Piloting an Intervention to Improve Continuity in Lung Cancer Patients

Purpose: Kentuckians facing a lung cancer diagnosis are at greater risk for care fragmentation due to the complexities associated with the diagnosis, staging and treatment of the disease combined with multiple health disparities such as advanced age, multiple comorbid conditions, low socioeconomic status, geographic isolation, and low literacy levels. Transitioning from primary to specialist care can be especially difficult for these patients. The main purpose of this paper was to determine the feasibility and effect of a nurse-led, multidimensional intervention designed to improve relational (RC), informational (IC), and management continuity (MC) across the primary to secondary care interface, as well as to assess the effect of perceived continuity of care on patient distress levels. Methods: This study included a sample of 40 patients (20 in the comparison group and 20 in the intervention group). The comparison group received usual care, while the intervention group received an intervention targeted at improving all three types of continuity (RC, IC, MC), beginning with the patient’s first visit to a multidisciplinary lung cancer clinic. Patients in both the comparison group and intervention group completed the Distress Thermometer and Nijmegen Continuity Questionnaire at three separate intervals: at the initial appointment with the specialist, at the specialist appointment following diagnosis and staging, and at the post-surgical follow-up appointment. Results: Results indicate that this intervention, along with the natural influence of time, may result in improved perceived continuity scores for the intervention group and in improved relational continuity with the PCP for those receiving the intervention. Distress decreased globally over time independent of group placement but decreased in a more linear fashion for the intervention group, though the differences between groups did not reach the level of significance. In addition, older age is associated with lower distress levels and may predict distress levels at time one and time two, but this effect disappears at time three. Conclusions: A nurse-led intervention to improve all three types of continuity for Kentuckians facing a lung cancer diagnosis was successfully implemented in a sample of 20 patients at a multidisciplinary lung cancer program at an NCI-designated academic cancer center. This pilot study demonstrated that it is feasible to measure continuity in this population in the clinic setting. This research fills a gap in the literature as the only nurse-led intervention designed to improve three types of continuity across the primary to specialty care interface for lung cancer patients who are in the diagnostic, staging, and treatment phase. This research is also unique in that it uses measured perceived continuity as an outcome. Future Implications: Interventions to improve continuity should be conducted on larger groups of patients with poor prognoses and high levels of distress. Evidence suggests that shared care interventions are appropriate for patient groups who are most likely to benefit, such as patients who are clinically anxious or distressed (Nielsen et al., 2003; Cossich et al., 2004; McCorkle et al., 2009; Johnson et al., 2015). Future studies should also incorporate technological advancements such as teleconferencing between the primary and specialty care teams, and shared electronic medical records such as health portals. Other outcomes in addition to distress, such as resource utilization, that may be sensitive to interventions to improve continuity should also be explored. The role of the APN as a leader for continuity interventions should be explored by performing a cost/benefit analysis

Germination and storage of apple seeds

Apple seeds will not germinate immediately after the fruit has become mature enough for picking. It is necessary for the seed to pass thru a stage of after-ripening. The freshly extracted apple seed contains about 85 percent moisture. At room temperature approximately one-half of the moisture is lost during the first five days. Soaking the seed prior to planting does not increase germination. Ninety-one percent of apple seeds prevented from drying out when they were extracted from the fruit germinated. The best temperature for storage was found to be a temperature between 10 and 30 C. Seeds which had air dried germinated poorly in all cases. Apple seeds which had been air dried and kept for a year did not germinate. Apple seeds may be planted any time after Nov. 1. Where seeds are to be shipped long distances, special precaution must be made to keep the seeds from deteriorating. The seed coat is not a factor in causing delayed germination

A baseline assessment of migratory and resident bird use of a prairie restoration site in eastern Washington

Prairies, and other types of grassland ecosystems, have suffered some of the most profound losses worldwide, due to anthropogenic factors such as fossil fuel extraction, agriculture, and climate change. Likewise, organisms inhabiting grassland ecosystems have become extirpated across much of their historical range, not the least of which has been a 50% decline in grassland birds since the 1960s. In response to losses of intact prairie in eastern Washington, a 120-ac site has been established on the EWU campus to regenerate native prairie and monitor changes in the ecosystem as native plants recolonize and replace non-natives. Because birds are an important indicator species of ecosystem health, the goal of our research was to estimate baseline abundance and diversity of birds at the prairie restoration site before restoration takes place. We also assessed bird abundance and diversity at a small, intact prairie remnant 20 mi north of the EWU campus to compare current bird use of the restoration site with that of an intact prairie system. We assessed bird abundance and bird diversity using the line-transect method. We established one transect at each site, and counted all birds seen or heard within 50 meters of the transects. Our findings will provide a baseline of knowledge about how and when birds will begin to reinhabit the EWU restoration site and inform future restoration efforts on the benefits and outcomes of restoring native grasslands locally, and worldwide

