Towards Social Services System Integration: A report from Alberta’s Elder Care Support Provision Community

Family caregivers are a significant unpaid labour force that provides at least 70% of all care to seniors in the community. It was estimated in 2009 that the formal Canadian healthcare system would have to spend $25 billion annually to replace the contributions of family caregivers. More recent estimates have placed the value of family caregiver labour as high as$66.5 billion.  While a wide range of public and private services are generally available to support family caregivers, many potential clients have difficulty both gaining access, and navigating those services once they have gained access. In this sense, they experience a highly fragmented ‘system’ of social support provision. As the population of older adults living in the community grows, and with it the demand for family caregivers’ provided support, policy attention has become increasingly focused on integration as a solution to the fragmentation challenge.  The family caregiver support sector was singled out by a Special Senate Committee in 2009 as particularly likely to benefit from integration.  Integration, the committee found, would allow the sectors to better address the needs of community-dwelling older adults with chronic health conditions, improve the financial sustainability of the formal healthcare system, and make necessary support services more accessible. Beyond the specifics of family caregiving, policy conversations and major reforms around the world have similarly focused on the need for increased integration of care, both in health and social services.Recognizing that integrating fragmented social and healthcare systems is a wicked problem generally, and a particularly urgent matter for the family caregiver support services (FCSS[1]) ‘system,’ the School of Public Policy (SPP) organized a day-long event drawing stakeholders together.  The event originated in the FCSS community’s own desire to better understand and accomplish integration.  As a facilitated discussion, it was designed as a space for participants to move away from talking about integration, and towards making both it, and the concept of a ‘system’ of care, real.In organizing the event and in line with a well-developed scholarly literature, we framed the problem of fragmentation as a ‘structural’ issue caused by, among other factors, divergent mandates, competitive funding models, disjointed assessment processes, and a lack of co-ordinated transition. Similar to other researchers, we saw the solution to fragmentation as integration through the lens of organizational structures, joint services, shared assessments, and coordinated planning. However, when we presented these concepts to the FCSS community, they initially connected with them, but quickly diverged away from the structural recommendations and instead generated their own initiatives through conversations and relationship building.  We found that the act of bringing service providers together to share experiences, learn about each other, and develop their knowledge of services is the foundation upon which the various structural elements are built. The structural interventions are not the pathway to real integration, because they cannot be undertaken without a number of preconditions in place. Trust, consensus, and collaborative relationships are the necessary preconditions to integration, in whatever form it may take. In other words, an unsiloed system does not emerge from structural reforms, but rather from trusting relationships, consensus, and the resources and space for collaboration.  The event provided participants with the opportunity to set agreed-upon goals for the sector to work on together. The collaborative space that FCSS community members envisioned during the event, along with the ambitious work packages they prioritized for action inside that space, were practical, implementable visions of integration as an activity emerging from a community working together.[1] The acronym FCSS is also commonly used in Alberta's social support community for Family and Community Support Services, which is a unique 80/20 funding partnership between the Government of Alberta and participating municipalities or Métis Settlements. 

On-orbit No-contact Anomaly Debug Procedure for the CuPID Cubesat

The CuPID CubeSat Observatory was a 6U cubesat launched into low-Earth orbit with a ride-share opportunity in Fall 2021. The mission was supported by NASA's Heliophysics division and motivated scientifically with the objective to image X-rays produced in the magnetosphere. After launch, the team was unable to communicate with the spacecraft. This document presents the testing and analysis of attempts to contact the spacecraft and investigation to the likely cause of failure with the radio system.Comment: 14 pages, 6 figure

Transplantation of a Gitelman Syndrome Kidney Ameliorates Hypertension: A Case Report

Gitelman syndrome is caused by inactivating mutations of the gene that encodes the renal sodium/chloride cotransporter (NCC; encoded by SLC12A3), resulting in hypokalemia, hypomagnesemia, hypocalciuria, and metabolic alkalosis. Renal salt wasting commonly provokes mild hypotension. The paucity of previous kidney transplants from donors with known tubulopathies suggests that such conditions may be considered contraindications to donation. A 76-year-old man received a live unrelated kidney transplant from a donor with known Gitelman syndrome secondary to a pathogenic mutation of SLC12A3. Immediate graft function preceded the emergence of the Gitelman syndrome biochemical phenotype and blood pressure subsequently improved. The recipient developed unexpected hyponatremia. Potential causes are discussed, including the possibility that it paralleled the physiologic changes seen in the high-volume state of thiazide-induced hyponatremia. Transplanted kidneys are subject to nephrotoxicity from the use of calcineurin inhibitors. Acquired Gitelman syndrome may confer a potential long-term advantage to the recipient through both improved blood pressure control and protection against the calcineurin inhibitor–induced side-effect profile caused by NCC overactivation. Both the donor and recipient remain well. In conclusion, Gitelman syndrome need not preclude kidney donation and transference of the phenotype may have benefits for the recipient

