Where Would You Turn For Help? Older Adults’ Knowledge and Awareness of Community Support Services

Community support services (CSSs) enable persons coping with health or social problems to maintain the highest possible level of social functioning and quality of life. Access to these services is challenging because of the multiplicity of small agencies providing these services and the lack of a central access point. A review of the literature revealed that most service awareness studies are marred by acquiescence bias. To address this issue, service providers developed a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In a telephone interview, 1152 older adults were presented with a series of vignettes and asked what they would do in that situation. They were also asked about their most important sources of information about CSSs. Findings show awareness of CSSs varied by the situation described and ranged from a low of 1% to 41%. The most important sources of information about CSSs included informational and referral sources, the telephone book, doctor’s offices, and through word of mouth.Community Support Services, awareness, knowledge, acquiencence bias, vignette methodology

Where Would You Turn For Help? Older Adults’ Knowledge and Awareness of Community Support Services

Community support services (CSSs) enable persons coping with health or social problems to maintain the highest possible level of social functioning and quality of life. Access to these services is challenging because of the multiplicity of small agencies providing these services and the lack of a central access point. A review of the literature revealed that most service awareness studies are marred by acquiescence bias. To address this issue, service providers developed a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In a telephone interview, 1152 older adults were presented with a series of vignettes and asked what they would do in that situation. They were also asked about their most important sources of information about CSSs. Findings show awareness of CSSs varied by the situation described and ranged from a low of 1% to 41%. The most important sources of information about CSSs included informational and referral sources, the telephone book, doctor’s offices, and through word of mouth.Community Support Services, awareness, knowledge, acquiencence bias, vignette methodology

Stress, anxiety, and the erosion of trust: Maternity staff experiences of incident management

Background Adverse incidents in maternity care and other healthcare systems continues to be a major cause of morbidity and mortality with significant financial cost to healthcare organisations, patients, and their families. Over the last decades healthcare organisations have focused their attention on improving the quality of patient care, safety, and experience. However, very little attention has been given to understanding and improving staff experience. This is despite the high probability that healthcare professionals who experience their workplace positively will deliver higher quality care, report incidents more commonly, and actively engage in incident investigation and learning processes. Objective The purpose of the study is to explore maternity staffs’ experiences of the incident reporting and investigation process, with specific reference to its impact on trust in local risk management leadership and organizational process. Design Semi-structured in-depth qualitative interviews analyzed using a methodological procedure that reveals the human experience of complex social phenomena (Interpretive Phenomenological Analysis). Setting Tertiary university maternity teaching hospital in England (UK) with approximately 6000 deliveries per annum. Subjects A purposive sample of 10 staff (2 consultants, 3 specialist registrars and 5 midwives) all involved in incidents requiring formal investigation during the preceding 12 months. Main outcome measures The lived experiences, personal feelings, and perceptions of how the incident reporting and investigation process impacts on their trust in the risk management leadership and organizational process. Results Incident reporting and investigation were found to be perceived by staff as very stressful events with no structured feedback and support system in place for staff. We found that this lead to diminished trust in the risk management leadership and organizational process with staff relying on colleagues for support and validation of their practice. Conclusion The study showed that poorly managed processes of incident reporting and investigation result in diminished trust in risk management leadership and organizational processes. It also reinforces understanding that adverse incidents have a profound impact on the mental health and wellbeing of healthcare professionals. Factors that will likely mitigate these experiences and effects include: (1) timely updates and feedback from incident investigation; (2) high levels of leadership visibility; and (3) structured support for staff during and after incident reporting and investigations

Where Would You Turn for Help? Older Adults’ Awareness of Community Support Services

Previous findings on older adults’ awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors’ offices, and word of mouth.aging, community support services, awareness, knowledge, acquiescence bias, vignette methodology

Where Would You Turn for Help? Older Adults’ Awareness of Community Health and Support Services for Dementia Care

Previous findings on older adults’ awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors’ offices, and word of mouth.aging, community support services, awareness, knowledge, acquiescence bias, vignette methodology

Altered Motoneuron Properties Contribute to Motor Deficits in a Rabbit Hypoxia-Ischemia Model of Cerebral Palsy

Cerebral palsy (CP) is caused by a variety of factors attributed to early brain damage, resulting in permanently impaired motor control, marked by weakness and muscle stiffness. To find out if altered physiology of spinal motoneurons (MNs) could contribute to movement deficits, we performed whole-cell patch-clamp in neonatal rabbit spinal cord slices after developmental injury at 79% gestation. After preterm hypoxia-ischemia (HI), rabbits are born with motor deficits consistent with a spastic phenotype including hypertonia and hyperreflexia. There is a range in severity, thus kits are classified as severely affected, mildly affected, or unaffected based on modified Ashworth scores and other behavioral tests. At postnatal day (P)0–5, we recorded electrophysiological parameters of 40 MNs in transverse spinal cord slices using whole-cell patch-clamp. We found significant differences between groups (severe, mild, unaffected and sham control MNs). Severe HI MNs showed more sustained firing patterns, depolarized resting membrane potential, and fired action potentials at a higher frequency. These properties could contribute to muscle stiffness, a hallmark of spastic CP. Interestingly altered persistent inward currents (PICs) and morphology in severe HI MNs would dampen excitability (depolarized PIC onset and increased dendritic length). In summary, changes we observed in spinal MN physiology likely contribute to the severity of the phenotype, and therapeutic strategies for CP could target the excitability of spinal MNs

