Effective health care for older people resident in care homes: the optimal study protocol for realist review

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112NIHR Health Services & Delivery Research Programme. Project number 11/1021/0

Risk perceptions of COVID-19 around the world

The World Health Organization has declared the rapid spread of COVID-19 around the world a global public health emergency. It is well-known that the spread of the disease is influenced by people’s willingness to adopt preventative public health behaviors, which are often associated with public risk perception. In this study, we present the first assessment of public risk perception of COVID-19 around the world using national samples (total N = 6,991) in ten countries across Europe, America, and Asia. We find that although levels of concern are relatively high, they are highest in the UK and lowest in South Korea. Across countries, personal experience with the virus, individualistic and prosocial values, hearing about the risk from friends and family, trust in government, science, and medical professionals, and personal and collective efficacy were all significant predictors of risk perception. Although there was substantial variability across cultures, individualistic worldviews, personal experience, prosocial values, and social amplification through friends and family in particular were found to be significant determinants in greater than half of the countries examined. Risk perception correlated with reported adoption of preventative health behaviors in all ten countries. Implications for effective risk communication are discussed.David & Claudia Harding Foundatio

The partitioning of poleward energy transport response between the atmosphere and Ekman flux to prescribed surface forcing in a simplified GCM

Recent studies have indicated that ocean circulation damps the atmospheric energy transport response to hemispherically differential energy perturbations, thereby muting the shifts of the Inter-Tropical Convergence Zone (ITCZ). Here, we focus on the potential role of Ekman heat transport in modulating this atmospheric response. An idealized representation of Ekman-driven heat transport (FE) is included in an aquaplanet slab ocean coupled to a gray radiation atmospheric model. We first alter the strength of FE in the control climate by tuning the gross stability of the Ekman layer SE. For a wide range of FE, the total poleward transport of energy remains nearly unchanged, but the ocean transports an increasing share for larger SE. The control climate is then perturbed by adding surface cooling in the Southern Hemisphere and warming in the Northern Hemisphere. The Ekman coupling damps the atmospheric energy transport response, as in previous coupled model experiments with full ocean dynamics. The ratio of the changes in Ekman to atmospheric energy transport is determined by the ratio of the gross stability in the Ekman layer to the atmosphere in the control climate, and is insensitive to the amplitude and location of forcing. We find that an unrealistically large SE is needed to reproduce the ratio of the changes in cross-equatorial oceanic to atmospheric energy transport in fully coupled models. The limited damping effect of Ekman transport highlights the need to examine the roles of deep circulation and subtropical gyres, as well as ocean heat uptake processes

Germline genetic variants of the renin-angiotensin system, hypoxia and angiogenesis in non-small cell lung cancer progression: Discovery and validation studies

Introduction: The renin–angiotensin system (RAS) is involved in cell proliferation, immunoinflammatory response, hypoxia and angiogenesis, which are critical biological processes in lung cancer. Our aim was to study the association of putatively functional genetic polymorphisms in genes coding for proteins involved in RAS, hypoxia and angiogenesis with non-small cell lung cancer (NSCLC) prognosis. Methods: Genotyping of 52 germline variants from genes of the RAS and hypoxic/angiogenic factors/receptors was performed using MassARRAY iPLEX Gold in a retrospective cohort (n = 167) of advanced NSCLC patients. Validation of the resulting genetic markers was conducted in an independent group (n = 190), matched by clinicopathological characteristics. Results: Multivariate analysis on the discovery set revealed that MME rs701109 C carriers were protected from disease progression in comparison with homozygous T (hazard ratio (HR) = 0.5, 95% confidence interval (CI) = 0.2–0.8, p = 0.010). Homozygous A and T genotypes for KDR rs1870377 were at increased risk for disease progression and death compared to heterozygous (HR = 1.7, 95% CI = 1.2–2.5, p = 0.005 and HR = 2.1, 95% CI = 1.2–3.4, p = 0.006, respectively). Carriers of homozygous genotypes for ACE2 rs908004 presented increased risk for disease progression, only in the subgroup of patients without tumour actionable driver mutations (HR = 2.9, 95% CI = 1.3–6.3, p = 0.010). Importantly, the association of homozygous genotypes in MME rs701109 with risk for disease progression was confirmed after multivariate analysis in the validation set. Conclusion: This study provides evidence that MME polymorphism, which encodes neprilysin, may modulate progression-free survival in advanced NSCLC. Present genetic variation findings will foster basic, translational, and clinical research on their role in NSCLC.M.J.C. was supported by the Associação de Estudos Respiratórios and the Portuguese Pulmonology Society

Inter-rater reliability of a reflective rubric to assess pharmacy students’ reflective thinking

