Increasing the Capacity of Primary Care Through Enabling Technology.

Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow

Graph-Facilitated Resonant Mode Counting in Stochastic Interaction Networks

Oscillations in a stochastic dynamical system, whose deterministic counterpart has a stable steady state, are a widely reported phenomenon. Traditional methods of finding parameter regimes for stochastically-driven resonances are, however, cumbersome for any but the smallest networks. In this letter we show by example of the Brusselator how to use real root counting algorithms and graph theoretic tools to efficiently determine the number of resonant modes and parameter ranges for stochastic oscillations. We argue that stochastic resonance is a network property by showing that resonant modes only depend on the squared Jacobian matrix $J^2$ , unlike deterministic oscillations which are determined by $J$. By using graph theoretic tools, analysis of stochastic behaviour for larger networks is simplified and chemical reaction networks with multiple resonant modes can be identified easily.Comment: 5 pages, 4 figure

Pedagogies of presence : contemplative education across the disciplines in Aotearoa New Zealand : a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Education at Massey University, Manawatū, New Zealand

Listed in 2020 Dean's List of Exceptional ThesesFigures are re-used with permission or in the public domain.This study investigated contemplative pedagogy and practice within New Zealand universities, in the form of both mindfulness interventions targeting wellness and connection, and classroom pedagogy fostering attentional, critical, and creative thinking. Little previous research had been undertaken on the topic in this country. The integrated research design developed for the project - Critical Realist Mixed Methods Sequential Explanatory Design (CRMMSED) - included two phases, an extensive exploratory survey phase (n = 258), and an intensive, in-depth interview phase (n = 22). Critical Realist abductive and dialectical analyses took place alongside statistical and thematic analyses. The findings show that educators incorporate contemplative methods to address pressing issues ranging from student stress to climate change. Most contemplative teaching takes place within extant disciplinary framings. Key entry points into academia are through reflective practice in the contexts of professional education, critical social justice teaching, and creative projects. The study suggests that contemplative education arises in response to complex social factors involving several disconnects - with nature, people, the self, and the capacity for self-transcendence. This emergence is an outworking of historical forces and a response to research showing the potential of contemplative education for ameliorating difficult problems

Protecting Sleep to Reduce Delirium in an Adult Intensive Care Unit

Practice Problem: Delirium is a common, yet often preventable complication in hospitalized patients. It is often caused by fragmented sleep, medications, environmental stimuli, and treatment therapies. PICOT: The PICOT question that guided this evidence-based practice change project was: For patients in an adult Intensive Care Unit (ICU), does using a nurse-initiated, non-pharmacological sleep-enhancement protocol, versus no sleep-enhancement protocol, reduce the incidence of ICU-delirium over a period of 2 months? Evidence: The reviewed literature supported the evidence for effective use of a nurse-initiated protocol in reducing delirium in the ICU. Sixteen articles met the inclusion criteria for the review of literature that supported the DNP project. Intervention: A nurse-initiated sleep-enhancement protocol was implemented, which reduced interruptions during the hours between midnight and 0400. Outcome: While there was a 50% reduction in delirious patients after the protocol was initiated, the data pool was small and was not proven to be statistically significant. Due to the Covid-19 outbreak, there were far fewer eligible patients than originally anticipated. Conclusion: Although a clinically significant project outcome was not realized, staff felt that the protocol improved patient care and advocated for its use on all patients as a standard of care. Unit-based shared governance councils on other acute care floors have also adopted the sleep enhancement protoco

