Changer de canal : analyse qualitative d’une intervention innovante au moyen d’une vidéo visant à explorer les attitudes des résidents à l’égard de la collaboration interprofessionnelle dans une unité de médecine gériatrique

Background: Medical learners develop a more positive attitude toward Interprofessional Collaboration (IPC) following Interprofessional Education (IPE) programs. However, IPE is not standardized and the most effective teaching tool is unclear. The purpose of our study was to develop an IPE teaching tool for medical residents during an inpatient geriatric medicine rotation at an academic hospital, evaluate and explore the impact of the program on resident attitudes towards teamwork, and identify barriers and facilitators to interprofessional collaboration. Methods: An innovative video was developed which simulated a common IPC scenario. Near the start of the rotation, learners watched the video then participated in a facilitated discussion around principles of IPE, using the Canadian Interprofessional Health Collaborative (CIHC) framework, which highlights interprofessional communication, patient-centered care, role clarification, team functioning, collaborative leadership, and interprofessional conflict resolution. At the end of their four-week rotation, focus groups were conducted to explore resident attitudes towards IPE. The Theoretical Domain Framework (TDF) was used for qualitative analysis. Results: Data from 23 participants in five focus groups were analyzed using the TDF framework. Residents were able to identify barriers and facilitators to IPC in five TDF domains: environmental context and resources, social/professional role and identity, knowledge, social influences and skills. Their observations correlated with the CIHC framework. Conclusion: The use of a scripted video and facilitated group discussion gave insights into residents’ attitudes, perceived barriers and facilitators towards IPC on a geriatric medicine unit. Future research could explore the use of this video intervention in other hospital services where team-based care is importantContexte : Les apprenants en médecine développent une attitude plus positive à l’égard de la collaboration interprofessionnelle (CIP) après avoir suivi un programme de formation interprofessionnelle (FIP). Toutefois, la FIP n’est pas normalisée et on ne sait pas quel outil d’enseignement est le plus efficace. Le but de notre étude était d’élaborer un outil de FIP pour les résidents en médecine gériatrique dans un hôpital universitaire, d’évaluer et d’explorer les effets du programme sur les attitudes des résidents à l’égard du travail d’équipe, et de recenser les facteurs qui entravent ou facilitent la collaboration interprofessionnelle. Méthodes : Une capsule vidéo innovante simulant un scénario courant de CIP a été créée. Au début de leur stage de résidence, les apprenants ont regardé la capsule et participé à une discussion animée sur les principes de la FIP, tels qu’ils ressortent du cadre du Consortium pancanadien pour l’interprofessionnalisme en santé (CPIS), qui met notamment en avant la communication interprofessionnelle, les soins centrés sur le patient, la clarification des rôles, le fonctionnement de l’équipe, le leadership collaboratif et la résolution des conflits interprofessionnels. À la fin du stage de quatre semaines, des groupes de discussion ont été organisés pour explorer les attitudes des résidents à l’égard de la FIP. Le cadre des domaines théoriques (CDT) a été appliqué pour réaliser l’analyse qualitative. Conclusion : Par le biais d’une capsule scénarisée et une discussion de groupe animée, nous avons pu cerner les attitudes des résidents d’une unité de médecine gériatrique par rapport à la CIP ainsi que leurs perceptions quant aux facteurs qui peuvent l’entraver ou la faciliter. Des recherches futures pourraient explorer la mise en œuvre de cette formule d’enseignement de la CIP dans d’autres services hospitaliers où les soins en équipe sont importants

A catalogue of omics biological ageing clocks reveals substantial commonality and associations with disease risk

Biological age (BA), a measure of functional capacity and prognostic of health outcomes that discriminates between individuals of the same chronological age (chronAge), has been estimated using a variety of biomarkers. Previous comparative studies have mainly used epigenetic models (clocks), we use ~1000 participants to compare fifteen omics ageing clocks, with correlations of 0.21-0.97 with chronAge, even with substantial sub-setting of biomarkers. These clocks track common aspects of ageing with 95% of the variance in chronAge being shared among clocks. The difference between BA and chronAge - omics clock age acceleration (OCAA) - often associates with health measures. One year’s OCAA typically has the same effect on risk factors/10-year disease incidence as 0.09/0.25 years of chronAge. Epigenetic and IgG glycomics clocks appeared to track generalised ageing while others capture specific risks. We conclude BA is measurable and prognostic and that future work should prioritise health outcomes over chronAge

A Selective HDAC 1/2 Inhibitor Modulates Chromatin and Gene Expression in Brain and Alters Mouse Behavior in Two Mood-Related Tests

