Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

<b>Background</b> In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.<p></p> <b>Discussion</b> As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.<p></p> <b>Summary</b> Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts

Ionising radiation exposure from medical imaging – A review of Patient's (un) awareness

Introduction: Medical imaging is the main source of artificial radiation exposure. Evidence, however, suggests that patients are poorly informed about radiation exposure when attending diagnostic scans. This review provides an overview of published literature with a focus on nuclear medicine patients on the level of awareness of radiation exposure from diagnostic imaging. Methods: A review of available literature on awareness, knowledge and perception of ionising radiation in medical imaging was conducted. Articles that met the inclusion criteria were subjected to critical appraisal using the Mixed Methods Appraisal Tool. Results: 140 articles identified and screened for eligibility, 24 critically assessed and 4 studies included in synthesis. All studies demonstrated that patients were generally lacking awareness about radiation exposure and highlighted a lack of communication between healthcare professionals and patients with respect to radiation exposure. Conclusion: Studies demonstrate a need to better inform patients about their radiation exposure, and further studies focusing on nuclear medicine patients are particularly warranted. Implications for practice: Adequate and accurate information is crucial to ensure the principle of informed consent is present

Segregation by thermal diffusion in granular shear flows

Segregation by thermal diffusion of an intruder immersed in a sheared granular gas is analyzed from the (inelastic) Boltzmann equation. Segregation is induced by the presence of a temperature gradient orthogonal to the shear flow plane and parallel to gravity. We show that, like in analogous systems without shear, the segregation criterion yields a transition between upwards segregation and downwards segregation. The form of the phase diagrams is illustrated in detail showing that they depend sensitively on the value of gravity relative to the thermal gradient. Two specific situations are considered: i) absence of gravity, and ii) homogeneous temperature. We find that both mechanisms (upwards and downwards segregation) are stronger and more clearly separated when compared with segregation criteria in systems without shear.Comment: 8 figures. To appear in J. Stat. Mec

Secondary literacy across the curriculum: Challenges and possibilities

This paper discusses the challenges and possibilities attendant upon successfully implementing literacy across the curriculum initiatives – or ‘school language policies’ as they have come to be known - particularly at the secondary or high school level. It provides a theoretical background to these issues, exploring previous academic discussions of school language policies, and highlights key areas of concern as well as opportunity with respect to school implementation of such policies. As such, it provides a necessary conceptual background to the subsequent papers in this special issue, which focus upon the Secondary Schools’ Literacy Initiative (SSLI) – a New Zealand funded programme that aims to establish cross-curricular language and literacy policies in secondary schools

Epidemic threshold in structured scale-free networks

We analyze the spreading of viruses in scale-free networks with high clustering and degree correlations, as found in the Internet graph. For the Suscetible-Infected-Susceptible model of epidemics the prevalence undergoes a phase transition at a finite threshold of the transmission probability. Comparing with the absence of a finite threshold in networks with purely random wiring, our result suggests that high clustering and degree correlations protect scale-free networks against the spreading of viruses. We introduce and verify a quantitative description of the epidemic threshold based on the connectivity of the neighborhoods of the hubs.Comment: 4 pages, 4 figure

Radiation exposure awareness from patients undergoing nuclear medicine diagnostic 99mTc-MDP bone scans and 2-deoxy-2-(18F) fluoro-D-glucose PET/computed tomography scans

INTRODUCTION: Medical imaging is on average the largest source of artificial radiation exposure worldwide. This study seeks to understand patient's awareness of radiation exposure derived from nuclear medicine diagnostic scans and assess if current information provided by leaflets is adequate. METHODS: Single-centre cross-sectional questionnaire study applied to bone scan and FDG PET/computed tomography patients, at a nuclear medicine and PET/computed tomography department over a 15-week period in 2018. Questionnaires on dose comparators were designed in collaboration with patients, public, and experts in radiation exposure. Qualitative data were analysed using thematic analysis and quantitative data using SPSS (V. 24). RESULTS: A total of 102 questionnaires were completed (bone scan = 50; FDG PET/computed tomography = 52). Across both groups, 33/102 (32.4%) patients reported having a reasonable understanding of nuclear medicine and 21/102 (20.6%) reported a reasonable knowledge of ionising radiations. When asked to compare the exposure dose of respective scans with common comparators 8/50 (16%) of bone scan patients and 11/52 (21.2%) FDG PET/computed tomography answered correctly. On leaflet information, 15/85 (17.6%) patients reported the leaflets do not provide enough information on radiation exposure and of these 10/15 (66.7%) commented the leaflets should incorporate more information on radiation exposure dose. CONCLUSION: More observational and qualitative studies in collaboration with patients are warranted to evaluate patients' understanding and preferences in communication of radiation exposure from nuclear medicine imaging. This will ensure communication tools and guidelines developed to comply with ionising radiation (medical exposure) regulation 2017 are according to patients needs and preferences

