Self-Management and Quality of Life in Young Adults After Healthcare Transition

The transition from pediatric to adult healthcare has become healthcare concern of increasing importance as more adolescents with chronic conditions survive to adulthood requiring continuing care. In order to understand the current status of healthcare transition (HCT), we identified the HCT services received by young adults, their existing healthcare self-management skills and how skills correlated with their quality of life. A correlational and retrospective cross-sectional online survey of English-speaking young adults in the United States ages 18-26 with at least one pediatrically diagnosed chronic condition was conducted August-October 2019. Participants completed a healthcare transition feedback survey, the TRANSITION-Q self-management skills evaluation and the PedsQL Well-Being and Generic Core Measures quality of life surveys. A total of 72 completed survey responses were included in the final analysis with a participant group that reported 26 pediatrically diagnosed chronic conditions; the three most reported conditions were asthma (n = 16), diabetes (n = 17), and cystic fibrosis (n = 8). A majority (54.2%) of participants indicated that they felt “very prepared” to transition to adult care and the average TRANSITION-Q skills score (25.51, SD = 6.45) was only 65.4% of the maximum possible score. Increased TRANSITION-Q scores were associated with increased trust and interaction in patient-provider relationships during HCT. A small negative correlation was found between TRANSITION-Q scores and Generic Core measure quality of life scores (r = -0.27, p = 0.026). Participants with cystic fibrosis showed increases quality of life scores with more independence in selected self-management skills compared with participants with asthma, diabetes, and the overall sample which demonstrated decreases. This study demonstrates the continuing nature of HCT into young adulthood and that interactions which build rapport and trust with a pediatric healthcare provider increase the acquisition of self-management skills. The relationship between self-management skills and quality of life is related to condition type and further research is needed to outline the relationship

Real space analysis of operando X-ray spectroscopy and scattering studies of Cobalt Fischer-Tropsch Synthesis catalysts

Size effects on Co-based Fischer Tropsch synthesis (FTS) catalysts are well known, however their evolution over time is less well interrogated. Three key issues related to particle size remain: the behaviour of small Co0 nanoparticles during FTS and their potential re-oxidation, the evolution and influence of the Co0 nanostructure (fcc/hcp/intermixed Co0), and the formation of metal-support interactions during FTS. Two synthesis methods were used to produce Co/SiO2 catalysts. The first experimental chapter concerns the application of an inverse micelle synthesis (IMS) method for preparing powder-supported FTS catalysts. The aim was to create a catalyst with tight particle size control in order to better study particle size effects, however this was limited by the difficulty in removing the surfactant. While the final two experimental chapters focus on operando characterization using synchrotron-based X-ray techniques for two different sized catalysts synthesized using a standard Schlenk technique; 3 and 11 nm which fall below and above the stable size range respectively. Novel Debye simulations using a unic model were applied to synchrotron-based X-Ray diffraction (XRD) data acquired from a working FTS catalyst. While the 11 nm particle size catalyst is stable, this analysis shows a small variation in the hcp/fcc/intermixed ratio over the first 12 h of FTS, possible related to a known drop in activity during the initial stages of FTS. The hcp fraction decreases by -5.03 %, fcc increase by 1.24 %, and the mixed block increase by 3.7 %. About 20 % of the initial sample is unreduced CoO which reduces very slightly under FTS conditions. The majority of the Co0 content in the 3 nm sample oxidizes in the first hour of exposure to FTS conditions, although some of the larger Co0 particles remain active - as observed by XRD. Additionally, no support phases are observed initially or being formed during FTS on either of the different average particle sized catalysts

Self-Management and Quality of Life in Young Adults After Healthcare Transition

The transition from pediatric to adult healthcare has become healthcare concern of increasing importance as more adolescents with chronic conditions survive to adulthood requiring continuing care. In order to understand the current status of healthcare transition (HCT), we identified the HCT services received by young adults, their existing healthcare self-management skills and how skills correlated with their quality of life. A correlational and retrospective cross-sectional online survey of English-speaking young adults in the United States ages 18-26 with at least one pediatrically diagnosed chronic condition was conducted August-October 2019. Participants completed a healthcare transition feedback survey, the TRANSITION-Q self-management skills evaluation and the PedsQL Well-Being and Generic Core Measures quality of life surveys. A total of 72 completed survey responses were included in the final analysis with a participant group that reported 26 pediatrically diagnosed chronic conditions; the three most reported conditions were asthma (n = 16), diabetes (n = 17), and cystic fibrosis (n = 8). A majority (54.2%) of participants indicated that they felt “very prepared” to transition to adult care and the average TRANSITION-Q skills score (25.51, SD = 6.45) was only 65.4% of the maximum possible score. Increased TRANSITION-Q scores were associated with increased trust and interaction in patient-provider relationships during HCT. A small negative correlation was found between TRANSITION-Q scores and Generic Core measure quality of life scores (r = -0.27, p = 0.026). Participants with cystic fibrosis showed increases quality of life scores with more independence in selected self-management skills compared with participants with asthma, diabetes, and the overall sample which demonstrated decreases. This study demonstrates the continuing nature of HCT into young adulthood and that interactions which build rapport and trust with a pediatric healthcare provider increase the acquisition of self-management skills. The relationship between self-management skills and quality of life is related to condition type and further research is needed to outline the relationship

How is Funding Medical Research Better for Patients?

