Exploring the Influence of Patient-Professional Partnerships on the Self-Management of Chronic Back Pain: A Qualitative Study

Patients are encouraged to take an active role in self-managing their chronic back pain and functional problems. However, research suggests that patients do not self-manage, and they expect health professionals to fulfill a comprehensive role in managing pain. A partnership between patients and health professionals is called for, and self-management works best when they share knowledge and work together toward optimal goals. To explore how patients' partnerships with health professionals may influence their ability to self-manage pain by exploring patients' experiences. A grounded theory approach with in-depth, semistructured interviews was undertaken. Each interview was analyzed using constant comparative analysis. This study was nested within a larger study on patient-professional partnerships and the self-management of chronic back pain. Twenty-six patients with chronic back pain were recruited in a community-based pain management service in Northern England, United Kingdom. Three themes emerged: building partnerships with health professionals; being supported by health professionals to self-manage the pain; and experiencing a change in self-management. Five approaches that underpinned health professionals' self-management support were identified. Facilitators of and barriers to a good partnership were reported. This study suggests that a good patient-professional partnership has a positive effect on patients’ self-management ability. A theoretical model explaining how such partnership may influence self-management was developed. It is necessary for both patients and health professionals to be aware of their partnerships, which may enhance the effect of pain management services

Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System

Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development

Correction to “Isotopic characterization of aerosol organic carbon components over the eastern United States”

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 117 (2012): D15399, doi:10.1029/2012JD018478.2013-01-0

Triacylglycerol profiling of microalgae strains for biofuel feedstock by liquid chromatography–high-resolution mass spectrometry

Biofuels from photosynthetic microalgae are quickly gaining interest as a viable carbon-neutral energy source. Typically, characterization of algal feedstock involves breaking down triacylglycerols (TAG) and other intact lipids, followed by derivatization of the fatty acids to fatty acid methyl esters prior to analysis by gas chromatography (GC). However, knowledge of the intact lipid profile could offer significant advantages for discovery stage biofuel research such as the selection of an algal strain or the optimization of growth and extraction conditions. Herein, lipid extracts from microalgae were directly analyzed by ultra-high pressure liquid chromatography–mass spectrometry (UHPLC-MS) using a benchtop Orbitrap mass spectrometer. Phospholipids, glycolipids, and TAGs were analyzed in the same chromatographic run, using a combination of accurate mass and diagnostic fragment ions for identification. Using this approach, greater than 100 unique TAGs were identified over the six algal strains studied and TAG profiles were obtained to assess their potential for biofuel applications. Under the growth conditions employed, Botryococcus braunii and Scenedesmus obliquus yielded the most comprehensive TAG profile with a high abundance of TAGs containing oleic acid

Effectiveness of interventions to support the early detection of skin cancer through skin self-examination: a systematic review and meta-analysis.

BACKGROUND: As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self-examination (SSE); however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE interventions. OBJECTIVES: To systematically examine, map, appraise and synthesize, qualitatively and quantitatively, studies evaluating the early detection of skin cancer, using SSE interventions. METHODS: This is a systematic review (narrative synthesis and meta-analysis) examining randomized controlled trials (RCTs) and quasiexperimental, observational and qualitative studies, published in English, using PRISMA and National Institute for Health and Care Excellence guidance. The MEDLINE, Embase and PsycINFO databases were searched through to April 2015 (updated in April 2018 using MEDLINE). Risk-of-bias assessment was conducted. RESULTS: Included studies (n = 18), totalling 6836 participants, were derived from 22 papers; these included 12 RCTs and five quasiexperiments and one complex-intervention development. More studies (n = 10) focused on targeting high-risk groups (surveillance) than those at no higher risk (screening) (n = 8). Ten (45%) study interventions were theoretically underpinned. All of the study outcomes were self-reported, behaviour related and nonclinical in nature. Meta-analysis demonstrated the impact of the intervention on the degree of SSE activity from five studies, especially in the short term (up to 4 months) (odds ratio 2·31, 95% confidence interval 1·90-2·82), but with small effect sizes. Risk-of-bias assessment indicated that 61% of the studies (n = 11) were of weak quality. CONCLUSIONS: Four RCTs and a quasiexperimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer. However, the actual clinical impact remains unclear, and this is based on overall weak study (evidence) quality

Assessing the blank carbon contribution, isotope mass balance, and kinetic isotope fractionation of the Ramped Pyrolysis/Oxidation instrument at NOSAMS

