Study protocol for the translating research in elder care (TREC): building context – an organizational monitoring program in long-term care project (project one)

<p>Abstract</p> <p>Background</p> <p>While there is a growing awareness of the importance of organizational context (or the work environment/setting) to successful knowledge translation, and successful knowledge translation to better patient, provider (staff), and system outcomes, little empirical evidence supports these assumptions. Further, little is known about the factors that enhance knowledge translation and better outcomes in residential long-term care facilities, where care has been shown to be suboptimal. The project described in this protocol is one of the two main projects of the larger five-year Translating Research in Elder Care (TREC) program.</p> <p>Aims</p> <p>The purpose of this project is to establish the magnitude of the effect of organizational context on knowledge translation, and subsequently on resident, staff (unregulated, regulated, and managerial) and system outcomes in long-term care facilities in the three Canadian Prairie Provinces (Alberta, Saskatchewan, Manitoba).</p> <p>Methods/Design</p> <p>This study protocol describes the details of a multi-level – including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities – and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey – a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data collection forms, and resident outcomes using the Resident Assessment Instrument-Minimum Data Set version 2.0 instrument. A variety of analytic techniques will be employed including descriptive analyses, psychometric analyses, multi-level modeling, and mixed-method analyses.</p> <p>Discussion</p> <p>Three key challenging areas associated with conducting this project are discussed: sampling, participant recruitment, and sample retention; survey administration (with unregulated caregivers); and the provision of a stable set of study definitions to guide the project.</p

The role of eclipses and european observers in the development of ‘modern astronomy’ in Thailand

‘Modern astronomy’ was introduced to Siam (present-day Thailand) (Siam officially changed its name to Thailand in 1939) when the Belgian Jesuit missionary-astronomer Father Antoine Thomas carried out stellar and lunar eclipse observations during 1681 and 1682 in order to determine the latitude and longitude of Ayutthaya. Three years later a contingent of French Jesuit missionary astronomers observed a total lunar eclipse from Lop Buri, which marked the start of an intensive two-and-a-half year period of observational activity at Lop Buri under the sponsorship of King Narai. During this interval, a partial solar eclipse and two further lunar eclipses were observed from a number of different observing sites. Although a substantial astronomical observatory was constructed in Lop Buri and this was used by French Jesuit missionary-astronomers, ‘modern astronomy’ ended suddenly in 1688 when King Narai died and most Western missionary-astronomers were expelled from Siam. ‘Modern astronomy’ only re-emerged in Siam after a hiatus of almost 200 years when another royal supporter of astronomy, King Rama IV, invited French astronomers to observe the total solar eclipse of 18 August 1868 from Siam, and his son, King Rama V, hosted British astronomers during the 6 April 1875 total solar eclipse. Thailand’s romance with total solar eclipses continued during the 9 May 1929 solar eclipse when King Rama VII visited British and German astronomers based near Siam’s southern border, and this was the catalyst required for the birth of home-grown ‘modern astronomy’. Soon after, Siam’s first astronomy classes began at Chulalongkorn University, and in 1944 this university hosted Siam’s first professional astronomer when Rawee Bhavilai, a solar specialist, joined the Physics Department. The latest phase in the professionalisation of astronomy occurred in 2009 when the Government approval the formation of the National Astronomical Research Institute of Thailand (NARIT). In this paper we trace the critical roles that solar and lunar eclipses played in the emergence and final adoption of ‘modern astronomy’ in Thailand from 1682 through to the present day

Biomarkers, genetic association, and genomic studies

Rheumatoid arthritis (RA) is a common autoimmune disorder which shows clinical heterogeneity. IT has multiple treatment options and there is individual variation in response to treatment. These features make RA an ideal condition to develop biomarkers for its pre-clinical detection, diagnosis, subtyping, prognostic stratification and selection of most optimal treatment. While a number of markers have been assessed for their biomarker quality, currently no marker has the statistical properties of a biomarker to be considered as a good classifier. In this chapter, a general review of biomarkers is followed by a detailed discussion of biomarker candidates for various aspects of RA. It is unlikely that a single marker will ever be sufficiently powerful as a biomarker, but combinations of clinical, biochemical, genetic, epigenetic, proteomic and metabolomic markers have the strongest potential to fulfill the requirements of biomarkers. Given the high heritability of RA and the progress in methodology of genome-wide association studies, genetic markers are the most promising group to be developed as biomarkers, in particular when epigenetic markers become more widely used. It is possible that in the near future, biomarkers with documented clinical utility will be available for use in clinical decision making and will most probably use multiple omics platforms