Increasing Ophthalmology Referrals for Early Detection of Diabetic Retinopathy

Diabetes mellitus currently afflicts 1 out of every 10 residents of North Carolina (North Carolina Department of Health and Human Services, 2016). Diabetic retinopathy (DR) is a distinct vascular complication of diabetes mellitus. Evidence reinforced the need for regular screenings to detect this condition in patients with diabetes mellitus because its initial stages are asymptomatic (American Diabetes Association, 2018). A Doctor of Nursing Practice (DNP) quality improvement (QI) project was implemented in a primary care clinic in rural North Carolina in an effort to increase the number of provider-given ophthalmology referrals to their patients with diabetes mellitus. Primary care providers and their clinical staff were educated on the use of the evidence-based teach-back method of providing patient instructions to increase awareness of the vision threatening complications of diabetes mellitus and the importance of yearly dilated eye exam screenings. The QI project was implemented over 8-weeks, with the DNP student project leader making weekly visits to the clinic to gather data and evaluate progress. Progress was evaluated using the Plan, Do, Study, Act (PDSA) Rapid Cycle of Improvement. A total of 178 charts were reviewed to evaluate the number of ophthalmology referrals given to patients with a diagnosis of diabetes mellitus. Results suggest that using the teach-back method to provide patient education assisted in prompting providers to give ophthalmology referrals when compared to referral occurrences prior to the use of the teach-back method of patient instruction.D.N.P

Cone Monotonicity: Structure Theorem, Properties, and Comparisons to Other Notions of Monotonicity

In search of a meaningful 2-dimensional analog to mono- tonicity, we introduce two new definitions and give examples of and dis- cuss the relationship between these definitions and others that we found in the literature. Note: After we published the article in Abstract and Applied Analysis and after we searched multiple times for previous work, we discovered that Clarke at al. had introduced the definition of cone monotonicity and given a characterization. See the addendum at the end of this paper for full reference information

Capital Flows, Capital Account Liberalisation and the Mediterranean Countries

This paper examines questions related to possible capital account liberalisation in the Mediterranean countries. First, we provide an overview of the extent to which these countries have capital controls along with their exchange rate regimes and some basic macroeconomic aggregates. Second, we examine the case for capital account liberalisation, along with the prerequisites for successful liberalisation. Here we consider issues such as sequencing and possible benefits of synchronisation. Finally, we examine the experience with capital flows – both FDI and other capital flows. We explain these flows and use the past experience of these countries to draw some conclusions for the successful opening up of the capital account.capital account liberalisation, Mediterranean countries, capital flows

Planning, implementation, and formative evaluation of a food literacy program

The overall purpose of this dissertation was to examine the planning, implementation, and formative evaluation of a community-based food literacy program for youth. Article 1 provided a summary of the community-based cooking program for at-risk youth. Objectives included the provision of applied food literacy and cooking skills education augmented with fieldtrips to local farms. Eight at-risk youth (five girls and three boys, mean age = 14.6) completed the intervention. Post intervention, five of eight participants completed in-depth interviews about their experiences. Article 2 was a formative evaluation of the cooking program focused on gaining an understanding of participants’ (i.e., at-risk youth, community partners, and parents/guardians) experiences (n=25). While Article 2 did not lend itself to a quantitative analysis, it was important to understand the program’s impact on participants’ food literacy and self-efficacy. A simple, self-reported tool (pre-post) to assess food literacy and self-efficacy among at-risk youth participants was implemented. Findings identified that the intervention provided a unique, hands-on learning opportunity for participants to gain essential food literacy and cooking skills which enhanced their self-reported confidence and self-efficacy. Recommendations included expanding this program and offering it in a centrally located location. The purpose of Article 3 was to qualitatively assess, through Photovoice methodology, the barriers and facilitators at-risk youth participants experienced to applying cooking skills in environments external to the intervention. Four major themes emerged as facilitators: aptitude; food literacy; local and fresh; and connectedness. Youth identified access to unhealthy foods as the only barrier. Findings indicated that a community-based cooking program for at-risk youth provided an opportunity to apply basic cooking techniques to ensure healthy, economical, home-made meals for youth while building confidence and self-efficacy. The intervention was a unique initiative that might provide a useful template to enhance existing food literacy programs or create similarly structured programs for relevant vulnerable populations. There is need for applied food literacy programming and research to reverse the erosion of cooking skills in Canadian society. An evaluated intervention can assist in providing evidence in support of the provision of food literacy for diverse participants