Targeting B-Raf inhibitor resistant melanoma with novel cell penetrating peptide disrupters of PDE8A – C-Raf

Background: Recent advances in the treatment of melanoma that involve immunotherapy and B-Raf inhibition have revolutionised cancer care for this disease. However, an un-met clinical need remains in B-Raf inhibitor resistant patients where first-generation B-Raf inhibitors provide only short-term disease control. In these cases, B-Raf inhibition leads to paradoxical activation of the C-Raf – MEK – ERK signalling pathway, followed by metastasis. PDE8A has been shown to directly interact with and modulate the cAMP microdomain in the vicinity of C-Raf. This interaction promotes C-Raf activation by attenuating the PKA-mediated inhibitory phosphorylation of the kinase. Methods: We have used a novel cell-penetrating peptide agent (PPL-008) that inhibits the PDE8A – C-Raf complex in a human malignant MM415 melanoma cell line and MM415 melanoma xenograft mouse model to investigate ERK MAP kinase signalling. Results: We have demonstrated that the PDE8A – C-Raf complex disruptor PPL-008 increased inhibitory C-Raf-S259 phosphorylation and significantly reduced phospho-ERK signalling. We have also discovered that the ability of PPL-008 to dampen ERK signalling can be used to counter B-Raf inhibitor-driven paradoxical activation of phospho-ERK in MM415 cells treated with PLX4032 (Vemurafenib). PPL-008 treatment also significantly retarded the growth of these cells. When applied to a MM415 melanoma xenograft mouse model, PPL-008C penetrated tumour tissue and significantly reduced phospho-ERK signalling in that domain. Conclusion: Our data suggests that the PDE8A-C-Raf complex is a promising therapeutic treatment for B-Raf inhibitor resistant melanoma

Recent advances: role of mycolactone in the pathogenesis and monitoring of Mycobacterium ulcerans infection/Buruli ulcer disease.

Infection of subcutaneous tissue with Mycobacterium ulcerans can lead to chronic skin ulceration known as Buruli ulcer. The pathogenesis of this neglected tropical disease is dependent on a lipid-like toxin, mycolactone, which diffuses through tissue away from the infecting organisms. Since its identification in 1999, this molecule has been intensely studied to elucidate its cytotoxic and immunosuppressive properties. Two recent major advances identifying the underlying molecular targets for mycolactone have been described. First, it can target scaffolding proteins (such as Wiskott Aldrich Syndrome Protein), which control actin dynamics in adherent cells and therefore lead to detachment and cell death by anoikis. Second, it prevents the co-translational translocation (and therefore production) of many proteins that pass through the endoplasmic reticulum for secretion or placement in cell membranes. These pleiotropic effects underpin the range of cell-specific functional defects in immune and other cells that contact mycolactone during infection. The dose and duration of mycolactone exposure for these different cells explains tissue necrosis and the paucity of immune cells in the ulcers. This review discusses recent advances in the field, revisits older findings in this context and highlights current developments in structure-function studies as well as methodology that make mycolactone a promising diagnostic biomarker

Solid phase synthesis of a metronidazole oligonucleotide conjugate

Direct, solid phase synthesis of an oligonucleotide conjugate of the antibiotic drug metronidazole was accomplished by the phosphoramidite method. Removal of protecting groups and cleavage from the controlled pore glass (CPG) solid support was successful using mild conditions (20% EtN in pyridine, then conc. NH (aq) at rt for 30 min) whereas standard conditions (conc. NH (aq) at 55°C for 16 h) cleaved the drug

Gastroenterologist perceptions of faecal microbiota transplantation

© 2015 Baishideng Publishing Group Inc. All rights reserved. AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation (FMT). METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed. RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT, 8% more than once. Ninety percent would refer patients with Clostridium difficile infection (CDI) for FMT if easily available, 37% for ulcerative colitis, 13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication, including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic, 17% nasoduodenal, 13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence, 12% infection risk, 10% non infectious adverse effects/lack of safety data, 10% aesthetic, 10% lack of efficacy, 4% disease exacerbation, and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution. CONCLUSION: Despite general enthusiasm, most gastroenterologists have limited experience with, or access to, FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required

