To medicate or not to medicate? Exchange, identity and care in everyday household medication practices

In contemporary societies, medications are one of the most commonly used resources for the prevention, treatment, or cure of illness and disease (Shoemaker & de Oliveira, 2008). Despite this, there is a lack of understanding about how medications are used and understood by lay persons in private domestic dwellings. This research explores the medication experiences, understandings, and practices enacted by mothers caring for their chronically ill children. Four households containing children with chronic illness were involved in this qualitative interpretive research. Semi-structured interviews, mapping, diary keeping, and photo-production exercises were utilised to explore the ways in which medications are implicated in caring practices enacted by the mothers. Giddens’ (1984) structuration theory and the concept of ‘gift exchange’ provide the theoretical foundation for this thesis. This research indicates that the medication understandings and beliefs held by the participants are central to the construction of everyday caring medication practices. These beliefs and practices are not fixed or homogeneous, but complex and changeable; reflecting differing contexts, experiences, and forms of knowledge. The agency of parents as they conceptualise ‘care’ and choose to embrace or resist medication use, challenges the notion of ‘passive’ medication consumers. As the use of medication impacts many relationships within and outside of the confines of the household, this thesis highlights the social and symbolic nature of medications. The relationship between a parent and child is central to medication use, but medical decisions made by parents also implicate various other individuals, including health professionals and lay persons. The findings point to the need for health policy which acknowledges and is responsive to, the shifting health needs and understandings of the lay population

Increasing patient engagement in healthcare service design: a qualitative evaluation of a co-design programme in New Zealand

The Health & Quality Safety Commission New Zealand commissioned Ko Awatea, an innovation and improvement centre, to deliver a co-design programme to nine teams of healthcare providers. The co-design programme was part of Partners in Care, a broader programme developed in 2012 to support and enable patient engagement and participation across the health and disability sector. In the current programme teams received training, guidance and mentorship in Experience Based Design (EBD) methodology through a one day masterclass, seven WebEx sessions, coaching calls, email and through the completion of workbooks. We evaluated the co-design programme to explore the experiences, challenges and solutions that participating teams encountered while engaging with patients in their projects. The evaluation involved seventeen semi-structured interviews with programme participants, including seven team members, five sponsors, four patients and the programme facilitator. A further two team members provided feedback in written form and eight of nine teams provided completed workbooks. Data from the interviews and workbooks was thematically analysed. Health professionals identified key challenges to patient engagement as capturing diverse experiences, clear communication of project details and the availability and health of the patient. Patients advised the importance of improved communication, planning in advance and providing feedback and assurance about the value of their contribution. There are several important considerations to secure and maintain patient engagement in co-design. These include tailored strategies for approaching patients and capturing their experiences, pre-existing relationships and continued rapport building between patients and health professionals, good communication throughout the project, planning, and visibility of outcomes

Increasing sustainability in co-design projects: A qualitative evaluation of a co-design programme in New Zealand

The Health Quality & Safety Commission New Zealand commissioned Ko Awatea, an innovation and improvement centre, to deliver a co-design programme to nine teams of healthcare providers. The co-design programme was part of Partners in Care, a broader programme developed in 2012 to support and enable patient engagement and participation across the health and disability sector. Teams received training, guidance and mentorship in Experience Based Design (EBD) methodology.1 We evaluated the co-design programme to explore barriers and facilitators to the sustainability of the co-design projects and the EBD approach. The evaluation involved seventeen semi-structured interviews with programme participants, including seven team members, five sponsors, four patients and the programme facilitator. A further two team members provided written feedback. Eight teams provided completed workbooks. Data from the interviews and workbooks was thematically analysed. Team members saw support from sponsors as important to increase visibility and successful completion of co-design projects, mitigate barriers, and to secure resources and buy-in from peers. Five of nine participating teams reported dissatisfaction with the support received. Communication and competing priorities were challenges to sponsor engagement. Sharing co-design skills with peers and alignment with organisational strategy were seen as important for sustainability. Teams identified lack of secured resources or staff time, and consumer or staff attrition as key barriers to sustainability. The conclusion: buy-in from sponsors and senior leaders, support from colleagues, user-friendliness of co-design tools, consumer and staff availability, alignment, and system or culture change were key factors that influenced project sustainability

Screening large-scale association study data: exploiting interactions using random forests

