Care pathways and designing the healthcare built environment: an explanatory framework

The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.

New scientific paradigms for probiotics and prebiotics

The inaugural meeting of the International Scientific Association for Probiotics and Prebiotics (ISAPP) was held May 3 to May 5 2002 in London, Ontario, Canada. A group of 63 academic and industrial scientists from around the world convened to discuss current issues in the science of probiotics and prebiotics. ISAPP is a non-profit organization comprised of international scientists whose intent is to strongly support and improve the levels of scientific integrity and due diligence associated with the study, use, and application of probiotics and prebiotics. In addition, ISAPP values its role in facilitating communication with the public and healthcare providers and among scientists in related fields on all topics pertinent to probiotics and prebiotics. It is anticipated that such efforts will lead to development of approaches and products that are optimally designed for the improvement of human and animal health and well being. This article is a summary of the discussions, conclusions, and recommendations made by 8 working groups convened during the first ISAPP workshop focusing on the topics of: definitions, intestinal flora, extra-intestinal sites, immune function, intestinal disease, cancer, genetics and genomics, and second generation prebiotics. Humans have evolved in symbiosis with an estimated 1014 resident microorganisms. However, as medicine has widely defined and explored the perpetrators of disease, including those of microbial origin, it has paid relatively little attention to the microbial cells that constitute the most abundant life forms associated with our body. Microbial metabolism in humans and animals constitutes an intense biochemical activity in the body, with profound repercussions for health and disease. As understanding of the human genome constantly expands, an important opportunity will arise to better determine the relationship between microbial populations within the body and host factors (including gender, genetic background, and nutrition) and the concomitant implications for health and improved quality of life. Combined human and microbial genetic studies will determine how such interactions can affect human health and longevity, which communication systems are used, and how they can be influenced to benefit the host. Probiotics are defined as live microorganisms which, when administered in adequate amounts confer a health benefit on the host.1 The probiotic concept dates back over 100 years, but only in recent times have the scientific knowledge and tools become available to properly evaluate their effects on normal health and well being, and their potential in preventing and treating disease. A similar situation exists for prebiotics, defined by this group as non-digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria. Prebiotics function complementary to, and possibly synergistically with, probiotics. Numerous studies are providing insights into the growth and metabolic influence of these microbial nutrients on health. Today, the science behind the function of probiotics and prebiotics still requires more stringent deciphering both scientifically and mechanistically. The explosion of publications and interest in probiotics and prebiotics has resulted in a body of collective research that points toward great promise. However, this research is spread among such a diversity of organisms, delivery vehicles (foods, pills, and supplements), and potential health targets such that general conclusions cannot easily be made. Nevertheless, this situation is rapidly changing on a number of important fronts. With progress over the past decade on the genetics of lactic acid bacteria and the recent, 2,3 and pending, 4 release of complete genome sequences for major probiotic species, the field is now armed with detailed information and sophisticated microbiological and bioinformatic tools. Similarly, advances in biotechnology could yield new probiotics and prebiotics designed for enhanced or expanded functionality. The incorporation of genetic tools within a multidisciplinary scientific platform is expected to reveal the contributions of commensals, probiotics, and prebiotics to general health and well being and explicitly identify the mechanisms and corresponding host responses that provide the basis for their positive roles and associated claims. In terms of human suffering, the need for effective new approaches to prevent and treat disease is paramount. The need exists not only to alleviate the significant mortality and morbidity caused by intestinal diseases worldwide (especially diarrheal diseases in children), but also for infections at non-intestinal sites. This is especially worthy of pursuit in developing nations where mortality is too often the outcome of food and water borne infection. Inasmuch as probiotics and prebiotics are able to influence the populations or activities of commensal microflora, there is evidence that they can also play a role in mitigating some diseases. 5,6 Preliminary support that probiotics and prebiotics may be useful as intervention in conditions including inflammatory bowel disease, irritable bowel syndrome, allergy, cancer (especially colorectal cancer of which 75% are associated with diet), vaginal and urinary tract infections in women, kidney stone disease, mineral absorption, and infections caused by Helicobacter pylori is emerging. Some metabolites of microbes in the gut may also impact systemic conditions ranging from coronary heart disease to cognitive function, suggesting the possibility that exogenously applied microbes in the form of probiotics, or alteration of gut microecology with prebiotics, may be useful interventions even in these apparently disparate conditions. Beyond these direct intervention targets, probiotic cultures can also serve in expanded roles as live vehicles to deliver biologic agents (vaccines, enzymes, and proteins) to targeted locations within the body. The economic impact of these disease conditions in terms of diagnosis, treatment, doctor and hospital visits, and time off work exceeds several hundred billion dollars. The quality of life impact is also of major concern. Probiotics and prebiotics offer plausible opportunities to reduce the morbidity associated with these conditions. The following addresses issues that emerged from 8 workshops (Definitions, Intestinal Flora, Extra-Intestinal Sites, Immune Function, Intestinal Disease, Cancer, Genomics, and Second Generation Prebiotics), reflecting the current scientific state of probiotics and prebiotics. This is not a comprehensive review, however the study emphasizes pivotal knowledge gaps, and recommendations are made as to the underlying scientific and multidisciplinary studies that will be required to advance our understanding of the roles and impact of prebiotics, probiotics, and the commensal microflora upon health and disease management.

