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Can oral healthcare for older people be embedded into routine community aged care practice? A realist evaluation using normalisation process theory
Get PDFThis author accepted manuscript is made available following 12 month embargo from date of publication (December 2018) in accordance with the publisher’s archiving policyBackground
An intervention ‘Better Oral Health in Home Care’ was introduced (2012–2014) to improve the oral health of older people receiving community aged care services. Implementation of the intervention was theoretically framed by the Promoting Action on Research Implementation in Health Services framework. Process outcomes demonstrated significant improvements in older people’s oral health.
Objective
To evaluate the extent to which the intervention has been embedded and sustained into routine community aged care practice 3 years after the initial implementation project.
Design
A Realist Evaluation applying Normalisation Process Theory within a single case study setting.
Setting
Community aged care (home care) provider in South Australia, Australia.
Participants
Purposeful sampling was undertaken. Twelve staff members were recruited from corporate, management and direct care positions. Two consumers representing high and low care recipients also participated.
Methods
Qualitative methods were applied in two subcases, reflecting different contextual settings. Data were collected via semi-structured interviews and analysed deductively by applying the Normalisation Process Theory core constructs (with the recommended phases of the Realist Evaluation cycle). Retrospective and prospective analytic methods investigated how the intervention has been operationalised by comparing two timeframes: Time 1 (Implementation June 2012–December 2014) and Time 2 (Post-implementation July 2017–July 2018).
Results
At Time 1, the initial program theory proposed that multi-level facilitation contributed to a favourable context that triggered positive mechanisms supportive of building organisational and workforce oral healthcare capacity. At Time 2, an alternative program theory of how the intervention has unfolded in practice described a changed context following the withdrawal of the project facilitation processes with the triggering of alternative mechanisms that have made it difficult for staff to embed sustainable practice.
Conclusion
Findings concur with the literature that successful implementation outcomes do not necessarily guarantee sustainability. The study has provided a deeper explanation of how contextual characteristics have contributed to the conceptualisation of oral healthcare as a low priority, basic work-ready personal care task and how this, in turn, hindered the embedding of sustainable oral healthcare into routine community aged care practice. This understanding can be used to better inform the development of strategies, such as multi-level facilitation, needed to navigate contextual barriers so that sustainable practice can be achieved
Efficacy and Efficiency of Multivariate Linear Regression for Rapid Prediction of Femoral Strain Fields during Activity
Get PDF© 2018 IPEM. Published by Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (December 2018) in accordance with the publisher’s archiving policy.Multivariate Linear Regression-based (MLR) surrogate models were explored to reduce the computational cost of predicting femoral strains during normal activity in comparison with finite element analysis. The musculoskeletal model of one individual, the finite-element model of the right femur, and experimental force and motion data for normal walking, fast walking, stair ascent, stair descent, and rising from a chair were obtained from a previous study. Equivalent Von Mises strain was calculated for 1000 frames uniformly distributed across activities. MLR surrogate models were generated using training sets of 50, 100, 200 and 300 samples. The finite-element and MLR analyses were compared using linear regression. The Root Mean Square Error (RMSE) and the 95th percentile of the strain error distribution were used as indicators of average and peak error. The MLR model trained using 200 samples (RMSE < 108 µε; peak error < 228 µε) was used as a reference. The finite-element method required 66 s per frame on a standard desktop computer. The MLR model required 0.1 s per frame plus 1848 s of training time. RMSE ranged from 1.2% to 1.3% while peak error ranged from 2.2% to 3.6% of the maximum micro-strain (5020 µε). Performance within an activity was lower during early and late stance, with RMSE of 4.1% and peak error of 8.6% of the maximum computed micro-strain. These results show that MLR surrogate models may be used to rapidly and accurately estimate strain fields in long bones during daily physical activity
Developing a screening tool to recognise social determinants of health in Australian clinical settings
Get PDF© 2018 Browne-Yung et al. This article is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms. See: www.creativecommons.org/licenses/by-nc-sa/4.0/Objective and importance of study: The importance of social determinants for individual health recovery outcomes is well recognised in public health. However, no succinct social health screening (SHS) tool exists that has beendeveloped with information from clinicians and patients. This proof-of-concept study asked health consumer advocates, patients and clinicians about their attitudes towards social determinants of health (SDH) and the usefulness of an SHS tool for collecting these data for use in clinical settings. We then developed a streamlined SHS tool to bring this knowledge to clinicians, and conducted a proof-of-concept trial to check its acceptability with patients and clinicians.
