Measuring horizontal integration among health care providers in the community: An examination of a collaborative process within a palliative care network

In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.

Dose-response relationship in phase 1 clinical trials: a European Drug Development Network (EDDN) Collaboration Study

Introduction: Because a dose–response relationship is characteristic of conventional chemotherapy, this concept is widely used for the development of novel cytotoxic (CTX) drugs. However, the need to reach the MTD to obtain optimal benefit with molecularly targeted agents (MTA) is controversial. In this study, we evaluated the relationship between dose and efficacy in a large cohort of phase I patients with solid tumors.

Experimental Design: We collected data on 1,182 consecutive patients treated in phase I trials in 14 European institutions in 2005–2007. Inclusion criteria were: (i) patients treated within completed single-agent studies in which a maximum-administered dose was defined and (ii) RECIST/survival data available.

Results: Seventy-two percent of patients were included in trials with MTA (N = 854) and 28% in trials with CTX (N = 328). The objective response (OR) rate was 3% and disease control at 6 months was 11%. OR for CTX was associated with higher doses (median 92% of MTD); this was not the case for MTA, where patients achieving OR received a median of 50% of MTD. For trials with MTA, patients treated at intermediate doses (40%–80%) had better survival compared with those receiving low or high doses (P = 0.038). On the contrary, there was a direct association between higher dose and better OS for CTX agents (P = 0.003).

Conclusion: Although these results support the development of novel CTX based on MTD, we found no direct relationship between higher doses and response with MTA in unselected patients. However, the longest OS was seen in patients treated with MTA at intermediate doses (40%–80% of MTD)

Mathematics Learning Support in Ireland in 2015

The provision of mathematics learning support in higher-level institutions on the island of Ireland has developed rapidly in recent times with the number of institutions providing some form of support doubling in the past seven years. The Irish Mathematics Learning Support Network aims to inform all mathematics support practitioners in Ireland on relevant issues. Consequently it was decided that a detailed picture of current provision was necessary. A comprehensive online survey was conducted to amass the necessary data. The ultimate aim of the survey is to benefit all mathematics support practitioners in Ireland, in particular those in third-level institutions who require further support to enhance the mathematical learning experience of their students. The survey reveals that the majority of Irish higher-level institutions provide mathematics learning support to some extent, with 65% doing so through a support centre. Learners of service mathematics are the primary users: first-year science, engineering and business undergraduates, with non-traditional students being a sizeable element. Despite the growing recognition for the need to offer mathematics learning support almost half of the centres are subject to annual review. Further, less than half the support offerings have a dedicated full-time manager, while 60% operate with a staff of five or fewer. The elevation of mathematics support as a viable and worthwhile career in order to attract and retain high quality staff is seen by many respondents as the crucial next phase of development.

An Evaluation of the Drug and Alcohol Service User Network in NI

Objectives:
The process evaluation will consider the views of the appointed SUN workers and representatives from selected service user groups as regards the setting up and maintenance of the SUN network. This component of the evaluation will also examine the perceptions of stakeholders from a number of relevant organisations.

The outcome evaluation will assess the effectiveness of the SUN project in achieving the intended outcomes as outlined in the original Action Plans.
The following outcomes will be evaluated:
To ascertain the level to which the SUN has provided support, information and advice to existing service user groups.
To examine the SUN co-ordination of Trust and regional networks of service user groups.
To consider how the SUN assists organisations to establish and maintain service user groups.
To examine the level of current and future membership of service users on relevant groups, with a particular focus on engagement of hard to reach populations.
To gauge service user perceptions of the Service User Network.
To examine the levels of training provided and consider the efficacy of training.

Audit of mathematics learning support in Ireland in 2015 – the key findings

In 2015 the Irish Mathematics Learning Support Network (IMLSN) commissioned a comprehensive audit of the extent and nature of mathematics learning support (MLS) provision on the island of Ireland. An online survey was sent to 32 institutions, including universities, institutes of technology, further education and teacher training colleges, and a 97% response rate was achieved. While the headline figure – 84% of institutions that responded to the survey provide MLS – sounds good, deeper analysis reveals that the true state of MLS is not so solid. For example, in 25% of institutions offering MLS, only five hours per week (at most) of physical MLS are available, while in 20% of institutions the service is provided by only one or two staff members. Furthermore, training of tutors is minimal or non-existent in at least half of the institutions offering MLS. The results provide an illuminating picture, however, identifying the true state of MLS in Ireland is beneficial only if it informs developments in the years ahead. This talk will present some of the findings of the survey in more depth along with conclusions and recommendations. Key among these is the need for institutions to recognise MLS as a vital element of mathematics teaching and learning strategy at third level and devote the necessary resources to facilitate the provision of a service which can grow and adapt to meet student requirements.

Effective network security monitoring: from attribution to target-centric monitoring

Network security monitoring remains a challenge. As global networks scale up, in terms of traffic, volume and speed, effective attribution of cyber attacks is increasingly difficult. The problem is compounded by a combination of other factors, including the architecture of the Internet, multi-stage attacks and increasing volumes of nonproductive traffic. This paper proposes to shift the focus of security monitoring from the source to the target. Simply put, resources devoted to detection and attribution should be redeployed to efficiently monitor for targeting and prevention of attacks. The effort of detection should aim to determine whether a node is under attack, and if so, effectively prevent the attack. This paper contributes by systematically reviewing the structural, operational and legal reasons underlying this argument, and presents empirical evidence to support a shift away from attribution to favour of a target-centric monitoring approach. A carefully deployed set of experiments are presented and a detailed analysis of the results is achieved.

Fruit and vegetable intake and risk of incident of type 2 diabetes: results from the consortium on health and ageing network of cohorts in Europe and the United States (CHANCES)

BACKGROUND/OBJECTIVES: There is limited information to support definitive recommendations concerning the role of diet in the development of type 2 Diabetes mellitus (T2DM). The results of the latest meta-analyses suggest that an increased consumption of green leafy vegetables may reduce the incidence of diabetes, with either no association or weak associations demonstrated for total fruit and vegetable intake. Few studies have, however, focused on older subjects.

SUBJECTS/METHODS: The relationship between T2DM and fruit and vegetable intake was investigated using data from the NIH-AARP study and the EPIC Elderly study. All participants below the age of 50 and/or with a history of cancer, diabetes or coronary heart disease were excluded from the analysis. Multivariate logistic regression analysis was used to calculate the odds ratio of T2DM comparing the highest with the lowest estimated portions of fruit, vegetable, green leafy vegetables and cabbage intake.

RESULTS: Comparing people with the highest and lowest estimated portions of fruit, vegetable or green leafy vegetable intake indicated no association with the risk of T2DM. However, although the pooled OR across all studies showed no effect overall, there was significant heterogeneity across cohorts and independent results from the NIH-AARP study showed that fruit and green leafy vegetable intake was associated with a reduced risk of T2DM OR 0.95 (95% CI 0.91,0.99) and OR 0.87 (95% CI 0.87,0.90) respectively.

CONCLUSIONS: Fruit and vegetable intake was not shown to be related to incident T2DM in older subjects. Summary analysis also found no associations between green leafy vegetable and cabbage intake and the onset of T2DM. Future dietary pattern studies may shed light on the origin of the heterogeneity across populations.European Journal of Clinical Nutrition advance online publication, 17 August 2016;