Evaluating case studies of community-oriented integrated care.

This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub - both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into 'wicked problems', and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention

Health outcomes of online consumer health information: A systematic mixed studies review with framework synthesis.

The Internet has become the first source of consumer health information. Most theoretical and empirical studies are centered on information needs and seeking, rather than on information outcomes. This review's purpose is to explore and explain health outcomes of Online Consumer Health Information (OCHI) in primary care. A participatory systematic mixed studies review with a framework synthesis was undertaken. Starting from an initial conceptual framework, our specific objectives were to (a) identify types of OCHI outcomes in primary care, (b) identify factors associated with these outcomes, and (c) integrate these factors and outcomes into a comprehensive revised framework combining an information theory and a psychosocial theory of behavior. The results of 65 included studies were synthesized using a qualitative thematic data analysis. The themes derived from the literature underwent a harmonization process that produced a comprehensive typology of OCHI outcomes. The revised conceptual framework specifies four individual and one organizational level of OCHI outcomes, while including factors such as consumers' information needs and four interdependent contextual factors. It contributes to theoretical knowledge about OCHI health outcomes, and informs future research, information assessment methods, and tools to help consumers find and use health information

Formation of Sub-galactic Clouds under UV Background Radiation

The effects of the UV background radiation on the formation of sub-galactic clouds are studied by means of one-dimensional hydrodynamical simulations. The radiative transfer of the ionizing photons due to the absorption by HI, HeI and HeII, neglecting the emission, is explicitly taken into account. We find that the complete suppression of collapse occurs for the clouds with circular velocities typically in the range V_c \sim 15-40 km/s and the 50% reduction in the cooled gas mass with V_c \sim 20-55 km/s. These values depend most sensitively on the collapse epoch of the cloud, the shape of the UV spectrum, and the evolution of the UV intensity. Compared to the optically thin case, previously investigated by Thoul & Weinberg (1996), the absorption of the external UV photon by the intervening medium systematically lowers the above threshold values by \Delta V_c \sim 5 km/s. Whether the gas can contract or keeps expanding is roughly determined by the balance between the gravitational force and the thermal pressure gradient when it is maximally exposed to the external UV flux. Based on our simulation results, we discuss a number of implications on galaxy formation, cosmic star formation history, and the observations of quasar absorption lines. In Appendix, we derive analytical formulae for the photoionization coefficients and heating rates, which incorporate the frequency/direction-dependent transfer of external photons.Comment: 38 pages, 16 figures, accepted for publication in Ap

Magnetic Field and Pressure Phase Diagrams of Uranium Heavy-Fermion Compound U2_2Zn17_{17}

We have performed magnetization measurements at high magnetic fields of up to 53 T on single crystals of a uranium heavy-fermion compound U$_2$Zn$_{17}$ grown by the Bridgman method. In the antiferromagnetic state below the N\'{e}el temperature $T_{\rm N}$ = 9.7 K, a metamagnetic transition is found at $H_c$ $\simeq$ 32 T for the field along the [11$\bar{2}$0] direction ($a$-axis). The magnetic phase diagram for the field along the [11$\bar{2}$0] direction is given. The magnetization curve shows a nonlinear increase at $H_m$ $\simeq$ 35 T in the paramagnetic state above $T_{\rm N}$ up to a characteristic temperature $T_{{\chi}{\rm max}}$ where the magnetic susceptibility or electrical resistivity shows a maximum value. This metamagnetic behavior of the magnetization at $H_m$ is discussed in comparison with the metamagnetic magnetism of the heavy-fermion superconductors UPt$_3$, URu$_2$Si$_2$, and UPd$_2$Al$_3$. We have also carried out high-pressure resistivity measurement on U$_2$Zn$_{17}$ using a diamond anvil cell up to 8.7 GPa. Noble gas argon was used as a pressure-transmitting medium to ensure a good hydrostatic environment. The N\'{e}el temperature $T_{\rm N}$ is almost pressure-independent up to 4.7 GPa and starts to increase in the higher-pressure region. The pressure dependences of the coefficient of the $T^2$ term in the electrical resistivity $A$, the antiferromagnetic gap $\Delta$, and the characteristic temperature $T_{{\rho}{\rm max}}$ are discussed. It is found that the effect of pressure on the electronic states in U$_2$Zn$_{17}$ is weak compared with those in the other heavy fermion compounds

Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study

Objective The mixed methods appraisal tool (MMAT) was developed for critically appraising different study designs. This study aimed to improve the content validity of three of the five categories of studies in the MMAT by identifying relevant methodological criteria for appraising the quality of qualitative, survey, and mixed methods studies. Study Design and Setting First, we performed a literature review to identify critical appraisal tools and extract methodological criteria. Second, we conducted a two-round modified e-Delphi technique. We asked three method-specific panels of experts to rate the relevance of each criterion on a five-point Likert scale. Results A total of 383 criteria were extracted from 18 critical appraisal tools and a literature review on the quality of mixed methods studies, and 60 were retained. In the first and second rounds of the e-Delphi, 73 and 56 experts participated, respectively. Consensus was reached for six qualitative criteria, eight survey criteria, and seven mixed methods criteria. These results led to modifications of eight of the 11 MMAT (version 2011) criteria. Specifically, we reformulated two criteria, replaced four, and removed two. Moreover, we added six new criteria. Conclusion Results of this study led to improve the content validity of this tool, revise it, and propose a new version (MMAT version 2018)

Translating big data to better treatment in bipolar disorder - a manifesto for coordinated action

Bipolar disorder (BD) is a major healthcare and socio-economic challenge. Despite its substantial burden on society, the research activity in BD is much smaller than its economic impact appears to demand. There is a consensus that the accurate identification of the underlying pathophysiology for BD is fundamental to realize major health benefits through better treatment and preventive regimens. However, to achieve these goals requires coordinated action and innovative approaches to boost the discovery of the neurobiological underpinnings of BD, and rapid translation of research findings into development and testing of better and more specific treatments. To this end, we here propose that only a large-scale coordinated action can be successful in integrating international big-data approaches with real-world clinical interventions. This could be achieved through the creation of a Global Bipolar Disorder Foundation, which could bring government, industry and philanthropy together in common cause. A global initiative for BD research would come at a highly opportune time given the seminal advances promised for our understanding of the genetic and brain basis of the disease and the obvious areas of unmet clinical need. Such an endeavour would embrace the principles of open science and see the strong involvement of user groups and integration of dissemination and public involvement with the research programs. We believe the time is right for a step change in our approach to understanding, treating and even preventing BD effectively

High-pressure phases of uranium monophosphide studied by synchrotron x-ray diffraction

X-ray diffraction studies have been performed on UP powder for pressures up to 51 GPa using synchrotron radiation and a diamond-anvil cell. At ambient pressure UP has the rocksalt structure. The bulk modulus has been determined to B$_0$=102(4) GPa and its pressure derivative to B'$_0$ =4.0(8). The cubic phase has been found to transform to a new phase, UP II, at about 10 GPa. UP II can be characterized by a rhombohedral Bravais lattice. UP II transforms to an orthorhombic phase, UP III, at 28 GPa. No volume change has been observed at the two transitions. The influence of the 5f electrons on the transformations is discussed

Reducing the rate and duration of Re-ADMISsions among patients with unipolar disorder and bipolar disorder using smartphone-based monitoring and treatment -- the RADMIS trials: study protocol for two randomized controlled trials

Abstract Background Unipolar and bipolar disorder combined account for nearly half of all morbidity and mortality due to mental and substance use disorders, and burden society with the highest health care costs of all psychiatric and neurological disorders. Among these, costs due to psychiatric hospitalization are a major burden. Smartphones comprise an innovative and unique platform for the monitoring and treatment of depression and mania. No prior trial has investigated whether the use of a smartphone-based system can prevent re-admission among patients discharged from hospital. The present RADMIS trials aim to investigate whether using a smartphone-based monitoring and treatment system, including an integrated clinical feedback loop, reduces the rate and duration of re-admissions more than standard treatment in unipolar disorder and bipolar disorder. Methods The RADMIS trials use a randomized controlled, single-blind, parallel-group design. Patients with unipolar disorder and patients with bipolar disorder are invited to participate in each trial when discharged from psychiatric hospitals in The Capital Region of Denmark following an affective episode and randomized to either (1) a smartphone-based monitoring system including (a) an integrated feedback loop between patients and clinicians and (b) context-aware cognitive behavioral therapy (CBT) modules (intervention group) or (2) standard treatment (control group) for a 6-month trial period. The trial started in May 2017. The outcomes are (1) number and duration of re-admissions (primary), (2) severity of depressive and manic (only for patients with bipolar disorder) symptoms; psychosocial functioning; number of affective episodes (secondary), and (3) perceived stress, quality of life, self-rated depressive symptoms, self-rated manic symptoms (only for patients with bipolar disorder), recovery, empowerment, adherence to medication, wellbeing, ruminations, worrying, and satisfaction (tertiary). A total of 400 patients (200 patients with unipolar disorder and 200 patients with bipolar disorder) will be included in the RADMIS trials. Discussion If the smartphone-based monitoring system proves effective in reducing the rate and duration of re-admissions, there will be basis for using a system of this kind in the treatment of unipolar and bipolar disorder in general and on a larger scale. Trial registration ClinicalTrials.gov, ID: NCT03033420 . Registered 13 January 2017. Ethical approval has been obtained