Barrett Technology (United States)

Memory making is a core component of holistic paediatric palliative care. However, traditional artifact-based keepsakes (e.g., handprints) are often passive and lack the developmental and cultural sensitivity needed for meaningful engagement. A more participatory, narrative-based, multimedia approach, such as digital storytelling, is therefore required. Following the ADAPT framework (Steps 1–2: Intervention-Context Fit and Planning Adaptations), this study adapted a U.S. developed digital storytelling intervention for children with life-limiting and life-threatening conditions and their families in Ireland. Methods included a literature review, stakeholder consultations (n = 21), co-production workshops, and the development of a facilitator training programme and delivery manual. The adaptation team comprised diverse stakeholders, including paediatric palliative care clinicians, creative practitioners, bereaved parents, and representatives from national children’s palliative care organisations. The adaptation, conducted in partnership with Barretstown Children’s Charity, yielded six key principles for the final intervention: emotionally safe framing, family and sibling inclusive design, flexible and multimodal participation methods, selective integration of therapeutic recreation, family-led pacing and facilitator preparedness. The final design incorporates play, visual, and audio elements to support meaningful, co-created engagement from all family members. Comprehensive training materials and a facilitator manual were developed to ensure fidelity and safety. This adaptation study presents a culturally and developmentally resonant digital storytelling intervention for Irish paediatric palliative care. Findings highlight the critical role of co-production, cultural fit, and emotional flexibility in successfully implementing complex psychosocial interventions for this population. Future pilot testing will evaluate the intervention’s feasibility, acceptability, and psychosocial impact.

En México, la selección de candidatos para la educación superior es un desafío debido al limitado número de cupos disponibles en las universidades. Para asegurar la calidad de los estudiantes admitidos, es crucial evaluar la validez de los exámenes de ingreso. Uno de los enfoques más revisados para la validación de pruebas educativas, en los últimos veinte años, es el Enfoque Basado en Argumentos propuesto por Michael Kane, sin embargo, no ha quedado claro el método, métodos o enfoques para poder evaluar la validez de las pruebas. Por ende, se realizó una Revisión Sistemática de la Literatura a través del modelo Prisma, con el fin de contribuir a esclarecerlo. Así, se encontró que en todos estudios que cubren este enfoque citan a Kane para que forme parte de su marco teórico y, en general, desarrollan métodos basados en argumentos sin esclarecerlos puntualmente. Asimismo, se encontró que el Enfoque Basado en Argumentos se ha extendido a enfoques de investigación mixta y cualitativas. Lo que demuestra, en conclusión, que el Enfoque Basado en Argumentos depende del contexto, la situación y las especificaciones de la prueba, aportando flexibilidad y estructura a la investigación en este campo.

Abstract Sensory signals are processed by the cerebellum to coordinate movements. Numerous cerebellar functions are thought to require the maintenance of a sensory representation that extends beyond the input signal. Granule cells receive sensory input, but they do not prolong the signal and are thus unlikely to maintain a sensory representation for much longer than the inputs themselves. Unipolar brush cells (UBCs) are excitatory interneurons that project to granule cells and transform sensory input into prolonged increases or decreases in firing, depending on their ON or OFF UBC subtype. Further extension and diversification of the input signal could be produced by UBCs that project to one another, but whether this circuitry exists is unclear. Here we test whether UBCs innervate one another and explore how these small networks of UBCs could transform spiking patterns. We characterized two transgenic mouse lines electrophysiologically and immunohistochemically to confirm that they label ON and OFF UBC subtypes and crossed them together, revealing that ON and OFF UBCs innervate one another. A Brainbow reporter was used to label UBCs of the same ON or OFF subtype with different fluorescent proteins, which showed that UBCs innervate their own subtypes as well. Computational models predict that these feed-forward networks of UBCs extend the length of bursts or pauses and introduce delays—transformations that may be necessary for cerebellar functions from modulation of eye movements to adaptive learning across time scales.

