unikátních vulkanogenních tvarů (dále jen "pseudo-hieroglyfy"), které se vyvíjely na skalní stěně vrcholu na hřbetě Sandfelli u vesnice Gjógv v severní části ostrova Eysturoy (Faerské ostrovy). Je popsán geomorfologický vývoj hřbetu a skalní stěny během kvartéru a jsou uvedeny podrobné petrografické analýzy vulkanogenních vlastností. Na základě pozorovaných petrografických rysů interpretujeme pseudo-hieroglyfy, které pravděpodobně představují jedinečné příklady chaotické horizontální sloupcovité odlučnosti. Po geomorfologickém a petrografickém studiu zájmové lokality analyzujeme současnou faerskou legislativu zaměřenou na ochranu přírody a užíváme tohoto příkladu k diskusi širších důsledků zachování a geoturistiky geografického dědictví ve vzdálených regionech

A university-based model for supporting computer science curriculum reform

Computer science curriculum reform in the United Kingdom has been subject to substantial scrutiny—as it has in many other countries around the world—with England introducing a radical new computing curriculum from September 2014. However, in Wales—a devolved nation within the UK—political, geographical and socio-cultural issues have to date hindered any substantive educational policy or curriculum reform for computer science. In this paper, we present the activities of Technocamps, a national university-based schools outreach programme founded in 2003, and consider its wider impact on computer science education, schools, pupils and teachers in Wales. In contrast to successful interventions elsewhere in the UK in building and sustaining communities of practice, certain political and cultural challenges in Wales have largely prevented these successful models from being adopted. Through the consideration of the national case study presented in this paper, we demonstrate the necessity of the nation-wide school- and student-focused Technocamps model in building resilient and scalable practitioner-led support networks. Furthermore, with emerging curriculum reform in Wales, we frame the wider opportunity for computer science education and sustainably embedding cross-curricular digital competencies—along with changing the wider public perception and perceived value of computer science as an academic discipline—as a prospective replicable case study of a national engagement model for nations with similar aspirations of developing digitally confident and capable citizens. To this end, we conclude by drawing out the important lessons learnt for consideration when embarking on a programme of national curriculum reform and associated professional development