A Systems Intervention for the Transition of Postpartum Women to Primary Care

The Institute of Medicine (2001) describes the United States’ healthcare system as poorly organized and difficult for patients to navigate. Patients are often lost during the transition between providers, failing to establish subsequent care (Thomas, 2015). Gaps in care lead to worsening conditions that result in billions of dollars in healthcare costs (National Quality Forum, 2016). Following discharge from the care of the obstetrician, postpartum women should establish care with a primary care provider (American College of Obstetrics and Gynecology, 2016). The American College of Obstetrics and Gynecology recommends that postpartum women transition to a primary care provider within the year following childbirth (Pai-jong, Nakashima, Yamamoto, Ngo, & Kaneshiro, 2011). Less than 33% of women nationally adhere to this recommendation (John Hopkins Medicine, 2014); less than 5% of women within the host clinic transitioned to a primary care provider. This project aimed to improve the transition of postpartum women, ages 18 to 44, to a primary care provider. The primary objective was to increase the number of postpartum women who scheduled and attended a primary care provider appointment within 2 months of delivery. The intervention included patient information material, staff training, and a process for establishing care with a primary care provider. Between June 12, 2016, and August 15, 2016, 27 women met the inclusion criteria. Following the intervention, 23 women (82%) scheduled a primary care provider appointment, and 12 women (44%) attended the appointment. Results suggest that a combination of provider counseling, patient education, and assistance with the transition process can influence patient adherence to expert recommendations for establishing subsequent care

Developmental Studies Courses and the Success of Non-Traditional Students at a Major Public University in the Southeast

The main purpose of the study was to determine the effect of academic preparation in basic skills classes on the academic performance in subsequent collegelevel classes for non-traditional students. A secondary purpose was to determine if academic preparation in basic skills classes had a long-term effect on academic performance as measured by graduation GPA. A third purpose was to obtain the perspectives of non-traditional students about the effect of academic preparation in basic skills classes on academic performance in subsequent college-level classes. Methodology included statistical comparisons of grade distributions and GPA using archival data from the Banner student record system, and a comparison of interview data for two groups: non-traditional students who took basic skills classes and Precalculus Algebra or English Composition I and non-traditional students who did not take basic skills classes but did take Precalculus Algebra or English Composition I. Statistical analysis showed a significant difference in the grades of non-traditional students who had basic skills classes before taking Precalculus Algebra or English Composition I and non-traditional students who took Precalculus Algebra or English Composition I without taking basic skills classes. Non-traditional students with basic skills classes made better grades, passed at a higher rate, and withdrew at a lower rate than students without basic skills classes, clearly demonstrating the benefit of basic skills classes for non-traditional students. Although the mean graduation GPA for nontraditional students with basic skills classes was greater than the mean graduation GPA for non-traditional students without basic skills classes, the difference was not statistically significant. Non-traditional students with basic skills classes who were interviewed indicated that even though they would not have taken the basic skills classes without placement into them, they found these classes to be beneficial and would recommend them to other non-traditional students, especially non-traditional students with an extended lapse of time before enrolling in college. Study results confirmed that a review of basic skills can make college-level courses easier and improve grades for non-traditional students

Investigating the effect of low and high intensity exercise on cognitive function with the use of a correlational design.

Engagement in exercise has been found to be one of the biggest predictors of cognitive health (Elwood et al, 2013). This study intends to build on this by investigating the relationship between exercise intensity and cognitive function in sixty healthy participants aged 18-75. The present study used a cross sectional design to assess the association between high and low intensity exercise and performance on memory and executive function tasks. This was investigated at the same time point to assess the relationship in current cognitive health. Multiple regression analyses revealed that high intensity exercise can uniquely and significantly predict cognitive performance in each of the two domains. Furthermore it suggests that high intensity exercise is positively associated with current cognitive health and suggests that participation in high intensity exercise produces an all-encompassing benefit on cognition. However there was no association discovered between low intensity exercise and cognitive function. Analysis indicated that low intensity exercise cannot significantly predict cognitive performance when assessed at the same time point. Therefore future research must investigate this relationship using objective measurement of intensity over a longer period of time. To conclude, the current findings have implications for the future study of pathological and non-pathological aging

