Creative cross-sectoral collaboration: a conceptual framework of factors influencing partnerships for arts, health and wellbeing.

OBJECTIVES: The objective of this study was to investigate the factors impacting cross-sectoral collaboration in arts, health and wellbeing programme, policy and strategy development in South West England. STUDY DESIGN: The study used a participatory action research approach and qualitative methods in the context of a broader effort to develop a regional arts, health and wellbeing strategy. METHODS: Data collection methods included participant observation, semi-structured interviews, a focus group and feedback collected through collaborative online discussion documents. Data were coded using qualitative data analysis software and analysed using thematic analysis. Data were used inductively to develop the conceptual framework of key factors influencing cross-sectoral collaboration in arts, health and wellbeing. RESULTS: Seven key factors that affect cross-sectoral collaboration for arts, health and wellbeing activities were derived from the data and analysis: value and legitimacy, relationships, policy and system complexity, power, capacity, resources and alignment. A conceptual framework shows how these factors relate to each other in multiple configurations and shape cross-sectoral collaborations. CONCLUSIONS: There are increasing opportunities for organisations to partner on arts, health and wellbeing activities. This study highlights key factors influencing the ability to collaborate across sectors and to align with local and national policy agendas. The proposed conceptual framework offers a way to think holistically about how to design for and manage these collaborations.

Theory of mind, empathy and emotion perception in cortical and subcortical neurodegenerative diseases.

Although the impact of neurodegenerative diseases on everyday interactions is well known in the literature, their impact on social cognitive processes remains unclear. The concept of social cognition refers to a set of skills, all of which are essential for living in a community. It involves social knowledge, perception and processing of social cues, and representation of mental states. This report is a review of recent findings on the impact of cortical and subcortical neurodegenerative diseases on three social cognitive processes, namely, the theory of mind, empathy and processing emotions. The focus here is on a conceptual approach to each of these skills and their cerebral underpinnings.

Technical note: Comparison of two methods to quantify exercise energy expenditure in trotters.

This study aimed at quantifying energy expenditure during 4 specific training exercises, that is, promenade, jogging, parcours, and interval exercises, using field measurements of oxygen consumption and heart rate in trotters. Six animals performed 2 preliminary tests to determine their individual maximum velocity and to establish their individual oxygen consumption/heart rate relationship from an incremental test. Then, they undertook each of the 4 specific exercises separated by 1 wk to avoid fatigue. The intensity of the 4 exercises was expressed in percent of individual maximum velocity as well as duration and distance set according to current training practices of French trotter trainers. Throughout the incremental test and the 4 exercises, oxygen consumption and heart rate were continuously recorded using a portable respiratory gas analyzer. Energy expenditure of the 3 different phases (warm-up, exercise, and recovery) of the 4 exercises and the total energy expended during exercises (sum of energy expended during the 3 phases) were calculated from direct oxygen uptake measurements and from estimated oxygen uptake using heart rate and O caloric equivalent. The quantification of total energy expenditure from the 2 methods was not significantly different. However, estimated energy expenditure was significantly lower from estimated oxygen consumption than direct oxygen uptake method concerning the warm-up and exercise phase of parcours. Our results indicate that the estimated oxygen uptake from heart rate measurements could be used to evaluate total energy expenditure of exercises in trotters. Whereas this method requires previous establishment of an individual oxygen consumption/heart rate curve, it is easy to record using commercially available instruments under practical conditions and opens new perspectives to assess energy balance in trotters' nutrition.

Quantification of the energy expenditure during training exercises in Standardbred trotters.