Methods: This qualitative study had two stages. Stage 1 involved focus groups with health consumer advocates and interviews with clinicians about the draft SHS tool. Stage 2 involved refining the SHS tool and piloting it with 50 new patients in anxiety disorder and sleep disorder clinics, which often treat patients living in disadvantaged socio-economic conditions. The tool was evaluated by patients and clinicians. The data were analysed using framework analysis.
Results: All interviewees were positive about the benefits of addressing SDH in clinical practice to help reduce health inequities. We developed and refined an SHS tool that could be completed by patients (‘self-complete’).
Conclusion: The response to introducing an SHS tool in clinical settings was positive. Further piloting across diverse clinical settings is required to determine efficacy. This tool promotes public health equity outcomes by improving clinician understanding of individual social circumstances, and has the potential to provide useful epidemiological data on SDH
Rare, potentially pathogenic variants in 21 keratoconus candidate genes are not enriched in cases in a large Australian cohort of European descent
Get PDFCopyright: © 2018 Lucas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Many genes have been suggested as candidate genes for keratoconus based on their function, their proximity to associated polymorphisms or due to the identification of putative causative variants within the gene. However, very few of these genes have been assessed for rare variation in keratoconus more broadly. In contrast, VSX1 and SOD1 have been widely assessed, however, the vast majority of studies have been small and the findings conflicting. In a cohort of Australians of European descent, consisting of 385 keratoconus cases and 396 controls, we screened 21 keratoconus candidate genes: BANP, CAST, COL4A3, COL4A4, COL5A1, FOXO1, FNDC3B, HGF, IL1A, IL1B, ILRN, IMMP2L, MPDZ, NFIB, RAB3GAP1, RAD51, RXRA, SLC4A11, SOD1, TF and VSX1. The candidate genes were sequenced in these individuals by either whole exome sequencing or targeted gene sequencing. Variants were filtered to identify rare (minor allele frequency <1%), potentially pathogenic variants. A total of 164 such variants were identified across the two groups with no variants fulfilling these criteria in cases in IL1RN, BANP, IL1B, RAD51 or SOD1. The frequency of variants was compared between cases and controls using chi-square or Fishers’ Exact tests for each gene with at least one rare potentially pathogenic variant identified in the case cohort. The number of rare potentially pathogenic variants per gene ranged from three (RXRA) to 102 (MPDZ), however for all genes, there was no difference in the frequency between the cases and controls. We conclude that rare potentially pathogenic variation in the 21 candidate genes assessed do not play a major role in keratoconus susceptibility and pathogenesis
GATTACA and genetic determinism
Get PDFCrown Copyright © 2018 Published by Elsevier Ltd. This
manuscript version is made available under the CC-BYNC-
ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (August 2018) in accordance with the publisher’s archiving policyGattaca (1997) is a film that depicts a world in “the not-so-distant future” where naturally conceived humans are labelled as in-valids or de-gene-erates. In-valids form the lower class of society, while genetically selected embryos are called valids and form the elite. Genetic selection of embryos can be easily achieved by visiting “your local geneticist”. The valid and in-valid labels call to mind Heidegger's authentic and inauthentic self. In-valids are denied access to high-status positions, education, and other social institutions, and are assigned menial jobs and low-status work. Valids form the elite and hold higher status jobs, although their participation is determined according to their level of genetic perfection. The name of the movie comprises the initial letters of the four nucleobases of DNA: Guanine, Adenine, Thymine, and Cytosine
Editor's letter, Volume 11 No. 1 (December 2018)
No full textEditor's letter, Volume 11 No. 1 (December 2018
Sleep spindles in adolescence: a comparison across sleep restriction and sleep extension
Get PDFBackground
The tendency for adolescents to have restricted sleep has been examined in numerous studies; however, the impact of sleep restriction on adolescents’ neural activity during sleep (measured by electroencephalography (EEG)) is less extensively researched, particularly regarding sleep spindles.
Methods
In this experimental study, 34 adolescents attended a 10-day laboratory study where they received five consecutive nights of either 5 h, 7.5 h or 10 h of sleep opportunity, with one adaptation, one baseline and two recovery nights of 10 h of sleep opportunity before and after the experimental phase.
Results
Both within- and between-subjects effects were observed for fast sleep spindle characteristics of density, duration and amplitude. Overall, when experiencing severe sleep restriction, fast spindles in adolescents were lower in amplitude and longer in duration. Sex differences were also seen for fast spindle amplitude.
