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Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
Objectives: Good glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation. Methods: As part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later. Results: Baseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control. Conclusions: IGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204–213)
The future of the American West depends on sustainable water resource governance. A variety of uncertainties associated with limited freshwater supplies, population growth, land use change, drought, and climate change impacts present substantial challenges. To inform decision making, managers are adopting new techniques such as scenario planning to understand how water resources might change and what practices can support economic, environmental, and social sustainability. Scenario planning can be informed by understanding the normative future preferences of a variety of stakeholders, including decision makers, who influence water governance. This article presents a survey of central Arizona decision makers to understand their visions for a desirable future for the water system in terms of supply, delivery, demand, outflow, and crosscutting activities. Principle components analysis is used to identify patterns underlying responses about preferences for each domain of the system and correlation analysis is used to evaluate associations between themes across the domains. The results reveal two distinct visions for water in central Arizona—one in which water experts and policy makers pursue supply augmentation to serve metropolitan development, and another in which broadened public engagement is used in conjunction with policy tools to reduce water consumption, restore ecosystem services, and limit metropolitan expansion. The results of this survey will inform the development of a set of normative scenarios for use in exploratory modeling and anticipatory governance activities.
The common mental disorders (CMDs) of anxiety and depression are the most common form of poor mental health in the general population. Evidence from the small number of previous cohort studies on the role of neighbourhood factors in mental health is inconclusive. We tested the hypothesis that high levels of neighbourhood social cohesion modify an adverse association between change in individual mental health and neighbourhood deprivation.
We carried out a longitudinal multilevel analysis using data from the Caerphilly Health and Social Needs Cohort Study with a 7-year follow-up (n = 4426; age range 18–74 years at baseline). Neighbourhood deprivation and neighbourhood social cohesion were assessed at baseline and change in mental health between follow-up and baseline was assessed using the five-item Mental Health Inventory (MHI-5).
Residence in the most deprived neighbourhoods was negatively associated with change in mental health, after adjusting for baseline individual socio-economic risk factors and transitions in life events. This negative effect was significantly reduced in high social cohesion neighbourhoods. The predicted change in mental health score was calculated for the 10th and 90th centiles of the household low-income distribution. The difference between them was −2.8 in the low social cohesion group and 1.1 in the high cohesion group. The difference between the groups was 3.9 [95% confidence interval (CI) 0.2–7.6].
The public health burden of poor mental health and mental health inequality could potentially be reduced by strengthening social cohesion in deprived neighbourhoods. This offers a mechanism to address the adverse effect of neighbourhood deprivation on population mental health.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known.
To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health.
Multilevel analysis of population data from the Welsh Health Survey, 2003/04-2010. A total of 88623 respondents aged 18-74 years were nested within 50587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a ‘case’ of common mental disorder.
High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. =0.33), P=0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88-0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate −1.35 (s.e.=0.54), P=0.012; OR=1.13, 95% CI 1.04-1.22).
The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level.
The Parkes pulsar data archive currently provides access to 144044 data files obtained from observations carried out at the Parkes observatory since the year 1991. Around 105 files are from surveys of the sky, the remainder are observations of 775 individual pulsars and their corresponding calibration signals. Survey observations are included from the Parkes 70 cm and the Swinburne Intermediate Latitude surveys. Individual pulsar observations are included from young pulsar timing projects, the Parkes Pulsar Timing Array and from the PULSE@Parkes outreach program. The data files and access methods are compatible with Virtual Observatory protocols. This paper describes the data currently stored in the archive and presents ways in which these data can be searched and downloaded.
The mental health information available to people with bipolar affective disorder is variable in quality. We conducted a qualitative survey in an urban out-patient department to elicit the opinions of people with bipolar affective disorder on the written information provided by three health information providers.
Participants' responses were generally positive for each leaflet. The two leaflets rated highest by participants used quality assurance tools. However, 20-30% had difficulty understanding the leaflets. Medical jargon and verbosity were common criticisms.
Professional bodies such as the Royal College of Psychiatrists play an important role in providing patients with written information. Quality assurance standards should be used in the production of patient information. A tool measuring individuals' appraisal of information may ensure information is appropriate to their requirements.
The lifetime prevalence of bipolar affective disorder is between 1 % and 2%. This educational review paper focuses on two areas of interest and relevance to trainees preparing for the membership examination of the Royal College of Psychiatrists: (a) advances in the genetics of bipolar affective disorder; and (b) mood-stabilising medication in bipolar affective disorder.
