Home care programs have become integral parts of the overall health service system in Canada and in many other developed nations. Resource allocation decision-making by home care case managers (CM) ...is a complex task where CMs are challenged to meet the dual responsibilities for clients, in order that they achieve high quality care, and to the system to contain costs. The purpose of this study was to extend what is known about resource allocation decision-making factors identified in a previous systematic literature review and ethnographic study within a high needs pediatric context conducted by the principal investigator in Western Canada. Spradley’s ethnoscience method was used in this research. The study sample consisted of 17 home care CMs, professional practice leads, and their managers from two separate home care offices. All participating CMs had assigned caseloads and were involved in the assessment and implementation of care planning for clients. Purposive sampling methods were employed. In keeping with Spradley’s ethnoscience approach, data collection occurred in three distinct phases or rounds. The first round of data collection began with a series of one-on-one interviews with card sorts, the second round of data collection was another series of one-on-one interviews with CMs who were not interviewed in the prior round, and the third and final round of data collection was a focus group to accomplish further refinement and verification of our established categories. Participants identified five categories of factors that effected their resource allocation decision-making. The categories were related to one of five main areas: the client, the CM, the home care program, community resources, or the health care system. The findings of this study reinforced the complexity of CM resource allocation decision-making in home care. This study provides new insights into CM resource allocation decision-making based on multidisciplinary, integrated home care teams caring for adults, the majority of whom are 65 years and older. This study also provides the comparison of taxonomy that differs between pediatric and adult home care populations that influence resource allocation decision-making.
One of the greatest challenges for healthcare systems is the management and prevention of chronic diseases. Wagner's Chronic Care Model aims to transform the daily care of patients with chronic ...illnesses from acute and reactive to proactive, planned, and population-based. The purpose of this article is to provide a review of the available research relating to the Chronic Care Model and consider the implications for Home Care Case Management practice. A total of 18 research studies (5 qualitative and 13 quantitative) were reviewed. A thematic content analysis approach was used. The findings included three themes: Chronic Care Model and positive chronic illness health behaviors and outcomes; Chronic Care Model and delivery of quality chronic illness care; and the importance of the supportive role of the home care nurse in the role of Home Care Case Management. Gaps and limitations of the Chronic Care Model in relation to Home Care Case Management were identified and discussed in relationship to partnership building and reciprocal trust between patients, family caregivers, and the Home Care Case Manager. Finally, implications for the use of the Chronic Care Model in Home Care Case Manager practice, policy development, and future research were presented.
Each human genome includes de novo mutations that arose during gametogenesis. While these germline mutations represent a fundamental source of new genetic diversity, they can also create deleterious ...alleles that impact fitness. Whereas the rate and patterns of point mutations in the human germline are now well understood, far less is known about the frequency and features that impact de novo structural variants (dnSVs). We report a family-based study of germline mutations among 9,599 human genomes from 33 multigenerational CEPH-Utah families and 2,384 families from the Simons Foundation Autism Research Initiative. We find that de novo structural mutations detected by alignment-based, short-read WGS occur at an overall rate of at least 0.160 events per genome in unaffected individuals, and we observe a significantly higher rate (0.206 per genome) in ASD-affected individuals. In both probands and unaffected samples, nearly 73% of de novo structural mutations arose in paternal gametes, and we predict most de novo structural mutations to be caused by mutational mechanisms that do not require sequence homology. After multiple testing correction, we did not observe a statistically significant correlation between parental age and the rate of de novo structural variation in offspring. These results highlight that a spectrum of mutational mechanisms contribute to germline structural mutations and that these mechanisms most likely have markedly different rates and selective pressures than those leading to point mutations.
The purpose of this scoping review was to explore peer-reviewed research and gray literature to examine the extent, range, and nature of available research that describes how home care case managers ...(HCCMs) provide integrated care for older adults with multiple chronic conditions (MCCs); identify how case management standards of practice correspond with functions of integrated care; identify facilitators and barriers to case management and integrated care delivery; and propose a framework to describe how HCCMs can use case management standards to provide integrated care to older adults with MCCs.
Community, home care settings.
Scoping review; older adults older than 65 years with MCCs, case managers and health care professionals who provide care for older adults with MCCs.