Estimation of self-sustained activity produced by persistent inward currents using firing rate profiles of multiple motor units in humans

Persistent inward calcium and sodium currents (IP) activated during motoneuron recruitment help synaptic inputs maintain self-sustained firing until de-recruitment. Here, we estimate the contribution of the IP to self-sustained firing in human motoneurons of varying recruitment threshold by measuring the difference in synaptic input needed to maintain minimal firing once the IP is fully activated compared with the larger synaptic input required to initiate firing prior to full IP activation. Synaptic input to ≈20 dorsiflexor motoneurons simultaneously recorded during ramp contractions was estimated from firing profiles of motor units decomposed from high-density surface-EMG. To avoid errors introduced when using high-threshold units firing in their nonlinear range, we developed methods where the lowest-threshold units firing linearly with force were used to construct a composite (control) firing rate profile to estimate synaptic input to the higher-threshold (test) units. The difference in the composite firing rate (synaptic input) at the time of test unit recruitment and de-recruitment (ΔF=Frecruit-Fde-recruit) was used to measure IP amplitude that sustained firing. Test units with recruitment thresholds 1-30% of maximum had similar ΔFs, which likely included both slow and fast motor units activated by small and large motoneurons, respectively. This suggests that the portion of the IP that sustains firing is similar across a wide range of motoneuron sizes. Higher-threshold units had more prolonged accelerations in firing rate at the onset of recruitment compared to lower-threshold units, likely reflecting IP activation closer to firing onset in the higher-threshold units, but well before firing onset in the lower-threshold units

On the clustering phase transition in self-gravitating N-body systems

The thermodynamic behaviour of self-gravitating $N$-body systems has been worked out by borrowing a standard method from Molecular Dynamics: the time averages of suitable quantities are numerically computed along the dynamical trajectories to yield thermodynamic observables. The link between dynamics and thermodynamics is made in the microcanonical ensemble of statistical mechanics. The dynamics of self-gravitating $N$-body systems has been computed using two different kinds of regularization of the newtonian interaction: the usual softening and a truncation of the Fourier expansion series of the two-body potential. $N$ particles of equal masses are constrained in a finite three dimensional volume. Through the computation of basic thermodynamic observables and of the equation of state in the $P - V$ plane, new evidence is given of the existence of a second order phase transition from a homogeneous phase to a clustered phase. This corresponds to a crossover from a polytrope of index $n=3$, i.e. $p=K V^{-4/3}$, to a perfect gas law $p=K V^{-1}$, as is shown by the isoenergetic curves on the $P - V$ plane. The dynamical-microcanonical averages are compared to their corresponding canonical ensemble averages, obtained through standard Monte Carlo computations. A major disagreement is found, because the canonical ensemble seems to have completely lost any information about the phase transition. The microcanonical ensemble appears as the only reliable statistical framework to tackle self-gravitating systems. Finally, our results -- obtained in a ``microscopic'' framework -- are compared with some existing theoretical predictions -- obtained in a ``macroscopic'' (thermodynamic) framework: qualitative and quantitative agreement is found, with an interesting exception.Comment: 19 pages, 20 figure

EPHA2 Polymorphisms and Age-Related Cataract in India

Objective: We investigated whether previously reported single nucleotide polymorphisms (SNPs) of EPHA2 in European studies are associated with cataract in India. Methods: We carried out a population-based genetic association study. We enumerated randomly sampled villages in two areas of north and south India to identify people aged 40 and over. Participants attended a clinical examination including lens photography and provided a blood sample for genotyping. Lens images were graded by the Lens Opacification Classification System (LOCS III). Cataract was defined as a LOCS III grade of nuclear >= 4, cortical >= 3, posterior sub-capsular (PSC) >= 2, or dense opacities or aphakia/pseudophakia in either eye. We genotyped SNPs rs3754334, rs7543472 and rs11260867 on genomic DNA extracted from peripheral blood leukocytes using TaqMan assays in an ABI 7900 real-time PCR. We used logistic regression with robust standard errors to examine the association between cataract and the EPHA2 SNPs, adjusting for age, sex and location. Results: 7418 participants had data on at least one of the SNPs investigated. Genotype frequencies of controls were in Hardy-Weinberg Equilibrium (p > 0.05). There was no association of rs3754334 with cataract or type of cataract. Minor allele homozygous genotypes of rs7543472 and rs11260867 compared to the major homozygote genotype were associated with cortical cataract, Odds ratio (OR) = 1.8, 95% Confidence Interval (CI) (1.1, 3.1) p = 0.03 and 2.9 (1.2, 7.1) p = 0.01 respectively, and with PSC cataract, OR = 1.5 (1.1, 2.2) p = 0.02 and 1.8 (0.9, 3.6) p = 0.07 respectively. There was no consistent association of SNPs with nuclear cataract or a combined variable of any type of cataract including operated cataract. Conclusions: Our results in the Indian population agree with previous studies of the association of EPHA2 variants with cortical cataracts. We report new findings for the association with PSC which is particularly prevalent in Indians

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely