Wider consultation on Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease

In this article we examine whether an innovative mixed method approach could highlight the positive and challenging effects of a Pulmonary Rehabilitation Programme (PRP) on the Quality of Life (QOL) of patients with Chronic Obstructive Pulmonary Disease (COPD). In 2012, we conducted three consultation workshops in Mid-West Wales, UK, with COPD patients that participated in a PRP, their significant others (e.g. spouses and partners), and healthcare professionals who delivered the PRP. We found that there was a resounding enthusiasm for the content and impact of the programme, particularly in the areas of: increased patient activity, enhanced patient control and confidence, a greater willingness to self-manage treatment, and an increased sense of group belonging. Seven key themes mattered most to our study participants: the patient, physical health, mental health, the programme, professionals and significant others, knowledge and education, and the future. We used these themes to craft a best-practice outcomes document (template) of the benefits and challenges of the PRP to inform and support future service evaluation and delivery.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs150179En este artículo examinamos si un innovador enfoque de método mixto podría poner de relieve los efectos positivos y desafiantes de un Programa de Rehabilitación Pulmonar (PRP) en la calidad de vida (CDV) de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). En 2012, realizamos tres talleres de consulta en el centro-oeste de Gales, Reino Unido, con pacientes con EPOC que participaron en un PRP, con personas importantes para ellos (por ejemplo, cónyuges y parejas), y profesionales de la salud que atienden el PRP. Encontramos que había un entusiasmo muy fuerte por el contenido e impacto del programa, en particular en las áreas de: aumento de la actividad del paciente, mayor control y confianza del paciente, una mayor disposición a autogestionar el tratamiento , y un mayor sentido de pertenencia al grupo. Siete temas importaron más a nuestros participantes del estudio: el paciente, la salud física, la salud mental, el programa, los profesionales y otras personas importantes, conocimientos y educación, y el futuro. Utilizamos estos temas para elaborar una plantilla de las mejores prácticas de los beneficios y desafíos de la PRP, para informar y apoyar la futura evaluación y provisión del servicio.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs150179In diesem Beitrag beschäftigen wir uns mit einem innovativen Mixed-Methods-Ansatz zur Bewertung der positiven und problematischen Effekte eines Rehabilitationsprogramms, das eine verbesserte Lebensqualität von Patient/innen mit chronisch obstruktiver Lungenerkrankung zum Ziel hatte. Hierzu führten wir 2012 drei Konsultationsworkshops in West-Wales durch mit Patient/innen, die an einem solchen Programm teilgenommen hatten, deren Angehörigen und mit Professionellen, die in dem Programm tätig gewesen waren. Die Resonanz war vergleichsweise enthusiastisch, sowohl was Inhalte und was den Impact des Programms angeht, und zwar vor allem mit Blick auf eine vermehrte Aktivität der Patient/innen, auf deren Kontrollgefühl, Zuversicht und Bereitschaft einer verbesserten Selbstfürsorge sowie ein erhöhtes Zusammengehörigkeitsgefühl. Sieben Schlüsselthemen konnten als besonders relevant für die Untersuchungsteilnehmer/innen herausgearbeitet werden: die Patient/innen, physische Gesundheit, psychische Gesundheit, das Programm, Professionale und Angehörige, Wissen und Bildung sowie die Zukunft. Ausgehend hiervon entwickelten wir einen Best-Practice-Vorschlag für die Konzeption und Durchführung von Folgeprogrammen und -Dienstleistungen.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs15017

Through the looking glass: public and professional perspectives on patient-centred professionalism in modern-day community pharmacy

