A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care

Background: Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods. An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). Results: The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n=45), episodic care (n=19), and chronic disease management (n=11). They were undertaken in a number of countries including Australia (n=25), USA (n=25), and UK (n=15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n=46 studies) or as a combination of two (n=20) or more strategies (n=9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n=43 studies), patient support (n=29), provision of new services (n=19), workforce development (n=11), and financial incentives (n=9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. Conclusions: This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these. © 2012 Comino et al.; licensee BioMed Central Ltd

Prolonged low flow reduces reactive hyperemia and augments low flow mediated constriction in the brachial artery independent of the menstrual cycle

© 2013 Rakobowchuk et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Non-invasive forearm ischemia-reperfusion injury and low flow induced vascular dysfunction models provide methods to evaluate vascular function. The role of oestrogen, an endogenous anti-oxidant on recovery from ischemia-reperfusion injury has not been evaluated nor has the impact of prolonged low flow on vascular function been established. Eight healthy women (33610 yr) attended the lab during the follicular, ovulatory and mid-luteal phases of their menstrual cycles. After 30 minutes of rest, brachial artery vascular function was assessed by ultrasound measurements of diameter changes during 5 minutes of forearm ischemia and 3 minutes after. Subsequently, a 20-minute forearm ischemia period was completed. Further, vascular function assessments were completed 15, 30 and 45 minutes into recovery. Flow-mediated dilation, lowflow-mediated constriction, and reactive hyperaemia proximal to the area of ischemia were determined. Flow-mediated dilation was reduced at 15 minutes of recovery but recovered at 30 and 45 minutes (PRE: 7.161.0%, POST15:4.560.6%, POST30:5. 560.7% POST45:5.960.4%, p,0.01). Conversely, low-flow mediated constriction increased (PRE: 21.360.4%, POST15: 23.360.6%, POST30: 22.560.5% POST45: 21.560.12%, p,0.01). Reactive hyperaemia was reduced throughout recovery (p,0.05). Data were unaffected by menstrual phase. Prolonged low flow altered vascular function and may relate as much to increased vasoconstriction as with decreased vasodilation. Reductions in anterograde shear and greater retrograde shear likely modulate the brachial artery response, but the reduced total shear also plays an important role. The data suggest substantial alterations in vascular function proximal to areas of ischemia with potential clinical implications following reperfusion.British Heart Foundation (PG/08/060/25340),a Physiological Society summer studentship to SG, and a Wellcome Trust Vacation Studentship to EP

Stormiest winter on record for Ireland and UK

Meteorological agencies of Ireland and the UK have confirmed that winter (December to February) 2013-14 (W2013/14) set records for precipitation totals and the occurrence of extreme wind speeds1,2,3. Less clear is whether storminess (characterised as the frequency and intensity of cyclones) during W2013/14 was equally unprecedented. We assess multidecadal variations in storminess by considering frequency and intensity together and find that W2013/14 was indeed exceptional. Given the potential societal impacts there is clearly a need to better understand the processes driving extreme cyclonic activity in the North Atlantic (NA)

Mechanical behaviour of additively manufactured lunar regolith simulant components

Additive manufacturing and its related techniques have frequently been put forward as a promising candidate for planetary in-situ manufacturing, from building life-sustaining habitats on the Moon to fabricating various replacements parts, aiming to support future extra-terrestrial human activity. This paper investigates the mechanical behaviour of lunar regolith simulant material components, which is a potential future space engineering material, manufactured by a laser-based powder bed fusion additive manufacturing system. The influence of laser energy input during processing was associated with the evolution of component porosity, measured via optical and scanning electron microscopy in combination with gas expansion pycnometry. The compressive strength performance and Vickers microhardness of the components were analysed and related back to the processing history and resultant microstructure of the lunar regolith simulant build material. Fabricated structures exhibited a relative porosity of 44 – 49% and densities ranging from 1.76 – 2.3 g cm-3 , with a maximum compressive strength of 4.2 ± 0.1 MPa and elastic modulus of 287.3 ± 6.6 MPa, the former is comparable to a typical masonry clay brick (3.5 MPa). The 2 AM parts also had an average hardness value of 657 ± 14 HV0.05/15, better than borosilicate glass (580 HV). This study has shed significant insight into realizing the potential of a laser-based powder bed fusion AM process to deliver functional engineering assets via in-situ and abundant material sources that can be potentially used for future engineering applications in aerospace and astronautics

The impact of heterogeneity on the capillary trapping of CO2 in the Captain Sandstone

A significant uncertainty which remains for CO2 sequestration, is the effect of natural geological heterogeneities and hysteresis on capillary trapping over different length scales. This paper uses laboratory data measured in cores from the Goldeneye formation of the Captain D Sandstone, North Sea in 1D numerical simulations to evaluate the potential capillary trapping from natural rock heterogeneities across a range of scales, from cm to 65m. The impact of different geological realisations, as well as uncertainty in petrophysical properties, on the amount of capillary heterogeneity trapping is estimated. In addition, the validity of upscaling trapping characteristics in terms of the Land trapping parameter is assessed. The numerical models show that the capillary heterogeneity trapped CO2 saturation may vary between 0 and 14% of the total trapped saturation, depending upon the geological realisation and petrophysical uncertainty. When upscaling the Land model from core-scale experimental data, using the maximum experimental Land trapping parameter could increase the expected heterogeneity trapping by a factor of 3. Conversely, depending on the form of the imbibition capillary pressure curve used in the numerical model, including capillary pressure hysteresis may reduce the heterogeneity trapping by up to 70%

Radiogenomic analysis of primary breast cancer reveals [18F]-fluorodeoxglucose dynamic flux-constants are positively associated with immune pathways and outperform static uptake measures in associating with glucose metabolism

Background: PET imaging of 18F-fluorodeoxygucose (FDG) is used widely for tumour staging and assessment of treatment response, but the biology associated with FDG uptake is still not fully elucidated. We therefore carried out gene set enrichment analyses (GSEA) of RNA sequencing data to find KEGG pathways associated with FDG uptake in primary breast cancers. Methods: Pre-treatment data were analysed from a window-of-opportunity study in which 30 patients underwent static and dynamic FDG-PET and tumour biopsy. Kinetic models were fitted to dynamic images, and GSEA was performed for enrichment scores reflecting Pearson and Spearman coefficients of correlations between gene expression and imaging. Results: A total of 38 pathways were associated with kinetic model flux-constants or static measures of FDG uptake, all positively. The associated pathways included glycolysis/gluconeogenesis (‘GLYC-GLUC’) which mediates FDG uptake and was associated with model flux-constants but not with static uptake measures, and 28 pathways related to immune-response or inflammation. More pathways, 32, were associated with the flux-constant K of the simple Patlak model than with any other imaging index. Numbers of pathways categorised as being associated with individual micro-parameters of the kinetic models were substantially fewer than numbers associated with flux-constants, and lay around levels expected by chance. Conclusions: In pre-treatment images GLYC-GLUC was associated with FDG kinetic flux-constants including Patlak K, but not with static uptake measures. Immune-related pathways were associated with flux-constants and static uptake. Patlak K was associated with more pathways than were the flux-constants of more complex kinetic models. On the basis of these results Patlak analysis of dynamic FDG-PET scans is advantageous, compared to other kinetic analyses or static imaging, in studies seeking to infer tumour-to-tumour differences in biology from differences in imaging. Trial registration NCT01266486, December 24th 2010