Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis

The Influence of Medicare Home Health Payment Incentives: Does Payer Source Matter?

During the late 1990s, an interim payment system (IPS) was instituted to constrain Medicare home health care expenditures. Previous research has largely focused on the implications of the IPS for Medicare patients, but our study broadens the analysis to consider patients with other payer sources. Using the National Home and Hospice Care Survey, we found similar effects of the IPS across payer types. Specifically, the IPS was associated with a decrease in access to care for the sickest patients, less agency assistance with activities of daily living, and shorter length-of-use. However, these changes did not translate into worse discharge outcomes.Medicare, health, incentives

eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Gemini/GMOS Transmission Spectral Survey: Complete Optical Transmission Spectrum of the hot Jupiter WASP-4b

We present the complete optical transmission spectrum of the hot Jupiter WASP-4b from 440-940 nm at R ~ 400-1500 obtained with the Gemini Multi-Object Spectrometers (GMOS); this is the first result from a comparative exoplanetology survey program of close-in gas giants conducted with GMOS. WASP-4b has an equilibrium temperature of 1700 K and is favorable to study in transmission due to a large scale height (370 km). We derive the transmission spectrum of WASP-4b using 4 transits observed with the MOS technique. We demonstrate repeatable results across multiple epochs with GMOS, and derive a combined transmission spectrum at a precision about twice above photon noise, which is roughly equal to to one atmospheric scale height. The transmission spectrum is well fitted with a uniform opacity as a function of wavelength. The uniform opacity and absence of a Rayleigh slope from molecular hydrogen suggest that the atmosphere is dominated by clouds with condensate grain size of ~1 um. This result is consistent with previous observations of hot Jupiters since clouds have been seen in planets with similar equilibrium temperatures to WASP-4b. We describe a custom pipeline that we have written to reduce GMOS time-series data of exoplanet transits, and present a thorough analysis of the dominant noise sources in GMOS, which primarily consist of wavelength- and time- dependent displacements of the spectra on the detector, mainly due to a lack of atmospheric dispersion correction.Comment: 23 pages, 12 figures, accepted for publication in AJ, 2017 July

Golabi-Ito-Hall syndrome results from a missense mutation in the WW domain of the PQBP1 gene

Background: Golabi, Ito, and Hall reported a family with X linked mental retardation (XLMR), microcephaly, postnatal growth deficiency, and other anomalies, including atrial septal defect, in 1984.Methods: This family was restudied as part of our ongoing study of XLMR, but significant linkage to X chromosome markers could not be found. Extreme short stature and microcephaly as well as other new clinical findings were observed. Mutations in the polyglutamine tract binding protein 1 gene (PQBP1) have recently been reported in four XLMR disorders (Renpenning, Hamel cerebro-palato-cardiac, Sutherland-Haan, and Porteous syndromes) as well as in several other families. The clinical similarity of our family to these patients with mutations in PQBP1, particularly the presence of microcephaly, short stature, and atrial septal defect, prompted examination of this gene.Results: A missense mutation in PQBP1 was identified which changed the conserved tyrosine residue in the WW domain at position 65 to a cysteine (p.Y65C).Conclusions: This is the first missense mutation identified in PQBP1 and the first mutation in the WW domain of the gene. The WW domain has been shown to play an important role in the regulation of transcription by interacting with the PPxY motif found in transcription factors. The p.Y65C mutation may affect the proper functioning of the PQBP1 protein as a transcriptional co-activator

Interventions for improving health literacy in people with chronic kidney disease

This is the protocol for a review and there is no abstract. The objectives are as follows: This review aims to look at the benefits and harms of interventions for improving health literacy in patients with CKD

Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews

Objective To explore the strategies used to improve retention in primary care randomised trials.<p></p> Design Qualitative in-depth interviews and thematic analysis.<p></p> Participants 29 UK primary care chief and principal investigators, trial managers and research nurses.<p></p> Methods In-depth face-to-face interviews.<p></p> Results Primary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers.<p></p> Conclusions The findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.<p></p&gt

RELATIONSHIPS BETWEEN ROTATOR CUFF STRENGTH PARAMETERS AND THROWING VELOCITY OF COLLEGE BASEBALL PLAYERS

Pitching a baseball is a complex, highly skilled movement that has been divided into four stages by sports researchers. In examining the throwing motion, researchers have: 1) attempted to find the most significant muscle groups of the upper extremity that contribute to throwing velocity (Jobe, 1987; Pedegna, 1982 and Toyoshima and Hoshikawa, 1974); 2) concluded that the shoulder and internal and external rotator groups are the most significant contributors to the throwing motion (Alderink and Kuck, 1986; Cain, Mutschler, Fu and Lee, 1987, Cook, Gray, Savinar-Nogue, Medeiros, 1987, and Pappas, Zawacki and MacCarthy, 1985); and 3) demonstrated that the motions of shoulder rotation are important during tht throwing performance (Atwater, Feltner and Dapena, 1986; Gainor, 1980; and Tullos and King, 1973)

Teaching Human Evolution

As science educators, we have two goals in writing this paper. The first is to show the importance of teaching human evolution to all students. The second is to provide up-to-date resources for classroom teachers to use in teaching the subject. Secondary biology textbooks suffer from the inherent limitations of mass produced books making it difficult for them to stay current with rapidly changing scientific fields such as paleoanthropology. One of our motives for writing this paper is to compensate for this inherent limitation of textbooks. The most important resource we provide is a review of current scientific research on human evolution that stresses the broad framework of what is reliably known about our origins. To this we have included a list of recommended books taken from our research that we feel are the most useful and accessible. In addition to text resources, we have added a list of web sites on human evolution that provide an increasingly sophisticated source of information. Together, this material should provide teachers with a variety of up-to-date resources for teaching human evolution