This paper presents five consultation workshops with 29 community pharmacists, stakeholders and patients that examined "patient-centred professionalism" in terms of pharmacists' working day and environment. The concept is ill-defined in both medical and pharmacy literature and the study aimed to clarify the situated nature of the term for patients and health professionals across settings. Workshops were supported by bio-photographic datasets of "in-situ" practice and Nominal Group Work. The thematic content analyses led to the following aspects: building caring relationships; managing external forces; the effects of space and environment, and different roles and expectations. The study reveals how patient-centred professionalism cannot be defined in any singular or stationary sense, but should be seen as a "moveable feast", best understood through everyday examples of practice and interaction, in relation to whose experience is being expressed, and whose needs considered. The phrase is being mobilised by a whole set of interests and stakeholders to reshape practice, the effect of which remains both uncertain and contested. Whilst patients prioritise a quick and efficient dispensing service from knowledgeable pharmacists, pharmacists rail against increasing public demands and overtly formalised consultations that take them away from the dispensary where the defining aspects of their professionalism lie. URN: urn:nbn:de:0114-fqs100177Unser Beitrag stellt die Ergebnisse aus insgesamt fünf Workshops mit 29 Apotheker/innen, Patient/innen und weiteren Akteuren vor, die sich mit "Patient/innen-zentrierter Versorgung" in der Alltagsarbeit und -umgebung von Apotheker/innen befassten. Dieses Konzept ist in der relevanten Literatur nur ungenügend definiert, und ein Ziel der Studie war, dessen situativen Charakter für Patient/innen und im Gesundheitssystem Tätige zu präzisieren. In den Workshops kamen Fotografien aus der Alltagspraxis und spezifische Gruppenarbeitsverfahren zum Einsatz. Im Beitrag werden nach einer Information über die Teilnehmenden die Ergebnisse der thematischen Inhaltsanalyse zusammengefasst, die die folgenden Schwerpunkte erbrachte: Aufbau von Beziehungen mit Patient/innen, Umgang mit externen Einflussgrößen, (räumliche) Umgebungseffekte und Unterschiedlichkeit von Rollen und Erwartungen. Die Ergebnisse zeigen, dass "Patient/innen-zentrierte Versorgung" nicht in einer singulären oder statischen Weise definiert werden kann, sondern am besten nachvollziehbar ist entlang von Beispielen aus der Alltagspraxis und von Alltagsinteraktionen, abhängig davon, wessen Erfahrungen ausgedrückt und wessen Bedürfnisse im Fokus stehen sollen. Dieses Verständnis trifft für eine Vielzahl an Interessen und Akteuren zu, um Praxis zu rekonzeptualisieren, die zugleich auch fragil und strittig ist: Während Patient/innen möglichst schnelle und effektive Dienstleistungen von sachkundigen Apotheker/innen erwarten, wenden diese sich gegen wachsende öffentliche Ansprüche und zunehmend formalisierte Beratungen, die sie von der Art von Arbeit entfernen, die Kern ihrer professionellen Identität ist. URN: urn:nbn:de:0114-fqs100177Este documento presenta cinco talleres de consulta con 29 farmacéuticos comunitarios, los promotores y los pacientes que examinaron "el profesionalismo centrado en el paciente" en términos de jornada de trabajo de los farmacéuticos y el medio ambiente. El concepto está mal definido, tanto en la literatura médica y farmacéutica, y el estudio tuvo como objetivo aclarar la naturaleza situada del término en los pacientes y en los profesionales de la salud en diferentes contextos. Los talleres fueron apoyados por conjuntos de datos bio-fotográficas de la práctica "in-situ" y el Grupo Nominal de Trabajo. El análisis de contenido temático c a los siguientes aspectos: creación de relaciones afectuosas; gestión de fuerzas externas; los efectos del espacio y el medio ambiente, y roles y expectativas diferentes. El estudio revela cómo el profesionalismo centrado en el paciente no puede definirse en un sentido singular o estacional, pero debe ser visto como “fiesta ambulante”, mejor entendida a través de ejemplos de la vida diaria y la interacción, en relación con cuya experiencia se expresa, y cuyas necesidades considera. La frase está siendo movilizada por un juego entero de intereses y de los promotores para reformar la práctica, el efecto del cual sigue siendo incierto y puesto en debate. Mientras los pacientes priorizan un servicio de distribución rápido y eficiente de parte de farmacéuticos bien informados, los farmacéuticos critican severamente las crecientes demandas públicas y abiertamente formalizan consultas que se los llevan lejos del dispensario donde radican los aspectos de definición de su profesionalismo. URN: urn:nbn:de:0114-fqs10017

Women’s Perceptions of Journeying Toward an Unknown Future With Breast Cancer: The “Lives at Risk Study”

Breast cancer risk classifications are useful for prognosis, yet little is known of their effect on patients. This study clarified women's understandings of risk as they "journeyed" through the health care system. Breast cancer patients and women undergoing genetic investigation were recruited ( N = 25) from a large UK Health Board, 2014-2015, completing a "Book of Experience," and Bio-photographic elicitation interviews. Stakeholder and Participant Feedback Forums were undertaken with key stakeholders, including patients, oncologists, funders, and policy developers, to inform team understanding. Thematic and visual frameworks from multidisciplinary analysis workshops uncovered two themes: "Subjective Understandings of Risk" and "Journeying Toward an Unknown Future." Breast cancer patients and women undergoing investigation experienced risk intuitively. Statistical formulations were often perplexing, diverting attention away from concrete life-and-death facts. Following risk classification, care must be co-defined to reduce patients' foreboding about an unknown future, taking into consideration personal risk management strategies and aspirations for a cancer-free future

Dynamical analysis of three distant trans-Neptunian objects with similar orbits

This paper reports the discovery and orbital characterization of two extreme trans-Neptunian objects (ETNOs), 2016 QV 89 and 2016 QU 89 , which have orbits that appear similar to that of a previously known object, 2013 UH 15 . All three ETNOs have semi-major axes a≈172 AU and eccentricities e≈0.77 . The angular elements (i,ω,Ω) vary by 6, 15, and 49 deg, respectively between the three objects. The two new objects add to the small number of TNOs currently known to have semi-major axes between 150 and 250 AU, and serve as an interesting dynamical laboratory to study the outer realm of our Solar System. Using a large ensemble of numerical integrations, we find that the orbits are expected to reside in close proximity in the (a,e) phase plane for roughly 100 Myr before diffusing to more separated values. We then explore other scenarios that could influence their orbits. With aphelion distances over 300 AU, the orbits of these ETNOs extend far beyond the classical Kuiper Belt, and an order of magnitude beyond Neptune. As a result, their orbital dynamics can be affected by the proposed new Solar System member, referred to as Planet Nine in this work. With perihelion distances of 35-40 AU, these orbits are also influenced by resonant interactions with Neptune. A full assessment of any possible, new Solar System planets must thus take into account this emerging class of TNOs

