A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong

<b>Background</b> Primary care based management of long-term conditions (LTCs) is high on the international healthcare agenda, including the Asia-Pacific region. Hong Kong has a 'mixed economy' healthcare system with both public and private sectors with a range of types of primary care doctors. Recent Hong Kong Government policy aims to enhance the management of LTCs in primary care possibly based on a 'family doctor' model. Patients' views on this are not well documented and the aim of the present study was to explore the views of patients with LTCs on family doctors in Hong Kong.<p></p> <b>Methods</b> The views of patients (with a variety of LTCs) on family doctors in Hong Kong were explored. Two groups of participants were interviewed; a) those who considered themselves as having a family doctor, b) those who considered themselves as not having a family doctor (either with a regular primary care doctor but not a family doctor or with no regular primary care doctor). In-depth individual semi-structured interviews were carried out with 28 participants (10 with a family doctor, 10 with a regular doctor, and 8 with no regular doctor) and analysed using the constant comparative method.<p></p> <b>Results</b> Participants who did not have a family doctor were familiar with the concept but regarded it as a 'luxury item' for the rich within the private healthcare system. Those with a regular family doctor (all private) regarded having one as important to their and their family's health. Participants in both groups felt that as well as the more usual family medicine specialist or general practitioner, traditional Chinese medicine practitioners also had the potential to be family doctors. However most participants attended the public healthcare system for management of their LTCs whether they had a family doctor or not. Cost, perceived need, quality, trust, and choice were all barriers to the use of family doctors for the management of their LTCs.<p></p> <b>Conclusions</b> Important barriers to the adoption of a 'family doctor' model of management of LTCs exist in Hong Kong. Effective policy implementation seems unlikely unless these complex barriers are addressed

A Forecasting Model to Predict the Demand of Roses in an Ecuadorian Small Business Under Uncertain Scenarios

