Physiotherapy practices and third party payers: issues in professional ethics in the Atlantic provinces

During a 4-month period, July 2nd 2014 to November 1st 2014, Canadian physiotherapy (PT) professionals were solicited for participation in an empirical cross-sectional online survey questionnaire. Our research team was interested in exploring the ethical challenges encountered in the interactions between PT professionals and third party payers. Analysis of the survey will be disseminated through scientific publications. The purpose of this report is to give detailed results relevant to your provincial association.

Physiotherapy practices and third party payers: issues in professional ethics in the Northern territories

During a 4-month period, July 2nd 2014 to November 1st 2014, Canadian physiotherapy (PT) professionals were solicited for participation in an empirical cross-sectional online survey questionnaire. Our research team was interested in exploring the ethical challenges encountered in the interactions between PT professionals and third party payers. Analysis of the survey will be disseminated through scientific publications. The purpose of this report is to give detailed results relevant to your provincial association.

Physiotherapy practices and third party payers: issues in professional ethics in Quebec

During a 4-month period, July 2nd 2014 to November 1st 2014, Canadian physiotherapy (PT) professionals were solicited for participation in an empirical cross-sectional online survey questionnaire. Our research team was interested in exploring the ethical challenges encountered in the interactions between PT professionals and third party payers. Analysis of the survey will be disseminated through scientific publications. The purpose of this report is to give detailed results relevant to your provincial association.

(Table 1) Oxygen isotopic composition of interstitial waters from ODP Hole 161-976

Interstitial waters recovered from Ocean Drilling Program, Leg 161, site 976 in the western Mediterranean Sea are used in conjunction with a numerical model to constrain the delta18O of seawater in the basin since the Last Glacial Maximum, including Sapropel Event 1. To resolve the oxygen isotopic composition of the deep Mediterranean, we use a model that couples fluid diffusion with advective transport, thus producing a profile of seawater delta18O variability that is unaffected by glacial-interglacial variations in marine temperature. Comparing our reconstructed seawater delta18O to recent determinations of 1.0 per mil for the mean ocean change in glacial-interglacial delta18O due to the expansion of global ice volume, we calculate an additional 0.2 per mil increase in Mediterranean delta18O caused by local evaporative enrichment. This estimate of delta18O change, due to salinity variability, is smaller than previous studies have proposed and demonstrates that Mediterranean records of foraminiferal calcite delta18O from the last glacial period include a strong temperature component. Paleotemperatures determined in combination with a stacked record of foraminiferal calcite depict almost 9°C of regional cooling for the Last Glacial Maximum. Model results suggest a decrease of ~1.1 per mil in seawater delta18O relative to the modern value caused by increased freshwater input and reduced salinity accompanying the formation of the most recent sapropel. The results additionally indicate the existence of isotopically light water circulating down to bottom water depths, at least in the western Mediterranean, supporting the existence of an 'anti-estuarine' thermohaline circulation pattern during Sapropel Event 1.

Stable isotope record of Uvigerina peregrina from the Mediterranean Sea

Based on the glacial to postglacial delta13C differences between endobenthic Uvigerina peregrina species from the Alboran basin and from other mediterranean basins, changes in the fertility of the western part of this basin during the last deglaciation are reconstructed. As a result of particulate organic carbon (POC) rain from the highly productive upwelling cell along the northwestern margin of the Alboran basin, U. peregrina is presently depleted by about 1.6per mil with respect to the measured delta13C values of bottom water SumCO2 and by about 0.9per mil with respect to specimens from other areas of the western Mediterranean or from the Gulf of Cadiz within the Mediterranean Outflow Water. The Uvigerina delta13C difference between the Alboran Sea and the Gulf of Cadiz (Delta delta13C), was close to 0per mil at the beginning of the last deglaciation and during the late glacial time. This suggests that highly fertile systems set in the Alboran Sea near 16 kyr B.P. Two rapid increases in the Delta delta13C offset are recorded near 15 kyr and 11 kyr B.P. Fluctuations around 1.1 to 1.2per mil occurred during the early Holocene, and a maximum was reached near 9 kyr B.P. After 4 kyr the Delta delta13C offset decreased to its present-day average value of 0.9per mil. Changes in the intensity of surficial production cannot account for all the observed fluctuations, especially in the early Holocene time. A strong decrease in the intermediate and deep water ventilation of the Alboran basin may have occurred near 8-9 kyr, in phase with the last stagnant phase in the eastern Mediterranean and the deposition of Sapropel S1. As a result, the redistribution and remineralization at depth of the produced organic matter was incomplete. The POC rain reaching the sediment was locally intensified and caused the lowering of the delta13C values of endobenthic foraminifers such as U. peregrina. The benthic 13C signal suggests that the difference between the Alboran Sea and the Gulf of Cadiz was at its maximum. At the same time, an important modification in the water masses structure may have occurred near 9-8 kyr B.P. The deepening of the permanent pycnocline probably related to a thicker Atlantic jet at a stage of high sea level stand is recorded by the replacement of the right coiling N. pachyderma dominance (coincident with a shallow pycnocline) by the G. inflata dominance (coincident with a deep pycnocline). Diatom abundances were strongly reduced indicating an important modification of the productive system. The glacial-postglacial evolution of productivity within the Alboran basin was therefore more complex than in the adjacent Atlantic Ocean and opposite to the global one which displays a general increase in productivity during glacial time. Although it is the global budget of paleoproductivity that would drive the partitioning of carbon within the ocean, local or regional discrepancies with the global glacial-interglacial model must be addressed. Local winds and regional atmospheric pressure systems, which are the forcing factors for circulation and exchange with the Atlantic, control the fertile systems of the Alboran basin.

