Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation

Introduction: The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. Theory and methods: The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n=49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n=44) and post (n=47) course and interviews (n=9) 2-5 months later. Results:Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. Conclusions and discussion:An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home

Cluster randomised trials in the medical literature: two bibliometric surveys

Background: Several reviews of published cluster randomised trials have reported that about half did not take clustering into account in the analysis, which was thus incorrect and potentially misleading. In this paper I ask whether cluster randomised trials are increasing in both number and quality of reporting. Methods: Computer search for papers on cluster randomised trials since 1980, hand search of trial reports published in selected volumes of the British Medical Journal over 20 years. Results: There has been a large increase in the numbers of methodological papers and of trial reports using the term 'cluster random' in recent years, with about equal numbers of each type of paper. The British Medical Journal contained more such reports than any other journal. In this journal there was a corresponding increase over time in the number of trials where subjects were randomised in clusters. In 2003 all reports showed awareness of the need to allow for clustering in the analysis. In 1993 and before clustering was ignored in most such trials. Conclusion: Cluster trials are becoming more frequent and reporting is of higher quality. Perhaps statistician pressure works

Temporal inabilities and decision-making capacity in depression

We report on an interview-based study of decision-making capacity in two classes of patients suffering from depression. Developing a method of second-person hermeneutic phenomenology, we articulate the distinctive combination of temporal agility and temporal inability characteristic of the experience of severely depressed patients. We argue that a cluster of decision-specific temporal abilities is a critical element of decision-making capacity, and we show that loss of these abilities is a risk factor distinguishing severely depressed patients from mildly/moderately depressed patients. We explore the legal and clinical consequences of this result

Tobacco Xenobiotics Release Nitric Oxide

Many xenobiotic compounds exert their actions through the release of free radicals and related oxidants [1,2], bringing about unwanted biological effects [3]. Indeed, oxidative events may play a significant role in tobacco toxicity from cigarette smoke. Here, we demonstrate the direct in vitro release of the free radical nitric oxide (•NO) from extracts and components of smokeless tobacco, including nicotine, nitrosonornicotine (NNN) and 4-(methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in phosphate buffered saline and human saliva using electron spin resonance and chemiluminescence detection. Our findings suggest that tobacco xenobiotics represent as yet unrecognized sources of •NO in the body

Body composition of HIV-positive candidates for and recipients of a kidney transplant: comparative analysis between DEXA and anthropometric indices

Objective: To determine body composition (BC) and the correlation, if any, between indices measured by anthropometry and dual-energy X-ray absorptiometry (DEXA).Design: Cross-sectional descriptive.Setting: National sample of HIV-positive patients on the ‘positive-to-positive’ kidney transplant programme, South Africa.Methodology: 34 participants categorised as (i) HIV-positive transplant recipients from an HIV-positive donor (n = 16); and (ii) HIV-positive transplant candidates on the waiting list to receive a kidney from an HIV-positive donor (n = 18). Pearson’s coefficient was used to correlate anthropometry with DEXA.Outcome measures: Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were compared with DEXA-derived percentage body fat (%BF), truncal fat (TF) and visceral adipose tissue (VAT). Mid arm muscle circumference (MAMC) was correlated with DEXA lean indices namely lean mass (LM), lean mass index (LMI) and appendicular lean mass index (ALMI).Results: Pearson’s correlation coefficient between BMI and %BF was strong (r = 0.773, p < 0.001). The correlation between WC with TF (r = 0.799, p < 0.001) and VAT (r = 0.885, p < 0.001) was highly significant, as was the correlation for WHtR with TF and VAT (r = 0.778, p = 0.013 and r = 0.830, p < 0.001). MAMC best correlated with ALMI (r = 0.511, p = 0.011).Conclusion: BMI, WC, WHtR and MAMC are suitable indicators of overall and regional adiposity as well as musculature, based on correlations with DEXA derived %BF, TF, VAT and ALMI respectively. The findings support the use of these anthropometric indices for measurement of BC in this patient group as a cost-effective alternative to DEXA

Exploring Evolutionary Relationships Across the Genome Using Topology Weighting.

We introduce the concept of topology weighting, a method for quantifying relationships between taxa that are not necessarily monophyletic, and visualizing how these relationships change across the genome. A given set of taxa can be related in a limited number of ways, but if each taxon is represented by multiple sequences, the number of possible topologies becomes very large. Topology weighting reduces this complexity by quantifying the contribution of each taxon topology to the full tree. We describe our method for topology weighting by iterative sampling of subtrees ($\textit{Twisst}$), and test it on both simulated and real genomic data. Overall, we show that this is an informative and versatile approach, suitable for exploring relationships in almost any genomic dataset. Scripts to implement the method described are available at http://github.com/simonhmartin/twisst.St John's College, University of Cambridge, NSF grant DEB-1257839, European Research Council grant 33987

Deep Convergence, Shared Ancestry, and Evolutionary Novelty in the Genetic Architecture of Heliconius Mimicry

Convergent evolution can occur through different genetic mechanisms in different species. It is now clear that convergence at the genetic level is also widespread, and can be caused by either (i) parallel genetic evolution, where independently evolved convergent mutations arise in different populations or species, or (ii) collateral evolution in which shared ancestry results from either ancestral polymorphism or introgression among taxa. The adaptive radiation of Heliconius butterflies shows color pattern variation within species, as well as mimetic convergence between species. Using comparisons from across multiple hybrid zones, we use signals of shared ancestry to identify and refine multiple putative regulatory elements in Heliconius melpomene and its comimics, Heliconius elevatus and Heliconius besckei, around three known major color patterning genes: optix, WntA, and cortex. While we find that convergence between H. melpomene and H. elevatus is caused by a complex history of collateral evolution via introgression in the Amazon, convergence between these species in the Guianas appears to have evolved independently. Thus, we find adaptive convergent genetic evolution to be a key driver of regulatory changes that lead to rapid phenotypic changes. Furthermore, we uncover evidence of parallel genetic evolution at some loci around optix and WntA in H. melpomene and its distant comimic Heliconius erato. Ultimately, we show that all three of convergence, conservation, and novelty underlie the modular architecture of Heliconius color pattern mimicry