The study findings demonstrated that HCCMs consistently used the case management standards assessment, planning, implementation, and evaluation to provide all professional and clinical integrated care functions, and were least likely to use the standards of identification of client and eligibility for case management and transition to provide professional and clinical integrated care functions. In addition, HCCM use of professional and clinical integrated care functions was inconsistent and varied based on use of case management standards. All case management standards and integrated care functions were found to be both facilitators and barriers, but were more likely to facilitate HCCM work. Interestingly, the standards of assessment, planning, and implementation were more likely to facilitate functional integration, whereas the integrated care functions of intra- and interpartnerships, shared accountability, person centered of care, and engagement for client self-management were more likely to facilitate normative integration. We also found that HCCMs use case management standards and integrated care functions to provide care for older adults with MCCs at the professional (meso) and clinical (micro) levels.
Variations in HCCM practice may impact the delivery of case management standards when caring for older adults with MCCs. This has implications for the comprehensiveness and consistency of HCCM practice, as well as interdisciplinary health professional and the client's awareness of the HCCM role when providing integrated care to older adults with MCCs within home settings. The greatest facilitators and barriers to integrated care are those case management standards and clinical and professional integrated care functions that focus on partnerships, collective and shared responsibility and accountability, coordinated person centered of care for clients, and ensuring engagement and partnership in self-management. This indicates the need for development of case management policies and programs that support the work of HCCMs in the delivery of seamless and collaborative case management and integrated care functions that foster collaboration and partnership-building efforts. The development of a new case management and integrated care conceptual framework that includes case management standards, professional and clinical integrated care functions would guide HCCM integrated care practice, policy and research to support client and family-centered care, and foster shared values for sustainable partnerships across care settings.
Idiopathic juxtafoveal retinal telangiectasis type 2 (macular telangiectasia type 2; MacTel) is a rare neurovascular degenerative retinal disease. To identify genetic susceptibility loci for MacTel, ...we performed a genome-wide association study (GWAS) with 476 cases and 1,733 controls of European ancestry. Genome-wide significant associations (P < 5 × 10
) were identified at three independent loci (rs73171800 at 5q14.3, P = 7.74 × 10
; rs715 at 2q34, P = 9.97 × 10
; rs477992 at 1p12, P = 2.60 × 10
) and then replicated (P < 0.01) in an independent cohort of 172 cases and 1,134 controls. The 5q14.3 locus is known to associate with variation in retinal vascular diameter, and the 2q34 and 1p12 loci have been implicated in the glycine/serine metabolic pathway. We subsequently found significant differences in blood serum levels of glycine (P = 4.04 × 10
) and serine (P = 2.48 × 10
) between MacTel cases and controls.
LAY SUMMARY
Homelessness is a problem among female Canadian Veterans. Approximately 15% of the Canadian Veteran population is female, yet female Veterans constitute approximately 30% of the homeless ...Canadian Veteran population. In response, the Standing Committee on Veterans Affairs has called for the investigation of homelessness among female Canadian Veterans to address this research gap. A scoping review was conducted on the lived experiences of homeless female Veterans to identify factors associated with homelessness. This review was the initial step in a larger research framework to investigate the lived experiences of homeless Canadian female Veterans. Fifteen articles met the inclusion criteria and were included for synthesis. Four themes were identified, corresponding with the period in which they occurred (pre-military service, post-military service, during military service, and across the lifespan). Several implications are clear. First, Canadian research on female Veteran homelessness is needed. Second, future research must use a framework that accounts for multifactorial and multi-dimensional issues, as well as a sex- and gender-based analysis lens.