With rising health care costs, often health research is viewed as a major cost driver, calling to question the role and value of provincial funding of health research. Most agree that the quality of healthcare provided is directly linked to our ability to conduct quality research; however currently there is little empirical evidence supporting the link between engagement in health research and healthcare performance. In Canada this has resulted in funding for health research that varies over time and between provinces. While medical knowledge is a public good, we hypothesize there are local benefits from health research, such as the attraction of a specialized human capital workforce, which fosters a culture of innovation in clinical practice. To address this question, we look at whether health outcomes are impacted by changes in provincial research funding in Alberta compared to other provinces. Provincial funding for medical research, which varies greatly over time and among provinces, is used as a proxy for medical treatment inputs. Trend rates of reduction in mortality from potentially avoidable causes (MPAC) (comprised of mortality from preventable causes (MPC) and mortality from treatable causes (MTC)), are used as a proxy health outcome measure sensitive to the contributions of technological progress in medical treatment. Our analysis suggests that investment in health research has payback in health outcomes, with greater improvements in the province where the research occurs. The trend declines seen in age standardized MPAC rates in different Canadian provinces may be impacted by shifts in provincial research funding investment, suggesting that knowledge is not transferred without cost between provinces. Up until the mid-1980s, Alberta had the most rapid rate of decline in MPAC compared to the other provinces. This is striking given the large and unique investment in medical research funding in Alberta in the early 1980s through AHFMR, the only provincial health research funding agency at the time. However in recent years, Alberta’s rate of decrease in MPAC has occurred at a rate slower than the other provinces (British Columbia, Ontario or Quebec) with provincial medical research funding. This is striking at a population level, where Alberta’s failure to achieve a reduction in age standardized rates of MTC comparable to British Columbia, Ontario or Quebec after 1985 represents 240 unnecessary deaths in 2011 and 48,250 Potential Life Years Lost worth around $4.8 billion. The findings from our study suggest that some of the divergence in the rates of reduction in MPAC between provinces may be due to beneficial changes in institutional structure and human capital, resulting in differences across provinces in the capacity to adopt new effective healthcare innovations. While health indicators such as MPAC are the result of complex interactions between the patient, treatment and the healthcare system, as well as socioeconomic and demographic factors, this analysis suggests that a different capacity for health research within the provinces impacts health outcomes. The findings from this analysis are limited by the lack of data related to research funding and the health research workforces within provinces. This analysis has important implications for health research policy and funding allocations, suggesting that decision makers should consider the long-term impact provincial funding for health research has on health outcomes. This study also highlights the lack of longitudinal public data available for provincial health research funding. This information is critical to inform future health research policy

Turning Passion Into Action: A Business Plan For Private Practice

Healthy & Fit is a start-up private practice positioning itself to become the market leader in offering comprehensive nutrition and fitness services that help health-conscious individuals and families achieve optimal health and wellness. The long term goal of Healthy & Fit is to develop into a niche private practice that specializes in improving the health of individuals and families, especially families that have overweight/obese children by providing weight management nutrition therapy and fitness classes. The company utilizes a customized approach in providing services based on the needs of the individual and/or family, while offering clients convenient service delivery options such as in-home and cost­ effective options in the form of packages. By leveraging key features (i.e. convenience, cost­ effectiveness, and customization) often underutilized in the health and wellness industry, Healthy & Fit will be able to outpace competitors and raise the bar for future competitors.Master of Public Healt

Vibration and its effect on the respiratory system

Vibration is a manual technique used widely to assist with the removal of pulmonary secretions. Little is known about how vibration is applied or its effect on the respiratory system. The purpose of this study was to describe mechanical consequences of vibration on the chest wall of a normal subject and the effects of vibration on expiratory flow rates and volumes. The effects of vibration were compared to other interventions of chest wall compression, chest wall oscillation, cough, huff from high lung volume, inspiration to total lung capacity with relaxed expiration, tidal breathing, and sham. Sixteen physiotherapists applied vibration and other interventions in a randomised order to the chest wall of a healthy adult female subject. The magnitude and direction of the force and the frequency of vibration were measured by an instrumented bed with seven load cells. Inductive plethsysmography measured the change in chest wall circumference with vibration. A heated pneumotachometer measured inspiratory and expiratory flow rates, which were integrated to provide volumes. Vibration was applied with a mean resultant force of 74.4 N (SD 47.1). The mean (SD) change in chest wall circumference and frequency of vibration were 0.8 cm (SD 0.4) and 5.5 Hz (SD 0.8) respectively. The mean peak expiratory flow rate was 0.97 l/s (SD 0.27). Peak expiratory flow rates with vibration were less than 20% of those achieved with cough or huff from high lung volume but greater than with chest wall compression, chest wall oscillation, relaxed expiration from total lung capacity, sham treatment or tidal breathing