Conclusions
This investigation adds to the knowledge in this field by investigating specific sleep spindle characteristics in the context of experimentally manipulated sleep. Sleep restriction is highly prevalent among adolescents. These findings indicate that chronic sleep restriction has an impact on brain activity related to sleep spindles.This work was supported by the Australasian Sleep Association Rob Pierce Grant in Aid
Unraveling the transcriptional complexity of compactness in sistan grape cluster
Get PDF© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 24 month embargo from date of publication (Feb 2018) in accordance with the publisher’s archiving policyYaghooti grape of Sistan is the earliest ripening grape in Iran, harvested every May annually. It is adapted to dry conditions in Sistan region and its water requirement is less than the other grape cultivars. The transcriptional complexity of this grape was studied in three stages of cluster development. Totally, 24121 genes were expressed in different cluster development steps (step 1: cluster formation, step 2: berry formation, step 3: final size of cluster) of which 3040 genes in the first stage, 2381 genes in the second stage and 2400 genes in the third stage showed a significant increase in expression. GO analysis showed that when the clusters are ripening, the activity of the nucleus, cytoplasmic, cytosol, membrane and chloroplast genes in the cluster architecture cells decreases. In contrast, the activity of the endoplasmic reticulum, vacuole and extracellular region genes enhances. When Yaghooti grape is growing and developing, some of metabolic pathways were activated in the response to biotic and abiotic stresses. Gene co-expression network reconstruction showed that AGAMOUS is a key gene in compactness of Sistan grape cluster, because it influences on expression of GA gene which leads to increase cluster length and berries size
Does induction of labour in nulliparous hypertensive women result in vaginal birth? – A descriptive study utilising birth registry data
Get PDF© 2018 Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (January 2018) in accordance with the publisher’s archiving policyBackground
Induction of labour (IOL) is a common procedure yet we have little information on the efficacy of the process for women with a hypertensive disorder of pregnancy (HDP).
Objective
To describe the birth type and associated factors in nulliparous HDP women undergoing an induction of labour.
Study design
Statutorily collected datasets on every birth and hospital admission which occurred in the state of NSW Australia between the years 2000–2011 were analysed. Hypertensive women were compared to normotensive women.
Results
Of the nulliparous women, 9.9% had a HDP. IOL for HDP women were 56.2% in a cohort of 447 558 women. The AOR for a woman with a HDP undergoing an IOL resulting in a vaginal delivery when compared to a normotensive woman is 0.86 (95% CI 0.83–0.88). Prior to 33 weeks, the lowest perinatal mortality rates (PMR) are seen in women who undergo elective caesarean section (C/S). For women with preeclampsia (PE), lower PMR are seen in women who undergo IOL.
Conclusion
For women with PE and SPE, IOL resulted in lower rates of vaginal delivery than spontaneous labour when compared to normotensive women who also underwent IOL. Women with PE at ≥33 weeks who underwent IOL had the lowest PMR
Beta estradiol and norepinephrine treatment of differentiated SH-SY5Y cells enhances tau phosphorylation at (Ser396) and (Ser262) via AMPK but not mTOR signaling pathway
Get PDF© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (February 2018) in accordance with the publisher’s archiving policyHyperphosphorylation of tau is one of the main hallmarks for Alzheimer's disease (AD) and many other tauopathies. Norepinephrine (NE), a stress-related hormone and 17-β-estradiol (E2) thought to influence tau phosphorylation (p-tau) and AD pathology. The controversy around the impact of NE and E2 requires further clarification. Moreover, the combination effect of physiological and psychological stress and estrogen alteration during menopause, which affect p-tau, has not been addressed. Exposure to E2 is believed to reduce NE release, however, the link between these two hormones and AD at cellular level was also remained unknown. Here, we examined whether NE and E2 treatment of differentiated SH-SY5Y cells affected tau phosphorylation. The involvement of adenosine monophosphate kinase protein kinase (AMPK) and target of Rapamycin (mTOR) as the possible mechanisms, underlying this effect was also investigated. Subsequent to SH-SY5Y differentiation to mature neurons, we treated the cells with NE, E2 and NE plus E2 in presence and absence of Compound C and Rapamycin. Cell viability was not affected by our treatment while our Western blot and immunofluorescent findings showed that exposure to NE and E2 separately, and in combination enhanced p-tau (Ser396) and (Ser262)/tau but not (Ser202/Thr205)/tau. Blocking AMPK by Compound C reduced p-tau (Ser396) and (Ser262), while GSK-3β and PP2A activities were remained unchanged. We also found that blocking mTOR by Rapamycin did not change increased p-tau (Ser396) and (Ser262) due to NE + E2 treatment. Collectively, our results suggested that tau hyperphosphorylation due to exposure to NE/E2 was mediated by AMPK, the main energy regulator of cells during stress with no significant involvement of mTOR, GSK-3β and PP2A