Interactions between herbal and conventional medicines

Herb-drug interactions are subject to much interest at present, but for various reasons reports may be unreliable or unsubstantiated. Herbal medicines are variable in composition and quality, which may affect their interaction profile as well as the reliability of reports concerning them. In this review, clinical and experimental reports have been collated, evaluated and summarised, and the theoretical and clinical evidence presented. There is an explanation of the particular issues involved with herbal medicines as compared with conventional drugs, and reasons why comparisons may or may not be valid, which is intended for those without specialist experience in herbal products. It has become apparent that only a few herbal drugs have so far been cited in interaction reports, for example St John's Wort, Ginkgo biloba, Dan Shen, liquorice, Ma huang and garlic, and that the main drugs involved are those which are already susceptible to interactions with many other conventional drugs, such as warfarin, protease inhibitors and anti-cancer drugs. An attempt has been made to put the matter into perspective and recommendations have been given for health professionals to advise or develop strategies to safeguard patients, without resorting to speculation or scaremongering.

To 'be', and not to 'have': auxiliary selection in unaccusative verbs in Italian

This paper investigates the characteristics of unaccusative verbs in Italian with respect to the consistency with which these verbs select the auxiliaries ‘be’ (essere) and ‘have’ (avere) in compound tense forms. The study builds on the gradient approach to split intransitivity (Sorace 2000) by exploring the behaviour of 29 intransitive Italian verbs with respect to their core-peripheral features: auxiliary selection acceptability ratings and associated variance measures. Although there is clear support for the gradient approach in relation to the general order of semantic categories along the unaccusativity gradient, the results reveal that the ordering of subclasses within the Change group conflict with that currently proposed in the literature. In addition, the findings demonstrate the aspectual and lexical semantic characteristics of internally-caused change-of-state verbs in Italian require further investigation before their auxiliary selection behaviour can be properly understood. Furthermore, contrary to the gradient account, Existence verbs, the most stative and therefore the most peripheral subclass in the unaccusativity hierarchy, exhibit behaviour more characteristic of core unaccusative verbs. This study examines a wider range of semantic subclasses of unaccusative verbs than has hitherto been reported and identifies the core-peripheral boundary for Italian.1

Health-related quality of life in Huntington’s Disease patients: a comparison of proxy assessment and patient self-rating using the disease-specific Huntington’s Disease health-related quality of life questionnaire (HDQoL)

