Steering self-organisation through confinement

Self-organisation is the spontaneous emergence of spatio-temporal structures and patterns from the interaction of smaller individual units. Examples are found across many scales in very different systems and scientific disciplines, from physics, materials science and robotics to biology, geophysics and astronomy. Recent research has highlighted how self-organisation can be both mediated and controlled by confinement. Confinement occurs through interactions with boundaries, and can function as either a catalyst or inhibitor of self-organisation. It can then become a means to actively steer the emergence or suppression of collective phenomena in space and time. Here, to provide a common framework for future research, we examine the role of confinement in self-organisation and identify overarching scientific challenges across disciplines that need to be addressed to harness its full scientific and technological potential. This framework will not only accelerate the generation of a common deeper understanding of self-organisation but also trigger the development of innovative strategies to steer it through confinement, with impact, e.g., on the design of smarter materials, tissue engineering for biomedicine and crowd management

Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background

OBJECTIVE: We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. DESIGN: Longitudinal interventional study. PATIENTS: The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of$55. RESULTS: CPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09-10.85), age (1.1, 1.03-1.17), AHI (>30 vs. <30) (4.87, 1.56-15.2), and by family/friends who had positive experience with CPAP (4.29, 1.05-17.51). Among average/high-income patients (n = 145) CPAP acceptance was affected by AHI (>30 vs. <30) (3.16, 1.14-8.75), living with a partner (8.82, 1.03-75.8) but not by the financial incentive. At one-year follow-up CPAP adherence was similar in the financial incentive and control groups, 35% and 39%, respectively (p = 0.82). Adherence rate was sensitive to education (+yr) (1.28, 1.06-1.55) and AHI (>30 vs. <30) (5.25, 1.34-18.5). CONCLUSIONS: Minimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients

Steering self-organisation through confinement

Self-organisation is the spontaneous emergence of spatio-temporal structures and patterns from the interaction of smaller individual units. Examples are found across many scales in very different systems and scientific disciplines, from physics, materials science and robotics to biology, geophysics and astronomy. Recent research has highlighted how self-organisation can be both mediated and controlled by confinement. Confinement is an action over a system that limits its units’ translational and rotational degrees of freedom, thus also influencing the system's phase space probability density; it can function as either a catalyst or inhibitor of self-organisation. Confinement can then become a means to actively steer the emergence or suppression of collective phenomena in space and time. Here, to provide a common framework and perspective for future research, we examine the role of confinement in the self-organisation of soft-matter systems and identify overarching scientific challenges that need to be addressed to harness its full scientific and technological potential in soft matter and related fields. By drawing analogies with other disciplines, this framework will accelerate a common deeper understanding of self-organisation and trigger the development of innovative strategies to steer it using confinement, with impact on, e.g., the design of smarter materials, tissue engineering for biomedicine and in guiding active matter

Spousal involvement and CPAP adherence: A dyadic perspective

Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention. Developing understanding of the role of spouses in adherence to CPAP has been identified to be a critical research need. This review expands the investigation of CPAP adherence to a broader context, from an exclusive focus on individual patients to a dyadic perspective encompassing both patients and their spouses. A conceptual framework based on social support and social control theories is proposed to understand spousal involvement in CPAP adherence. Methodologies for future investigations are discussed, along with implications for developing interventions that engage both patients and their spouses to improve CPAP use

Healthcare utilization of breast cancer patients following telephone-based consultations of oncology nurse navigator via telemedical care.

ObjectivesTo characterize breast cancer patients who received telephone-based consultations of oncology nurse navigator via telemedical care (TMC patients) and analyze their healthcare utilization (HCU) one year before and after receiving this service.MethodsA retrospective study among Maccabi Healthcare Services enrollees that were newly diagnosed during 2016 (n = 1035). HCU, demographic characteristics and comorbidities were obtained from computerized database. Multivariable ordered logit model was specified for the determinants of HCU by quarters. Independent variables included: annual number of telephone-based consultations, gap between diagnosis and first consultation, age, socio-economic status, eligibility for disability and income security benefits, and comorbidities.ResultsTwenty-two percent of our cohort were TMC patients. Compared to others, these patients were younger and had a lower prevalence of hypertension. A higher proportion of these patients received disability benefits, and a lower proportion received income security benefits. The total average annual HCU of TMC patients (n = 107) before first consultation was $8857 and increased to$44130 in the first year following it (pConclusionsThere was a significant increase in outpatient care and medications usage following first consultation. Moreover, a more intense use of this service was associated with elevated HCU. This result may stem from the proactive nature of the telemedical care