An appropriate energy feeding management that ensures the optimal dietary energy supply according to the energy expenditure (EE) is a crucial component for the horse's performance. The main purpose of this study was to determine the EE during four specific exercises used in the training of Standardbred trotters (promenade, jogging, parcours and interval work-outs). A total of six Standardbred geldings performed four different testing situations on a track. The intensity (expressed in percentage of the maximal velocity over 500 m, i.e. v500) and volume (distance and duration) of the testing situations were determined according to practices reported by French trainers. Promenade and jogging included only an exercise phase, whereas parcours and interval situations also included a warm-up and a recovery phase. Oxygen uptake (VO2), carbon dioxide production (VCO2) and heart rate (HR) were continuously recorded from 2 min before the beginning through to the end of the testing situations, using a portable respiratory gas analyser. Blood lactate levels and rectal temperature were determined before and immediately after the exercise phase of each testing situations. EE of the different phases (warm-up, exercise and recovery) and EE of the entire testing situations (EETOTAL) were calculated from VO2 measurements and the O2 caloric equivalent. Interval and parcours situations induced higher physiological responses than promenade and jogging situations, particularly in terms of VO2peak, VCO2peak and HRpeak. The highest blood lactate concentration (6 mmol/l) was measured after the interval exercise, and respiratory exchange ratios ⩾1 were observed only for the parcours situation. The EE of exercise phase varied from 0.49 to 1.79 kJ/min per kg for promenade and parcours situations. The EE of warm-up and recovery phases did not differ between parcours and interval situations, and was estimated at 1.04 and 0.57 kJ/min per kg BW, respectively. On average, the warm-up and the recovery phases contributed to 38% and 19% of the EETOTAL. For promenade, jogging, parcours and interval situations, EETOTAL was evaluated at 12 618, 11 119, 13 698 and 18 119 kJ, respectively.

Effects of two field continuous incremental tests on cardiorespiratory responses in Standardbred trotters.

In humans, cardiorespiratory responses are widely evaluated from field incremental exercise tests. On the contrary, equine exercise physiology faces a huge lack of oxygen consumption measurements (VO2) in field conditions due to technical concerns. The aim of this study was to test the effects of two incremental continuous field tests on cardiorespiratory responses in Standardbred trotters. The two protocols were realized at trot and ended when horses galloped. The tests started at 4.2 m/s (T1) and 6.4 m/s (T2), with speed increments of 1.4 m/s every 3 min for T1 and 0.8 m/s every 2 min for T2. Velocity (v), heart rate (HR) and gas exchanges were recorded continuously, and blood lactate concentration [La(-)] was measured before and after tests. Values recorded at the end of the tests were considered as peak values. The vpeak values were 10.6 ± 0.3 and 10.7 ± 0.7 m/s for T1 and T2 respectively. Horses reached higher VO2peak (T1: 116.6 ± 11.5 ml/min/kg; T2: 88.9 ± 10.2 ml/min/kg; p < 0.05) and HRpeak (T1: 217 ± 5 bpm; T2: 209 ± 3 bpm; p < 0.05) during T1 compared with T2. T1 was significantly longer than T2 (17.5 ± 1.9 vs. 12.9 ± 1.6 min respectively, p < 0.01), and the number of steps entirely ran tended to be different (T1: 5.6 ± 0.6; T2: 6.2 ± 0.8, p = 0.07). Compared to T2, the design of T1 appeared easier to implement and allowed higher cardiorespiratory responses. The relationship between HR-VO2 obtained through T1 gave a better correlation between the two variables than T2. These findings suggest that T1 might be better than T2 for evaluating cardiorespiratory adaptations to exercise and for estimating aerobic energy expenditure in exercising trotters.

POU4F1 is associated with t(8;21) acute myeloid leukemia and contributes directly to its unique transcriptional signature.

The t(8;21)(q22;q22) translocation, present in approximately 5% of adult acute myeloid leukemia (AML) cases, produces the AML1/ETO (AE) fusion protein. Dysregulation of the Pit/Oct/Unc (POU) domain-containing transcription factor POU4F1 is a recurring abnormality in t(8;21) AML. In this study, we showed that POU4F1 overexpression is highly correlated with, but not caused by, AE. We observed that AE markedly increases the self-renewal capacity of myeloid progenitors from murine bone marrow or fetal liver and drives the expansion of these cells in liquid culture. POU4F1 is neither necessary nor sufficient for these AE-dependent properties, suggesting that it contributes to leukemia through novel mechanisms. To identify targets of POU4F1, we performed gene expression profiling in primary mouse cells with genetically defined levels of POU4F1 and identified 140 differentially expressed genes. This expression signature was significantly enriched in human t(8;21) AML samples and was sufficient to cluster t(8;21) AML samples in an unsupervised hierarchical analysis. Among the most highly differentially expressed genes, half are known AML1/ETO targets, implying that the unique transcriptional signature of t(8;21) AML is, in part, attributable to POU4F1 and not AML1/ETO itself. These genes provide novel candidates for understanding the biology and developing therapeutic approaches for t(8;21) AML.

