Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Perceived Exercise Habits of Individuals with Parkinson’s Disease Living in the Community

Context Exercise has been shown to improve gait in individuals with Parkinson’s disease (PD). Stepping practice at higher intensity levels has been suggested as a beneficial treatment option to improve gait in the neurological population. Unfortunately, this mode is poorly understood and underutilized within the PD population. Information on what individuals with PD are doing for exercise would be beneficial to help tailor exercise programs to improve gait and provide exercise options in the community for intensity-based exercise. Objective To investigate the current exercise habits of individuals living with PD in the community aimed at improving walking and to understand the impact of perceived intensity on daily exercise practices. Design, setting, participants One hundred thirty-eight individuals with PD living in the community were surveyed online regarding their current exercise habits. Main outcome measure A total of 22 questions aimed to understand exercise selection, focus, and perceived intensity. Questions asked basic demographic, symptom presentation and management of disease related symptoms that were present while living with PD. Exercise questions focused understanding participants current function level, practice exercise habits and perceived levels of exercise intensity during daily routines. Results Of the 138 individuals surveyed for this preliminary study, eighty-seven percent of individuals with PD participated in exercise with seventy-five percent choosing walking as a mode for exercise. Sixty-five percent of the respondents noted that despite exercise, their walking speed and endurance has worsened since diagnosis. Eighty-one percent perceived exercising at moderate intensity levels, however little provocation of intensity symptoms was noted. Conclusion Our preliminary study survey results suggest that individuals with PD are exercising but not at high enough intensity levels to promote improvements in gait performance. Individuals with PD may need to be pushed at higher intensity levels, beyond their voluntary limits, to induce gait performance changes. These findings can provide a foundation for future fitness interventions within this population to target improving gait

Self-exclusion from gambling : A toothless tiger?

Peer reviewe

Layer-by-Layer Spray-Coating of Cellulose Nanofibrils and Silver Nanoparticles for Hydrophilic Interfaces

Silver nanoparticles (AgNPs) and AgNP-based composite materials have attracted growing interest due to their structure-dependent optical, electrical, catalytic, and stimuli-responsive properties. For practical applications, polymeric materials are often combined with AgNPs to provide flexibility and offer a scaffold for homogenous distribution of the AgNPs. However, the control over the assembly process of AgNPs on polymeric substrates remains a big challenge. Herein, we report the fabrication of AgNP/cellulose nanofibril (CNF) thin films via layer-by-layer (LBL) spray-coating. The morphology and self-assembly of AgNPs with increasing number of spray cycles are characterized by atomic force microscopy (AFM), grazing-incidence small-angle X-ray scattering (GISAXS), and grazing-incidence wide-angle X-ray scattering (GIWAXS). We deduce that an individual AgNP (radius = 15 ± 3 nm) is composed of multiple nanocrystallites (diameter = 2.4 ± 0.9 nm). Our results suggest that AgNPs are assembled into large agglomerates on SiO2 substrates during spray-coating, which is disadvantageous for AgNP functionalization. However, the incorporation of CNF substrates contributes to a more uniform distribution of AgNP agglomerates and individual AgNPs by its network structure and by absorbing the partially dissolved AgNP agglomerates. Furthermore, we demonstrate that the spray-coating of the AgNP/CNF mixture results in similar topography and agglomeration patterns of AgNPs compared to depositing AgNPs onto a precoated CNF thin film. Contact-angle measurements and UV/vis spectroscopy suggest that the deposition of AgNPs onto or within CNFs could increase the hydrophilicity of AgNP-containing surfaces and the localized surface plasmon resonance (LSPR) intensity of AgNP compared to AgNPs sprayed on SiO2 substrates, suggesting their potential applications in antifouling coatings or label-free biosensors. Thereby, our approach provides a platform for a facile and scalable production of AgNP/CNF films with a low agglomeration rate by two different methods as follows: (1) multistep layer-by-layer (LBL) spray-coating and (2) direct spray-coating of the AgNP/CNF mixture. We also demonstrate the ability of CNFs as a flexible framework for directing the uniform assembly of AgNPs with tailorable wettability and plasmonic properties

