Developmental care for high-risk newborns:Emerging science, clinical application, and continuity from newborn intensive care unit to community

Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.

Analyzing longitudinal continuity and change in public sector organizations

This article provides the introduction to a special edition that presents for the first time a series of detailed country case studies concerned with the matter of organizational life cycles. Building on some recent scholarship, it begins by surveying the development of the field, before setting out some of the key methodological and theoretical issues and challenges involved in adopting a longitudinal perspective to the study of organizational change. It proposes that by capturing the variety of ways in which public sector organizations emerge, survive, and terminate, new perspectives on how administrative systems evolve can be presented and compared. © Taylor & Francis Group, LLC.

Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients

Background: Previous end-of-life cancer research has shown an association between increased family physician continuity of care and reduced use of acute care services; however, it did not focus on a homecare population or control for homecare nursing.

Aim: Among end-of-life homecare cancer patients, to investigate the association of family physician continuity with location of death and hospital and emergency department visits in the last 2 weeks of life while controlling for nursing hours.

Design: Retrospective population-based cohort study.

Setting/participants: Cancer patients with ≥1 family physician visit in 2006 from Ontario, Canada. Family physician continuity of care was assessed using two measures: Modified Usual Provider of Care score and visits/week. Its association with location of death and hospital and emergency department visits in the last 2 weeks of life was examined using logistic regression.

Results: Of 9467 patients identified, the Modified Usual Provider of Care score demonstrated a dose-response relationship with increasing continuity associated with decreased odds of hospital death and visiting the hospital and emergency department in the last 2 weeks of life. More family physician visits/week were associated with lower odds of an emergency department visit in the last 2 weeks of life and hospital death, except for patients with greater than 4 visits/week, where they had increased odds of hospitalizations and hospital deaths.

Conclusions: These results demonstrate an association between increased family physician continuity of care and decreased odds of several acute care outcomes in late life, controlling for homecare nursing and other covariates.©The Author(s) 2013 Reprints and permissions sagepub.co.uk/journalsPermissions.nav.

Impact of composite ply continuity constraints on aerospace stiffened panel design

Considering the development of aerospace composite components, designing for reduced manufacturing layup cost and structural complexity is increasingly important. While the advantage of composite materials is the ability to tailor designs to various structural loads for minimum mass, the challenge is obtaining a design that is manufacturable and minimizes local ply incompatibility. The focus of the presented research is understanding how the relationships between mass, manufacturability and design complexity, under realistic loads and design requirements, can be affected by enforcing ply continuity in the design process. Presented are a series of sizing case studies on an upper wing cover, designed using conventional analyses and the tabular laminate design process. Introducing skin ply continuity constraints can generate skin designs with minimal ply discontinuities, fewer ply drops and larger ply areas than designs not constrained for continuity. However, the reduced design freedom associated with the addition of these constraints results in a weight penalty over the total wing cover. Perhaps more interestingly, when considering manual hand layup the reduced design complexity is not translated into a reduced recurring manufacturing cost. In contrast, heavier wing cover designs appear to take more time to layup regardless of the laminate design complexity. © 2012 AIAA.