Knowledge sharing to support long term condition self-management - patient and healthcare professional perspectives

Background: Increased self management is a suggested solution to the burden on healthcare services of long term conditions (LTCs). This requires effective sharing of knowledge between healthcare professionals and patients, and is an underexplored area. Objective: To understand how patients and healthcare professionals (HCPs) share and utilise knowledge in the social context of healthcare interactions within long term condition management. Methods: Thematic analysis of 93 hours of observations of healthcare interactions and 33 semi-structured interviews involving patients, carers and HCPs. Results: 3 themes were identified: normative social roles, differing professional roles and the value of knowledge. Knowledge sharing was a complex process heavily influenced by social and cultural norms within the healthcare context. Not all knowledge was easily shared within routine healthcare interactions. Discussion: The social context in which healthcare is practiced influences what knowledge is shared and how this is achieved. It favours sharing of clinical knowledge from HCPs to patients, and disadvantages patients in their ability to share their unique knowledge based on lived experience of illness. The opportunities for patients to be supported in their knowledge, skills and confidence within routine healthcare interactions is limited. Conclusion: Both patients and HCPs need support to recognise the characteristics of the social context of healthcare and their understandings of their roles within this in order for them to move beyond accepted behaviours to develop more effective partnership working. Patient or Public Contribution-patients were involved in initial design of the study, particularly ethics of ethnographic observation

Comparison of a Flow Assay for Brucellosis Antibodies with the Reference cELISA Test in West African Bos indicus

Brucellosis is considered by the Food and Agricultural Organisation and the World Health Organisation as one of the most widespread zoonoses in the world. It is a major veterinary public health challenge as animals are almost exclusively the source of infection for people. It is often undiagnosed in both human patients and the animal sources and it is widely acknowledged that the epidemiology of brucellosis in humans and animals is poorly understood, particularly in sub-Saharan Africa. It is therefore important to develop better diagnostic tools in order to improve our understanding of the epidemiology and also for use in the field for disease control and eradication. As with any new diagnostic test, it is essential that it is validated in as many populations as possible in order to characterise its performance and improve the interpretation of its results. This paper describes a comparison between a new lateral flow assasy (LFA) for bovine brucellosis and the widely used cELISA in a no gold standard analysis to estimate test performance in this West African cattle population. A Bayesian formulation of the Hui-Walter latent class model incorporated previous studies' data on sensitivity and specificity of the cELISA. The results indicate that the new LFA is very sensitive (∼87%) and highly specific (∼97%). The analysis also suggests that the current cut-off of the cELSIA may not be optimal for this cattle population but alternative cut-offs did not significantly change the estimates of the LFA. This study demonstrates the potential usefulness of this simple to use test in field based surveillance and control which could be easily adopted for use in developing countries with only basic laboratory facilities

Functional MRI evidence for the decline of word retrieval and generation during normal aging

International audienceThis fMRI study aimed to explore the effect of normal aging on word retrieval and generation. The question addressed is whether lexical production decline is determined by a direct mechanism, which concerns the language operations or is rather indirectly induced by a decline of executive functions. Indeed, the main hypothesis was that normal aging does not induce loss of lexical knowledge, but there is only a general slowdown in retrieval mechanisms involved in lexical processing , due to possible decline of the executive functions. We used three tasks (verbal fluency, object naming , and semantic categorization). Two groups of participants were tested (Young, Y and Aged, A), without cognitive and psychiatric impairment and showing similar levels of vocabulary. Neuropsychological testing revealed that older participants had lower executive function scores, longer processing speeds, and tended to have lower verbal fluency scores. Additionally, older participants showed higher scores for verbal automa-tisms and overlearned information. In terms of behav-ioral data, older participants performed as accurate as younger adults, but they were significantly slower for the semantic categorization and were less fluent for verbal fluency task. Functional MRI analyses suggested that older adults did not simply activate fewer brain regions involved in word production, but they actually showed an atypical pattern of activation. Significant correlations between the BOLD (Blood Oxygen Level Dependent) signal of aging-related (A > Y) regions and cognitive scores suggested that this atypical pattern of the activation may reveal several compensatory mechanisms (a) to overcome the slowdown in retrieval, due to the decline of executive functions and processing speed and (b) to inhibit verbal automatic processes. The BOLD signal measured in some other aging-dependent regions did not correlate with the behavioral and neuro-psychological scores, and the overactivation of these uncorrelated regions would simply reveal dedifferentia-tion that occurs with aging. Altogether, our results suggest that normal aging is associated with a more difficult access to lexico-semantic operations and representations by a slowdown in executive functions, without any conceptual loss

Purinergic signalling and immune cells

This review article provides a historical perspective on the role of purinergic signalling in the regulation of various subsets of immune cells from early discoveries to current understanding. It is now recognised that adenosine 5'-triphosphate (ATP) and other nucleotides are released from cells following stress or injury. They can act on virtually all subsets of immune cells through a spectrum of P2X ligand-gated ion channels and G protein-coupled P2Y receptors. Furthermore, ATP is rapidly degraded into adenosine by ectonucleotidases such as CD39 and CD73, and adenosine exerts additional regulatory effects through its own receptors. The resulting effect ranges from stimulation to tolerance depending on the amount and time courses of nucleotides released, and the balance between ATP and adenosine. This review identifies the various receptors involved in the different subsets of immune cells and their effects on the function of these cells

Fast Methods for Computing Isosurface Topology with Betti Numbers

Betti numbers can be used as a means for feature detections to aid in the exploration of complex large-scale data sets. We present a fast algorithm for the calculation of Betti numbers for triangulated isosurfaces, along with examples of their use. Once any isosurface is extracted from a data set, calculating Betti numbers only requires time and space proportional to the isosurfaces, not the data set. Because the overhead of obtaining Betti numbers is small, our algorithm can be used with large data

Enforcing Determinism of Java Smart Contracts

Java is a high-level, well-known and powerful object-oriented language, with a large support library and a comfortable toolbelt. Hence, it has been proposed for writing smart contracts in blockchain. However, its support library is non-deterministic, which is a blocking issue for its application to smart contracts. This paper discusses the kind of (non-)determinism of the methods of the Java library and how a deterministic fragment of that library can be specified. It shows that some relevant parts are deterministic only under specific conditions on run-time values. It concludes with the description of an instrumentation, for the Takamaka blockchain, that enforces such conditions, statically or dynamically, reporting experiments with its implementation