Using Loose Coupling Theory to Understand Interprofessional Collaborative Practice on a Transplantation Team

Background: A central paradox dwells at the heart of interprofessional care: the tension between autonomy and interdependence. This report uses an ethnographic study to understand how this tension shapes collaborative practice on a distributed, interprofessional transplant team in a Canadian teaching hospital.Methods & Findings: Over four months, two trained observers conducted an ethnography through 162 observation hours, 30 field interviews and 17 formal interviews with 39 consented participants. Data collection and inductive analysis proceeded iteratively. Loose coupling theory was used as a resource to make sense of key themes. We describe the transplant team as a constellation made up of core, inter-service, and outside hospital dimensions. Next, we trace the nature of coupling activities within and across these dimensions of the team constellation, focusing on recurring communication challenges which can signal the relationship between autonomy and interdependence in collaborative acts.Conclusions: We conclude that coupling is fluid and subject to human agency, and that the tension between autonomy and interdependence can be highly productive. Team members, including patients, may negotiate and construct their relations on an autonomy/interdependence axis for strategic purposes. Far from being trapped in a paradox, team members use autonomy and interdependence as resources to achieve complex goals in collaborative settings.&nbsp

Argon behaviour in an inverted Barrovian sequence, Sikkim Himalaya: the consequences of temperature and timescale on ⁴⁰Ar/³⁹Ar mica geochronology

40Ar/39Ar dating of metamorphic rocks sometimes yields complicated datasets which are difficult to interpret in terms of timescales of the metamorphic cycle. Single-grain fusion and step-heating data were obtained for rocks sampled through a major thrust-sense shear zone (the Main Central Thrust) and the associated inverted metamorphic zone in the Sikkim region of the eastern Himalaya. This transect provides a natural laboratory to explore factors influencing apparent 40Ar/39Ar ages in similar lithologies at a variety of metamorphic pressure and temperature (P–T) conditions. The 40Ar/39Ar dataset records progressively younger apparent age populations and a decrease in within-sample dispersion with increasing temperature through the sequence. The white mica populations span ~ 2–9 Ma within each sample in the structurally lower levels (garnet grade) but only ~ 0–3 Ma at structurally higher levels (kyanite-sillimanite grade). Mean white mica single-grain fusion population ages vary from 16.2 ± 3.9 Ma (2σ) to 13.2 ± 1.3 Ma (2σ) from lowest to highest levels. White mica step-heating data from the same samples yields plateau ages from 14.27 ± 0.13 Ma to 12.96 ± 0.05 Ma. Biotite yield older apparent age populations with mean single-grain fusion dates varying from 74.7 ± 11.8 Ma (2σ) at the lowest structural levels to 18.6 ± 4.7 Ma (2σ) at the highest structural levels; the step-heating plateaux are commonly disturbed. Temperatures > 600 °C at pressures of 0.4–0.8 GPa sustained over > 5 Ma, appear to be required for white mica and biotite ages to be consistent with diffusive, open-system cooling. At lower temperatures, and/or over shorter metamorphic timescales, more 40Ar is retained than results from simple diffusion models suggest. Diffusion modelling of Ar in white mica from the highest structural levels suggests that the high-temperature rocks cooled at a rate of ~ 50–80 °C Ma− 1, consistent with rapid thrusting, extrusion and exhumation along the Main Central Thrust during the mid-Miocene

Indirect effects of the COVID-19 pandemic on paediatric healthcare use and severe disease: a retrospective national cohort study