Sleepiness/alertness among healthy evening and morning type individuals.

Objective: The aim of this study was to determine the level of sleepiness/alertness among different chronotypes.Background: The Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) has allowed the characterization of chronotypes that are associated with a number of biological factors including: body temperature, cortisol rhythm, sleep patterns, and architecture.Methods: Fifty-six consecutive normal volunteers underwent an 8-h polysomnogram followed by a multiple sleep latency test (MSLT). Each subject also completed the MEQ and the Sleep/Wake Activity Inventory.Results: Evening types (ET) reported significantly later bedtimes and risetimes than both morning types (MT) and neither types (NT, P<0.05). On nocturnal polysomnography, the ET documented significantly longer latencies to stage 1 and persistent sleep when compared to both the NT and MT (P<0.01). There were no significant differences in the level of sleepiness on the MSLT across the different chronotypes. However, the pattern of sleepiness differed among them. While ET and NT showed differential sleep latencies across nap opportunities, MT showed no evidence of circadian variation on their level of sleepiness.Conclusions: There were no overall differences in daytime sleepiness/alertness across chronotypes. However, a differential pattern of sleep latencies was noted on the MSLT.

Self-reported levels of sleepiness among subjects with insomnia.

Objectives: To determine the prevalence of sleepiness in a cohort of insomnia subjects. We evaluated if differential levels of subjective sleepiness predict systematic differences in the polysomnographic characteristics of these subjects.Background: Insomnia is prevalent among the adult population. While it has been speculated that sleepiness may be an important daytime consequence of insomnia, this has not been demonstrated.Methods: Sixty-two subjects with complaints of insomnia for at least 6 months were polysomnographically evaluated. Subjects were asked to self-report their level of sleepiness based on their experiences for the previous 7 days. Subjects were divided into three groups based on their level of sleepiness. Sleepiness was determined using the excessive daytime sleepiness scale of the Sleep/Wake Activity Inventory (SWAI-EDS).Results: Twenty-two percent of insomnia subjects were found to be sleepy on the EDS scale of the SWAI. The level of sleepiness was also found to predict difficulty initiating sleep both on the nocturnal scale of the SWAI, and on nocturnal polysomnography.Conclusions: This study established a base rate of sleepiness among a cohort of insomnia subjects. It also demonstrated a wide spectrum of sleepiness/alertness among subjects with insomnia. Differential levels of sleepiness were found to predict nocturnal sleep latencies.

Intraoperative vs postoperative morphine improves analgesia without increasing PONV on emergence from ambulatory surgery.

PURPOSE: To compare the timing of administration of morphine in patients undergoing painful ambulatory surgical procedures to determine whether there was a difference in postoperative nausea or vomiting (PONV), quality of analgesia, and recovery profile. METHODS: In a double-blinded, placebo-controlled, prospective study, 70 ASA I-II patients were randomized to receive 0.1 mg x kg(-1) morphine intraoperatively (lop) (n=35), or postoperatively (Pop) (n=35). The severity of nausea and pain were measured using visual analog scales (VAS). RESULTS: There was no difference between the groups in postoperative nausea scores or the incidence of PONV. Upon awakening, patients who received Pop morphine had higher pain VAS scores with movement (7.6 +/- 2 vs 5.4 +/- 3, P < 0.003) and at rest (6.9 +/- 3 vs 5.1 +/- 3, P < 0.013) than the lop morphine group. The total number of PCA attempts and analgesic requirements were similar. Patients who received Pop morphine were able to drink sooner than the lop group (90 +/- 34 vs 111 +/- 38 min, P < 0.05). All other recovery milestones were similar. Times to discharge from hospital were similar. CONCLUSIONS: Administration of 0.1 mg x kg(-1) morphine iv intraoperatively improves postoperative analgesia upon emergence from painful ambulatory surgical procedures without increasing the incidence of PONV There was no increase in PONV when morphine was administered intraoperatively rather than postoperatively.

Structural, relative, and absolute agreement between parents' and adolescent inpatients' reports of adolescent functional impairment.