Huntington’s disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. Proxy evaluation is relevant for HD as its manifestation might limit the ability of persons to report their health-related quality of life (HrQoL). This study explored patient–proxy ratings of HrQoL of persons at different stages of HD, and examined factors that may affect proxy ratings. A total of 105 patient–proxy pairs completed the Huntington’s disease health-related quality of life questionnaire (HDQoL) and other established HrQoL measures (EQ-5D and SF-12v2). Proxy–patient agreement was assessed in terms of absolute level (mean ratings) and intraclass correlation. Proxies’ ratings were at a similar level to patients’ self-ratings on an overall Summary Score and on most of the six Specific Scales of the HDQoL. On the Specific Hopes and Worries Scale, proxies on average rated HrQoL as better than patients’ self-ratings, while on both the Specific Cognitive Scale and Specific Physical and Functional Scale proxies tended to rate HrQoL more poorly than patients themselves. The patient’s disease stage and mental wellbeing (SF-12 Mental Component scale) were the two factors that primarily affected proxy assessment. Proxy scores were strongly correlated with patients’ self-ratings of HrQoL, on the Summary Scale and all Specific Scales. The patient–proxy correlation was lower for patients at moderate stages of HD compared to patients at early and advanced stages. The proxy report version of the HDQoL is a useful complementary tool to self-assessment, and a promising alternative when individual patients with advanced HD are unable to self-report.

Measuring lexical diversity among L2 learners of French: an exploration of the validity of D, MTLD and HD-D as measures of language ability

In this study two new measures of lexical diversity are tested for the first time on French. The usefulness of these measures, MTLD (McCarthy and Jarvis (2010 and this volume) ) and HD-D (McCarthy and Jarvis 2007), in predicting different aspects of language proficiency is assessed and compared with D (Malvern and Richards 1997; Malvern, Richards, Chipere and Durán 2004) and Maas (1972) in analyses of stories told by two groups of learners (n=41) of two different proficiency levels and one group of native speakers of French (n=23). The importance of careful lemmatization in studies of lexical diversity which involve highly inflected languages is also demonstrated. The paper shows that the measures of lexical diversity under study are valid proxies for language ability in that they explain up to 62 percent of the variance in French C-test scores, and up to 33 percent of the variance in a measure of complexity. The paper also provides evidence that dependence on segment size continues to be a problem for the measures of lexical diversity discussed in this paper. The paper concludes that limiting the range of text lengths or even keeping text length constant is the safest option in analysing lexical diversity.

Thirst for knowledge: the effects of curiosity and interest on memory in younger and older adults

Given age-related memory impairments, one’s level of curiosity or interest could enhance memory for certain information. In the current study, younger and older adults read trivia questions, rated how curious they were to learn each answer, provided confidence and interest ratings, and judgments of learning (JOL) after learning the answer. No age-related differences in memory were found. Analyses indicated that curiosity and interest contributed to the formation of JOLs. Additionally, interest had a unique increasing relationship with older, but not younger, adults’ memory performance after a week. The results suggest that subjective interest may serve to enhance older adults’ memory.

Voluntary action and causality in temporal binding

Previous studies have documented temporal attraction in perceived times of actions and their effects. While some authors argue that voluntary action is a necessary condition for this phenomenon, others claim that the causal relationship between action and effect is the crucial ingredient. In the present study, we investigate voluntary action and causality as the necessary and sufficient conditions for temporal binding. We used a variation of the launching effect proposed by Michotte, in which participants controlled the launch stimulus in some blocks. Volunteers reported causality ratings and estimated the interval between the two events. Our results show dissociations between causality ratings and temporal estimation. While causality ratings are not affected by voluntary action, temporal bindings were only found in the presence of both voluntary action and high causality. Our results indicate that voluntary action and causality are both necessary for the emergence of temporal binding.

Analysis of the economic and financial relations between Latin American and the Caribbean and the BRICS group

This document has been prepared in compliance with Activity III.1.2 of the Work Programme of SELA for the year 2015, entitled “Analysis of the economic and financial relations between Latin America and the Caribbean and the BRICS countries”. The document comprises an introduction, four chapters and a final section with the conclusions and recommendations stemming from the study. Chapter I describes the economic performance of the BRICS countries, their economic relations with Latin America and the Caribbean and the functioning of the development banks of the member countries. Chapter II assesses the financial architecture of Latin America and the Caribbean and explores the needs for financing in the region. Chapter III deals with the regulatory frameworks governing public and private investments in Latin America and the Caribbean and the Bilateral Investment Treaties with the BRICS countries. Finally, Chapter IV describes the main features of the New Development Bank (NDB) and the Contingent Reserve Agreement of the BRICS

