How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.

ObjectiveIf patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.DesignQualitative study; 103 in-depth, semi-structured interviews.ParticipantsSixty clinicians and eight managers were interviewed at two established ACOs.ApproachWe interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.Key resultsInterviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.ConclusionsWithout understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care

Bayes-X: a Bayesian inference tool for the analysis of X-ray observations of galaxy clusters

We present the first public release of our Bayesian inference tool, Bayes-X, for the analysis of X-ray observations of galaxy clusters. We illustrate the use of Bayes-X by analysing a set of four simulated clusters at z=0.2-0.9 as they would be observed by a Chandra-like X-ray observatory. In both the simulations and the analysis pipeline we assume that the dark matter density follows a spherically-symmetric Navarro, Frenk and White (NFW) profile and that the gas pressure is described by a generalised NFW (GNFW) profile. We then perform four sets of analyses. By numerically exploring the joint probability distribution of the cluster parameters given simulated Chandra-like data, we show that the model and analysis technique can robustly return the simulated cluster input quantities, constrain the cluster physical parameters and reveal the degeneracies among the model parameters and cluster physical parameters. We then analyse Chandra data on the nearby cluster, A262, and derive the cluster physical profiles. To illustrate the performance of the Bayesian model selection, we also carried out analyses assuming an Einasto profile for the matter density and calculated the Bayes factor. The results of the model selection analyses for the simulated data favour the NFW model as expected. However, we find that the Einasto profile is preferred in the analysis of A262. The Bayes-X software, which is implemented in Fortran 90, is available at http://www.mrao.cam.ac.uk/facilities/software/bayesx/.Comment: 22 pages, 11 figure

Post-Disaster Housing Reconstruction in Sri Lanka: What Methodology?

Research methodology is the procedural framework within which the research is conducted. This includes the overall approach to a problem that could be put into practice in a research process, from the theoretical underpinning to the collection and analysis of data. Choice of methodology depends on the primary drivers: topic to be researched and the specific research questions. Hence, methodological perspectives of managing stakeholder expectations of PDHR context are composed of research philosophies, research strategy, research design, and research techniques. This research belonged to social constructivism or interpretivism within a philosophical continuum. The nature of the study was more toward subjectivism where human behavior favored voluntary stance. Ontological, methodological, epistemological, and axiological positioning carried the characteristics of idealism, ideographic, anti-positivism, and value laden, respectively. Data collection comprises two phases, preliminary and secondary. Exploratory interviews with construction experts in the United Kingdom and Sri Lanka were carried out to refine the interview questions and identify the case studies. Case study interviews during the secondary phase took place in Sri Lanka. Data collected at the preliminary stage were used to assess the attributes of power, legitimacy/proximity, and urgency of stakeholders to the project using Stakeholder Circle™ software. Moreover, the data collected at secondary phase via case studies will be analyzed with NVivo 8. This article aims to discuss these methodological underpinnings in detail applied in a post-disaster housing reconstruction context in Sri Lanka

Displaying desire and distinction in housing

The article discusses the significance of cultural capital for the understanding of the field of housing in contemporary Britain. It explores the relationship between housing and the position of individuals in social space mapped out by means of a multiple correspondence analysis. It considers the material aspects of housing and the changing contexts that are linked to the creation and display of desire for social position and distinction expressed in talk about home decoration as personal expression and individuals' ideas of a `dream house'. It is based on an empirical investigation of taste and lifestyle using nationally representative survey data and qualitative interviews. The article shows both that personal resources and the imagination of home are linked to levels of cultural capital, and that rich methods of investigation are required to grasp the significance of these normally invisible assets to broaden the academic understanding of the field of housing in contemporary culture

Reply: Expression of oestrogen receptor beta proteins in human breast cancer biopsies

British Journal of Cancer (2002) 87, 688–689. doi:10.1038/sj.bjc.6600535 www.bjcancer.co

The development of absorptive capacity-based innovation in a construction SME

Traditionally, construction has been a transaction-oriented industry. However, it is changing from the design-bid-build process into a business based on innovation capability and performance management, in which contracts are awarded on the basis of factors such as knowledge, intellectual capital and skills. This change presents a challenge to construction-sector SMEs with scarce resources, which must find ways to innovate based on those attributes to ensure their future competitiveness. This paper explores how dynamic capability, using an absorptive capacity framework in response to these challenges, has been developed in a construction-based SME. The paper also contributes to the literature on absorptive capacity and innovation by showing how the construct can be operationalized within an organization. The company studied formed a Knowledge Transfer Partnership using action research over a two-year period with a local university. The aim was to increase its absorptive capacity and hence its ability to meet the changing market challenges. The findings show that absorptive capacity can be operationalized into a change management approach for improving capability-based competitiveness. Moreover, it is important for absorptive capacity constructs and language to be contextualized within a given organizational setting (as in the case of the construction-based SME in the present study)

Randomized controlled trial of Web-based alcohol screening and brief intervention in primary care

Background: University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program. Methods: A randomized controlled trial was conducted at an Australian university in 2007. Invitations were sent to 13 000 undergraduates (age range, 17-24 years) to complete a Web-based Alcohol Use Disorders Identification Test. Of 7237 students who responded, 2435 scored in the hazardous/harmful range (≥8) and were randomized, and 2050 (84%) completed at least 1 follow-up assessment. Intervention was 10 minutes of Web-based motivational assessment and personalized feedback. Controls received only screening. Follow-up assessments were conducted at 1 and 6 months with observers and participants blinded to allocation. Outcome measures were drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, prevalence of binge drinking, and prevalence of heavy drinking. Results: Mean (SD) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 (5.1) and 14.2 (5.1), respectively. After 1 month, participants receiving intervention drank less often (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.83-0.94), smaller quantities per occasion (RR, 0.93; 95% CI, 0.88-0.98), and less alcohol overall (RR, 0.83; 95% CI, 0.78-0.90) than did controls. Differences in alcohol-related harms were nonsignificant. At 6 months, intervention effects persisted for drinking frequency (RR, 0.91; 95% CI, 0.85-0.97) and overall volume (RR, 0.89; 95% CI, 0.82-0.96) but not for other variables. Conclusion: Proactive Web-based screening and intervention reduces drinking in undergraduates, and such a program could be implemented widely

The Correlation Between Galaxy HI Linewidths and K' Luminosities

The relationship between galaxy luminosities and rotation rates is studied with total luminosities in the K' band. Extinction problems are essentially eliminated at this band centered at 2.1 micron. A template luminosity-linewidth relation is derived based on 65 galaxies drawn from two magnitude-limited cluster samples. The zero-point is determined using 4 galaxies with accurately known distances. The calibration is applied to give the distance to the Pisces Cluster (60 Mpc) at a redshift in the CMB frame of 4771 km/s. The resultant value of the Hubble Constant is 81 km/s/Mpc. The largest sources of uncertainty arises from the small number of zero-point calibrators at this time at K' and present application to only one cluster.Comment: 13 pages including 5 figures and 2 tables. Accepted for publication in Astrophysical Journa

Mood instability : significance, definition and measurement

Mood instability is common, and an important feature of several psychiatric disorders. We discuss the definition and measurement of mood instability, and review its prevalence, characteristics, neurobiological correlates and clinical implications. We suggest that mood instability has underappreciated transdiagnostic potential as an investigational and therapeutic target