[EN] Ecuador is worldwide considered as one of the main natural flower producers and exporters ¿being roses the most salient ones. Such a fact has naturally led the emergence of small and medium sized companies devoted to the production of quality roses in the Ecuadorian highlands, which intrinsically entails resource usage optimization. One of the first steps towards optimizing the use of resources is to forecast demand, since it enables a fair perspective of the future, in such a manner that the in-advance raw materials supply can be previewed against eventualities, resources usage can be properly planned, as well as the misuse can be avoided. Within this approach, the problem of forecasting the supply of roses was solved into two phases: the first phase consists of the macro-forecast of the total amount to be exported by the Ecuadorian flower sector by the year 2020, using multi-layer neural networks. In the second phase, the monthly demand for the main rose varieties offered by the study company was micro-forecasted by testing seven models. In addition, a Bayesian network model is designed, which takes into consideration macroeconomic aspects, the level of employability in Ecuador and weather-related aspects. This Bayesian network provided satisfactory results without the need for a large amount of historical data and at a low-computational cost.Authors of this publication acknowledge the contribution of the Project 691249, RUC-APS ¿Enhancing and implementing Knowledge based ICT solutions within high Risk and Uncertain Conditions for Agriculture Production Systems¿ (www.ruc-aps.eu), funded by the European Union under their funding scheme H2020-MSCA-RISE-2015. In addition, the authors are greatly grateful by the support given by the SDAS Research Group (www.sdas-group.com)Herrera-Granda, ID.; Lorente-Leyva, LL.; Peluffo-Ordóñez, DH.; Alemany Díaz, MDM. (2021). A Forecasting Model to Predict the Demand of Roses in an Ecuadorian Small Business Under Uncertain Scenarios. Lecture Notes in Computer Science. 12566:245-258. https://doi.org/10.1007/978-3-030-64580-9_21S24525812566Asociación de Productores y Exportadores de Flores: Inicio – Expoflores. https://expoflores.com/Palacios, J., Rosero, D.: Análisis de las condiciones climáticas registradas en el Ecuador continental en el año 2013 y su impacto en el sector agrícola. Estud. e Investig. meteorológicas. Ina. Inst. Nac. Meteorol. e Hidrol. Ecuador, 28, p. (2014)Hidalgo-Proaño, M.: Variabilidad climática interanual sobre el Ecuador asociada a ENOS. CienciAmérica 6, 42–47 (2017)Ritchie, J.W., Abawi, G.Y., Dutta, S.C., Harris, T.R., Bange, M.: Risk management strategies using seasonal climate forecasting in irrigated cotton production: a tale of stochastic dominance. Aust. J. Agric. Resour. Econ. 48, 65–93 (2004). https://doi.org/10.1111/j.1467-8489.2004.t01-1-00230.xLetson, D., Podesta, G.P., Messina, C.D., Ferreyra, R.A.: The uncertain value of perfect ENSO phase forecasts: Stochastic agricultural prices and intra-phase climatic variations. Clim. Change 69, 163–196 (2005). https://doi.org/10.1007/s10584-005-1814-9Weber, E.U., Laciana, C., Bert, F., Letson, D.: Agricultural decision making in the argentine Pampas: Modeling the interaction between uncertain and complex environments and heterogeneous and complex decision makers (2008)Loy, J.-P., Pieniadz, A.: Optimal grain marketing revisited a german and polish perspective. Outlook Agric. 38, 47–54 (2009). https://doi.org/10.5367/000000009787762761Wang, Q.J., Robertson, D.E., Haines, C.L.: A Bayesian network approach to knowledge integration and representation of farm irrigation: 1. Model development. WATER Resour. Res. 45 (2009). https://doi.org/10.1029/2006wr005419Keesman, K.J., Doeswijk, T.: uncertainty analysis of weather controlled systems (2010). https://www.scopus.com/inward/record.uri?eid=2-s2.0-79960073961&doi=10.1007%2F978-3-642-03735-1_12&partnerID=40&md5=210525584472097e996a9f124f96fddbSchnepf, R.: U.S. livestock and poultry feed use and availability: background and emerging issues. In: Feed Market Dynamics and U.S. Livestock Implications. pp. 1–36. Nova Science Publishers, Inc., CRS, United States (2012)Medellín-Azuara, J., Howitt, R.E., MacEwan, D.J., Lund, J.R.: Economic impacts of climate-related changes to California agriculture. Clim. Change 109, 387–405 (2011). https://doi.org/10.1007/s10584-011-0314-3McCown, R.L., Carberry, P.S., Dalgliesh, N.P., Foale, M.A., Hochman, Z.: Farmers use intuition to reinvent analytic decision support for managing seasonal climatic variability. Agric. Syst. 106, 33–45 (2012). https://doi.org/10.1016/j.agsy.2011.10.005Scott, S.L., Varian, H.R.: Predicting the present with bayesian structural time series. Available SSRN 2304426 (2013)Prudhomme, C., Shaffrey, L., Woollings, T., Jackson, C., Fowler, H., Anderson, B.: IMPETUS: Improving predictions of drought for user decision-making. International Conference on Drought: Research and Science-Policy Interfacing, 2015. pp. 273–278. CRC Press/Balkema, Centre for Ecology and Hydrology, Wallingford, Oxfordshire, United Kingdom (2015)Wiles, P., Enke, D.: A hybrid neuro-fuzzy model to forecast the Soybean complex. International Annual Conference of the American Society for Engineering Management 2015, ASEM 2015. pp. 1–5. American Society for Engineering Management, Missouri University of Science and Technology, Engineering Management and Systems Engineering Department, United States (2015)Hansen, B.G., Li, Y.: An analysis of past world market prices of feed and milk and predictions for the future. Agribusiness 33, 175–193 (2017). https://doi.org/10.1002/agr.21474Johnson, M.D., Hsieh, W.W., Cannon, A.J., Davidson, A., Bedard, F.: Crop yield forecasting on the Canadian Prairies by remotely sensed vegetation indices and machine learning methods. Agric. For. Meteorol. 218, 74–84 (2016). https://doi.org/10.1016/j.agrformet.2015.11.003Chen, J., Yang, J., Zhao, J., Xu, F., Shen, Z., Zhang, L.: Energy demand forecasting of the greenhouses using nonlinear models based on model optimized prediction method. Neurocomputing 174, 1087–1100 (2016). https://doi.org/10.1016/j.neucom.2015.09.105Fodor, N., et al.: Integrating plant science and crop modeling: assessment of the impact of climate change on soybean and maize production. Plant Cell Physiol. 58, 1833–1847 (2017). https://doi.org/10.1093/pcp/pcx141Chapman, R., et al.: Using Bayesian networks to predict future yield functions with data from commercial oil palm plantations: a proof of concept analysis. Comput. Electron. Agric. 151, 338–348 (2018). https://doi.org/10.1016/j.compag.2018.06.006Lara-Estrada, L., Rasche, L., Sucar, L.E., Schneider, U.A.: Inferring Missing Climate Data for Agricultural Planning Using Bayesian Networks. LAND. 7 (2018). https://doi.org/10.3390/land7010004Abdelaal, H.S.A., Thilmany, D.: Grains production prospects and long run food security in Egypt. Sustain. 11 (2019). https://doi.org/10.3390/su11164457Kusunose, Y., Ma, L., Van Sanford, D.: User responses to imperfect forecasts: findings from an experiment with Kentucky wheat farmers. Weather. Clim. Soc. 11, 791–808 (2019). https://doi.org/10.1175/wcas-d-18-0135.1Kadigi, I.L., et al.: Forecasting yields, prices and net returns for main cereal crops in Tanzania as probability distributions: a multivariate empirical (MVE) approach. Agric. Syst. 180 (2020). https://doi.org/10.1016/j.agsy.2019.102693McGrath, G., Rao, P.S.C., Mellander, P.-E., Kennedy, I., Rose, M., van Zwieten, L.: Real-time forecasting of pesticide concentrations in soil. Sci. Total Environ. 663, 709–717 (2019). https://doi.org/10.1016/j.scitotenv.2019.01.401Yang, B., Xie, L.: Bayesian network modelling for “direct farm” mode based agricultural supply chain risk. Ekoloji 28, 2361–2368 (2019)Zaporozhtseva, L.A., Sabetova, T. V, Yu Fedulova, I.: Assessment of the uncertainty factors in computer modelling of an agricultural company operation. International Conference on Information Technologies in Business and Industries, ITBI 2019. Institute of Physics Publishing, Voronezh State Agrarian University, Michurina Str. 30, Voronezh, 394087, Russian Federation (2019)Box, G.E.P., Jenkins, G.M., Reinsel, G.C., Ljung, G.M.: Time series analysis: forecasting and control. Wiley (2015)Hanke, J., Wichern, D.: Business forecast. Pearson Educación (2010)Novagric: Invernaderos para Cultivo de Rosas. https://www.novagric.com/es/invernaderos-rosasWeather Spark: Clima promedio en Quito, Ecuador, durante todo el año - Weather Spark. https://es.weatherspark.com/y/20030/Clima-promedio-en-Quito-Ecuador-durante-todo-el-añoInstituto Nacional de Estadísticas y Censos-INEC: Encuesta Nacional de Empleo, Desempleo y subempleo-ENEMDU. https://www.ecuadorencifras.gob.ec/empleo-diciembre-2019/Central Bank of Ecuador: Central Bank of Ecuador. www.bce.fin.ecHyndman, R., Athnasopoulos, G.: Forecasting: Principles and Practice. OTexts, Australia (2018)Herrera-Granda, I.D., et al.: Artificial neural networks for bottled water demand forecasting: a small business case study. In: Rojas, I., Joya, G.C.A. (eds.) International Work-Conference on Artificial Neural Networks, pp. 362–373. Springer, Canaria (2019