Questioning the merits and demerits of electronic communication in Social Work

This paper examines the social dynamics of electronic exchanges in the human services, particularly in social work. It focuses on the observable effects that email and texting have on the linguistic, relational and clinical rather than managerial aspects of the profession. It highlights how electronic communication is affecting professionals in their practice and learners as they become acculturated to social work. What are the gains and losses of the broad use of electronic devices in daily lay and professional, verbal and non-verbal communication? Will our current situation be seriously detrimental to the demeanor of future practitioners, their use of language, and their ability to establish close personal relationships? The paper analyzes social work linguistic and behavioral changes in light of the growth of electronic communication and offers a summary of merits and demerits viewed through a prism emerging from Baron’s (2000) analysis of human communication.

Inverse Association Between Gluteofemoral Obesity and Risk of Barrett's Esophagus in a Pooled Analysis

BACKGROUND & AIMS: Gluteofemoral obesity (determined by measurement of subcutaneous fat in hip and thigh regions) could reduce risks of cardiovascular and diabetic disorders associated with abdominal obesity. We evaluated whether gluteofemoral obesity also reduces risk of Barrett's esophagus (BE), a premalignant lesion associated with abdominal obesity.

METHODS: We collected data from non-Hispanic white participants in 8 studies in the Barrett's and Esophageal Adenocarcinoma Consortium. We compared measures of hip circumference (as a proxy for gluteofemoral obesity) from cases of BE (n=1559) separately with 2 control groups: 2557 population-based controls and 2064 individuals with gastroesophageal reflux disease (GERD controls). Study-specific odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using individual participant data and multivariable logistic regression and combined using random effects meta-analysis.

RESULTS: We found an inverse relationship between hip circumference and BE (OR per 5 cm increase, 0.88; 95% CI, 0.81-0.96), compared with population-based controls in a multivariable model that included waist circumference. This association was not observed in models that did not include waist circumference. Similar results were observed in analyses stratified by frequency of GERD symptoms. The inverse association with hip circumference was only statistically significant among men (vs population-based controls: OR, 0.85; 95% CI, 0.76-0.96 for men; OR, 0.93; 95% CI, 0.74-1.16 for women). For men, within each category of waist circumference, a larger hip circumference was associated with decreased risk of BE. Increasing waist circumference was associated with increased risk of BE in the mutually adjusted population-based and GERD control models.

CONCLUSIONS: Although abdominal obesity is associated with increased risk of BE, there is an inverse association between gluteofemoral obesity and BE, particularly among men.

Staff training in autism: The one-eyed wo/man….

Having well-trained staff is key to ensuring good quality autism services, especially since people affected with autism generally tend to have higher support needs than other populations in terms of daily living as well as their mental and physical health. Poorly-trained staff can have detrimental effects on service provision and staff morale and can lead to staff burn-out as well as increased service user anxiety and stress. This paper reports on a survey with health, social care, and education staff who work within the statutory autism services sector in the UK that explored their knowledge and training with regards to autism. Interview data obtained from staff and service users offer qualitative illustrations of survey findings. Overall, the findings expose an acute lack of autism specific training that has detrimental impacts. At best this training was based on brief and very basic awareness raising rather than on in-depth understanding of issues related to autism or skills for evidence-based practice. Service users were concerned with the effects that lack of staff training had on the services they received. The paper concludes with a discussion of policy routes to achieving quality staff training based on international best practice. The focus is on improving the quality of life and mental health for services users and staff as well as making potentially significant cost-savings for governments.

