Umbilical Cord Milking at Birth

The World Health Organization recommends delaying cord clamping for at least 30-60 seconds after the birth of a full-term newborn. However, the recommendation on the time of cord clamping is not as clear with preterm infants or infants who need immediate resuscitation. The purpose of this study was to examine the best, most recent evidence regarding the timing of cord clamping. The methodology was a literature review. Recent research has focused on umbilical cord milking prior to cord clamping. Umbilical cord milking is described as “the unclamped umbilical cord is grasped and blood is pushed toward the infant several times before it is clamped to auto-infuse blood into the preterm neonate,” (Katheria et al, 2015, p. 62). This technique has been shown to have numerous benefits in preterm infants, including decreased rates of intraventricular hemorrhage, higher levels of hemoglobin/hematocrit, decreased risk of oxygenation at 36 weeks, and higher rates of systemic blood flow. Umbilical cord milking is a way to ensure more blood volume reaches the neonate at a time where delayed cord clamping is not an option

Developing Clinical Leadership: : Trainees’ experiences and the supervisors’ role

This document is the Accepted Manuscript version of the following article: Barbara Mason, Hannah Bowers, and Margo Ononaiye, “Developing Clinical Leadership: trainees’ experiences and the supervisor’s role”,Clinical Psychology Forum, Vol. 281, May 2016. The Version of Record is available online at: https://shop.bps.org.uk/publications/clinical-psychology-forum-no-281-may-2016.htmlThis paper describes the findings of research exploring factors which may help or hinder the development of clinical leadership among trainee clinical psychologists, and the extent to which trainees gain experience consistent with the Leadership Development Framework.Peer reviewedFinal Accepted Versio

Evaluation of the Wellspring Model for Improving Nursing Home Quality

Examines how successfully the Wellspring model improved the quality of care for residents of eleven nonprofit nursing homes in Wisconsin. Looks at staff turnover, and evaluates the impact on facilities, employees, residents, and cost

Food Security: The What, How, Why and Where to of Food Security in NSW. Discussion Paper

This Discussion Paper considers food security in the context of food supply and access systems, and articulates how it links with food consumption patterns, weight and risk of chronic disease, in order to provide direction for research, policy and programs. The paper provides an overview of what is meant by the term ‘food security’, a summary of studies describing patterns of food insecurity in Australia, and strategies for promoting food security, with examples of programs. This synthesis also discusses the implications for research and programs in NSW. Importantly, it also seeks to clarify where there are or might be both common and divergent approaches to addressing food security and obesity and chronic disease prevention. Whilst there are known global and national influences on food security, this document mainly focuses on community, household and individual level food security

Fact Sheet: Collaborative partnerships in research

Collaborative partnerships between researchers, practitioners, decision makers, consumers and community members can strengthen research. They can enhance the relevance of research questions, ensure that the research methods are appropriate and feasible, and improve the chances of research funding. These partnerships can also aid the translation of research results into practice and policy, as well as contribute to faster development of the body of research and a research culture. Collaborations occur to enable sharing of different perspectives, skills, resources and other attributes that contribute to effectively addressing the research problem

New Evidence on the Green House Model of Nursing Home Care: Synthesis of Findings and Implications for Policy, Practice, and Research

OBJECTIVE: To synthesize new findings from the THRIVE Research Collaborative (The Research Initiative Valuing Eldercare) related to the Green House (GH) model of nursing home care and broadly consider their implications. DATA SOURCES: Interviews and observations conducted in GH and comparison homes, Minimum Data Set (MDS) assessments, Medicare data, and Online Survey, Certification and Reporting data. STUDY DESIGN: Critical integration and interpretation of findings based on primary data collected 2011-2014 in 28 GH homes (from 16 organizations), and 15 comparison nursing home units (from 8 organizations); and secondary data derived from 2005 to 2010 for 72 GH homes (from 15 organizations) and 223 comparison homes. PRINCIPAL FINDINGS: Implementation of the GH model is inconsistent, sometimes differing from design. Among residents of GH homes, adoption lowers hospital readmissions, three MDS measures of poor quality, and Part A/hospice Medicare expenditures. Some evidence suggests the model is associated with lower direct care staff turnover. CONCLUSIONS: Recommendations relate to assessing fidelity, monitoring quality, capitalizing opportunities to improve care, incorporating evidence-based practices, including primary care providers, supporting high-performance workforce practices, aligning Medicare financial incentives, promoting equity, informing broad culture change, and conducting future research

Assembly of Drosophila Centromeric Chromatin Proteins during Mitosis

Semi-conservative segregation of nucleosomes to sister chromatids during DNA replication creates gaps that must be filled by new nucleosome assembly. We analyzed the cell-cycle timing of centromeric chromatin assembly in Drosophila, which contains the H3 variant CID (CENP-A in humans), as well as CENP-C and CAL1, which are required for CID localization. Pulse-chase experiments show that CID and CENP-C levels decrease by 50% at each cell division, as predicted for semi-conservative segregation and inheritance, whereas CAL1 displays higher turnover. Quench-chase-pulse experiments demonstrate that there is a significant lag between replication and replenishment of centromeric chromatin. Surprisingly, new CID is recruited to centromeres in metaphase, by a mechanism that does not require an intact mitotic spindle, but does require proteasome activity. Interestingly, new CAL1 is recruited to centromeres before CID in prophase. Furthermore, CAL1, but not CENP-C, is found in complex with pre-nucleosomal CID. Finally, CENP-C displays yet a different pattern of incorporation, during both interphase and mitosis. The unusual timing of CID recruitment and unique dynamics of CAL1 identify a distinct centromere assembly pathway in Drosophila and suggest that CAL1 is a key regulator of centromere propagation

The Green House Model of Nursing Home Care in Design and Implementation

OBJECTIVE: To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH. DATA SOURCES/STUDY SETTING: Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014. STUDY DESIGN: This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation. DATA COLLECTION/EXTRACTION METHODS: Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach. PRINCIPAL FINDINGS: GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers. CONCLUSIONS: Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes

Establishment of Centromeric Chromatin by the CENP-A Assembly Factor CAL1 Requires FACT-Mediated Transcription

SummaryCentromeres are essential chromosomal structures that mediate accurate chromosome segregation during cell division. Centromeres are specified epigenetically by the heritable incorporation of the centromeric histone H3 variant CENP-A. While many of the primary factors that mediate centromeric deposition of CENP-A are known, the chromatin and DNA requirements of this process have remained elusive. Here, we uncover a role for transcription in Drosophila CENP-A deposition. Using an inducible ectopic centromere system that uncouples CENP-A deposition from endogenous centromere function and cell-cycle progression, we demonstrate that CENP-A assembly by its loading factor, CAL1, requires RNAPII-mediated transcription of the underlying DNA. This transcription depends on the CAL1 binding partner FACT, but not on CENP-A incorporation. Our work establishes RNAPII passage as a key step in chaperone-mediated CENP-A chromatin establishment and propagation

Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: A User-Friendly Spreadsheet Program to Estimate Costs of Providing Patient-Centered Interventions

Background—Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. Methods and Results—Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers and health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. Conclusions—The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions