Evolving ‘self’-management: exploring the role of social network typologies on individual long-term condition management

BackgroundWhilst there has been a focus on the importance of social support for managing long‐term conditions, there has been little specific focus on the characteristics of social networks that shape self‐management. Policy emphasis is placed on individual responsibility for self‐care, and this influences commissioning of health‐care services. Assumptions are often made by policymakers about accessibility and preference for support and the influence of the social context on chronic illness management. ObjectiveTo examine the social networks of individuals with long‐term conditions and identify how the characteristics of their composition influences support needs. Design, setting and participantsThirty participants completed initial face‐to‐face in‐depth interviews, telephone follow‐ups and final face‐to‐face interviews in the north‐west of England. A longitudinal qualitative design was used to elicit the subtle changes in relationships over a year. FindingsThe findings suggest that the relationships which constitute a social network influence perceived support needs and attitudes to self‐management. The amalgamation of relationships was characterized into three network typologies (family focused, friend focused or health‐care professional focused) according to which types of relationships were dominant. In the absence of support, accounts highlighted a small number of substitutes who could provide support at times of critical need. DiscussionThis study challenges the notion of ‘self’‐management as an individual construct as many of the practices of illness management involved the support and/or negotiation of roles with others. By examining the nuances of relationships, this study has highlighted the tacit boundaries of practical and emotional support provision.<br/

Influences on Foster Care Reentry Rate

Influences on Foster Care Reentry Rate looked at demographic and socioeconomic characteristics in each state within the United States. Those characteristics were then studied to see how they related to foster care reentry rates. Then, a case study analysis was conducted on three states, Minnesota, North Carolina, and Tennessee, because of their similarity in demographic and socioeconomic characteristics and divergence in foster care reentry rates. The case analysis was an in depth pursuit of differences in each of the state\u27s policies that may be a driving force of higher reentry rates

How mHealth can facilitate collaboration in diabetes care: qualitative analysis of codesign workshops

Background - Individuals with diabetes are using mobile health (mHealth) to track their self-management. However, individuals can understand even more about their diabetes by sharing these patient-gathered data (PGD) with health professionals. We conducted experience-based co-design (EBCD) workshops, with the aim of gathering end-users’ needs and expectations for a PGD-sharing system. Methods - N = 15 participants provided feedback about their experiences and needs in diabetes care and expectations for sharing PGD. The first workshop (2017) included patients with Type 2 Diabetes (T2D) (n = 4) and general practitioners (GPs) (n = 3). The second workshop (2018) included patients with Type 1 Diabetes (T1D) (n = 5), diabetes specialists (n = 2) and a nurse. The workshops involved two sessions: separate morning sessions for patients and healthcare providers (HCPs), and afternoon session for all participants. Discussion guides included questions about end-users’ perceptions of mHealth and expectations for a data-sharing system. Activities included brainstorming and designing paper-prototypes. Workshops were audio recorded, transcribed and translated from Norwegian to English. An abductive approach to thematic analysis was taken. Results Emergent themes were mHealth technologies’ impacts on end-users, and functionalities of a data-sharing system. Within these themes, similarities and differences between those with T1D and T2D, and between HCPs, were revealed. Patients and providers agreed that HCPs could use PGD to provide more concrete self-management recommendations. Participants’ paper-prototypes revealed which data types should be gathered and displayed during consultations, and how this could facilitate shared-decision making. Conclusion The diverse and differentiated results suggests the need for flexible and tailorable systems that allow patients and providers to review summaries, with the option to explore details, and identify an individual’s challenges, together. Participants’ feedback revealed that both patients and HCPs acknowledge that for mHealth integration to be successful, not only must the technology be validated but feasible changes throughout the healthcare education and practice must be addressed. Only then can both sides be adequately prepared for mHealth data-sharing in diabetes consultations. Subsequently, the design and performance of the joint workshop sessions demonstrated that involving both participant groups together led to efficient and concrete discussions about realistic solutions and limitations of sharing mHealth data in consultations