A Strategy for Maternity Care in Northern Ireland 2012-2018

DHSSPS has carried out a review of policy on maternity service provision in Northern Ireland. The review focused on the best available evidence for the care and treatment of mothers-to-be; quality, safety and service sustainability; wider workforce issues; and professional roles and responsibilities. As a result, a draft strategy was developed, which was the subject of a public consultation from 28 September 2011 to 23 January 2012. Following an analysis of the responses to the consultation, the final strategy, A Strategy for Maternity Care in Northern Ireland 2012-2018, was published on 2 July 2012. The Strategy is outcomes focused. The six outcomes are:- give every baby and family the best start in life; effective communication and high-quality maternity care; healthier women at the start of pregnancy (preconception care); effective, locally accessible, antenatal care and a positive experience for prospective parents; safe labour and birth (intrapartum) care with improved experiences for mothers and babies; and appropriate advice, and support for parents and baby after birth The strategy aims to provide women and their partners, HSC staff, commissioners and policy makers with a clear pathway for maternity care in Northern Ireland from pre conceptual care through to postnatal care. Within the document, twenty two objectives have been identified which link to the six outcomes identified above. The HSC Board and Public Health Agency will co-lead on implementation. An action plan will be developed to take account of the outcomes and objectives listed in the document. The Department will receive an annual report on progress towards implementation.

Understanding Suicide and Help-seeking in Urban and Rural Areas in Northern Ireland

Funded by HSC R&D Division, Public Health Agency Why did we start? Most people who complete suicide are in contact with their family doctors or other services in the months prior to death. A better understanding of the nature of these contacts and the various pathways experienced by suicidal people should reveal the gaps and barriers to effective service provision. We also need better information about the difficulties experienced by family carers, both prior to the death and afterwards. Of particular interest to policy makers in Northern Ireland was a concern that people from rural areas may be at increasing risk of suicide. We were commissioned by the Health and Social Care R&D Division of the Northern Ireland Public Health Agency to address the gaps in our understanding of suicide in NI. What did we do? We undertook a mixed methods study in which we examined the records of 403 people who took their own lives over a two-year period between March 2007 and February 2009. We linked these data to GP records and then examined help-seeking pathways of people and their contacts with services. We did in-depth face-to-face interviews with 72 bereaved relatives and friends who discussed their understanding of the events and circumstances surrounding the death, the experience of seeking help for the family member, the personal impact of the suicide, and use of support services. Additionally, we interviewed 19 General Practitioners about their experiences of managing people who died by suicide.            

Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114). RESULTS: There were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use. CONCLUSIONS: Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods. TRIAL REGISTRATION: Clinicaltrials.gov NCT01827995.

Exploring the Experiences of Community-based Children's Nurses Providing Palliative Care

Aim: To explore the experiences of community children’s nurses (CCNs) and children’s palliative care nurses (CPCNs) who provide end-stage palliative care to children with cancer in the family home. Method: A qualitative approach was adopted. One-to-one interviews and facilitated case discussions were undertaken with 30 community nurses who had provided palliative care to a child or young person with cancer. A grounded theory approachwas used for data analysis. Findings: Because of the relative rarity of childhood cancer many CCNs and CPCNs engage infrequently in the palliative care of children or young people. This makes it difficult for them to develop and maintain knowledge and skills. There is a variation in the out-of-hours service provision available to families. Conclusion: Further funding is needed to develop teams of trained, experienced CCNs and CPCNs who can provide palliative care for children and young people 24 hours a day and 365 days a year. Keywords Community nursing, oncology, out-of-hours services, palliative care