Sleep quality predicts quality of life in chronic obstructive pulmonary disease

Steven M Scharf1*, Nimrod Maimon2*, Tzahit Simon-Tuval3, Barbara J Bernhard-Scharf4, Haim Reuveni2, Ariel Tarasiuk21Department of Pulmonary and Critical Care, University of Maryland, Baltimore, MD, USA; 2Faculty of Health Sciences, Ben-Gurion University, Beersheba, Israel; 3Guilford Glazer School of Business and Management, Ben Gurion University, Beersheba, Israel; 4Mt. Washington Pediatric Hospital, Baltimore, MD, USA; The study was performed at the Soroka University Medical Center, Beer Sheva, Israel*Drs Scharf and Maimon contributed equally to this manuscript.Purpose: Chronic obstructive pulmonary disease (COPD) patients may suffer from poor sleep and health-related quality of life. We hypothesized that disturbed sleep in COPD is correlated with quality of life.Methods: In 180 patients with COPD (forced expired volume in 1 second [FEV1] 47.6 &amp;plusmn; 15.2% predicted, 77.8% male, aged 65.9 &amp;plusmn; 11.7 years), we administered general (Health Utilities Index 3) and disease-specific (St George&amp;rsquo;s Respiratory) questionnaires and an index of disturbed sleep (Pittsburgh Sleep Quality Index).Results: Overall scores indicated poor general (Health Utilities Index 3: 0.52 &amp;plusmn; 0.38), disease-specific (St George&amp;rsquo;s: 57.0 &amp;plusmn; 21.3) quality of life and poor sleep quality (Pittsburgh 11.0 &amp;plusmn; 5.4). Sleep time correlated with the number of respiratory and anxiety symptoms reported at night. Seventy-seven percent of the patients had Pittsburg scores &amp;gt;5, and the median Pittsburgh score was 12. On multivariate regression, the Pittsburgh Sleep Quality Index was an independent predictor of both the Health Utilities Index 3 and the St George&amp;rsquo;s scores, accounting for 3% and 5%, respectively, of the scores. Only approximately 25% of the patients demonstrated excessive sleepiness (Epworth Sleepiness Scale &amp;gt;9).Conclusions: Most patients with COPD suffer disturbed sleep. Sleep quality was correlated with general and disease-specific quality of life. Only a minority of COPD patients complain of being sleepy.Keywords: COPD, quality of life, Pittsburgh Sleep Quality Index, St George&amp;rsquo;s Respiratory Questionnaire, Health Utilities Index, sleep qualit

Unique patterns of healthcare utilization following the opening of the Samson Assuta Ashdod University Hospital

Abstract Our aim was to examine the influence of the market entry of Samson Assuta Ashdod University Hospital on community and hospital-based healthcare utilization (HCU). A retrospective study was conducted among Maccabi Health Services enrollees in the regions of Ashdod (n = 94,575) and Netanya (control group, n = 80,200) before and after this market entry. Based on difference-in-differences framework, we examined the change in HCU of Ashdod region’s enrollees compared to the control group and following the market entry using multivariable generalized estimating equations models. Our results revealed that, as hypothesized, after the market entry and compared to the control group, there was a 4% increase in specialists visits not requiring referral (RR = 1.04, 95% CI 1.03–1.06, p < 0.001), a 4% increase in MRI and CT scans (RR = 1.04, 95% CI 1.01–1.08, p = 0.022), and a 33% increase in emergency room visits (RR = 1.33, 95% CI 1.29–1.38, p < 0.001). Unexpectedly, no changes were observed in the number of hospital admissions (RR = 1.05, 95% CI 0.97–1.14, p = 0.250), and hospitalization days (RR = 0.99, 95% CI 0.94–1.04, p = 0.668). Moreover, and unexpectedly, there was a 1% decrease in primary care physician visits (RR = 0.99, 95% CI 0.98–1.00, p = 0.002), a 11% decrease in specialists visits requiring a referral (RR = 0.89, 95% CI 0.86–0.91, p < 0.001), and a 42% decrease in elective surgeries (RR = 0.58, 95% CI 0.55–0.60, p < 0.001). We conclude that this market entry was not translated to an increase in utilization of all services. The unique model of maintaining the continuity of care that was adopted by the hospital and patients’ loyalty may led to the unique inter-relationship between the hospital and community care