Dynamic efficiency in the English and Welsh water and sewerage industry

The English and Welsh water and sewerage industry is characterised by indivisible capital which has a long service life. Previous studies of efficiency for the English and Welsh water and sewerage industry take a static framework, assuming all inputs can be adjusted instantaneously. This paper measures dynamic efficiency by incorporating intertemporal links of capital within the production function for the English and Welsh water and sewerage industry for the period 1997–2011. Dynamic Data Envelopment Analysis (DEA) considers capital as a quasi-fixed input and is modelled as a contemporaneous output into current production and an input from past production. The results show that the inadequate intertemporal allocation of quasi-fixed inputs is the largest contributor of inefficiency

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Background: Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status. Methods: A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Results: Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. Conclusions: There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity

The relationship between forest cover and diet quality:a case study of rural southern Malawi

Peer reviewedPublisher PD

Artificial intelligence in digital pathology: a diagnostic test accuracy systematic review and meta-analysis

Ensuring diagnostic performance of AI models before clinical use is key to the safe and successful adoption of these technologies. Studies reporting AI applied to digital pathology images for diagnostic purposes have rapidly increased in number in recent years. The aim of this work is to provide an overview of the diagnostic accuracy of AI in digital pathology images from all areas of pathology. This systematic review and meta-analysis included diagnostic accuracy studies using any type of artificial intelligence applied to whole slide images (WSIs) in any disease type. The reference standard was diagnosis through histopathological assessment and / or immunohistochemistry. Searches were conducted in PubMed, EMBASE and CENTRAL in June 2022. We identified 2976 studies, of which 100 were included in the review and 48 in the full meta-analysis. Risk of bias and concerns of applicability were assessed using the QUADAS-2 tool. Data extraction was conducted by two investigators and meta-analysis was performed using a bivariate random effects model. 100 studies were identified for inclusion, equating to over 152,000 whole slide images (WSIs) and representing many disease types. Of these, 48 studies were included in the meta-analysis. These studies reported a mean sensitivity of 96.3% (CI 94.1-97.7) and mean specificity of 93.3% (CI 90.5-95.4) for AI. There was substantial heterogeneity in study design and all 100 studies identified for inclusion had at least one area at high or unclear risk of bias. This review provides a broad overview of AI performance across applications in whole slide imaging. However, there is huge variability in study design and available performance data, with details around the conduct of the study and make up of the datasets frequently missing. Overall, AI offers good accuracy when applied to WSIs but requires more rigorous evaluation of its performance.Comment: 26 pages, 5 figures, 8 tables + Supplementary material

An authentic learner-centered planetary health assignment: A five-year evaluation of student choices to address Sustainable Development Goal 13 (Climate Action)

A Code Red has been declared for the planet and human health. Climate change (e.g., increasing temperatures, adverse weather events, rising sea levels) threatens the planet's already declining ecosystems. Without urgent action, all of Earth's inhabitants face an existential threat. Health professions education should therefore prepare learners to not only practice in a changing world, but authentic educational activities should also develop competencies for global and planetary citizenship. Planetary health has been integrated across the five-year Bond University (Australia) medical curriculum. It begins in the second week of Year 1 and ends with a session on Environmentally Sustainable Healthcare in the General Practice rotation in the final year. The purpose of this article is to describe the outcomes of the first 5 years (2018–2022) of a learner-centered planetary health assignment, underpinned by the 2030 United Nations (UN) Sustainable Development Goals (SDGs), in the second year of a five-year medical program. Using systems and/or design thinking with a focus on SDG13 (Climate Action) plus a second SDG of choice, self-selected teams of 4–6 students submit a protocol (with feedback) to develop a deliverable “product” for an intended audience. Data analysis of the first 5 years of implementation found that the most frequently selected SDGs in addition to SDG13 were: SDG12 Sustainable Production and Consumption (41% of teams), mostly relating to healthcare emissions and waste; SDG3 Health and Well-being (22%), generally involving the impact of air pollution; and SDG6 Clean Water and Sanitation (15%). A survey at the concluding conference garnered student feedback across various criteria. The planetary health assignment is authentic in that teams provide solutions to address climate change. Where appropriate, final “products” are sent to local or federal ministers for consideration (e.g., policy proposals) or integrated into the curriculum (e.g., learning modules). We believe that the competencies, attitudes, and values fostered through engagement with planetary health. Throughout the medical program, as evidenced by their evaluations, stands students in good stead to be change agents, not only in clinical practice but in society. An awareness has been created about the need for planetary citizenship in addition to global citizenship