Providing Palliative Care for the Child with Cancer: The Experience of GPs

Background Childhood cancers are rare and general practitioners (GPs) have limited experience in caring for these children and even less in providing their palliative care. Most families prefer that their child is cared for at home in the palliative phase of their illness, with professional support from those known to them (Chambers and Oakhill 1995, Vickers and Carlisle 2000, Craft and Killen 2007). A community based qualitative study examined the experiences of ten GPs following their involvement in the care of a child with cancer receiving palliative care within the family home. Methods Data collection was through 1:1 in-depth interviews and facilitated case discussion supported by field notes and grounded theory analysis (chronological comparative data analysis identifying generated themes). Social worlds theory was used as a framework to aid examination, and facilitate critical understanding, of the experiences of the GPs. Findings This presentation focuses on five of the findings relating to the experiences of the GP; the impact of minimal contact; lack of knowledge and experience, uncertain role, out of hours service provision and the emotional toll. Findings highlighted that GPs often have to re-establish their role at the child’s transition to palliative care. Factors hindering the GP in this process include a deficit of specialist knowledge and experience of paediatric palliative care and lack of role clarity. Conclusions/points of interest Strategies for enhancing the role of the Macmillan team in supporting GPs have been identified by this study, such as enhanced collaborative working. Findings have also provided further confirmation of the substantial variation in out of hours medical palliative care provision; with evidence that some GPs work beyond their remit in providing informal out of hours care. This presentation details the findings of one aspect (the experiences of GPs) of a wider study that explored the experiences of 54 community based health professionals (GPs, community nurses and allied health professionals) who had been involved in caring for a dying with cancer receiving palliative care at home (Neilson 2009).

Estudo numérico do impacto das emissões veiculares e fixas da cidade de Manaus nas concentrações de poluentes atmosféricos da região amazônica

The main aim of this study was to evaluate the impact of the urban pollution plume from the city of Manaus by emissions from mobile and stationary sources in the atmospheric pollutants concentrations of the Amazon region, by using The Weather Research and Forecasting with Chemistry (WRF-Chem) model. The air pollutants analyzed were CO, NOx, SO2, O3, PM2.5, PM10 and VOCs. The model simulations have been configured with a grid spacing of 3 km, with 190 x and 136 y grid points in horizontal spacing, centered in the city of Manaus during the period of 17 and 18 of March 2014. The anthropogenic emissions inventories have gathered from mobile sources that were estimated the emissions of light and heavy-duty vehicles classes. In addition, the stationary sources have considered the thermal power plants by the type of energy sources used in the region as well as the emissions from the refinery located in Manaus. Various scenarios have been defined with numerical experiments that considered only emissions by biogenic, mobile and stationary sources, and replacement fuel from thermal power plant, along with a future scenario consisting with twice as much anthropogenic emissions. A qualitative assessment of simulation with base scenario has also been carried out, which represents the conditions of the region in its current state, where several statistical methods were used in order to compare the results of air pollutants and meteorological fields with observed ground-based data located in various points in the study grid. The qualitative analysis showed that the model represents satisfactorily the variables analyzed from the point of view of the adopted parameters. Regarding the simulations, defined from the base scenarios, the numerical experiments indicate relevant results such as: it was found that the stationary sources scenario, where the thermal power plants are predominant, resulted in the highest concentrations, for all air pollutants evaluated, except for carbon monoxide when compared to the vehicle emissions scenario; The replacement of the energy matrix of current thermal power plants for natural gas have showed significant reductions in pollutants analyzed, for instance, 63% reductions of NOx in the contribution of average concentration in the study grid; A significant increase in the concentrations of chemical species was observed in a futuristic scenario, reaching up to a 81% increase in peak concentrations of SO2 in the study area. The spatial distributions of the scenarios have showed that the air pollution plume from Manaus is predominantly west and southwest, where it can reach hundreds of kilometers to areas dominated by original soil covering.

FluxEngine: A flexible processing system for calculating atmosphere-ocean carbon dioxide gas fluxes and climatologies

The air-sea flux of greenhouse gases (e.g. carbon dioxide, CO2) is a critical part of the climate system and a major factor in the biogeochemical development of the oceans. More accurate and higher resolution calculations of these gas fluxes are required if we are to fully understand and predict our future climate. Satellite Earth observation is able to provide large spatial scale datasets that can be used to study gas fluxes. However, the large storage requirements needed to host such data can restrict its use by the scientific community. Fortunately, the development of cloud-computing can provide a solution. Here we describe an open source air-sea CO2 flux processing toolbox called the ‘FluxEngine’, designed for use on a cloud-computing infrastructure. The toolbox allows users to easily generate global and regional air-sea CO2 flux data from model, in situ and Earth observation data, and its air-sea gas flux calculation is user configurable. Its current installation on the Nephalae cloud allows users to easily exploit more than 8 terabytes of climate-quality Earth observation data for the derivation of gas fluxes. The resultant NetCDF data output files contain >20 data layers containing the various stages of the flux calculation along with process indicator layers to aid interpretation of the data. This paper describes the toolbox design, the verification of the air-sea CO2 flux calculations, demonstrates the use of the tools for studying global and shelf-sea air-sea fluxes and describes future developments.