Challenges of managing people with multimorbidity in today’s healthcare systems

Multimorbidity is a growing issue and poses a major challenge to health care systems around the world. Multimorbidity is related to ageing but many studies have now shown that it is also socially patterned, being more common and occurring at an earlier age in areas of high socioeconomic deprivation. There is lack of research on patients with multimorbidity, and thus guidelines are based on single-conditions. Polypharmacy is common in multimorbidity, increasing drug-disease and drug-drug interactions. Multimorbid patients need holistic care, but secondary care services are highly specialised and thus are often duplicative and fragmented and thus increase treatment burden in multimorbid patients. The cost of care is high in multimorbidity, due to high rates of primary and secondary care consultations and unplanned hospital admissions. The combination of mental and physical conditions increases complexity of care, and costs. Mental-physical multimorbidity is especially common in deprived areas. General practitioners and primary care teams have a key role in managing patients with multimorbidity, using a patient-centred generalist approach. Consultation length and continuity of care may need to be substantially enhanced in order to enable such patients. This will require a radical change in how health care systems are organised and funded in order to effectively meet the challenges of multimorbidity

A new Devonian fish (Crossopterygii: Rhipidistia) considered in relation of the origin of the Amphibia

Hyneria lindae, gen. et sp. nov., is a large rhizodontid rhipidistian fish from the Upper Devonian (Oswayo Formation) of Pennsylvania. It shows a remarkable similarity to the intermediate stages that must have preceded the first true Amphibia. The similarity is due to the parallel evolution of rhizodontid Rhipidistia and the Amphibia from a common stock in the Middle or early Late Devonian

New evidence on the evolution of the paired fins of Rhipidistia and the origin of the tetrapod limb, with description of a new genus of Osteolepidae

A specimen of Sterropterygion brandei, gen. et sp. nov., a rhipidistian from the Upper Devonian of Pennsylvania, shows for the first time the detailed internal structure of the pectoral and pelvic fins and girdles in a member of the Family Osteolepidae. The structure conforms to the general pattern once thought to be directly antecedent to that of tetrapods but which now must also be considered an ancient feature of rhipidistian fishes. It is contended that the known Rhipidistia could not support their own weight during terrestrial locomotion through fin action alone and a scheme of evolution is proposed according to which the paired fins of osteolepids and tristicopterids evolved with a dual function: in locomotion and support of lung ventilation

An Early Triassic hybodont shark from Northern Madagascar

Material of the upper and lower jaws, together with teeth and other remains, of a Triassic hybodont shark from Madagascar is tentatively referred to the genus Acrodus. The material offers new evidence concerning the jaw suspension in hybodont sharks and its significance in the evolution of Elasmobranchii

Glyptolepis from the Middle Devonian of Scotland

The Rhipidistia (Osteichthyes, Crossopterygii) comprise three superfamilies of Paleozoic fossil fishes, the Holoptychoidea, Osteolepoidea and Rhizodontoidea…

Lung ventilation in dipnoan fishes

Lung ventilation in Dipnoi and probably all other primitive fishes is effected by muscular action of the buccopharyngeal region (inhalation) and the muscular and elastic lung wall (exhalation). Differential hydrostatic pressure plays no major part in ventilation. Lung volume is under precise control

On the biology of cosmine

Cosmine is a unique combination of dentine, enameloid and, at least in the functional sense, some true bone, with the pore-canal sensory system, and is found only in certain early fishes….https://elischolar.library.yale.edu/peabody_museum_natural_history_bulletin/1039/thumbnail.jp

Multimorbidity: Technical Series on Safer Primary Care

No abstract available

Union Power: The Charged Politics of Electricity in Ontario

A neoliberal electricity privatization experiment in Ontario, Canada’s largest province, was supposed to eliminate one of the country’s biggest public utilities and introduce market discipline to the system. The grand experiment would begin in 2001. But an activist campaign by an opposition coalition initiated by electricity workers was crucial in turning back the market-oriented reforms, and indeed turning it into one of the great political train-wrecks in Ontario history