Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

Introduction: Older, chronically ill patients with limited health literacy are often under-engagedin managing their health and turn to the emergency department (ED) for healthcare needs. Wetested the impact of an ED-initiated coaching intervention on patient engagement and follow-updoctor visits in this high-risk population. We also explored patients’ care-seeking decisions. Methods: We conducted a mixed-methods study including a randomized controlled trial andindepth interviews in two EDs in northern Florida. Participants were chronically ill older EDpatients with limited health literacy and Medicare as a payer source. Patients were assignedto an evidencebased coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitativeinterviews (n=9) explored patients’ reasons for ED use. We assessed average between-groupdifferences in patient engagement over time with the Patient Activation Measure (PAM) tool,using logistic regression and a difference-in-difference approach. Between-group differences infollow-up doctor visits were determined. We analyzed qualitative data using open coding andthematic analysis. Results: PAM scores fell in both groups after the ED visit but fell signi ficantly more in “usualcare” (average decline -4.64) than “intervention” participants (average decline -2.77) (β=1.87,p=0.043). There were no between-group differences in doctor visits. Patients described wellinformedreasons for ED visits including onset and severity of symptoms, lack of timely provideraccess, and immediate and comprehensive ED care. Conclusion: The coaching intervention significantly reduced declines in pati ent engagementobserved after usual post-ED care. Patients reported well-informed reasons for ED use andwill likely continue to make ED visits unless strategies, such as ED-initiated coaching, areimplemented to help vulnerable patients better manage their health and healthcare

Community action for sustainable housing: Building a low-carbon future

This paper presents a new analytical framework of 'grassroots innovations' which views community-led initiatives for sustainable development as strategic green niches with the potential for wider transformation of mainstream society. This framework is applied to a low-carbon, low-impact, community-based sustainable housing initiative in the USA that pioneers straw bale housing techniques within a strong community-building ethos. The project is evaluated according to New Economics criteria of sustainable consumption, and is found to be successful at localising the construction supply chain, reducing ecological footprints, community-building, enabling collective action and building new institutions and systems of provision around housebuilding. However, viewing it as a strategic niche with aim to influence wider society, it is clear that it faces significant challenges in diffusing its ideas and practices beyond the niche. Its model is not necessarily suitable for scaling up or widespread replication; however, the scope for niche lessons to be adopted by mainstream builders is greater, given a supportive policy environment. Recognising the innovative nature of green niches at the policy level could lead to new approaches to governance of bottom-up community action for sustainable development

Photon- and pion-nucleon interactions in a unitary and causal effective field theory based on the chiral Lagrangian

We present and apply a novel scheme for studying photon- and pion-nucleon scattering beyond the threshold region. Partial-wave amplitudes for the $\gamma\, N$ and $\pi N$ states are obtained by an analytic extrapolation of subthreshold reaction amplitudes computed in chiral perturbation theory, where the constraints set by electromagnetic-gauge invariance, causality and unitarity are used to stabilize the extrapolation. Based on the chiral Lagrangian we recover the empirical s- and p-wave amplitudes up to energies $\sqrt{s}\simeq 1300$ MeV in terms of the parameters relevant at order $Q^3$.Comment: 76 pages, 23 figures, one additional figure, Tables 4,5 and Figure 4 are corrected, a few references and comments are added. The role of higher partial waves in pion photoproduction is clarifie

The CANNA-TICS Study Protocol: A Randomized Multi-Center Double-Blind Placebo Controlled Trial to Demonstrate the Efficacy and Safety of Nabiximols in the Treatment of Adults With Chronic Tic Disorders

Background: Gilles de la Tourette syndrome (TS) is a chronic neuropsychiatric disorder characterized by motor and vocal tics. First-line treatments for tics are antipsychotics and tic-specific behavioral therapies. However, due to a lack of trained therapists and adverse events of antipsychotic medication many patients seek alternative treatment options including cannabis. Based on the favorable results obtained from case studies on different cannabis-based medicines as well as two small randomized controlled trials using delta-9-tetrahydrocannabinol (THC), we hypothesize that the cannabis extract nabiximols can be regarded as a promising new and safe treatment strategy in TS. Objective: To test in a double blind randomized clinical trial, whether treatment with the cannabis extract nabiximols is superior to placebo in patients with chronic tic disorders. Patients and Methods: This is a multicenter, randomized, double-blind, placebo controlled, parallel-group, phase IIIb trial, which aims to enroll 96 adult patients with chronic tic disorders (TS or chronic motor tic disorder) across 6 centers throughout Germany. Patients will be randomized with a 2:1 ratio into a nabiximols and a placebo arm. The primary efficacy endpoint is defined as tic reduction of at least 30% (compared to baseline) according to the Total Tic Score of the Yale Global Tic Severity Scale (YGTSS-TTS) after 13 weeks of treatment. In addition, several secondary endpoints will be assessed including changes in different psychiatric comorbidities, quality of life, driving ability, and safety assessments. Discussion: This will be the first large, controlled study investigating efficacy and safety of a cannabis-based medicine in patients with TS. Based on available data using different cannabis-based medicines, we expect not only a reduction of tics, but also an improvement of psychiatric comorbidities. If the cannabis extract nabiximols is proven to be safe and effective, it will be a valuable alternative treatment option. The results of this study will be of high health-economic relevance, because a substantial number of patients uses cannabis (illegally) as self-medication. Conclusion: The CANNA-TICS trial will clarify whether nabiximols is efficacious and safe in the treatment of patients with chronic tic disorders