OBJECTIVES: To determine the indirect consequences of the COVID-19 pandemic on paediatric healthcare utilisation and severe disease at a national level following lockdown on 23 March 2020. DESIGN: National retrospective cohort study. SETTING: Emergency childhood primary and secondary care providers across Scotland; two national paediatric intensive care units (PICUs); statutory death records. PARTICIPANTS: 273 455 unscheduled primary care attendances; 462 437 emergency department attendances; 54 076 emergency hospital admissions; 413 PICU unplanned emergency admissions requiring invasive mechanical ventilation; and 415 deaths during the lockdown study period and equivalent dates in previous years. MAIN OUTCOME MEASURES: Rates of emergency care consultations, attendances and admissions; clinical severity scores on presentation to PICU; rates and causes of childhood death. For all data sets, rates during the lockdown period were compared with mean or aggregated rates for the equivalent dates in 2016–2019. RESULTS: The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell as a proportion of cases for the entire population, with an OR of 0.52 for likelihood of admission during lockdown (95% CI 0.37 to 0.73), compared with the equivalent period in previous years. Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared with 2016–2019. CONCLUSIONS: National lockdown led to a reduction in paediatric emergency care utilisation, without associated evidence of severe harm

The reporting of theoretical health risks by the media: Canadian newspaper reporting of potential blood transmission of Creutzfeldt-Jakob disease

BACKGROUND: The media play an important role at the interface of science and policy by communicating scientific information to the public and policy makers. In issues of theoretical risk, in which there is scientific uncertainty, the media's role as disseminators of information is particularly important due to the potential to influence public perception of the severity of the risk. In this article we describe how the Canadian print media reported the theoretical risk of blood transmission of Creutzfeldt-Jakob disease (CJD). METHODS: We searched 3 newspaper databases for articles published by 6 major Canadian daily newspapers between January 1990 and December 1999. We identified all articles relating to blood transmission of CJD. In duplicate we extracted information from the articles and entered the information into a qualitative software program. We compared the observations obtained from this content analysis with information obtained from a previous policy analysis examining the Canadian blood system's decision-making concerning the potential transfusion transmission of CJD. RESULTS: Our search identified 245 relevant articles. We observed that newspapers in one instance accelerated a policy decision, which had important resource and health implication, by communicating information on risk to the public. We also observed that newspapers primarily relied upon expert opinion (47 articles) as opposed to published medical evidence (28 articles) when communicating risk information. Journalists we interviewed described the challenges of balancing their responsibility to raise awareness of potential health threats with not unnecessarily arousing fear amongst the public. CONCLUSIONS: Based on our findings we recommend that journalists report information from both expert opinion sources and from published studies when communicating information on risk. We also recommend researchers work more closely with journalists to assist them in identifying and appraising relevant scientific information on risk

Mosaic maternal ancestry in the Great Lakes region of East Africa

The Great Lakes lie within a region of East Africa with very high human genetic diversity, home of many ethno-linguistic groups usually assumed to be the product of a small number of major dispersals. However, our knowledge of these dispersals relies primarily on the inferences of historical, linguistics and oral traditions, with attempts to match up the archaeological evidence where possible. This is an obvious area to which archaeogenetics can contribute, yet Uganda, at the heart of these developments, has not been studied for mitochondrial DNA (mtDNA) variation. Here, we compare mtDNA lineages at this putative genetic crossroads across 409 representatives of the major language groups: Bantu speakers and Eastern and Western Nilotic speakers. We show that Uganda harbours one of the highest mtDNA diversities within and between linguistic groups, with the various groups significantly differentiated from each other. Despite an inferred linguistic origin in South Sudan, the data from the two Nilotic-speaking groups point to a much more complex history, involving not only possible dispersals from Sudan and the Horn but also large-scale assimilation of autochthonous lineages within East Africa and even Uganda itself. The Eastern Nilotic group also carries signals characteristic of West-Central Africa, primarily due to Bantu influence, whereas a much stronger signal in the Western Nilotic group suggests direct West-Central African ancestry. Bantu speakers share lineages with both Nilotic groups, and also harbour East African lineages not found in Western Nilotic speakers, likely due to assimilating indigenous populations since arriving in the region ~3000 years ago

Bringing analysis of gender and social–ecological resilience together in small-scale fisheries research: Challenges and opportunities