Self-Consistent Multiscale Modeling in the Presence of Inhomogeneous Fields

Molecular dynamics (MD) simulations of a Lennard–Jones fluid in an inhomogeneous external field generate steady-state profiles of density and pressure with nanoscopic heterogeneities. The continuum level of mass, momentum, and energy transport balances is capable of reproducing the MD profiles only when the equation of state for pressure as a function of density is extracted directly from the molecular level of description. We show that the density profile resulting from simulation is consistent with both a molecular-level theoretical prediction from statistical mechanics as well as the solution of the continuum-level set of differential equations describing the conservation of mass and momentum

Apathy, but not depression, is associated with executive dysfunction in cerebral small vessel disease.

OBJECTIVE: To determine the prevalence of apathy and depression in cerebral small vessel disease (SVD), and the relationships between both apathy and depression with cognition. To examine whether apathy is specifically related to impairment in executive functioning and processing speed. METHODS: 196 patients with a clinical lacunar stroke and an anatomically corresponding lacunar infarct on MRI were compared to 300 stroke-free controls. Apathy and depression were measured using the Geriatric Depression Scale, and cognitive functioning was assessed using an SVD cognitive screening tool, the Brief Memory and Executive Test, which measures executive functioning/processing speed and memory/orientation. Path analysis and binary logistic regression were used to assess the relation between apathy, depression and cognitive impairment. RESULTS: 31 participants with SVD (15.8%) met criteria for apathy only, 23 (11.8%) for both apathy and depression, and 2 (1.0%) for depression only. In the SVD group the presence of apathy was related to global cognition, and specifically to impaired executive functioning/processing speed, but not memory/orientation. The presence of depression was not related to global cognition, impaired executive functioning/processing speed or memory/orientation. CONCLUSIONS: Apathy is a common feature of SVD and is associated with impaired executive functioning/processing speed suggesting the two may share biological mechanisms. Screening for apathy should be considered in SVD, and further work is required to develop and evaluate effective apathy treatment or management in SVD.This work was supported by a Priority Program Grant from the Stroke Association (TSA PPA 2015-02; www.stroke.org.uk). The BMET Study was supported by a grant from the Stroke Association (TSA2008/10). Valerie Lohner is supported by a Stroke Association/British Heart Foundation Program Grant (TSA BHF 2010/01; www.bhf.org.uk). Rebecca Brookes is supported by a BHF Project Grant (PG/13/30/30005). Recruitment to the BMET Study was supported by the English National Institute of Health Research (NIHR) Clinical Stroke Research Network (www.crn.nihr.ac.uk/stroke). Hugh Markus is supported by an NIHR Senior Investigator award (www.nihr.ac.uk) and his work is supported by the Cambridge University Hospital Comprehensive NIHR Biomedical Research Unit (www.cambridge-brc.org.uk)

Large-scale variation in wave attenuation of oyster reef living shorelines and the influence of inundation duration

One of the paramount goals of oyster reef living shorelines is to achieve sustained and adaptive coastal protection, which requires meeting ecological (i.e., develop a self-sustaining oyster population) and engineering (i.e., provide coastal defense) targets. In a large-scale comparison along the Atlantic and Gulf coasts of the United States, the efficacy of various designs of oyster reef living shorelines at providing wave attenuation was evaluated accounting for the ecological limitations of oysters with regards to inundation duration. A critical threshold for intertidal oyster reef establishment is 50% inundation duration. Living shorelines that spent less than half of the time (\u3c 50%) inundated were not considered suitable habitat for oysters, however, were effective at wave attenuation (68% reduction in wave height). Reefs that experienced \u3e 50% inundation were considered suitable habitat for oysters, but wave attenuation was similar to controls (no reef; ~5% reduction in wave height). Many of the oyster reef living shoreline approaches therefore failed to optimize the ecological and engineering goals. In both inundation regimes, wave transmission decreased with an increasing freeboard (difference between reef crest elevation and water level), supporting its importance in the wave attenuation capacity of oyster reef living shorelines. However, given that the reef crest elevation (and thus freeboard) should be determined by the inundation duration requirements of oysters, research needs to be re-focused on understanding the implications of other reef parameters (e.g. width) for optimising wave attenuation. A broader understanding of the reef characteristics and seascape contexts that result in effective coastal defense by oyster reefs is needed to inform appropriate design and implementation of oyster-based living shorelines globally. Accepted manuscript version