Author Posting. © The Author(s), 2017. This is the author's version of the work. It is posted here under a nonexclusive, irrevocable, paid-up, worldwide license granted to WHOI. It is made available for personal use, not for redistribution. The definitive version was published in Radiocarbon 59 (2017): 179-193, doi:10.1017/RDC.2017.3.We estimate the blank carbon mass over the course of a typical Ramped PyrOx (RPO) analysis (150 to 1000 °C; 5 °C×min-1) to be (3.7 ± 0.6) μg C with an Fm value of 0.555 ± 0.042 and a δ13C value of (-29.0 ± 0.1) ‰ VPDB. Additionally, we provide equations for RPO Fm and δ13C blank corrections, including associated error propagation. By comparing RPO mass-weighted mean and independently measured bulk δ13C values for a compilation of environmental samples and standard reference materials (SRMs), we observe a small yet consistent 13C depletion within the RPO instrument (mean – bulk: μ = -0.8 ‰; ±1σ = 0.9 ‰; n = 66). In contrast, because they are fractionation-corrected by definition, mass-weighted mean Fm values accurately match bulk measurements (mean – bulk: μ = 0.005; ±1σ = 0.014; n = 36). Lastly, we show there exists no significant intra-sample δ13C variability across carbonate SRM peaks, indicating minimal mass-dependent kinetic isotope fractionation during RPO analysis. These data are best explained by a difference in activation energy between 13C- and 12C-containing compounds (13–12ΔE) of 0.3 to 1.8 J×mol-1, indicating that blank and mass-balance corrected RPO δ13C values accurately retain carbon source isotope signals to within 1 to 2‰.J.D.H. was partly supported by the NSF Graduate Research Fellowship Program under grant number 2012126152; V.V.G. was partly supported by the US National Science Foundation (grants OCE- 0851015 and OCE-0928582), the WHOI Coastal Ocean Institute (grant 27040213) and an Independent Study Award (grant 27005306) from WHOI; G.S. and P.K.Z. were supported by the WHOI Postdoctoral Scholar Program with funding provided by NOSAMS (OCE-1239667)

Movement of deep-sea coral populations on climatic timescales

During the past 40,000 years, global climate has moved into and out of a full glacial period, with the deglaciation marked by several millennial-scale rapid climate change events. Here we investigate the ecological response of deep-sea coral communities to both glaciation and these rapid climate change events. We find that the deep-sea coral populations of Desmophyllum dianthus in both the North Atlantic and the Tasmanian seamounts expand at times of rapid climate change. However, during the more stable Last Glacial Maximum, the coral population globally retreats to a more restricted depth range. Holocene populations show regional patterns that provide some insight into what causes these dramatic changes in population structure. The most important factors are likely responses to climatically driven changes in productivity, [O_2] and [CO_3^(2–)]

A patient-led approach to product innovation in patient education and wound management

This paper reports results from a multi-disciplinary industry-academia research partnership whose goal was to conceive, design and prototype solutions for older adults with chronic wounds. Aim: The aim of the project was to explore the potential enhanced benefits of extended patient involvement in an entire live product development process, from understanding the wound care environment, through needs identification, to solution generation and iteration. Methods: An action-design research methodology was used to engage with 47 target users and develop design ideas and prototypes. The research was built around a theoretical framework that integrates aspirations and needs of target users with socio-technical systems thinking and innovation management processes. Results: The design component of the research methodology resulted in the concept design of a wound management education and information system for use by patients and their caregivers. This concept was developed based on observations of and interaction with patients and caregivers. A prototype solution was built and used as a vehicle to gain an understanding of opportunities, issues, and challenges to be addressed in supporting older adults with chronic wounds and enabling them to maintain and improve their personal wellbeing. This led to the identification of the need for readily available, current wound care information, advice, and support for older people and caregivers. The design concept was a response to this need. From early evaluations of a prototype implementation, age was identified as not necessarily being a barrier to the use of a technology-based solution; IT skills, confidence, and access to the internet were identified as more important factors. Outcomes: A prototypical wound care information system was developed that has been evaluated with target users using deliberative panels and home-based evaluations of a prototype implemented on a tablet platform. Wound care solutions focussed on the need to support people in maintaining their personal wellbeing lead to different requirements from those that support wound treatment. By considering wider perspectives, solution providers have opportunities to utilise fewer or re-allocate resources whilst improving user wellbeing by creating user-focussed outcomes that are effective, efficient, and valued by both patient and provider

A high-performance 14C accelerator mass spectrometry system

Author Posting. © Arizona Board of Regents on behalf of the University of Arizona, 2010. This article is posted here by permission of Dept. of Geosciences, University of Arizona for personal use, not for redistribution. The definitive version was published in Radiocarbon 52 (2010): 228-235.A new and unique radiocarbon accelerator mass spectrometry (AMS) facility has been constructed at the Woods Hole Oceanographic Institution. The defining characteristic of the new system is its large-gap optical elements that provide a larger-than-standard beam acceptance. Such a system is ideally suited for high-throughput, high-precision measurements of 14C. Details and performance of the new system are presented