Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams. The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy

Electronic Health Records and Support For Primary Care Teamwork

This study examined primary care practices' experiences using electronic health records (EHRs) as they strive to function as teams in patientcentered medical homes (PCMHs). We identify how EHRs facilitate and pose challenges to teamwork and how practices overcame such challenges. We describe solutions and identify opportunities to improve care processes as well as EHR functionalities and policies, to support teamwork

Low-Intensity Continuous Ultrasound for the Symptomatic Treatment of Upper Shoulder and Neck Pain: A Randomized, Double-Blind Placebo-Controlled Clinical Trial

Purpose: Low-intensity continuous ultrasound (LICUS) is an emerging high-dosimetry ultrasound-based therapy for accelerated tissue healing and the treatment of myofascial pain. In this study, LICUS treatment is clinically evaluated for chronic upper neck and shoulder pain in a randomized, multi-site, double-blind, placebo-controlled study. Patients and Methods: CONSORT guidelines were followed in conducting and reporting the clinical trial. Thirty-three participants with upper trapezius myofascial pain were randomized for treatment with active (n=25) or placebo (n=8) devices. Investigators and subjects were blinded to treatment groups. Participants self-reported pain daily, rating from 0– 10 on the numeric rating scale. If pain rating was more significant than or equal to 3, the LICUS (3MHz, 0.132W/cm 2, 1.3W, 4 hours) was self-applied for total energy dosimetry of 18,720 Joules per treatment. During the 4-week study, daily pain rating was recorded. If LICUS treatment was delivered, pain before, during, and after treatment were recorded as well as the global rate of change (GROC). Independent t-tests were used to assess change from baseline and differences between treatment groups. ClinicalTrials.gov: NCT02135094. Results: There was a 100% completion rate for participants enrolled in the study and no significant differences between the groups regarding demographic variables or baseline outcome measures. Participants treated with active therapy observed a significant mean pain reduction from baseline of 2.61 points for active (p\u3c 0.001), compared to 1.58 points decrease from baseline for placebo (p=0.087), resulting in a 1.03 points significant decrease in the active group over placebo (p=0.003). The total GROC was significantly higher in the active group at 2.84 points compared to the placebo group at 0.46 points (p\u3c 0.001). Conclusion: Low-intensity continuous ultrasound treatment significantly reduced pain in patients with upper trapezius myofascial pain of the neck and shoulder. LICUS treatment showed a clinically meaningful improvement in the GROC scores for patients. The results from this clinical trial indicate that the LICUS treatment of 18,720 Joules can effectively be used to treat clinical pain related to upper trapezius myofascial pain. Further research could investigate varying dosimetry to improve efficacy and/or reduce the dose

Long Island Follows Bumpy New York Road to National Health Reform

At first glance, New York and the Long Island metropolitan area appear well positioned for smooth implementation of the federal Patient Protection and Affordable Care Act (ACA) of 2010, according to a new Center for Studying Health System Change (HSC) study of Long Island's commercial and Medicaid insurance markets (see Data Source). Key ACA reforms—expanded Medicaid eligibility, premium rating restrictions in the nongroup, or individual, and small-group markets, minimum medical loss ratios (MLRs)—have long been features of New York's broad public health insurance programs and highly regulated health insurance market. Once the ACA became law, there was little doubt that New York would embrace reform. Yet, partisan gridlock in Albany has made for a rough road to health reform for New York. After many months of wrangling with the state Legislature, Gov. Andrew Cuomo (D) resorted to authorizing the state health insurance exchange by executive order in 2012, giving New York's exchange a later start than in many states. Another threat to successful implementation is the state's commitment to stringent insurance regulations that exceed ACA requirements, most notably in small-group and nongroup community rating. Most respondents expected stricter state regulations to keep New York nongroup premiums very high and lead many healthier state residents to continue staying out of the nongroup risk pool. However, when 2014 premiums were released in July, the approved rates were lower than most had expected. What remains uncertain is how sustainable these rates will be over time—specifically, whether they will remain sufficiently low to attract and retain a sizable pool of younger, healthier enrollees

The geology of Mount Orliakas and the Pindos Ophiolite, Greece.

The Greveniotiki Pindos Mountains of Greece showcases the tectonics affecting the Central Mediterranean; however no detailed geological maps have been produced of the region. In this study we present a 1:10000 geological map of Mount Orliakas and its surrounding areas, including westernmost parts of the Pindos Ophiolite complex and the Mesohellenic basin. We also provide new lithological, structural, and palaeontological discussions of the region and give new evidence for the provenance of the Kranea Formation

Integrated Optical Polarization of Nearby Galaxies

We performed an integrated optical polarization survey of 70 nearby galaxies to study the relationship between linear polarization and galaxy properties. To date this is the largest survey of its kind. The data were collected at McDonald Observatory using the Imaging Grism Polarimeter on the Otto Struve 2.1m telescope. Most of the galaxies did not have significant level of linear polarization, where the bulk is <1%. A fraction of the galaxies showed a loose correlation between the polarization and position angle of the galaxy, indicating that dust scattering is the main source of optical polarization. The unbarred spiral galaxies are consistent with the predicted relationship with inclination from scattering models of ~sin^2i.Comment: accepted in ApJ, 21 pages, 5 figure

Student voice in work integrated learning scholarship: a review of teacher education and geographical sciences

Work integrated learning is an umbrella term that refers to the opportunities provided to university students to integrate knowledge of theory and practice as part of their degree program. As the role of students in higher education is evolving, we sought to develop our understanding of the role of students in the work integrated learning (WIL) space through exploring current literature on student voice. In this paper, we consider what has been reported about WIL in relation to student voice, how it has been represented, and how this has influenced practice. We undertook a systematic literature review for two different disciplines, one which represented an example of a professionally accredited undergraduate degree program (teacher education), and the other an example of a program with no professional accreditation (geographical sciences). The teacher education literature demonstrated more clearly the use of student voice to inform WIL within curriculum design. However, the geographical sciences literature did include examples of student voice being incorporated within the design of collaborative community-based forms of WIL. A role for students as researchers, who lead research and initiate curriculum change into WIL, was noticeably absent in both disciplinary sets of literature. The lack of evidence of the inclusion of students in the design, conduct, and analysis of WIL provides an invitation for SoTL scholars to redefine the role of students in this space