BlueFriends: measuring, analyzing and preventing social exclusion between elementary school students

Social exclusion is a relatively recent term, whose creation is attributed to René Lenoir(Lenoir, 1974). Its concept covers a remarkably wide range of social and economic problems, and can be triggered for various reasons: mentally and physically handicapped, abused children, delinquents, multi-problem households, asocial people, and other social “misfits” (Silver, 1995, pp. 63; Foucault, 1992). With an increasingly multi-cultural population, cultural and social inequalities rapidly ascend, bringing with them the need for educational restructuring. We are living in an evermore diverse world, and children need to be educated to be receptive to the different types of people around them, especially considering social and cultural aspects. It is with these goals that inclusive education has seen an increased trend in today’s academic environment, reminding us that even though children may be taught under the same roof, discriminatory practices might still happen. There are, however, a number of developed tools to assess the various dimensions of social networks. These are mostly based on questionnaires and interviews, which tend to be fastidious and don’t allow for longitudinal, large scale measurement. This thesis introduces BlueFriends, a Bluetooth-based measurement tool for social inclusion/exclusion on elementary school classes. The main goals behind the development of this tool were a) understanding how exclusion manifests in students’ behaviors, and b) motivating pro-social behaviors on children through the use of a persuasive technology. BlueFriends is a distributed application, comprised by an application running on several smartphones, a web-hosted database and a computer providing a visual representation of the data collected on a TV screen, attempting to influence children behaviors. The application makes use of the Bluetooth device present on each phone to continuously sample the RSSI (Received Signal Strength Indication) from other phones, storing the data locally on each phone. All of the stored data is collected, processed and then inserted into the database at the end of each day. At the beginning of each recess, children are reminded of how their behaviors affect others with the help of a visual display, which consists of interactions between dogs. This display illustrates every child’s best friends, as well as which colleagues they don’t interact with as much. Several tips encouraging social interaction and inclusiveness are displayed, inspiring children to change their behaviors towards the colleagues they spend less time with. This thesis documents the process of designing, deploying and analyzing the results of two field studies. On the first study, we assess how the current developed tools are inferior to our measuring tool by deploying a measurement only study, aimed at perceiving how much information can be obtained by the BlueFriends application and attempting to understand how exclusion manifests itself in the school environment. On the second study, we pile on the previous to try and motivate pro-social behaviors on students, with the use of visual cues and recommendations. Ultimately, we confirm that our measurement tool’s results were satisfying towards measuring and changing children’s behaviors, and conclude with our thoughts on possible future work, suggesting a number of possible extensions and improvements.

Design and ergonomics of package inserts of drugs in Brazil: a reality in construction

This research deals with the design of leaflets of medicines, evidencing the problems resulting from the lack of Brazilian normalization to promote the use of the graphical representation of instructional texts warnings. It approaches studies related to the effectiveness and efficiency of information systems, highlighting the semiotics and the cultural and informational ergonomics. The analysis of the context uses as method, an analytical study on selected warnings of thirty leaflets of medicines, followed by interviews lead with the public managers involved with the regulation of the pharmaceutical companies, and two experiments with users performed in city of Recife, in State of Pernambuco: one aiming at to identify how they interact with the leaflets of medicines, and the second one testing their understanding concerning standardized illustrations in the United States and the South Africa. The results show the need for improvements in presentation and graphic representation of leaflets of medicines, powering them to the role of communication, to ensure the consumption of medicine safely by its users. The conclusion congregates parameters and recommendations for the graphic representation of warnings in leaflets of medicines in Brazil.

A territorial perspective: towards the consolidation of human settlements in Latin America and the Caribbean

Includes bibliography

Tax performance and reform in the Organization of Eastern Caribbean States (OECS)

Includes bibliography

Trade and investment promotion between Asia-Pacific and Latin America: present position and future prospects

Includes bibliography

Promoting corporate social responsibility in small and medium enterprises in the Caribbean: survey results

Includes bibliography