Creating an Information Industry in Hawaii: the State Government's Pro-active Approach and its Potential for Success

Paper presented at the 8th International Telecommunications Society Conference, Venice, Italy March 18-21, 1990.This paper will briefly review the unique geographic, socioeconomic, and political background of the State of Hawaii, as well as the existing telecommunications and information infrastructures for the purpose of highlighting the recent efforts of the state government to encourage the creation and growth of an information industry. The State's efforts will be outlined as an example of a highly pro-active governmental stance vis-a-vis the "information industry" in the midst of the general climate of deregulation in the U.S. and Hawaii telecommunications sectors. The existing resources upon which an information industry in Hawaii could be based and factors both favorable to the success of this initiative as well as potential pitfalls and obstacles will be reviewed. Finally, new activity in this area of the Hawaiian economy as it relates to the initiatives that the government has taken will be looked at and possible scenarios for future development will be presented

Post-traumatic osteoarthritis in mice following mechanical injury to the synovial joint

We investigated the spectrum of lesions characteristic of post-traumatic osteoarthritis (PTOA) across the knee joint in response to mechanical injury. We hypothesized that alteration in knee joint stability in mice reproduces molecular and structural features of PTOA that would suggest potential therapeutic targets in humans. The right knees of eight-week old male mice from two recombinant inbred lines (LGXSM-6 and LGXSM-33) were subjected to axial tibial compression. Three separate loading magnitudes were applied: 6N, 9N, and 12N. Left knees served as non-loaded controls. Mice were sacrificed at 5, 9, 14, 28, and 56 days post-loading and whole knee joint changes were assessed by histology, immunostaining, micro-CT, and magnetic resonance imaging. We observed that tibial compression disrupted joint stability by rupturing the anterior cruciate ligament (except for 6N) and instigated a cascade of temporal and topographical features of PTOA. These features included cartilage extracellular matrix loss without proteoglycan replacement, chondrocyte apoptosis at day 5, synovitis present at day 14, osteophytes, ectopic calcification, and meniscus pathology. These findings provide a plausible model and a whole-joint approach for how joint injury in humans leads to PTOA. Chondrocyte apoptosis, synovitis, and ectopic calcification appear to be targets for potential therapeutic intervention

Definitions of advanced multimorbidity : a scoping review

Funding: Wellcome Trust (223499/Z/21/Z) (SB).Background Increasing numbers of people are living with and dying from multimorbidity (the presence of two or more physical or mental health conditions). However, it has been seen as challenging to identify when people with multiple health conditions may be approaching the end of life (so-called advanced multimorbidity). Aims & Objectives This scoping review aims to comprehensively detail how advanced multimorbidity are currently defined in research, policy and clinical practice. Methods This scoping review is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search strategy was developed and implemented into Medline, EMBASE, CINAHL, Scopus and PsychINFO. A further grey literature search was undertaken. Title and abstract then full text screening was undertaken by three co-reviewers. The study’s Public Advisory Group have been instrumental in shaping the research question and summarising our findings. Results From 13,758 initial studies 9499 titles and abstracts screened 760 full texts screened approximately 50 full texts included. There were no studies found from low-middle income countries. Various study designs were utilised, most were retrospective observational studies. Definitions of advanced multimorbidity were often study-specific however a few used a validated prognostic tool e.g. NECPAL. Very few end-of-life care policies were specific to people with advanced multimorbidity. Conclusion The results of this scoping review will enable researchers, policy makers, clinicians and patients to better understand ways to identify when people with multimorbidity may be approaching the end of life.Publisher PDFPeer reviewe

Current definitions of advanced multimorbidity: a protocol for a scoping review

INTRODUCTION: People living with and dying from multimorbidity are increasing in number, and ensuring quality care for this population is one of the major challenges facing healthcare providers. People with multimorbidity often have a high burden of palliative and end-of-life care needs, though they do not always access specialist palliative care services. A key reason for this is that they are often not identified as being in the last stages of their life by current healthcare providers and systems.This scoping review aims to identify and present the available evidence on how people with multimorbidity are currently included in research, policy and clinical practice.METHODS AND ANALYSIS: Scoping review methodology, based on Arksey and O'Malley's framework, will be undertaken and presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Search terms have been generated using the key themes of 'multimorbidity', 'end of life' and 'palliative care'. Peer-reviewed research will be obtained through systematic searching of Medline, EMBASE, CINAHL, Scopus and PsycINFO. Grey literature will be searched in a systematic manner. Literature containing a definition for adults with multimorbidity in a terminal phase of their illness experience will be included. After screening studies for eligibility, included studies will be described in terms of setting and characteristics as well as using inductive content analysis to highlight the commonalities in definitions.ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review. The findings of the scoping review will be used internally as part of SPB's PhD thesis at the University of St Andrews through the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust (223499/Z/21/Z) and published in an open access, peer-reviewed journal for wider dissemination.</p

Consultant psychiatrists’ experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study

Background: Shared decision making represents a clinical consultation model where both clinician and service user are conceptualised as experts; information is shared bilaterally and joint treatment decisions are reached. Little previous research has been conducted to assess experience of this model in psychiatric practice. The current project therefore sought to explore the attitudes and experiences of consultant psychiatrists relating to shared decision making in the prescribing of antipsychotic medications. Methods: A qualitative research design allowed the experiences and beliefs of participants in relation to shared decision making to be elicited. Purposive sampling was used to recruit participants from a range of clinical backgrounds and with varying length of clinical experience. A semi-structured interview schedule was utilised and was adapted in subsequent interviews to reflect emergent themes. Data analysis was completed in parallel with interviews in order to guide interview topics and to inform recruitment. A directed analysis method was utilised for interview analysis with themes identified being fitted to a framework identified from the research literature as applicable to the practice of shared decision making. Examples of themes contradictory to, or not adequately explained by, the framework were sought. Results: A total of 26 consultant psychiatrists were interviewed. Participants expressed support for the shared decision making model, but also acknowledged that it was necessary to be flexible as the clinical situation dictated. A number of potential barriers to the process were perceived however: The commonest barrier was the clinician's beliefs regarding the service users' insight into their mental disorder, presented in some cases as an absolute barrier to shared decision making. In addition factors external to the clinician - service user relationship were identified as impacting on the decision making process, including; environmental factors, financial constraints as well as societal perceptions of mental disorder in general and antipsychotic medication in particular. Conclusions: This project has allowed identification of potential barriers to shared decision making in psychiatric practice. Further work is necessary to observe the decision making process in clinical practice and also to identify means in which the identified barriers, in particular 'lack of insight', may be more effectively managed. © 2014 Shepherd et al.; licensee BioMed Central Ltd

REVIEW: Toronto Trailblazers: Women in Canadian Publishing

Ruth Panofsky, Toronto Trailblazers: Women in Canadian Publishing (Toronto: University of Toronto Press, 2019), 304 pp., ISBN 9781487523862 (paperback), ISBN 9781487505578 (hardcover), ISBN 9781487532345 (e‑book