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

What makes a 'good group'? Exploring the characteristics and performance of undergraduate student groups

Group work forms the foundation for much of student learning within higher education, and has many educational, social and professional benefits. This study aimed to explore the determinants of success or failure for undergraduate student teams and to define a ‘good group’ through considering three aspects of group success: the task, the individuals, and the team. We employed a mixed methodology, combining demographic data with qualitative observations and task and peer evaluation scores. We determined associations between group dynamic and behaviour, demographic composition, member personalities and attitudes towards one another, and task success. We also employed a cluster analysis to create a model outlining the attributes of a good small group learning team in veterinary education. This model highlights that student groups differ in measures of their effectiveness as teams, independent of their task performance. On the basis of this, we suggest that groups who achieve high marks in tasks cannot be assumed to have acquired team working skills, and therefore if these are important as a learning outcome, they must be assessed directly alongside the task output

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

The Electron Spectral Function in Two-Dimensional Fractionalized Phases

We study the electron spectral function of various zero-temperature spin-charge separated phases in two dimensions. In these phases, the electron is not a fundamental excitation of the system, but rather ``decays'' into a spin-1/2 chargeless fermion (the spinon) and a spinless charge e boson (the chargon). Using low-energy effective theories for the spinons (d-wave pairing plus possible N\'{e}el order), and the chargons (condensed or quantum disordered bosons), we explore three phases of possible relevance to the cuprate superconductors: 1) AF*, a fractionalized antiferromagnet where the spinons are paired into a state with long-ranged N\'{e}el order and the chargons are 1/2-filled and (Mott) insulating, 2) the nodal liquid, a fractionalized insulator where the spinons are d-wave paired and the chargons are uncondensed, and 3) the d-wave superconductor, where the chargons are condensed and the spinons retain a d-wave gap. Working within the $Z_2$ gauge theory of such fractionalized phases, our results should be valid at scales below the vison gap. However, on a phenomenological level, our results should apply to any spin-charge separated system where the excitations have these low-energy effective forms. Comparison with ARPES data in the undoped, pseudogapped, and superconducting regions is made.Comment: 10 page

Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol

<b>Background</b> Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.<p></p> <b>Objectives</b> The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures.<p></p> <b>Methods</b> A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings.<p></p> <b>Discussion</b> The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices

Symptomatic Social Science: Reflexivity, Recognition and Redistribution in the GBCS

The article examines methodological and theoretical issues related to the GBCS. It acknowledges its importance for the public profile of sociology, whilst arguing that it needs to develop a better sense of what it stands for not only in terms of understanding societal changes, but contributing to human betterment. To achieve this it discusses the role of reflexivity in the GBCS with reference to position and disposition and accounts of its process. It then moves on to examine its normative basis in terms of an ‘existential analytics’ and suggests a series of ways in which it might advance its insights as the work develops

Benchmarking coarse-grained models of organic semiconductors via deep backmapping

The potential of mean force is an effective coarse-grained potential, which is often approximated by pairwise potentials. While the approximated potential reproduces certain distributions of the reference all-atom model with remarkable accuracy, important cross-correlations are typically not captured. In general, the quality of coarse-grained models is evaluated at the coarse-grained resolution, hindering the detection of important discrepancies between the all-atom and coarse-grained ensembles. In this work, the quality of different coarse-grained models is assessed at the atomistic resolution deploying reverse-mapping strategies. In particular, coarse-grained structures for Tris-Meta-Biphenyl-Triazine are reverse-mapped from two different sources: 1) All-atom configurations projected onto the coarse-grained resolution and 2) snapshots obtained by molecular dynamics simulations based on the coarse-grained force fields. To assess the quality of the coarse-grained models, reverse-mapped structures of both sources are compared revealing significant discrepancies between the all-atom and the coarse-grained ensembles. Specifically, the reintroduced details enable force computations based on the all-atom force field that yield a clear ranking for the quality of the different coarse-grained models