Integrated Administrative Data for Early Childhood Iowa: A Governance Model to inform Policy and Program Collaboration

In response to demands on public systems to do more, do better, and cost less, the value of integrated administrative data systems (IDS) for social policy is increasing (Fantuzzo & Culhane, 2016). This is particularly relevant in programming for young children where services are historically fragmented, disconnected from systems serving school-aged children, and siloed among health, human services, and education agencies. Guided by the vision that Iowa’s early childhood system will be effectively and efficiently coordinated to support healthy families, we are developing an early childhood IDS to address this disconnection and facilitate relevant and actionable social policy research. Iowa’s IDS is a state-university partnership that acknowledges the need for agencies to retain control of their data while enabling it to be integrated across systems for social policy research. The innovative governance model deliberately incorporates procedures for stakeholder engagement at critical tension points between executive leaders, program managers, researchers, and practitioners. Standing committees (Governance Board, Data Stewardship, and Core team) authorize and implement the work of the IDS, while ad-hoc committees are solicited for specific projects to advise and translate research into practice. This paper will articulate the Iowa IDS governance model that was informed by means tested principles articulated by the Actionable Intelligence for Social Policy Network. It will include our collaborative development process; articulated mission and principles that guided discussions about legal authorization, governance, and use cases; and the establishment of governance committees to implement our vision for ethical and efficient use of administrative data for social policy

Salsalate treatment improves glycemia without altering adipose tissue in nondiabetic obese hispanics.

ObjectiveSalsalate treatment has well-known effects on improving glycemia, and the objective of this study was to examine whether the mechanism of this effect was related to changes in adipose tissue.MethodsA randomized double-blind and placebo-controlled trial in obese Hispanics (18-35 years) was conducted. The intervention consisted of 4 g day(-1) of salsalate (n = 11) versus placebo (n = 13) for 4 weeks. Outcome measures included glycemia, adiposity, ectopic fat, and adipose tissue gene expression and inflammation.ResultsIn those receiving salsalate, plasma fasting glucose decreased by 3.4% (P < 0.01), free fatty acids decreased by 42.5% (P = 0.06), and adiponectin increased by 27.7% (P < 0.01). Salsalate increased insulin AUC by 38% (P = 0.01) and HOMA-B by 47.2% (P < 0.01) while estimates of insulin sensitivity/resistance were unaffected. These metabolic improvements occurred without changes in total, abdominal, visceral, or liver fat. Plasma markers of inflammation/immune activation were unchanged following salsalate. Salsalate had no effects on adipose tissue including adipocyte size, presence of crown-like structures, or gene expression of adipokines, immune cell markers, or cytokines downstream of NF-κB with the exception of downregulation of IL-1β (P < 0.01).ConclusionsFindings suggest that metabolic improvements in response to salsalate occurred without alterations in adiposity, ectopic fat, or adipose tissue gene expression and inflammation

Chondroitin Sulfate Proteoglycans Are a Common Component of Neuronal Inclusions and Astrocytic Reaction in Neurodegenerative Diseases

Previously, we showed three differentially sulfated forms of chondroitin sulfate proteoglycans (CSPG) associated with senile plaques, astrocytes and neurofibrillary tangles in Alzheimer\u27s disease. Here, monoclonal antibodies were used to demonstrate CSPGs in other neurodegenerative diseases. CSPGs were found associated with inclusions of Parkinson\u27s, diffuse Lewy body, Pick\u27s diseases, and progressive supranuclear palsy. Reacting astrocytes in each of these neurodegenrative diseases and Huntington\u27s disease showed immunoreactivity for CSPG. CSPG distribution in a variety of neurodegenerative diseases suggests that similar mechanisms may be involved in the accumulation of proteoglycans in a number of filamentous inclusions