Introduction: The proportion of Canadian female Veterans who are homeless is greater than that of their male counterparts. The Standing Committee on Veterans Affairs recommended research be conducted to better understand Canadian female Veteran homelessness. In response to this recommendation, this scoping review of peer-reviewed literature and grey literature was undertaken as a first step to identify the existing literature exploring homelessness among female Veterans. Methods: A scoping review of the literature was performed, focusing on the risk factors and lived experiences associated with homelessness among female Veterans. Articles were screened for relevance and critically appraised. Results: A total of 927 studies were retrieved. Nine articles were added from additional sources. After a two-phase screening approach, 15 studies were included for analysis. All studies were from the United States. Several risk factors for homelessness were identified for female Veterans across their lifespan: adverse childhood events, abuse, family upheaval, military sexual trauma, intimate partner violence, substance use, physical and mental health diagnoses, race and racism, and gender discrimination. Discussion: This scoping review illustrates that a paucity of literature exists on the life experiences of Canadian female Veterans who are homeless. However, it identified several important themes that can guide future research focused on understanding the risk factors contributing to homelessness for this population. Furthermore, a critical analysis of existing literature illustrated the need for research focused on the interactions among social location, historical experience, and socio-demographic characteristics to more fully understand the risk factors that influence being homeless.
How the Venus flytrap (Dionaea muscipula) evolved the remarkable ability to sense, capture, and digest animal prey for nutrients has long puzzled the scientific community.
Recent genome and ...transcriptome sequencing studies have provided clues to the genes thought to play a role in these tasks.
However, proving a causal link between these and any aspect of the plant's hunting behavior has been challenging due to the genetic intractability of this non-model organism. Here, we use CRISPR-Cas9 methods to generate targeted modifications in the Venus flytrap genome. The plant detects prey using touch-sensitive trigger hairs located on its bilobed leaves.
Upon bending, these hairs convert mechanical touch signals into changes in the membrane potential of sensory cells, leading to rapid closure of the leaf lobes to ensnare the animal.
Here, we generate mutations in trigger-hair-expressed MscS-like (MSL)-family mechanosensitive ion channel genes FLYCATCHER1 (FLYC1) and FLYCATCHER2 (FLYC2)
and find that double-mutant plants have a reduced leaf-closing response to mechanical ultrasound stimulation. While we cannot exclude off-target effects of the CRISPR-Cas9 system, our genetic analysis is consistent with these and other functionally redundant mechanosensitive ion channels acting together to generate the sensory system necessary for prey detection.
LAY SUMMARY This study examines relationships between military rank at release and various health indicators among Canadian Veterans, separately for males and females. These results provide new ...information about Veterans at greater risk of negative health outcomes, which could be used for targeted military health promotion as well as Veteran outreach and service delivery planning.
Introduction: Military rank influences individuals’ work tasks and experiences and may also relate to their broader life experience. This study examined relationships between military rank at release and various health indicators among male and female Veterans. Methods: Data were obtained from the 2019 Life After Service Survey, a national study of Canadian Veterans released from Canadian Armed Forces Regular Force service between 1998 and 2018. The analytic sample included 2,118 male and 288 female Veterans. Individual logistic regression models were used to calculate odds ratios by rank category and each health variable by sex. Results: For all health outcomes with significant associations, officers fared better than junior and senior non-commissioned members (NCMs). Both senior and junior NCM ranks fared more poorly than officers in self-rated health fair or poor (males and females), chronic obstructive pulmonary disease (males), back problems (males), arthritis (males), stomach ulcer (males), diabetes (males), migraine (males), hearing problems (males), urinary incontinence (females), chronic pain (males and females), self-rated mental health fair or poor (males and females), mood disorder (males), anxiety (males and females), posttraumatic stress disorder (males), and suicidal ideation (males). Significant associations for senior NCM rank only were observed for arthritis (females) and hearing problems (females). A significant association for junior NCM rank only was observed for asthma (males). Discussion: This study highlights the importance of rank and sex in Veteran research and identifies groups at potentially greater risk of negative health outcomes. These findings may inform the development of targeted, sex-specific military health promotion and Veteran services.
Deep sequencing of ribosome protected mRNA footprints, also called ribosome profiling or Ribo-Seq, is a relatively new methodology well suited to address questions regarding the mechanisms and ...efficiency of protein expression. Specifically, the ability of this technique to quantify ribosome abundance with codon resolution enables experiments aimed at studying many aspects of translation, including gene-specific translational efficiency, translation of regulatory upstream short open reading frames, sites of ribosome pausing, and most importantly for selenoproteins, the efficiency by which UGA codons are redefined to encode selenocysteine. Here, we describe a streamlined protocol that was developed in our lab to process mammalian tissue to produce the requisite matched ribosome profiling and RNA-Seq libraries for deep sequencing.
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