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There have been multiple calls in the United States for public health workforce development approaches that expand practitioner skill sets to respond to profound inequities and improve population health more effectively. However, most workforce models address individual competencies that instead focus on collective approaches to systems change. In response to this opportunity, the HRSA-funded Regional Public Health Training Centers (PHTCs) and the University of Illinois Chicago Policy, Practice, and Prevention Research Center (P3RC) released Creating a Learning Agenda for Systems Change: A Toolkit for Building an Adaptive Public Health Workforce (the Toolkit) in December 2020. We later supplemented the Toolkit with additional learning activities to launch the Learning Agenda Toolkit Pilot Test (Toolkit Pilot). From June to August 2021, 24 diverse teams piloted the Toolkit. Teams completed a multistep process simulating the development of a learning agenda aimed at addressing community health issues and impacting systems change. We conducted an evaluation process to assess the usability and impact of the Toolkit Pilot to inform its improvement and future implementation. An evaluation subcommittee analyzed worksheets completed by the Pilot Teams that are aligned to the Learning Agenda steps and conducted and analyzed 12 key informant interviews using concepts from the Toolkit Pilot Logic Model. Evaluation results suggest that most Pilot Teams found that the Toolkit Pilot offered a step-by-step process toward a clear vision that produced a concrete product on how to address community challenges through learning and systems change. Pilot Teams noted that the Toolkit Pilot provided exposure to and a unique focus on systems thinking; however, prior knowledge of systems thinking and systems change was important. Building readiness for systems change and having more time, resources, and technical assistance would be needed for future versions of the Learning Agenda Toolkit.

Abstract Michael Loewe has repeatedly and as recently as 2021 looked at how Confucius appears in Han sources and has drawn attention to his lack of prominence, at least to the degree one might expect. Here, a preliminary assessment of the sources of opposition to Buddhism in one key sixth-century c.e. collection of polemics further demonstrates that adherence to mingjiao 名教 (Teaching of a Good Name) or to lijiao 禮教 (teaching on ritual) appears there as the main identifiers of opponents; rujiao, the term often later translated as “Confucianism,” is mentioned but once. While the commitment to values such as filial piety promoted by opponents of Buddhism is clear; their institutional coherence and self-awareness as a group does not seem to have been at all on a par with that of the Buddhist community. That situation did not start to shift until the Tang dynasty.

Recent policies by public and private payers have increased incentives to reduce hospital admissions. Using data from four states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, this study compared the payer-specific population-based rates of adults using inpatient, observation, and emergency department (ED) services for 10 common medical conditions in 2009 and in 2013. Patients had an expected primary payer of private insurance, Medicare, Medicaid, or no insurance. Across all four payer populations, inpatient admissions declined, and care shifted toward treat-and-release observation stays and ED visits. The percentage of hospitalizations that began with an observation stay increased. Implications for quality of care and costs to patients warrant further examination. Journal of Hospital Medicine 2017;12:443-446.

Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays. We found little difference in the cost and length of medical stays and in readmission rates. One explanation is that Medicare Advantage plans use outpatient settings for many patients with behavioral health conditions and for injury and surgical patients with less complex health needs. Alternatively, the observed differences in behavioral health cost and length of stay may represent skimping on appropriate care.

BackgroundBecause managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor. This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients.MethodsA cross-sectional design was used to examine the association between managed care and inpatient mortality for four common inpatient conditions. Data from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases for 11 states were linked to data from the American Hospital Association Annual Survey Database. Hospital discharges were categorized as managed care or fee for service. A phased approach to multivariate logistic modeling examined the likelihood of inpatient mortality when adjusting for individual patient and hospital characteristics and for county fixed effects.ResultsResults showed different effects of managed care for Medicare and privately insured patients. Privately insured patients in managed care had an advantage over their fee-for-service counterparts in inpatient mortality for acute myocardial infarction, stroke, pneumonia, and congestive heart failure; no such advantage was found for the Medicare managed care population. To the extent that the study showed a protective effect of privately insured managed care, it was driven by individuals aged 65 years and older, who had consistently better outcomes than their non-managed care counterparts.ConclusionsPrivately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS. Additional research is needed to understand the role of patient selection, hospital quality, and differences among county populations in the decreased odds of inpatient mortality among patients in private managed care and to determine why this result does not hold for Medicare.