Inefficiency of orientation averaging: evidence for hybrid serial/parallel temporal integration

Intuition suggests that increased viewing time should allow for the accumulation of more visual information, but scant support for this idea has been found in studies of voluntary averaging, where observers are asked to make decisions based on perceived average size. In this paper we examine the dynamics of information accrual in an orientation-averaging task. With orientation (unlike intensive dimensions such as size), it is relatively safe to use an item's physical value as an approximation for its average perceived value. We displayed arrays containing 8 iso-eccentric Gabor patterns, and asked six trained psychophysical observers to compare their average orientation with that of probe stimuli that were visible before, during, or only after the presentation of the Gabor array. From the relationship between orientation variance and human performance, we obtained estimates of effective set size, i.e. the number of items that an ideal observer would need to assess in order to estimate average orientation as well as our human observers did. We found that display duration had only a modest influence on effective set size. It rose from an average of ~2 for 0.1-s displays to an average of ~3 for 3.3-s displays. These results suggest that the visual computation is neither purely serial nor purely parallel. Computations of this nature can be made with a hybrid process that takes a series of subsamples of a few elements at a time

HD DVD substrates for surface enhanced Raman spectroscopy analysis : fabrication, theoretical predictions and practical performance

Commercial HD DVDs provide a characteristic structure of encoding pits which were utilized to fabricate cost efficiently large area SERS substrates for chemical analysis. The study targets the simulation of the plasmonic structure of the substrates and presents an easily accessible fabrication process to obtain highly sensitive SERS active substrates. The theoretical simulation predicted the formation of supermodes under optimized illumination conditions, which were verified experimentally. First tests of the developed SERS substrates demonstrated their excellent potential for detecting vitamin A and pro- vitamin A at low concentration levels

Socioeconomic and Psychosocial Adversities Experienced by Creative Freelancers in the UK During the COVID-19 Pandemic: A Qualitative Study

There are concerns that the socioeconomic consequences of COVID-19, including unemployment and financial insecurity, are having adverse effects on the mental wellbeing of the population. One group particularly vulnerable to socioeconomic adversity during this period are those employed freelance within the cultural industry. Many workers in the sector were already subject to income instability, erratic work schedules and a lack of economic security before the pandemic, and it is possible that COVID-19 may exacerbate pre-existing economic precarity. Through interviews with 20 freelancers working within the performing arts, visual arts, and film and television industries, this article explores the impact of the pandemic on their working lives. Findings suggest the pandemic is affecting the psychological wellbeing of freelancers through employment loss, financial instability and work dissonance, and illustrates the need for urgent economic and psychosocial support for those employed within the cultural sector

The Impact of America\u27s Choice on Writing Performance in Georgia: First-Year Results

During the first year of implementation, the emphasis of the America\u27s Choice school reform design is an intensive focus on building students\u27 writing skills. Writers workshop, the primary instructional emphasis of America\u27s Choice during this year, is the component of the design for which teachers first receive in-depth training. In keeping with the emphasis of America\u27s Choice, this year-one external evaluation study of the impact of America\u27s Choice on student performance in Georgia focuses on student writing performance. The study examines changes in student writing performance from 2001 to 2002, the initial year of implementation of America\u27s Choice in 109 Georgia elementary schools and 50 Georgia middle schools. Because state writing assessments were administered to students in fifth and eighth grades, our analyses are restricted to these grade levels