The Tibetan Uterotonic Zhi Byed 11: Mechanisms of Action, Efficacy, and Historical Use for Postpartum Hemorrhage

Objective. To explore evidence for the traditional Tibetan medicine, Zhi Byed 11 (ZB11), for use as a uterotonic. Methods. The eleven ingredients in ZB11 were chemically analyzed by mass spectroscopy. A review was conducted of Western allopathic literature for scientific studies on ZB11's individual components. Literature from Tibetan and other traditional paradigms were reviewed. Results. Potential mechanisms of action for ZB11 as a uterotonic include laxative effects, a dose-dependant increase in smooth muscle tissue peristalsis that may also affect the uterus smooth muscle, and chemical components that are prostaglandin precursors and/or increase prostaglandin synthesis. A recent RCT demonstrated comparable efficacy to misoprostol in reducing severe postpartum hemorrhage (PPH) (>1000 mL) and greater effect than placebo. Historical and anecdotal evidence for ZB11 and its ingredients for childbirth provide further support. Discussion. ZB11 and its ingredients are candidates for potentially effective uterotonics, especially in low-resource settings. Further research is warranted to understand the mechanisms of action and synergy between ingredients

Brief Screening of Vascular Cognitive Impairment in Patients With Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Without Dementia.

BACKGROUND AND PURPOSE: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic form of cerebral small vessel disease leading to early-onset stroke and dementia, with younger patients frequently showing subclinical deficits in cognition. At present, there are no targeted cognitive screening measures for this population. However, the Brief Memory and Executive Test (BMET) and the Montreal Cognitive Assessment (MoCA) have shown utility in detecting cognitive impairment in sporadic small vessel disease. This study assesses the BMET and the MoCA as clinical tools for detecting mild cognitive deficits in CADASIL. METHODS: Sixty-six prospectively recruited patients with CADASIL, and 66 matched controls completed the BMET, with a subset of these also completing the MoCA. Receiver operating characteristic curves were calculated to examine the sensitivity and specificity of clinical cutoffs for the detection of vascular cognitive impairment and reduced activities of daily living. RESULTS: Patients with CADASIL showed more cognitive impairment overall and were poorer on both executive/processing and memory indices of the BMET relative to controls. The BMET showed good accuracy in predicting vascular cognitive impairment (85% sensitivity and 84% specificity) and impaired instrumental activities of daily living (92% sensitivity and 77% specificity). The MoCA also showed good predictive validity for vascular cognitive impairment (80% sensitivity and 78% specificity) and instrumental activities of daily living (75% sensitivity and 76% specificity). The most important background predictor of vascular cognitive impairment was a history of stroke. CONCLUSIONS: The results indicate that the BMET and the MoCA are clinically useful and sensitive screening measures for early cognitive impairment in patients with CADASIL.Stroke Association (Grant ID: TSA2008/10), British Heart Foundation (Grant ID: PG/13/30/30005), Stroke Association/British Heart Foundation (Grant ID: TSA BHF 2010/01), Agency for Science, Technology and Research, Singapore, National Institute for Health Research (Senior Investigator award), Cambridge University Hospital Comprehensive National Institute for Health Research Biomedical Research UnitThis is the final version of the article. It first appeared from Wolters Kluwer via http://dx.doi.org/10.1161/STROKEAHA.116.01376