"They think we're OK and we know we're not". A qualitative study of asylum seekers' access, knowledge and views to health care in the UK

<i>Background</i>: The provision of healthcare for asylum seekers is a global issue. Providing appropriate and culturally sensitive services requires us to understand the barriers facing asylum seekers and the facilitators that help them access health care. Here, we report on two linked studies exploring these issues, along with the health care needs and beliefs of asylum seekers living in the UK. <i>Methods</i>: Two qualitative methods were employed: focus groups facilitated by members of the asylum seeking community and interviews, either one-to-one or in a group, conducted through an interpreter. Analysis was facilitated using the Framework method. <i>Results</i>: Most asylum seekers were registered with a GP, facilitated for some by an Asylum Support nurse. Many experienced difficulty getting timely appointments with their doctor, especially for self-limiting symptoms that they felt could become more serious, especially in children. Most were positive about the health care they received, although some commented on the lack of continuity. However, there was surprise and disappointment at the length of waiting times both for hospital appointments and when attending accident and emergency departments. Most had attended a dentist, but usually only when there was a clinical need. The provision of interpreters in primary care was generally good, although there was a tension between interpreters translating verbatim and acting as patient advocates. Access to interpreters in other settings, e.g. in-patient hospital stays, was problematic. Barriers included the cost of over-the-counter medication, e.g. children's paracetamol; knowledge of out-of-hours medical care; and access to specialists in secondary care. Most respondents came from countries with no system of primary medical care, which impacted on their expectations of the UK system. <i>Conclusion</i>: Most asylum seekers were positive about their experiences of health care. However, we have identified issues regarding their understanding of how the UK system works, in particular the role of general practitioners and referral to hospital specialists. The provision of an Asylum Support nurse was clearly a facilitator to accessing primary medical care. Initiatives to increase their awareness and understanding of the UK system would be beneficial. Interpreting services also need to be developed, in particular their role in secondary care and the development of the role of interpreter as patient advocate

Improving medical students' attitudes towards the chronic sick: a role for social science research

<b>Background</b> Many medical students are negatively disposed toward the elderly and chronic sick. The present study assessed the impact of a community-based teaching initiative, the Life History Project, on students' attitudes to these groups. <p></p> <b>Methods</b> A questionnaire including Likert based responses and free text comments was distributed to all first-year MBChB students after completion of their Life History coursework. Data was analysed using SPSS and content analysis. <p></p> <b>Results</b> A high proportion of students believed the Life History Project had increased their understanding of both psychological and social aspects of health and illness and the role of the humanistic social sciences within this. We discovered that the Life History Project not only gave students first-hand experience of the elderly and chronic sick but also had a positive effect on their attitudes towards these groups. The qualitative free text comments corroborated these views. <p></p> <b>Conclusions</b> It is possible to positively influence medical students' attitudes towards these stigmatised groups; it is therefore important that we continue to enhance opportunities for learning about the impact of chronic illness on individuals and society throughout the curriculum

Mapping Dynamic Histone Acetylation Patterns to Gene Expression in Nanog-depleted Murine Embryonic Stem Cells

Embryonic stem cells (ESC) have the potential to self-renew indefinitely and to differentiate into any of the three germ layers. The molecular mechanisms for self-renewal, maintenance of pluripotency and lineage specification are poorly understood, but recent results point to a key role for epigenetic mechanisms. In this study, we focus on quantifying the impact of histone 3 acetylation (H3K9,14ac) on gene expression in murine embryonic stem cells. We analyze genome-wide histone acetylation patterns and gene expression profiles measured over the first five days of cell differentiation triggered by silencing Nanog, a key transcription factor in ESC regulation. We explore the temporal and spatial dynamics of histone acetylation data and its correlation with gene expression using supervised and unsupervised statistical models. On a genome-wide scale, changes in acetylation are significantly correlated to changes in mRNA expression and, surprisingly, this coherence increases over time. We quantify the predictive power of histone acetylation for gene expression changes in a balanced cross-validation procedure. In an in-depth study we focus on genes central to the regulatory network of Mouse ESC, including those identified in a recent genome-wide RNAi screen and in the PluriNet, a computationally derived stem cell signature. We find that compared to the rest of the genome, ESC-specific genes show significantly more acetylation signal and a much stronger decrease in acetylation over time, which is often not reflected in an concordant expression change. These results shed light on the complexity of the relationship between histone acetylation and gene expression and are a step forward to dissect the multilayer regulatory mechanisms that determine stem cell fate.Comment: accepted at PLoS Computational Biolog