BACKGROUND: Genome-wide association studies for complex diseases will produce genotypes on hundreds of thousands of single nucleotide polymorphisms (SNPs). A logical first approach to dealing with massive numbers of SNPs is to use some test to screen the SNPs, retaining only those that meet some criterion for futher study. For example, SNPs can be ranked by p-value, and those with the lowest p-values retained. When SNPs have large interaction effects but small marginal effects in a population, they are unlikely to be retained when univariate tests are used for screening. However, model-based screens that pre-specify interactions are impractical for data sets with thousands of SNPs. Random forest analysis is an alternative method that produces a single measure of importance for each predictor variable that takes into account interactions among variables without requiring model specification. Interactions increase the importance for the individual interacting variables, making them more likely to be given high importance relative to other variables. We test the performance of random forests as a screening procedure to identify small numbers of risk-associated SNPs from among large numbers of unassociated SNPs using complex disease models with up to 32 loci, incorporating both genetic heterogeneity and multi-locus interaction. RESULTS: Keeping other factors constant, if risk SNPs interact, the random forest importance measure significantly outperforms the Fisher Exact test as a screening tool. As the number of interacting SNPs increases, the improvement in performance of random forest analysis relative to Fisher Exact test for screening also increases. Random forests perform similarly to the univariate Fisher Exact test as a screening tool when SNPs in the analysis do not interact. CONCLUSIONS: In the context of large-scale genetic association studies where unknown interactions exist among true risk-associated SNPs or SNPs and environmental covariates, screening SNPs using random forest analyses can significantly reduce the number of SNPs that need to be retained for further study compared to standard univariate screening methods

Mapping complex traits using Random Forests

Random Forest is a prediction technique based on growing trees on bootstrap samples of data, in conjunction with a random selection of explanatory variables to define the best split at each node. In the case of a quantitative outcome, the tree predictor takes on a numerical value. We applied Random Forest to the first replicate of the Genetic Analysis Workshop 13 simulated data set, with the sibling pairs as our units of analysis and identity by descent (IBD) at selected loci as our explanatory variables. With the knowledge of the true model, we performed two sets of analyses on three phenotypes: HDL, triglycerides, and glucose. The goal was to approach the mapping of complex traits from a multivariate perspective. The first set of analyses mimics a candidate gene approach with a high proportion of true genes among the predictors while the second set represents a genome scan analysis using microsatellite markers. Random Forest was able to identify a few of the major genes influencing the phenotypes, such as baseline HDL and triglycerides, but failed to identify the major genes regulating baseline glucose levels

Associations between changes in ferritin levels and susceptibility-weighted imaging filtered phase in patients with relapsing–remitting multiple sclerosis over 24weeks of therapy with subcutaneous interferon beta-1a three times weekly

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Immunological and short-term brain volume changes in relapsing forms of multiple sclerosis treated with interferon beta-1a subcutaneously three times weekly: an open-label two-arm trial

Abstract Background Brain volume atrophy is observed in relapsing–remitting multiple sclerosis (RRMS). Methods Brain volume changes were evaluated in 23 patients with RRMS treated with interferon β-1a 44 μg given subcutaneously (SC) three times a week (tiw) and 15 healthy controls. Percentages of whole brain and tissue-specific volume change were measured from baseline (0 months) to 3 months, from 3 to 6 months, and from baseline to 6 months using SIENAX Multi Time Point (SX-MTP) algorithms. Immunological status of patients was also determined and correlations between subsets of T cells and changes in brain volume were assessed. Results Interferon β-1a 44 μg SC tiw in 23 patients with RRMS resulted in significant reductions in whole brain and gray matter tissue volume early in the treatment course (baseline to 3 months; mean change; –0.95 %; P = 0.030, –1.52 %; P = 0.004, respectively), suggesting a short-term treatment-induced pseudoatrophy effect. From baseline to 6 months, there were significant correlations observed between decreased T- cell expression of IL-17 F and decreased whole brain and brain tissue-specific volume. Conclusions These findings are consistent with the interpretation of the pseudoatrophy effect as resolution of inflammation following treatment initiation with interferon β-1a 44 μg SC tiw, rather than disease-related tissue loss. Trial registration ClinicalTrials.gov; NCT0108531