Finding the magnetopause location using soft X-ray observations and a statistical inverse method

Variability in the location and shape of the dayside magnetopause is attributed to magnetic reconnection, a fundamental process that enables the transfer of mass, energy, and momentum from the solar wind into the magnetosphere. The spatial and temporal properties of the magnetopause, under varying solar and magnetospheric conditions, remain largely unknown because empirical studies using in-situ observations are challenging to interpret. Global wide field-of-view (FOV) imaging is the only means to simultaneously observe the spatial distribution of the plasma properties over the vast dayside magnetospheric region and, subsequently, quantify the energy transport from the interplanetary medium into the terrestrial magnetosphere. Two upcoming missions, ESA/CAS SMILE and NASA’s LEXI will provide wide-field imagery of the dayside magnetosheath in soft X-rays, an emission generated by charge exchange interactions between high charge-state heavy ions of solar wind origin and exospheric neutral atoms. High-cadence two-dimensional observations of the magnetosheath will allow the estimation of dynamic properties of its inner boundary, the magnetopause, and enable studies of its response to changes in the solar wind dynamic pressure and interplanetary magnetic field orientation. This work introduces a statistically-based estimation approach based on inverse theory to estimate the spatial distribution of magnetosheath soft X-ray emissivities and, with this, identify the location of the magnetopause over the Sun−Earth line. To do so, we simulate the magnetosheath structure using the MHD-based OpenGGCM model and generate synthetic soft X-ray images using LEXI’s orbit and attitude information. Our results show that 3-D estimations using the described statistically-based technique are robust against Poisson-distributed shot noise inherent to soft X-ray images. Also, our proposed methodology shows that the accuracy of both three-dimensional (3-D) estimation and the magnetopause standoff distance calculation highly depends on the observational point

Carbon Materials as Positive Electrodes in Bromine-Based Flow Batteries

This is the final version. Available on open access from Wiley via the DOI in this recordCarbon materials demonstrate suitable physical and chemical properties for applications in bromine based redox flow batteries (RFBs). This review summarizes the bromine/bromide reaction mechanisms taking place at the carbon electrode and provides an overview of different carbon based materials as the bromine electrodes. Built on this, its application in three RFB systems (e. g. zinc-bromine, hydrogen-bromine, and polysulphide-bromine) have been examined in detail. A perspective highlights the importance of surface activation and treatment and aspects deserving further R&D.European Union Horizon 2020Engineering and Physical Sciences Research Council (EPSRC)Royal Academy of Engineering (RAE

On the dynamics of the Zanzibar Channel

Author Posting. © American Geophysical Union, 2015. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Oceans 120 (2015): 6091–6113, doi:10.1002/2015JC010879.The Zanzibar Channel lies between the mainland of Tanzania and Zanzibar Island in the tropical western Indian Ocean, is about 100 km long, 40 km wide, and 40 m deep, and is essential to local socioeconomic activities. This paper presents a model of the seasonal and tidal dynamics of the Zanzibar Channel based on the Regional Ocean Modeling System (ROMS) and a comparison of the model and observations. The seasonal dynamics of the channel is forced by remote processes and the local wind. Remote forcing creates the East African Coastal Current, a portion of which flows through the channel northward with a seasonally varying magnitude. The local wind enhances this seasonality in the surface Ekman layer, resulting in a stronger northward flow during the southwest monsoon season and a weak northward or occasionally southward flow during the northeast monsoon season. The tidal flows converge and diverge in the center of the channel and reduce the transport in the channel. The remotely forced, wind-forced, and tidal dynamics contain 5%, 3%, and 92% of the total kinetic energy, respectively. Despite their low kinetic energy, the remotely forced and wind-forced flows are most relevant in advecting channel water to the open ocean, which occurs in 19 days at the peak of the southwest monsoon season. The channel is well mixed, except during brief periods in the two rainy seasons, and temporarily cools between December and February. The dispersion of passive tracers is presented as an example of potential model applications.National Science Foundation Grant Numbers: OISE-0827059 , OCE-0550658 , OCE-0851493 , OCE-09274722016-03-1