This study assessed agreement between parents' and adolescent inpatients' scores on caretaker and self-report versions of the Functional Impairment Scale for Children and Adolescents (FISCA and FISCA-SR). Self-report data describing impairment in eight domains were collected from 375 inpatients (M age = 15.0 years, 55% females), with parent data available for 233 (62%). Confirmatory factor analysis demonstrated structural congruence between a hypothesized, three-factor model, based on a prior study of the parent FISCA, and an observed model, based on responses to the FISCA-SR (GFI = .95). Correlations (measuring relative agreement) and paired comparisons of means (assessing absolute agreement) generally identified stronger agreement in "public" than "private" domains of impairment, and greater relative than absolute agreement in covert, antisocial domains.

A comparison of midazolam, alfentanil and propofol for sedation in outpatient intraocular surgery.

PURPOSE: To determine the ideal sedative regimen for intraocular surgery under peribulbar or retrobulbar block. The addition of alfentanil and or propofol to midazolam was evaluated with regard to hemodynamic variables, respiratory rate, pain, anxiety, sedation, postoperative recovery and patient satisfaction. METHODS: Eighty two patients aged between 50 and 85 were recruited into this prospective, randomised, double blind study. Patients, in four groups, received 0.015 mg x kg(-1) midazolam, 5 microg x kg(-1) alfentanil and 0.15 mg x kg(-1) propofol; 0.015 mg x kg(-1) midazolam and 0.15 mg x kg(-1) propofol; 0.015 mg x kg(-1) midazolam and 5 microg x kg(-1) alfentanil or 0.015 mg x kg(-1) midazolam alone. Blood pressure, heart rate, respiratory rate, pain, anxiety and sedation scores were measured. Times to discharge from the Post Anesthesia Care Unit (PACU) and Day Surgery Unit (DSU) were documented. A 24 hr telephone interview was carried out to determine patient satisfaction. RESULT: Systolic blood pressure of patients in groups that had received alfentanil was 6% lower than that of patients who had not (P<0.05) at the time of insertion of intraocular block. Patients in the alfentanil groups also had lower respiratory rates during the first 15 min after drug administration, but all patients were given supplemental oxygen therefore oxygen saturation was unaffected. Pain scores of patients who had been given alfentanil were lower during the first postoperative hour than those who had not. CONCLUSION: The addition of alfentanil to midazolam is advantageous in providing sedation for insertion of intraocular block.

[Clinical case management of severely mentally ill homeless people.]. / Le suivi systématique clinique de personnes itinérantes souffrant de troubles mentaux graves et persistants.

The aim of this clinical case management project was to improve the health and quality of life of homeless mentally ill people and to help them use more appropriately health and welfare services. During a descriptive study that lasted 12 months, data was collected concerning the case manager's intervention as well as the assessment of these interventions on the clients' health and behavior and on community resources' services. Although limited in scope and length, the project shows some positive results. Recommendations are made concerning essential collaboration between all health and welfare professionals working with this population.

Tracheal resection and reconstruction.

PURPOSE: To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed. SOURCE: Articles obtained from a Medline search (1960 to October 1997; keywords: tracheal surgery, carinal surgery, airway management). Textbook literature including the bibliographies were also consulted. PRINCIPAL FINDINGS: Benign or malignant tracheal and carinal pathology causing obstruction can be managed in several ways but resection and reconstruction are the treatment of choice for most patients with tracheal stenosis or tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic consideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet ventilation, high frequency jet ventilation, distal tracheal intubation, spontaneous ventilation, and cardiopulmonary bypass. CONCLUSION: The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques for airway management is crucial. Meticulous planning and communication between the anesthesia and surgical teams are mandatory for the safe and successful outcome of surgery for patients undergoing this procedure.

The detection of brief daytime sleep episodes.

INTRODUCTION: In the present study we evaluated the characteristics of sleep-onset detection (during daytime nap opportunities) as a function of differing sleep lengths among healthy, asymptomatic subjects. METHODS: Twenty subjects were randomized into a Latin square design in which each subject received 1, 5, 10, and 20 minutes of sleep during an MSLT. Subjects were asked after each nap if they fell asleep. The rate of sleep detection was analyzed as a function of sleep duration. RESULTS: Three subjects detected sleep onset after 1 minute of sleep, 7 subjects after 5 minutes of sleep, 10 subjects after 10 minutes of sleep, and 14 after 20 minutes of sleep (chi 2 = 9.63, p < .05). CONCLUSIONS: The present data indicate the importance of sleep duration in an individual's ability to detect the occurrence of sleep. Importantly, only three subjects detected sleep after 1 minute of sleep, emphasizing the dangerous nature of brief sleep episodes in the context of public safety.

Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients.

OBJECTIVES: Many patients have limited English proficiency and require an interpreter. The authors evaluated the effect of current interpreting practices on Spanish-speaking patients' satisfaction with the patient-provider relationship. METHODS: A cross-sectional survey was conducted of 457 patients seen in a public hospital emergency department. Measures were satisfaction with the provider's friendliness, respectfulness, concern, ability to make the patient comfortable, and time spent for the exam. RESULTS: A total of 237 patients communicated adequately with their provider without the use of an interpreter (group 1), 120 patients communicated through an interpreter (88% of whom were ad hoc interpreters; group 2), and 100 patients communicated directly with the provider but said an interpreter should have been called (group 3). Compared with patients in group 1, patients who communicated through an interpreter (group 2) rated their provider as less friendly, less respectful, less concerned for the patient as a person, and less likely to make the patient comfortable. Patients who said an interpreter should have been called (group 3) had the lowest satisfaction ratings; compared with group 2, they were less satisfied with their provider's friendliness, concern for the patient as a person, efforts to make the patient comfortable, and amount of time spent. CONCLUSIONS: Patients who communicated through an interpreter or who did not have an interpreter when they thought one was necessary were less satisfied with the patient-provider relationship. Further efforts are needed to ensure interpreter availability and proper interpretation technique.

Unanticipated admission after ambulatory surgery--a prospective study.

PURPOSE: To determine the incidence, the reasons, and the predictive factors for unanticipated admission after ambulatory surgery. METHODS: Preoperative, intraoperative, and postoperative data were collected prospectively on 15,172 consecutive ambulatory surgical patients during a 32-month period. The data were built into a statistical model, and predictive factors were identified and classified. RESULTS: The overall incidence of unanticipated admission was 1.42%. Admitted patients were more likely to be older, male, and ASA status II or III. Duration of anaesthesia was longer, and surgery was more likely to be completed after 3 pm. Length of stay in the Postanaesthesia Care Unit and the Ambulatory Surgery Unit was longer. Surgical reasons were cited in 38.1% of admitted patients; anaesthesia-related reasons were cited in 25%; social reasons accounted for 19.5%, and medical reasons for 17.2%. Ear, nose and throat (ENT) patients had the highest unanticipated admission rate (18.2%), followed by urology (4.8%) and chronic pain block (3.9%). Gynaecological patients had the lowest rate (0.4%). Among the predictive factors found were male, ASA status II and III, long duration of surgery, surgery finishing after 3 pm, postoperative bleeding, excessive pain, nausea and vomiting, and excessive drowsiness or dizziness. CONCLUSION: Earlier operating time for certain surgical procedures, screening for proper support at home, and implementation of clinical pathways to deal aggressively with problems such as pain, nausea and vomiting should decrease the incidence of unanticipated admission.

Development of an ostomy competency.

Staff educators and staff nurses developed an ostomy competency, with the guidance and expertise of the advanced practitioner and enterostomal nurse at a large teaching hospital. The competency improved the quality of care for surgical ostomy patients. Care was standardized and staff nurses' clinical knowledge was enhanced. Following the sessions, staff nurses verbalized increased confidence in working with patients with ostomies and demonstrated increased autonomy and problem-solving abilities. No variances in educational aspects of care were noted on clinical pathways.

Determinants of thymotropism in Kaplan radiation leukemia virus and nucleotide sequence of its envelope region.

Radiation leukemia viruses (RadLVs) are a group of murine leukemia viruses which are induced by radiation and cause T-cell leukemia. Viral clones isolated from the BL/VL3 lymphoid cell line derived from a thymoma show variable tropism and leukemogenic potential. We have constructed chimeric viruses by in vitro recombination between two viruses, a RadLV that is thymotropic and an endogenous ecotropic virus that is nonthymotropic. We show here that, in contrast to thymotropism determinants identified previously, which lie in the long terminal repeat (LTR), it is the envelope region that is responsible for the thymotropism of BL/VL3 RadLV. The nonthymotropic virus which we have rendered thymotropic by transfer of the env region of RadLV in the present study has been shown previously to become thymotropic when the LTR of another thymotropic virus is inserted in its genome. Thus, the LTR and envelope gene may be involved in complementary action to lead to thymotropism.