Broadband infrared photometry of comet Hale-Bopp with ISOPHOT

Comet Hale-Bopp was observed five times with ISOPHOT, the photometer on board ESA's Infrared Space Observatory (ISO) between 4.6 and 2.8 AU. Each time, broadband photometry was performed using 4 different detectors, 5 apertures and 10 filters covering the range between 3.6 and 170 μm. Background observations were performed with identical instrument settings at the same positions on the sky several days after the comet observations. The observation strategy and the data reduction steps are described in some detail, including the techniques to correct for variable detector responsivity. The resulting inband power values of the Hale-Bopp observations and their uncertainties are given. The mean uncertainty is 25%. The final fluxes were computed, taking into account the zodiacal background, possible offset of the comet's position from the center of the aperture, the brightness distribution within the coma, and the spectral energy distribution of the comet's emission. Strong thermal emission from a broad size distribution of dust particles was detected in all of the data sets, even at r = 4.6-4.9 AU pre-perihelion and 3.9 AU post-perihelion; the total thermal energy varied as r-3. The 7.3-12.8 μm color temperature was ~1.5 times the blackbody temperature, higher than that observed in any other comet. Silicate features at 10 and 25 μm were prominent in all 5 data sets, the largest heliocentric distances that silicate emission has been detected in a comet. The presence of crystalline water ice grains is suggested from the 60 μm excess emission at 4.6-4.9 AU, consistent with the observed QOH if the icy grains were slightly warmer than an equilibrium blackbody. The average albedo of the dust is higher than that of comet P/Halley, but lower than other albedo measurements for Hale-Bopp nearer perihelion. There is no evidence for a component of cold, bright icy grains enhancing the scattered light at 4.6 AU. Simple models for a mixture of silicate and absorbing grains were fit to the ISO spectra and photometry at 2.8 AU. The observed flux at λ >100 μm requires a size distribution in which most of the mass is concentrated in large particles. Dust production rates of order 1.5 x 105 kg s-1 at 2.8 AU and 3 x 104 kg s-1 at 4.6 AU have been found. They correspond to dust to gas mass ratios of 6 to 10

Three decades of subsidiary exits: Parent firm financial performance and moderators

This study aimed to find important constructs and relationships among models of subsidiary divestment during the period from 1989 to 2018 using correlation matrices of 80 studies, the selection of which was based on six criteria. It revealed eight important constructs, namely firm innovativeness, environmental factors in the target country, type of experience, organizational characteristics, investment strategy, parent firm financial performance, subsidiary divestment, and the moderating effects of advertising intensity and product diversification. Furthermore, it shed light on seven relationships that should be considered in future attempts to assess parent performance related to its antecedents and subsidiary divestment. Moreover, advertising intensity and product diversification were respectively weakening and strengthening moderators on firm financial performance, and advertising intensity was a weakening moderator between organizational characteristics and subsidiary divestment. The implementation of a product diversification policy did not assist in preventing subsidiary divestment. Conclusions, implications, limitations, and future research are discussed

Pre-Bilaterian Origins of the Hox Cluster and the Hox Code: Evidence from the Sea Anemone, Nematostella vectensis

BACKGROUND: Hox genes were critical to many morphological innovations of bilaterian animals. However, early Hox evolution remains obscure. Phylogenetic, developmental, and genomic analyses on the cnidarian sea anemone Nematostella vectensis challenge recent claims that the Hox code is a bilaterian invention and that no “true” Hox genes exist in the phylum Cnidaria. METHODOLOGY/PRINCIPAL FINDINGS: Phylogenetic analyses of 18 Hox-related genes from Nematostella identify putative Hox1, Hox2, and Hox9+ genes. Statistical comparisons among competing hypotheses bolster these findings, including an explicit consideration of the gene losses implied by alternate topologies. In situ hybridization studies of 20 Hox-related genes reveal that multiple Hox genes are expressed in distinct regions along the primary body axis, supporting the existence of a pre-bilaterian Hox code. Additionally, several Hox genes are expressed in nested domains along the secondary body axis, suggesting a role in “dorsoventral” patterning. CONCLUSIONS/SIGNIFICANCE: A cluster of anterior and posterior Hox genes, as well as ParaHox cluster of genes evolved prior to the cnidarian-bilaterian split. There is evidence to suggest that these clusters were formed from a series of tandem gene duplication events and played a role in patterning both the primary and secondary body axes in a bilaterally symmetrical common ancestor. Cnidarians and bilaterians shared a common ancestor some 570 to 700 million years ago, and as such, are derived from a common body plan. Our work reveals several conserved genetic components that are found in both of these diverse lineages. This finding is consistent with the hypothesis that a set of developmental rules established in the common ancestor of cnidarians and bilaterians is still at work today