Students' attitudes towards the introduction of a Personal and Professional Development portfolio: potential barriers and facilitators

Peer reviewedPublisher PD

Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - A qualitative investigation

© 2016 The Author(s). Background: Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model - the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) - brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. Methods: Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. Results: One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: 'Whole system' engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and 'collaboration' to enable coproduction were identified as 'process' themes. System-level integration and innovation were identified as potential 'outcomes' with far-reaching impacts on population health and service delivery. Conclusion: The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and healthcare delivery at a time of considerable organisational turmoil and financial constraints. The concept gained momentum and will likely be of interest to those involved in setting up similar arrangements, and researchers in the social and implementation sciences with an interest in their evaluation

Using a New Odour-Baited Device to Explore Options for Luring and Killing Outdoor-Biting Malaria Vectors: A Report on Design and Field Evaluation of the Mosquito Landing Box.

Mosquitoes that bite people outdoors can sustain malaria transmission even where effective indoor interventions such as bednets or indoor residual spraying are already widely used. Outdoor tools may therefore complement current indoor measures and improve control. We developed and evaluated a prototype mosquito control device, the 'Mosquito Landing Box' (MLB), which is baited with human odours and treated with mosquitocidal agents. The findings are used to explore technical options and challenges relevant to luring and killing outdoor-biting malaria vectors in endemic settings. Field experiments were conducted in Tanzania to assess if wild host-seeking mosquitoes 1) visited the MLBs, 2) stayed long or left shortly after arrival at the device, 3) visited the devices at times when humans were also outdoors, and 4) could be killed by contaminants applied on the devices. Odours suctioned from volunteer-occupied tents were also evaluated as a potential low-cost bait, by comparing baited and unbaited MLBs. There were significantly more Anopheles arabiensis, An. funestus, Culex and Mansonia mosquitoes visiting baited MLB than unbaited controls (P<=0.028). Increasing sampling frequency from every 120 min to 60 and 30 min led to an increase in vector catches of up to 3.6 fold (P<=0.002), indicating that many mosquitoes visited the device but left shortly afterwards. Outdoor host-seeking activity of malaria vectors peaked between 7:30 and 10:30pm, and between 4:30 and 6:00am, matching durations when locals were also outdoors. Maximum mortality of mosquitoes visiting MLBs sprayed or painted with formulations of candidate mosquitocidal agent (pirimiphos-methyl) was 51%. Odours from volunteer occupied tents attracted significantly more mosquitoes to MLBs than controls (P<0.001). While odour-baited devices such as the MLBs clearly have potential against outdoor-biting mosquitoes in communities where LLINs are used, candidate contaminants must be those that are effective at ultra-low doses even after short contact periods, since important vector species such as An. arabiensis make only brief visits to such devices. Natural human odours suctioned from occupied dwellings could constitute affordable sources of attractants to supplement odour baits for the devices. The killing agents used should be environmentally safe, long lasting, and have different modes of action (other than pyrethroids as used on LLINs), to curb the risk of physiological insecticide resistance

π+\pi^+ photoproduction on the proton for photon energies from 0.725 to 2.875 GeV

Differential cross sections for the reaction $\gamma p \to n \pi^+$ have been measured with the CEBAF Large Acceptance Spectrometer (CLAS) and a tagged photon beam with energies from 0.725 to 2.875 GeV. Where available, the results obtained here compare well with previously published results for the reaction. Agreement with the SAID and MAID analyses is found below 1 GeV. The present set of cross sections has been incorporated into the SAID database, and exploratory fits have been made up to 2.7 GeV. Resonance couplings have been extracted and compared to previous determinations. With the addition of these cross sections to the world data set, significant changes have occurred in the high-energy behavior of the SAID cross-section predictions and amplitudes.Comment: 18 pages, 10 figure