© 2017 Elsevier Inc. Introduction Many health education programs aspire to foster reflective practices to enhance the reflective thinking of students during their study years and throughout their professional careers. Given the increasing attention paid to incorporating reflective practice activities into health education and evidence attributed to rater variability, it is important for educators to carefully consider the assessment criteria and reliability of assessment tools. A reflective rubric was developed to assess pharmacy students’ levels of reflection from a reflective writing task. This study investigates the inter-rater reliability (IRR) of a rubric as a tool to assess the levels of reflective thinking apparent in students’ written statements. Methods The research involved four raters from different disciplines utilizing a rubric to assess a random sample of the same forty-three reflective statements from a cohort of two hundred and sixty-four students. The IRR was measured using the intra-class correlation coefficient (ICC), using a two-way random effects model (ANOVA) with absolute agreement, to determine reliability of the assessment tool among the raters. Results Results showed measures between the raters for (i) overall reflective statement scores, and (ii) average scores for stages of reflection with an “almost perfect” agreement, ICC = 0.81 (95% CI 0.61–0.90), (F(42, 126) = 7.83, p < 0.01); and ICC = 0.89 (95% CI 0.83–0.93), (F(42, 840) = 12.49, p < 0.01) respectively. Discussion and conclusions The proposed rubric utilized by four raters showed high agreement with each other's scores, and is a tool for academic assessment of pharmacy students’ reflective thinking processes

The State of Research on Racial and Ethnic Discrimination in the Receipt of Health Care

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.30077

The role of Comprehension in Requirements and Implications for Use Case Descriptions

Within requirements engineering it is generally accepted that in writing specifications (or indeed any requirements phase document), one attempts to produce an artefact which will be simple to comprehend for the user. That is, whether the document is intended for customers to validate requirements, or engineers to understand what the design must deliver, comprehension is an important goal for the author. Indeed, advice on producing ‘readable’ or ‘understandable’ documents is often included in courses on requirements engineering. However, few researchers, particularly within the software engineering domain, have attempted either to define or to understand the nature of comprehension and it’s implications for guidance on the production of quality requirements. Therefore, this paper examines thoroughly the nature of textual comprehension, drawing heavily from research in discourse process, and suggests some implications for requirements (and other) software documentation. In essence, we find that the guidance on writing requirements, often prevalent within software engineering, may be based upon assumptions which are an oversimplification of the nature of comprehension. Hence, the paper examines guidelines which have been proposed, in this case for use case descriptions, and the extent to which they agree with discourse process theory; before suggesting refinements to the guidelines which attempt to utilise lessons learned from our richer understanding of the underlying discourse process theory. For example, we suggest subtly different sets of writing guidelines for the different tasks of requirements, specification and design

Ballistic Josephson junctions in edge-contacted graphene

Hybrid graphene-superconductor devices have attracted much attention since the early days of graphene research. So far, these studies have been limited to the case of diffusive transport through graphene with poorly defined and modest quality graphene-superconductor interfaces, usually combined with small critical magnetic fields of the superconducting electrodes. Here we report graphene based Josephson junctions with one-dimensional edge contacts of Molybdenum Rhenium. The contacts exhibit a well defined, transparent interface to the graphene, have a critical magnetic field of 8 Tesla at 4 Kelvin and the graphene has a high quality due to its encapsulation in hexagonal boron nitride. This allows us to study and exploit graphene Josephson junctions in a new regime, characterized by ballistic transport. We find that the critical current oscillates with the carrier density due to phase coherent interference of the electrons and holes that carry the supercurrent caused by the formation of a Fabry-P\'{e}rot cavity. Furthermore, relatively large supercurrents are observed over unprecedented long distances of up to 1.5 $\mu$m. Finally, in the quantum Hall regime we observe broken symmetry states while the contacts remain superconducting. These achievements open up new avenues to exploit the Dirac nature of graphene in interaction with the superconducting state.Comment: Updated version after peer review. Includes supplementary material and ancillary file with source code for tight binding simulation

Antagonistic Bacterial Interactions Help Shape Host-Symbiont Dynamics within the Fungus-Growing Ant-Microbe Mutualism

Conflict within mutually beneficial associations is predicted to destabilize relationships, and theoretical and empirical work exploring this has provided significant insight into the dynamics of cooperative interactions. Within mutualistic associations, the expression and regulation of conflict is likely more complex than in intraspecific cooperative relationship, because of the potential presence of: i) multiple genotypes of microbial species associated with individual hosts, ii) multiple species of symbiotic lineages forming cooperative partner pairings, and iii) additional symbiont lineages. Here we explore complexity of conflict expression within the ancient and coevolved mutualistic association between attine ants, their fungal cultivar, and actinomycetous bacteria (Pseudonocardia). Specifically, we examine conflict between the ants and their Pseudonocardia symbionts maintained to derive antibiotics against parasitic microfungi (Escovopsis) infecting the ants' fungus garden. Symbiont assays pairing isolates of Pseudonocardia spp. associated with fungus-growing ants spanning the phylogenetic diversity of the mutualism revealed that antagonism between strains is common. In contrast, antagonism was substantially less common between more closely related bacteria associated with Acromyrmex leaf-cutting ants. In both experiments, the observed variation in antagonism across pairings was primarily due to the inhibitory capabilities and susceptibility of individual strains, but also the phylogenetic relationships between the ant host of the symbionts, as well as the pair-wise genetic distances between strains. The presence of antagonism throughout the phylogenetic diversity of Pseudonocardia symbionts indicates that these reactions likely have shaped the symbiosis from its origin. Antagonism is expected to prevent novel strains from invading colonies, enforcing single-strain rearing within individual ant colonies. While this may align ant-actinomycete interests in the bipartite association, the presence of single strains of Pseudonocardia within colonies may not be in the best interest of the ants, because increasing the diversity of bacteria, and thereby antibiotic diversity, would help the ant-fungus mutualism deal with the specialized parasites