Effects of confinement and surface enhancement on superconductivity

Within the Ginzburg-Landau approach a theoretical study is performed of the effects of confinement on the transition to superconductivity for type-I and type-II materials with surface enhancement. The superconducting order parameter is characterized by a negative surface extrapolation length $b$. This leads to an increase of the critical field $H_{c3}$ and to a surface critical temperature in zero field, $T_{cs}$, which exceeds the bulk $T_c$. When the sample is {\em mesoscopic} of linear size $L$ the surface induces superconductivity in the interior for $T T_{cs}$. In analogy with adsorbed fluids, superconductivity in thin films of type-I materials is akin to {\em capillary condensation} and competes with the interface delocalization or "wetting" transition. The finite-size scaling properties of capillary condensation in superconductors are scrutinized in the limit that the ratio of magnetic penetration depth to superconducting coherence length, $\kappa \equiv \lambda/\xi$, goes to zero, using analytic calculations. While standard finite-size scaling holds for the transition in non-zero magnetic field $H$, an anomalous critical-point shift is found for H=0. The increase of $T_c$ for H=0 is calculated for mesoscopic films, cylindrical wires, and spherical grains of type-I and type-II materials. Surface curvature is shown to induce a significant increase of $T_c$, characterized by a shift $T_c(R)-T_c(\infty)$ inversely proportional to the radius $R$.Comment: 37 pages, 5 figures, accepted for PR

The welfare of water buffaloes during the slaughter process: a review

This paper reviews the scientific literature on water buffalo welfare in all stages of the live animal supply chain from the farm gate to slaughter (loading/unloading, markets, transportation, handling, lairage, stunning and slaughter) with the objective of identifying risk factors and potential mitigation strategies. Although in some countries legislation exists to protect the welfare of farm animals during transport and killing, the handling practices used to load and unload buffaloes and move them in livestock markets and abattoirs are often harsh. This is frequently due to inadequate equipment designed principally for cattle, and the fact that water buffaloes are considered more temperamental than cattle. Additionally, more reactive animals have increased stress responses to handling, which can lead to more negative human interventions with increased numbers of skin lesions and bruises to the carcasses. During transport, buffaloes may suffer periods of thermal stress due to overstocking, inadequate ventilation and because in many tropical climates trips are made during the hottest time of the day. The anatomical and physiological characteristics of water buffalo make them particularly susceptible to thermal stress in the absence of water for wallowing. Although water buffaloes belong to the same Bovidae family as domestic cattle, certain anatomical features of the head make effective stunning very problematic. Buffaloes have extensive sinuses and frontal bones, meaning that the penetrating captive bolt devices recommended for cattle may prove ineffective in reliably inducing unconsciousness. There is a need for further development of procedures, stunning positions and appropriate devices to improve the efficiency of buffalo stunning. Finally, in many parts of the world where buffalo are routinely slaughtered in basic conditions without prior stunning. Slaughter without stunning can result in pain and stress associated with delays in the time to loss of consciousness, pain from the cutting of the neck and potential distress associated with aspiration of blood into the respiratory tract. Specific legislation, guidelines and handler/stockman/operator training programmes should be developed to improve the welfare of buffaloes during all ante mortem stages of loading, unloading, handling, stunning and slaughter

The Effects of Infant Age on Parental Vocalizations About Object Categories in a Play-type Setting

Previous studies have examined the role of various perceptual features of objects on an infant’s ability to effectively categorize the object. Few, if any studies have examined the role of parents in the formation of categories early in infancy and the effect of the infants’ age on the type of categorical information provided by the parents. In two studies, parental vocalizations directed to their infants (3- to 12-months of age) about objects were videotaped and analyzed. In Study 1 the proportion of superordinate labels used by parents increased as a function of the infant’s age while the proportion of basic level labels decreased with age. In Study 2, parental attempts at label elicitation increased as a function of the infant’s age. The results show definite age-related patterns in parental vocalizations about objects and their categories. The results indicate that parents are a source of categorical information early in infancy

E-Journal Management and Access Methods

Libraries are struggling to determine how to invest their e-resource dollars to meet the needs of their patrons. During this session, Melissa Holmberg and Bobby Bothmann presented their analysis of two e-journal management tools: EBSCO\u27s EJS and OCLC\u27s ECO. Their study compared the usage of print-plus-free-online titles at Minnesota State University, Mankato which are accessed through a fee-based and free e-journal management tool