Targeted delivery of antisense oligonucleotides by molecular conjugates

Antisense oligonucleotides efficiently inhibit gene expression in vitro; however, the successful therapeutic application of this technology in vivo will require the development of improved delivery systems. In this report we describe a technique that efficiently delivers antisense oligonucleotides into cells using molecular conjugates. This technique, which was initially developed for the delivery of eukaryotic genes, is based on the construction of DNA-protein complexes that are recognized by the liver-specific asialoglycoprotein receptor. Binding of poly( l -lysine)-asialoorosomucoid (AsOR) protein conjugates with phosphorothioate antisense oligonucleotides to chloramphenicol acetyltransferase (CAT) led to the formation of 50- to 150-nm toroids. Exposure of the antisense molecular complexes (3 µM oligonucleotide) to NIH 3T3 cells genetically modified to express both the AsOR receptor and CAT, inhibited CAT expression by 54%, which was completely blocked by excess AsOR. Equivalent inhibition of CAT activity with purified oligonucleotide alone was observed at a 30 µM concentration. Furthermore, examination of the cells using indirect immunofluorescence for the presence of CAT protein showed 28% of cells exposed to the molecular conjugates lacked any detectable CAT enzyme. Cells exposed to oligonucleotide alone showed a highly variable staining pattern, and only a few of the cells were completely void of CAT protein. Together these data demonstrate that molecular conjugates provide a highly specific and efficient system for the delivery of antisense oligonucleotides.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45543/1/11188_2005_Article_BF01232652.pd

Chapter 1 Civic Space—and Desire—Deranged

Civic Spaces and Desire presents an original and critical appraisal of civic spaces for a novel theoretical intersection of architecture and human geography. The authors address civic spaces that embody a strong moral code, such as a remembrance park or a casino, in various places in the United Kingdom, Europe, North America, Australia and Asia. The consecutive chapters of the book present these chosen spaces as the interconnection between the everyday and the ideological. By doing so the book reimagines the socio-political effects of the countercultural assemblages and ontologies of difference that these spaces produce, represent and foster, as presented through outcasts and nomads of various kinds and forms. The book reflects on different interpretations of the key texts from primarily post-linguistic theoreticians, such as Gilles Deleuze, Félix Guattari and Jacques Derrida. It will benefit students and academics in architecture, geography, philosophy and urban studies and planning, who seek to understand the politics of space, place and civility. By deconstructing normative ideological constructs, the book uses the concept of desire to explore the tensions between expectations of civic spaces and the disappointment and wonder of their immanent existence

Dialectics revisited. Reality discharged

Dialectics is a powerful way of engaging with our conflicted world, and yet it remains obscure, neglected, and badly misunderstood. Despite the prevalence of attempts to come to terms with all manner of antagonisms, contradictions, polarities, and oppositions across a host of theoretical practices and domains, relatively few authors make recourse to dialectics, and those who do invariably frame it within the following, rather unhelpful, terms: thesis – antithesis – synthesis or position – negation – negation-of-the-negation. While the advent of poststructuralism in general, and of deconstruction in particular, has arguably robbed the dialectic of much of its purchase, it is nonetheless worth revisiting dialectics since it offers an exemplary distillation of what is at stake in thinking through the Real as conflicted and charged. Accordingly, the paper is an attempt to clarify the dialectical articulation of the Real in its confliction, and advances the heretical possibility that the Real may be bereft of charge. Almost everyone works on the basis of a charged Reality—of a Real that is essentially polarized, antagonized, and conflicted—and most critical and fatal theorists dream of discharging the Real: selectively in the case of the former; wholesale in the case of the latter. Thinking through dialectics in the company of deconstruction and poststructuralism, however, opens up an entirely new terrain for the Real that is untouched by the positive and the negative, and which slips through the grasp of both critical and fatal theory. Reality is always already cracked open, but there is nothing to discharge.

Waiting for geography

The editors of this issue of the journal called for a response to the question: 'What next?' Instead of offering a programmatic or visionary statement, I endeavour to amplify the sense of suspense that would ordinarily be foreclosed by answering the question directly. This is achieved by playing off the literal and colloquial meanings of the question: 'What next?', 'What more absurd, shocking, or surprising thing is possible?' The upshot of this encounter is an undecidable vacillation between the probable and the improbable, the rational and the irrational, and the expected and the unexpected. By alluding to both realism and surrealism, and drawing on programmation, speculation, and fabulation, I deploy some poststructuralist and materialist motifs in order to ensure that the future of human geography will remain in perpetual suspense and thereby open to those aleatory encounters that come from who knows where.