Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD).

INTRODUCTION: Care for patients with chronic obstructive pulmonary disease (COPD) is provided by both family physicians (FP) and specialists. Ideally, patients receive comprehensive and coordinated care from this provider team. The objectives for this study were: 1) to describe the family and specialist physician network of care for Ontario patients newly diagnosed with COPD and 2) to determine the associations between selected characteristics of the physician network and unplanned healthcare utilization. METHODS: We conducted a retrospective cohort study using Ontario health administrative data housed at ICES (formerly the Institute for Clinical Evaluative Sciences). Ontario patients, ≥ 35 years, newly diagnosed with COPD were identified between 2005 and 2013. The FP and specialist network of care characteristics were described, and the relationship between selected characteristics (i.e., continuity of care) with unplanned healthcare utilization during the first 5 years after COPD diagnosis were determined in multivariate models. RESULTS: Our cohort consisted of 450,837 patients, mean age 61.5 (SD 14.6) years. The FP was the predominant provider of care for 86.4% of the patients. Using the Bice-Boxerman's Continuity of Care Index (COCI), a measure reflecting care across different providers, 227,082 (50.4%) were categorized in a low COCI group based on a median cut-off. In adjusted analyses, patients in the low COCI group were more likely to have a hospital admission (OR = 2.27, 95% CI 2.20,2.22), 30-day readmission (OR = 2.44, 95% CI 2.39, 2.49) and ER visit (OR = 2.27, 95% CI 2.25, 2.29). CONCLUSION: Higher indices of continuity of care are associated with reduced unplanned hospital use for patients with COPD. Primary care-based practice models to enhance continuity through coordination and integration of both primary and specialist care have the potential to enhance the health experience for patients with COPD and should be a health service planning priority.

Organic liquid mobility induced by smoldering remediation.

Laboratory column experiments plus analytical and numerical modeling together suggest that, under certain conditions, downward organic liquid mobilization can occur and impact smoldering behavior. This applies for organic liquids mixed with inert sand subjected to smoldering as thermal treatment. The observed effects include increased peak temperatures (here by up to 35%) and increased treatment times (here by up to 30%). Downward organic liquid migration occurs when (i) injected Darcy air flux is less than a threshold value (here less than 3cm/s), (ii) treatment systems are tall (here 90cm, not 30cm), and (iii) the organic liquid is temperature-sensitive (viscosity less than 0.01Pas at 150°C). The developed analytical equation provides the applied air flux that can negate the downwards organic liquid gradient required for migration. Smoldering behavior is demonstrated to adjust to liquid migration and thereby still destroy all the organic waste in the system. Smoldering is a relatively new, energy-efficient thermal treatment for organic liquid waste and these results are important for designing field applications of smoldering treatment.

Evidence-based practice needs evidence-based implementation.

Clinical pathways have been designed to provide an effective interface between evidence and practice in healthcare. Strong evidence supports the assertion that when clinical pathways are utilized they improve outcomes. However, published evidence measuring the uptake of clinical pathways by health professionals remains sparse. This article presents a study evaluating the degree of documented compliance with the clinical pathway chart used for patients diagnosed with an acute myocardial infarction (AMI) in a major Australian regional hospital. The relationships between compliance and demographic and illness were also examined. Data were collected from 124 records with the result that the level of documented compliance was 16.5%. Clients with private health insurance had significantly higher documented compliance with the clinical pathway than those with no private health insurance. There were also significant variations in documented compliance according to the type of AMI recorded. Recommendations to improve compliance with clinical pathways are included along with recommendations for future research.

Parameters affecting the formation of perfluoroalkyl acids during wastewater treatment.

This study examined the fate and behaviour of perfluoroalkyl acids (PFAAs) in liquid and solid samples from five different wastewater treatment types: facultative and aerated lagoons, chemically assisted primary treatment, secondary aerobic biological treatment, and advanced biological nutrient removal treatment. To the best of our knowledge, this is the largest data set from a single study available in the literature to date for PFAAs monitoring study in wastewater treatment. Perfluorooctanoic acid (PFOA) was the predominant PFAA in wastewater with levels from 2.2 to 150ng/L (influent) and 1.9 to 140ng/L (effluent). Perfluorooctanesulfonic acid (PFOS) was the predominant compound in primary sludge, waste biological sludge, and treated biosolids with concentrations from 6.4 to 2900ng/g dry weight (dw), 9.7 to 8200ng/gdw, and 2.1 to 17,000ng/gdw, respectively. PFAAs were formed during wastewater treatment and it was dependant on both process temperature and treatment type; with higher rates of formation in biological wastewater treatment plants (WWTPs) operating at longer hydraulic retention times and higher temperatures. PFAA removal by sorption was influenced by different sorption tendencies; median log values of the solid-liquid distribution coefficient estimated from wastewater biological sludge and final effluent were: PFOS (3.73)>PFDA (3.68)>PFNA (3.25)>PFOA (2.49)>PFHxA (1.93). Mass balances confirmed the formation of PFAAs, low PFAA removal by sorption, and high PFAA levels in effluents.

The effects of hormones and inhibitors on amaranthin synthesis in seedlings of Amaranthus tricolor.

Both gibberellic acid and abscisic acid inhibit the light induced synthesis of amaranthin in Amaranthus tricolor seedlings. The auxin, indolyl-3-acetic acid has no effect. The protein/RNA inhibitors, cycloheximide and 8-azaguanine, also reduced the levels of amaranthin produced.

A gibberellin bioassay based on betacyanin production in Amaranthus caudatus seedlings.

Amaranthus caudatus L. seedlings produce less amaranthin in the presence of gibberellic acid A3 (GA3). This phenomenon has been tested as a bioassay for gibberellic acid and has been compared to the bioassay based on lettuce hypocotyl extension. The inhibition of pigment synthesis is much more sensitive to GA3 at concentrations from 1 to 0.01 µg/ml. Of the gibberellins tested GA1, GA3, GA4, and GA7 are the most active in the described bioassay.

The hormonal control of amaranthin synthesis in Amaranthus caudatus seedlings.

Exogenous gibberellic acid, A3 (GA3) inhibits phytochrome mediated betacyanin synthesis in seedlings of Amaranthus caudatus. The growth retardants, ß-chloroethyl-trimethylammonium chloride (CCC), 'isopropyl-4'-(triethylammonium chloride)-5'-methylphenyl piperidine carboxylate (AMO 1618) and tributyl-2,4,-dichlorobenzylphosphonium chloride (phosphon D) enhance pigment synthesis. Retardant stimulation of pigment synthesis is overcome by GA3 application. Besides lowering endogenous GA levels the retardants inhibit protein synthesis by as much as 25%. Retardant inhibition of protein synthesis is not overcome by GA3. The results suggest that amaranthin synthesis in Amaranthus caudatus can be directly controlled by endogenous GA. GA3 has no effect on kinin induced dark pigment synthesis. Kinins, however, do not overcome GA3 inhibition of pigment synthesis in the light.