The demand for gender analysis is now increasingly orthodox in natural resource programming, including that for small-scale fisheries. Whilst the analysis of social–ecological resilience has made valuable contributions to integrating social dimensions into research and policy-making on natural resource management, it has so far demonstrated limited success in effectively integrating considerations of gender equity. This paper reviews the challenges in, and opportunities for, bringing a gender analysis together with social–ecological resilience analysis in the context of small-scale fisheries research in developing countries. We conclude that rather than searching for a single unifying framework for gender and resilience analysis, it will be more effective to pursue a plural solution in which closer engagement is fostered between analysis of gender and social-ecological resilience whilst preserving the strengths of each approach. This approach can make an important contribution to developing a better evidence base for small-scale fisheries management and policy

Psychology and aggression

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68264/2/10.1177_002200275900300301.pd

Maritime frontogenesis

Numerical experiments are conducted with a hydrostatic primitive equation model initialized in a baroclinically unstable state to simulate the passage of cold fronts over the ocean. The model includes K-theory planetary boundary layer (PBL) parameterization with implicitly defined diffusion coefficients. An adiabatic and inviscid simulation provided the control for these experiments. The PBL simulations are integrated 1) with zi held constant at 0.4 m and no heat flux; 2) with sea surface temperature (SST) set equal to e1 at t = 0 h; 3) with a 5 warmer SST; 4) with diffusion coefficients set equal to 1. Horizontal resolution is increased to achieve smaller scale fronts in the inviscid and ocean simulations. The frontogenetic effects of shear, tilting, convergence, and the PBL on isentropic surfaces are evaluated. Relative to the inviscid simulation, the PBL simulations produce reduced frontogenesis. Surface heat and momentum fluxes combined with turbulent mixing of heat promote the development of a deep, well-mixed layer whose depth is dependent on the air-sea temperature difference. The rate of frontogenesis is extremely dependent on the parameterization of the PBL, specifically surface roughness lengths. Smaller scale fronts were produced during the ocean simulations than the PBL land case. Forcing in all simulations is due primarily to shearing deformation initially. As the wave grows in amplitude, convergence contributes more to frontogenesis than shear. Other terms in the frontogenetic equation become important in the PBL simulations.http://archive.org/details/maritimefrontoge10945971

Airway epithelial cell function in childhood wheeze

Nasal AEC cultures were established from children (0.6-14.9 years) undergoing elective surgical procedures under general anaesthetic, categorised as atopic asthmatics (n=12), virus-induced wheezers (n=8) or healthy controls (n=32) using questionnaire and serum IgE levels. All subjects were free of current respiratory symptoms. Successful AEC cultures were maintained to passage 2 or 41 (79%) subjects. AEC from children with a history of wheeze produced significantly less IL-8, IL-6, MCP-1 and G-CSF than AEC from healthy controls. When the wheezing phenotypes were considered separately, AEC from atopic asthmatic children released significantly less IL-8, IL-6, MCP-1 and G-CSF than AEC from controls but there were no significant differences between AEC mediator release from children with virus-induced wheeze and either atopic asthmatics or controls. Similar results were found for cytokine-stimulated AEC. In non-wheezy subjects, there were no differences in AEC mediator release between atopic and non-atopic individuals. There were no differences between the study groups in the percentage increments in mediator release in response to stimulation. In multivariate analysis, taking into account age, gender, passive smoke exposure, use of inhaled corticosteroids, total serum IgE and specific responses to inhaled aeroallergens as possible confounders, wheeze was the only significant predictor of AEC mediator release. It was concluded that there are intrinsic differences in AEC from children with a history of wheeze compared to healthy controls and these are independent of atopic status. This study provides further evidence that the airway epithelium is implicated in the pathogenesis of childhood wheezing. It is hypothesised that different systemic factors, such as atopy and viral responsiveness, interact with common epithelial abnormalities to give rise to different wheezing phenotypes. Further work is required to establish whether these abnormalities are primary or secondary and to confirm these findings in well-differentiated AEC cultured with an air-liquid interface.EThOS - Electronic Theses Online ServiceGBUnited Kingdo