Quality assessment of primary care for common mental disorders in isolated communities: Taking advantage of health records.

INTRODUCTION: This article is part of a research study on the organization of primary health care (PHC) for mental health in two of Quebec's remote regions. It introduces a methodological approach based on information found in health records, for assessing the quality of PHC offered to people suffering from depression or anxiety disorders. METHODS: Quality indicators were identified from evidence and case studies were reconstructed using data collected in health records over a 2-year observation period. Data collection was developed using a three-step iterative process: (1) feasibility analysis, (2) development of a data collection tool, and (3) application of the data collection method. The adaptation of quality-of-care indicators to remote regions was appraised according to their relevance, measurability and construct validity in this context. RESULTS: As a result of this process, 18 quality indicators were shown to be relevant, measurable and valid for establishing a critical quality appraisal of four recommended dimensions of PHC clinical processes: recognition, assessment, treatment and follow-up. CONCLUSIONS: There is not only an interest in the use of health records to assess the quality of PHC for mental health in remote regions but also a scientific value for the rigorous and meticulous methodological approach developed in this study. From the perspective of stakeholders in the PHC system of care in remote areas, quality indicators are credible and provide potential for transferability to other contexts. This study brings information that has the potential to identify gaps in and implement solutions adapted to the context

Continuum of care for persons with common mental health disorders in Nunavik: a descriptive study.

BACKGROUND: Changing Directions, Changing Lives, the Mental Health Strategy for Canada, prioritizes the development of coordinated continuums of care in mental health that will bridge the gap in services for Inuit populations. OBJECTIVE: In order to target ways of improving the services provided in these contexts to individuals in Nunavik with depression or anxiety disorders, this research examines delays and disruptions in the continuum of care and clinical, individual and organizational characteristics possibly associated with their occurrences. DESIGN: A total of 155 episodes of care involving a common mental disorder (CMD), incident or recurring, were documented using the clinical records of 79 frontline health and social services (FHSSs) users, aged 14 years and older, living in a community in Nunavik. Each episode of care was divided into 7 stages: (a) detection; (b) assessment; (c) intervention; (d) planning the first follow-up visit; (e) implementation of the first follow-up visit; (f) planning a second follow-up visit; (g) implementation of the second follow-up visit. Sequential analysis of these stages established delays for each one and helped identify when breaks occurred in the continuum of care. Logistic and linear regression analysis determined whether clinical, individual or organizational characteristics influenced the breaks and delays. RESULTS: More than half (62%) the episodes of care were interrupted before the second follow-up. These breaks mostly occurred when planning and completing the first follow-up visit. Episodes of care were more likely to end early when they involved anxiety disorders or symptoms, limited FHSS teams and individuals over 21 years of age. The median delay for the first follow-up visit (30 days) exceeded guideline recommendations significantly (1-2 weeks). CONCLUSION: Clinical primary care approaches for CMDs in Nunavik are currently more reactive than preventive. This suggests that recovery services for those affected are suboptimal

African-American patients with cancer Talking About Clinical Trials (TACT) with oncologists during consultations: evaluating the efficacy of tailored health messages in a randomised controlled trial—the TACT study protocol

Introduction Low rates of accrual of African-American (AA) patients with cancer to therapeutic clinical trials (CTs) represent a serious and modifiable racial disparity in healthcare that impedes the development of promising cancer therapies. Suboptimal physician–patient consultation communication is a barrier to the accrual of patients with cancer of any race, but communication difficulties are compounded with AA patients. Providing tailored health messages (THM) to AA patients and their physician about CTs has the potential to improve communication, lower barriers to accrual and ameliorate health disparities. Objective (1) Demonstrate the efficacy of THM to increase patient activation as measured by direct observation. (2) Demonstrate the efficacy of THM to improve patient outcomes associated with barriers to AA participation. (3) Explore associations among preconsultation levels of: (A) trust in medical researchers, (B) knowledge and attitudes towards CTs, (C) patient-family member congruence in decision-making, and (D) involvement/information preferences, and group assignment. Methods and analysis First, using established methods, we will develop THM materials. Second, the efficacy of the intervention is determined in a 2 by 2 factorial randomised controlled trial to test the effectiveness of (1) providing 357 AA patients with cancer with THM with 2 different ‘depths’ of tailoring and (2) either providing feedback to oncologists about the patients\u27 trial THM or not. The primary analysis compares patient engaged communication in 4 groups preconsultation and postconsultation. Ethics and dissemination This study was approved by the Virginia Commonwealth University Institutional Review Board. To facilitate use of the THM intervention in diverse settings, we will convene ‘user groups’ at 3 major US cancer centres. To facilitate dissemination, we will post all materials and the implementation guide in publicly available locations

Rigorous numerics for analytic solutions of differential equations : the radii polynomial approach

Judicious use of interval arithmetic, combined with careful pen and paper estimates, leads to effective strategies for computer assisted analysis of nonlinear operator equations. The method of radii polynomials is an efficient tool for bounding the smallest and largest neighborhoods on which a Newton-like operator associated with a nonlinear equation is a contraction mapping. The method has been used to study solutions of ordinary, partial, and delay differential equations such as equilibria, periodic orbits, solutions of initial value problems, heteroclinic and homoclinic connecting orbits in the Ck category of functions. In the present work we adapt the method of radii polynomials to the analytic category. For ease of exposition we focus on studying periodic solutions in Cartesian products of infinite sequence spaces. We derive the radii polynomials for some specific application problems and give a number of computer assisted proofs in the analytic framework