DN interaction from meson exchange

A model of the DN interaction is presented which is developed in close analogy to the meson-exchange KbarN potential of the Juelich group utilizing SU(4) symmetry constraints. The main ingredients of the interaction are provided by vector meson (rho, omega) exchange and higher-order box diagrams involving D*N, D\Delta, and D*\Delta intermediate states. The coupling of DN to the pi-Lambda_c and pi-Sigma_c channels is taken into account. The interaction model generates the Lambda_c(2595) resonance dynamically as a DN quasi-bound state. Results for DN total and differential cross sections are presented and compared with predictions of an interaction model that is based on the leading-order Weinberg-Tomozawa term. Some features of the Lambda_c(2595) resonance are discussed and the role of the near-by pi-Sigma_c threshold is emphasized. Selected predictions of the orginal KbarN model are reported too. Specifically, it is pointed out that the model generates two poles in the partial wave corresponding to the Lambda(1405) resonance.Comment: 14 pages, 8 figure

Phenotypic and functional analysis of bovine peripheral blood dendritic before parturition by a novel purification methods

Dendritic cells (DCs) are specialized antigen presenting cells specializing in antigen uptake and processing, and play an important role in the innate and adaptive immune response. A subset of bovine peripheral blood DCs was identified as CD172a+/CD11c+/MHC (major histocompatibility complex) class II+ cells. Although DCs are identified at 0.1%?0.7% of peripheral blood mononuclear cells (PBMC), the phenotype and function of DCs remain poorly understood with regard to maintaining tolerance during the pregnancy. All cattle used in this study were 1 month before parturition. We have established a novel method for the purification of DCs from PBMC using magnetic?activated cell sorting, and purified the CD172a+/CD11c+ DCs, with high expression of MHC class II and CD40, at 84.8% purity. There were individual differences in the expressions of CD205 and co?stimulatory molecules CD80 and CD86 on DCs. There were positive correlations between expression of cytokine and co?stimulatory molecules in DCs, and the DCs maintained their immune tolerance, evidenced by their low expressions of the co?stimulatory molecules and cytokine production. These results suggest that before parturition a half of DCs may be immature and tend to maintain tolerance based on the low cytokine production, and the other DCs with high co?stimulatory molecules may already have the ability of modulating the T?cell linagepublishersversionPeer reviewe

Qri7/OSGEPL, the mitochondrial version of the universal Kae1/YgjD protein, is essential for mitochondrial genome maintenance

Yeast Qri7 and human OSGEPL are members of the orthologous Kae1(OSGEP)/YgjD protein family, the last class of universally conserved proteins without assigned function. Phylogenetic analyses indicate that the eukaryotic Qri7(OSGEPL) proteins originated from bacterial YgjD proteins. We have recently shown that the archaeal Kae1 protein is a DNA-binding protein that exhibits apurinic endonuclease activity in vitro. We show here that the Qri7/OSGEPL proteins localize in mitochondria and are involved in mitochondrial genome maintenance in two model eukaryotic organisms, Saccharomyces cerevisiae and Caenorhabditis elegans. Furthermore, S. cerevisiae Qri7 complements the loss of the bacterial YgjD protein in Escherichia coli, suggesting that Qri7/OSGEPL and YgjD proteins have retained similar functions in modern organisms. We suggest to name members of the Kae1(OSGEP)/YgjD family UGMP, for Universal Genome Maintenance Proteins

Infrastructure for Detector Research and Development towards the International Linear Collider

The EUDET-project was launched to create an infrastructure for developing and testing new and advanced detector technologies to be used at a future linear collider. The aim was to make possible experimentation and analysis of data for institutes, which otherwise could not be realized due to lack of resources. The infrastructure comprised an analysis and software network, and instrumentation infrastructures for tracking detectors as well as for calorimetry.Comment: 54 pages, 48 picture

Overcoming Ex-Post Development Stagnation: Interventions with Continuity and Scaling in Mind

Project interventions are important vehicles for development globally. However, while there is often allocation of resources for new and innovative (pilot) projects—with varying levels of success—there is seemingly less focus on consolidating and/or scaling the positive impacts of successful larger interventions. Assuming an overarching development goal to have long lasting impact at scale, this approach seems somewhat contradictory. Scaling is often not integrated into project planning, design and implementation and rarely pursued genuinely in the ex-post. However, where demand for further development remains outstanding beyond project completion, opportunities may exist to build upon project platforms and extend benefits in a cost effective manner. This paper examines existing scaling typologies, before introducing “scaling-within” as a concept to promote greater continuity of development to a wider range of stakeholders. Scaling-within offers the opportunity to “in-fill” intervention principles and practices to both project and non-project communities within a broader strategic framework to address disparities and to promote sustainable development. The authors draw on research from case studies of large-scale integrated watershed rehabilitation projects and assess scaling-within against a contemporary scaling framework drawn from the literature. While the concept is tested with watersheds as the administrative unit, the authors anticipate applications for other project management units