High density single nucleotide polymorphism (SNP) genotyping panels provide an alternative to microsatellite markers for genome scans. However, genotype errors have a major impact on power to detect linkage or association and are difficult to detect for SNPs. We estimated error rates with the Affymetrix GeneChip® SNP platform in samples from a family with a mixed set of monozygotic (MZ) and dizygotic (DZ) triplets using lymphocyte, buccal DNA and samples from whole genome amplification using the multiple displacement amplification (MDA) technique. The average call rate from 58,960 SNPs for five genomic samples was 99.48%. Comparison of results for the MZ twins showed only three discordant genotypes (concordance rate 99.995%). The mean concordance rate for comparisons of samples from lymphocyte and buccal DNA was 99.97%. Mendelian inconsistencies were identified in 46 SNPs with errors in one or more family members, a rate of 0.022%. Observed genotype concordance rates between parents, between parents and children, and among siblings were consistent with previously reported allele frequencies and Hardy–Weinberg equilibrium. Using the MDA technique, results for two samples had equivalent high accuracy to results with genomic samples. However, the SNP call rate for the remaining seven samples varied from 72.5% to 99.5%, with an average of 86.11%. Quality of the DNA sample following the MDA reaction appears to be the critical factor in SNP call rate for MDA samples. Our results demonstrate highly accurate and reproducible genotyping for the Affymetrix GeneChip® Human Mapping Set in lymphocyte and buccal DNA samples.
Layered orthogneisses of the Oygarden Islands preserve evidence for four high-grade deformation
events (D1 to D4). Archaean D1 and D2 structures are only patchily preserved due to extensive
recrystallization during D3 and D4, which represent effects of the c. 1000 Ma Rayner Structural
Episode. Ductile thrusting at middle to lower crustal levels occurred during D3, which is separated into
two mutually cross-cutting phases based on structural geometry; the two phases represent changes in
finite strain that developed during progressive deformation. East-directed transport during D3a developed
subhorizontal thrusts that contain co-axial, east-trending F3a folds and L3a lineations. Buckling
as a consequence of constriction in thrust duplexes developed upright F3b folds coaxial to F3a folds,
and steeply south-dipping D3b shear zones. Garnet–clinopyroxene- and garnet–orthopyroxene-bearing
assemblages in mafic lithologies, and garnet–sillimanite-bearing assemblages in pelitic lithologies
reflect D3 conditions of P=9 kbar and T=800–850 °C. The well-exposed D3 duplex structures indicate
that shortening of the lower crust may be accommodated by extensive strain partitioning to
develop contemporary kilometre-scale thrust stacking and ductile flow.
A field study was conducted over 2 yr to compare efficacy and economics of glyphosate-resistant, sulfonylurea-tolerant, and conventional soybean (Glycine max) weed control programs. Herbicide programs in the three soybean systems provided at least 90% control of browntop millet (Brachiaria ramosa), prickly sida (Sida spinosa), yellow nutsedge (Cyperus esculentus), pitted morningglory (Ipomoea lacunosa), and hemp sesbania (Sesbania exaltata) in most cases and postemergence (POST)-only programs were as effective as preemergence (PRE) followed by POST programs. Control of hyssop spurge (Euphorbia hyssopifolia) ranged from 93 to 100% in glyphosate-resistant soybean and from 88 to 100% in conventional soybean, but control was 60 to 100% in sulfonylurea-tolerant soybean. Sicklepod (Senna obtusifolia) control was at least 91% in glyphosate-resistant and sulfonylurea-tolerant soybean but was 81% for the standard SAN 582 plus imazaquin PRE and acifluorfen plus bentazon early POST treatment in conventional soybean. In glyphosate-resistant soybean, glyphosate applied sequentially resulted in an average yield of 3,020 kg/ha with a net return of $407/ha. In sulfonylurea-tolerant soybean, chlorimuron applied sequentially yielded 2,500 kg/ha with a net return of $271/ha. Conventional soybean yield with the standard herbicide program was 2,770 kg/ha with a net return of $317/ha. Yields for the cultivars were equivalent when the same standard herbicide program was used. When weed control is satisfactory and herbicide costs relatively comparable, yield potential of the cultivar and seed cost, including any technology fee, would be key factors in selecting a weed management system.
The present study examined neuropsychological (NP) functioning and associated medical, neurological, brain magnetic resonance imaging (MRI), and psychiatric findings in 389 nondemented males infected with Human Immunodeficiency Virus-Type 1 (HIV-1), and in 111 uninfected controls. Using a comprehensive NP test battery, we found increased rates of impairment at each successive stage of HIV infection. HIV-related NP impairment was generally mild, especially in the medically asymptomatic stage of infection, and most often affected attention, speed of information processing, and learning efficiency; this pattern is consistent with earliest involvement of subcortical or frontostriatal brain systems. NP impairment could not be explained on the bases of mood disturbance, recreational drug or alcohol use, or constitutional symptoms; by contrast, impairment in HIV-infected subjects was related to central brain atrophy on MRI, as well as to evidence of cellular immune activation and neurological abnormalities linked to the central nervous system. (JINS, 1995, 1, 231–251.)
Results of preliminary investigations on varying the adhesion and growth behaviour of osteoblast-like cells on silicon are presented. Significant changes in growth behaviour are obtained by implanting oxygen or by growing a thermal oxide on the surface. The objective of the work is to modify tissue adhesion to materials used as prosthetic devices.
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