A Characterization of the Medical-Legal Partnership (MLP) of Nebraska Medicine

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as healthcare issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person\u27s poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient\u27s social determinants of health (SDHs). The goal of this quality improvement study was to enhance the effectiveness of future Health, Education, and Law Project (HELP) outreach and operations and to analyze the effect the project has on the patients that it aids and the community. Using quantitative and qualitative methods, including statistical analysis and one-on-one in-person interviews, a characterization of the patients/clients who receive aid was formed. By means of this study, we were able to generate a picture of who is receiving aid, what problems they are facing, where they are coming from, and why such aid is necessary to successfully receive appropriate healthcare

Life-Space Mobility and Aging in Place

Research on older adults explores the notion of “aging in place”—providing older adults the opportunity to continue to occupy familiar surroundings, to live in their own homes and communities. But oftentimes one’s ability to stay or leave, particularly in old age, depends on the built environment. Mobility is the ability to meet the basic needs to access goods, activities, services, and social interactions as they relate to quality of life. Thus, mobility is essential to older adults due to their limited, or gradually reducing, physical and cognitive abilities. In transportation research, mobility is often regarded in terms of travel behavior and it is measured by the number of outside-home travel. However, in other fields, including public health, it refers to the relative ease and freedom of movement in all of its forms. This study intends to broaden the understanding of the environmental factors on older adults’ mobility in different life spaces, from one’s bedroom to sidewalk, from home to a final destination via walking, public transit and/or driving. We document and examine 1) the ways in which older adults talk about, understand, and make meaning of their experiences and conditions related to life-space mobility and, 2) how these frames of reference guide their ability to be able to age in place. To achieve these aims, we developed a life-space mobility assessment tool and conduct semi-structured interviews with 25 older adults who have participated in home accessibility modification programs in the U.S. Western region. Given that interviewees already have engaged in some level of self-determination to improve their lives at home, we are interested in their life-space mobility and which opportunities they might see to improve their auto sufficiency. Our work provides both a basis and springboard for studying further geographies and discussion about policy initiatives to effectively and equitably address growing mobility disparities

Variation of serum hyaluronan with activity in individuals with knee osteoarthritis

PURPOSE: Serum hyaluronan (HA) was evaluated for diurnal variation in participants with osteoarthritis (OA) of the knee. METHODS: Twenty participants with radiographic OA of at least one knee were admitted overnight to the General Clinical Research Center for serial serum sampling. Serum was obtained between 6:00 p.m. and 8:00 p.m. on Day 1 (T3) after a day of normal activity. During the night of bed rest, participants remained supine for a minimum of 5 h between the hours of 3:00 a.m. and 8:00 a.m. Blood was drawn prior to arising from bed (T0), and 1h (T1) and 4 h (T2) after arising and performing usual morning activities, including eating breakfast. During the morning, participants were encouraged to remain physically active and were not permitted to sit for more than 30 min at a time. Serum HA was measured by enzyme-linked immunosorbent assay. Results were analyzed using non-parametric Freidman's test with Dunn's post-hoc Multiple Comparison test. RESULTS: Serum levels of HA increased significantly from T0 to T1 (P < 0.01). There were no other significant changes in serum HA levels observed between any of the other time points. CONCLUSIONS: Although a rise in serum HA with activity and eating has been demonstrated previously in individuals with rheumatoid arthritis, this is the first study to demonstrate a similar rise in individuals with OA. These results suggest that serum sampling for HA in OA clinical trials should be performed more than 1h after arising in the morning and at least 1h after breaking an overnight fast

Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring.Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.Five UK private sector care homes.41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.Problems addressed and changes in medicines prescribed.Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.ISRCTN 48133332

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

BackgroundPain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed.Aims and objectivesTwo studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals.MethodsFor the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team.ResultsData from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information.LimitationsGrey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate.ConclusionsNo single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts

Daylight, manual sunshade use and occupant-centric circadian lighting stimulus in an open office

9 pagesDaylight is essential to human productivity. It has been shown that if we do not receive enough daylight, our health and well-being is negatively affected. However, an overabundance of daylight into the indoors can make performing with computer-based visual tasks difficult and uncomfortable due to glare. This study is a collaboration with SRG Partnership, an Architecture firm in Portland, OR, to analyze their own workspace in determining optimal amounts of daylight as an occupant-centric circadian resource in the office. The historic office space has large south-east-facing windows that can be a source of glare, which negatively affects productivity, and are controlled manually with motorized shades. Participating occupants were given a wearable light sensor to track the light levels received throughout the day over the course of one work week. Sunshade use was also monitored and recorded

The International Space Station: Peaceful Common Ground for Adversaries

In 2022, Europe and the United States faced fundamental changes in international economic and diplomatic relations due to Russia’s war against Ukraine. Yet, the NATO-Russia split has excluded the International Space Station (ISS), where the U.S., Japanese, Canadian, and European space agencies continue cooperation with Russia. To understand how adversaries maintain peaceful relations in some institutions, I utilized two political science theories – structural realism and neoliberal institutionalism – to analyze factors influencing cooperation. Findings on the ISS’s political dynamics offer strategies to pressure space-faring nations into peaceful relations, allowing for other nations and NGOs to access space resources for all of humanity’s benefit. My project consists of historical and current policy analysis of U.S. ambitions for a space station. I reviewed government documents, peer-reviewed journals and periodicals for information on the ISS. I identified three periods to test: initial agreements made without Russia (1988), revised agreements with Russia (1993), and 2022 NATO-Russia split. I applied key concepts from the above-mentioned theories to explain why the U.S. did or did not cooperate with Russia. For structural realism, I hypothesized that the U.S. would cooperate with Russia if it views the ISS as a material capability and has no relative gains issues. For neoliberal institutionalism, I hypothesized that the U.S. would cooperate, if the ISS is an institution and cooperation is necessary for its function. Political science research on outer-space is limited despite its growing civil and military importance. Although scholarship exists that applies realist theories, I could not find research that utilizes neoliberal institutionalism to explain governmental actions relating to the ISS. Thus, my project offers a novel suggestion that the ISS is an institution that has taken on a life of its own, necessitating cooperation between space-faring adversaries regardless of terrestrial politics. The ISS is model for peaceful common ground

How to Determine the Role of the Microbiome in Drug Disposition.

With a paradigm shift occurring in health care toward personalized and precision medicine, understanding the numerous environmental factors that impact drug disposition is of paramount importance. The highly diverse and variant nature of the human microbiome is now recognized as a factor driving interindividual variation in therapeutic outcomes. The purpose of this review is to provide a practical guide on methodology that can be applied to study the effects of microbes on the absorption, distribution, metabolism, and excretion of drugs. We also highlight recent examples of how these methods have been successfully applied to help build the basis for researching the intersection of the microbiome and pharmacology. Although in vitro and in vivo preclinical models are highlighted, these methods are also relevant in late-phase drug development or even as a part of routine after-market surveillance. These approaches will aid in filling major knowledge gaps for both current and upcoming therapeutics with the long-term goal of achieving a new type of knowledge-based medicine that integrates data on the host and the microbiome