Psychiatric diseases, including schizophrenia, bipolar disorder and major depression, are projected to lead global disease burden within the next decade. Pharmacotherapy, the primary – albeit often ineffective – treatment method, has remained largely unchanged over the past 50 years, highlighting the need for novel target discovery and improved mechanism-based treatments. Here, we examined in wild type mice the impact of chronic, systemic treatment with Compound 60 (Cpd-60), a slow-binding, benzamide-based inhibitor of the class I histone deacetylase (HDAC) family members, HDAC1 and HDAC2, in mood-related behavioral assays responsive to clinically effective drugs. Cpd-60 treatment for one week was associated with attenuated locomotor activity following acute amphetamine challenge. Further, treated mice demonstrated decreased immobility in the forced swim test. These changes are consistent with established effects of clinical mood stabilizers and antidepressants, respectively. Whole-genome expression profiling of specific brain regions (prefrontal cortex, nucleus accumbens, hippocampus) from mice treated with Cpd-60 identified gene expression changes, including a small subset of transcripts that significantly overlapped those previously reported in lithium-treated mice. HDAC inhibition in brain was confirmed by increased histone acetylation both globally and, using chromatin immunoprecipitation, at the promoter regions of upregulated transcripts, a finding consistent with in vivo engagement of HDAC targets. In contrast, treatment with suberoylanilide hydroxamic acid (SAHA), a non-selective fast-binding, hydroxamic acid HDAC 1/2/3/6 inhibitor, was sufficient to increase histone acetylation in brain, but did not alter mood-related behaviors and had dissimilar transcriptional regulatory effects compared to Cpd-60. These results provide evidence that selective inhibition of HDAC1 and HDAC2 in brain may provide an epigenetic-based target for developing improved treatments for mood disorders and other brain disorders with altered chromatin-mediated neuroplasticity.Stanley Medical Research InstituteNational Institutes of Health (U.S.) (R01DA028301)National Institutes of Health (U.S.) (R01DA030321

Data on vegetation across forest edges from the FERN(Forest Edge Research Network)

Published versionMany studies have focused on vegetation across forest edges to study impacts of edges created by human activities on forest structure and composition, or patterns of vegetation at inherent natural edges. Our objective was to create a database of plant-related variables across different types of edges from various studies (mainly from across Canada, but also in Brazil and Belize) to facilitate edge research. We compiled data on vegetation along more than 300 transects perpendicular to forest edges adjacent to clear-cuts, burned areas, bogs, lakes, barrens, insect disturbances, and riparian areas from 24 studies conducted over the past three decades. Data were compiled for more than 400 plant species and forest structure variables (e.g., trees, logs, canopy cover). All data were collected with a similar sampling design of quadrats along transects perpendicular to forest edges, but with varying numbers of transects and quadrats, and distances from the edge. The purpose for most of the studies was either to determine the distance of edge influence (edge width) or to explore the pattern of vegetation along the edge to interior gradient. We provide data tables for the cover of plant species and functional groups, the species and size of live and dead trees, the density of saplings, maximum height of functional groups and shrub species, and the cover of functional groups at different heights (vertical distribution of vegetation). The Forest Edge Research Network (FERN) database provides extensive data on many variables that can be used for further study including meta-analyses and can assist in answering questions important to conservation efforts (e.g., how is distance of edge influence from created edges affected by different factors?). We plan to expand this database with subsequent studies from the authors and we invite others to contribute to make this a more global database. The data are released under a CC0 license. When using these data, we ask that you cite this data paper and any relevant publications listed in our metadata file. We also encourage you to contact the first author if you are planning to use or contribute to this database

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Fee-for-Service Medicaid in Wisconsin: An Evaluation of Quality Improvement Initiatives for the Aged, Blind and Disabled

For PA 869: Public Affairs Workshop, Domestic IssuesThis report examines alternatives for improving the quality of health care provided to the aged, blind, and disabled population in fee-for-service Medicaid in Wisconsin. Options considered include maintaining the status quo, implementing a pay-for-performance system, adopting a primary care case management program, operating a chronic disease management program, and pursuing a combination of primary care and chronic disease management

Sprint interval and traditional endurance training induce similar improvements in peripheral arterial stiffness and flow-mediated dilation in healthy humans

Low-volume sprint interval training (SIT), or repeated sessions of brief, intense intermittent exercise, elicits metabolic adaptations that resemble traditional high-volume endurance training (ET). The effects of these different forms of exercise training on vascular structure and function remain largely unexplored. To test the hypothesis that SIT and ET would similarly improve peripheral artery distensibility and endothelial function and central artery distensibility, we recruited 20 healthy untrained subjects (age: 23.3 ± 2.8 yr) and had them perform 6 wk of SIT or ET (n = 5 men and 5 women per group). The SIT group completed four to six 30-s “all-out” Wingate tests separated by 4.5 min of recovery 3 days/wk. The ET group completed 40–60 min of cycling at 65% of their peak oxygen uptake (V̇o2peak) 5 days/wk. Popliteal endothelial function, both relative and normalized to shear stimulus, was improved after training in both groups (main effect for time, P < 0.05). Carotid artery distensibility was not statistically altered by training (P = 0.29) in either group; however, popliteal artery distensibility was improved in both groups to the same degree (main effect, P < 0.05). We conclude that SIT is a time-efficient strategy to elicit improvements in peripheral vascular structure and function that are comparable to ET. However, alterations in central artery distensibility may require a longer training stimuli and/or greater initial vascular stiffness than observed in this group of healthy subjects