New Limits to the Infrared Background: Bounds on Radiative Neutrino Decay and on Contributions of Very Massive Objects to the Dark Matter Problem

From considering the effect of γ-γ interactions on recently observed TeV gamma-ray spectra, improved limits are set to the density of extragalactic infrared photons which are robust and essentially model independent. The resulting limits are more than an order of magnitude more restrictive than direct observations in the 0.025–0.3 eV regime. These limits are used to improve constraints on radiative neutrino decay in the mass range above 0.05 eV and to rule out very massive objects as providing the dark matter needed to explain galaxy rotation curves. Lower bounds on the maximum distance which TeV gamma rays may probe are also derived

Simultaneous traveling convection vortex events and Pc1 wave bursts at cusp latitudes observed in Arctic Canada and Svalbard

Traveling convection vortices (TCVs), which appear in ground magnetometer records at near‐cusp latitudes as solitary ~5 mHz pulses, are a signature of dynamical processes in the ion foreshock upstream of the Earth's bow shock that can stimulate transient compressions of the dayside magnetosphere. These compressions can also increase the growth rate of electromagnetic ion cyclotron (EMIC) waves, which appear in ground records at these same latitudes as bursts of Pc1 pulsations. In this study we have identified TCVs and simultaneous Pc1 burst events in two regions, Eastern Arctic Canada and Svalbard, using a combination of fluxgate magnetometers and search coil magnetometers in each region. By looking for the presence of TCVs and Pc1 bursts in two different sequences, we have found that the distribution of Pc1 bursts was more tightly clustered near local noon than that of TCV events, that neither TCVs nor Pc1 bursts were always associated with the other, and even when they occurred simultaneously their amplitudes showed little correlation. Magnetometer data from GOES‐12 were also used to characterize the strength of the magnetic compressions at geosynchronous orbit near the magnetic equator. Compressions > 2 nT at GOES‐12 occurred during 57% of the Canadian TCV events, but during ~85% of the simultaneous TCV/Pc1 burst events. There was again little evident correlation between TCV and GOES‐12 compression amplitudes. We have also documented unusually low EMIC wave activity during this deep solar minimum interval, and we attribute the low occurrence percentage of combined events in this study to this minimum. Key Points TCVs and Pc1 bursts often occur together in high‐latitude magnetometer data Pc1 events were more tightly clustered near local noon than TCV events Pc1 activity was unusually low during the solar activity minimum in 2008–2010.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101826/1/jgra50604.pd

Transient Ionospheric Upflow Driven by Poleward Moving Auroral forms Observed During the Rocket Experiment for Neutral Upwelling 2 (RENU2) Campaign

This study examines cumulative effects of a series of poleward moving auroral forms on ion upflow and downflow. These effects are investigated using an ionospheric model with inputs derived from the Rocket Experiment for Neutral Upwelling 2 (RENU2) sounding rocket campaign. Auroral precipitation inputs are constrained by all‐sky imager brightness values resulting in significant latitudinal structuring in simulated ionospheric upflows due to transient forcing. For contrast, a case with steady forcing generates almost double the O+ upflow transport through 1,000 km when compared to poleward moving auroral form‐like structures. At high altitudes, model results show a spread in upflow response time dependent on ion mass, with molecular ions responding slower than atomic ions by several minutes. While the modeled auroral precipitation is not strong enough to accelerate ions to escape velocities, source populations available for higher‐altitude energization processes are greatly impacted by variable forcing exhibited by the RENU2 event.Key PointsImager data provide realistic transient forcing constraints for model inputs to simulate observations from a high‐latitude rocket flightTransient forcing deposits energy over a wider latitudinal region but less energy in any specific locationModeling a sequence of poleward moving auroral forms with realistic spatiotemporal variability generates significant latitudinal structuringPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150562/1/grl59002.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150562/2/grl59002-sup-0001-Text_SI-S01.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150562/3/grl59002_am.pd

Admission Hyperglycemia in Setting of Acute Heart Failure is Associated with Increased In-hospital Mortality Among Patients without Diabetes

Background: Heart Failure (HF) in the setting of comorbid diabetes mellitus (DM) has been extensively examined and is associated with increased mortality. More recently, hyperglycemia independent of DM status during critical illness admissions has become recognized as an indicator of poor outcomes. Despite evolving understanding of DM in the setting of acute HF, hyperglycemia at time of admission for acute HF has not been examined with regard to in-hospital treatment and patient outcomes. Objective: The goal of this study is to examine differences in in-hospital treatment and outcomes of patients hospitalized for acute HF according to glycemic status. Methods: The sample consisted of 9,748 residents of the Worcester (MA) metropolitan area hospitalized at all 11 greater Worcester medical centers for acute decompensated HF during the years 1995 - 2004 with data available on diabetic status and admission glucose measurements. Patients were stratified into three groups based on history of DM and admission hyperglycemia defined by glucose ≥200 mg/dL: 1) nondiabetic, normoglycemic (NDNG); 2) non-diabetic, hyperglycemic (NDHG); and 3) diabetic (DM). Results: Non-diabetic, normoglycemic patients were similar to NDHG patients with respect to age and medical history and were significantly older and less likely to have a history of various comorbid conditions such as hypertension, stroke and renal disease when compared to diabetics (p-values Conclusions: The results of our population-based investigation suggest that non-diabetic patients hospitalized for acute HF who are hyperglycemic at the time of admission represent a vulnerable group of patients at risk for increased mortality during hospitalization. Hyperglycemia ≥200 mg/dL during acute HF hospitalization should be taken into account when providing in-hospital management for HF with additional consideration given to ascertainment of diabetic status and glycemic control