Psychological Journey of a Patient With a Ventricular Assist Device: A VAD Coordinator’s Perspective

Background A thorough psychosocial assessment is needed during the evaluation of candidacy for ventricular assist device placement to identify potential barriers that would limit success with the device. Ventricular assist device coordinators are generally involved in the psychosocial assessment of the patient, allowing them to provide a more holistic approach to ventricular assist device candidacy during discussions at multidisciplinary meetings. There is a gap in the literature describing the psychological journey of patients after ventricular assist device implantation and the challenges ventricular assist device coordinators face when caring for this complex population. Objective The psychological journey of 3 patients with a ventricular assist device was explored to determine if common themes exist and to describe the experiences faced by the ventricular assist device coordinators with each patient. Methods Three patient case scenarios are described, as are the interactions with the patients’ ventricular assist device coordinator team members. Results All 3 case scenarios demonstrate similarities of younger ages, the need of family and social support, and ventricular assist device coordinators who went beyond the call of duty to assist in the successful heart transplantation for 2 cases and the successful decommission of the ventricular assist device in another case. Conclusion The psychosocial needs of patients with a ventricular assist device and ventricular assist device coordinators require ongoing assessment because of the many physical and emotional challenges that arise during the time a patient has an implanted ventricular assist device.

Linking behavioural type with cannibalism in Eurasian perch

The propensity to kill and consume conspecifics (cannibalism) varies greatly between and within species, but the underlying mechanisms behind this variation remain poorly understood. A rich literature has documented that consistent behavioural variation is ubiquitous across the animal kingdom. Such inter-individual behavioural differences, sometimes referred to as personality traits, may have far-reaching ecological consequences. However, the link between predator personality traits and the propensity to engage in cannibalistic interactions remains understudied. Here, we first quantified personality in Eurasian perch (Perca fluviatilis), measured as activity (time spent moving) and sociability (time spent near conspecifics). We then gave perch of contrasting behavioural types the option to consume either conspecific or heterospecific (roach, Rutilus rutilus) prey. Individual perch characterized by a social-active behavioural phenotype (n = 5) selected roach before being cannibalistic, while asocial-inactive perch (n = 17) consumed conspecific and heterospecific prey evenly. Thus, asocial-inactive perch expressed significantly higher rates of cannibalism as compared to social-active individuals. Individual variation in cannibalism, linked to behavioural type, adds important mechanistic understanding to complex population and community dynamics, and also provides insight into the diversity and maintenance of animal personality.

Inequity in Health Among People Living With Alzheimer's Disease and Related Dementias in Adult Day Centers

In adult day centers (ADCs), 58% of clients identify as racial/ethnic minorities, and at least 30% have Alzheimer’s Disease and related dementias (ADRD). ADCs offer culturally and linguistically congruent care to clients, making them well-positioned to address potential health disparities affecting persons with ADRD. We used data from 53 California ADCs (n=3,053) to identify differences in clinical characteristics among ADC clients’ with ADRD based on demographics such as race and English proficiency. We found that, when compared to their respective counterparts, a significantly greater proportion of racial/ethnic minorities and non-English speakers (p<.001) had 5 or more chronic conditions in addition to ADRD. We noted considerable missing data on race, likely because ADCs in California are not mandated to report data on race/ethnicity. In order to identify inequities in care within this complex population, social determinants of health, including race, must be a standard component of client assessment.

Primary care networks: navigating new organisational forms

BackgroundNational Health Service England (NHSE) instigated Primary Care Networks (PCNs) as a collaboration of general practices working together at scale to improve population health in the local community.AimThe aim of the study was to capture general practitioner PCN leaders’ perceptions of the opportunities and pitfalls of PCNs, as well as points of learning, during their inception and development, in order to guide the future development of PCN form and function.Design & settingThe study, carried out in primary care, took a qualitative design.MethodNine PCN general practitioner leaders were interviewed in depth to gather their views and experiences of PCNs. We also collated 31 free-text survey responses pertaining to how participants perceived the purpose of PCNs.ResultsThe key themes were - defining purpose and managing ambiguity; bureaucracy vs. local autonomy; relational working; facilitative leadership. The need for purpose setting to remain adaptive was seen as crucial in avoiding the constraints of too rigid a structure in order to retain local ownership, whilst remaining focussed around meeting complex population needs and reducing variation. Participants reported navigating their way through striking a balance between the ‘top down’ mandate and recognising local need. Of importance to the success of PCNs was the necessity of effective relational working and facilitative leadershipConclusionWhilst the desire to be proactive and collaborative was emphasised by the PCN leaders, the importance of distributed leadership and time given to building trust and effective working relationships within new organisational forms cannot be underestimated.

COVID-19 Impacts on Mental Health Care in Veterans Health Administration Community Living Centers

COVID-19 forced VHA Community Living Centers (CLC) to adjust how mental health (MH) care is provided. Beginning March 2020, admissions and staff entering CLC space were restricted in response to the pandemic. Some care shifted from in-person to virtual. Veterans were more isolated due to visitor restrictions and cancellation of communal activities. Pre-COVID, CLC teams cared for an already complex population – 80% of residents had a MH diagnosis (24% with serious mental illness). Changing resident composition and increased isolation may intensify challenges in providing MH care. Using VHA administrative data, we assess the impact of the changing CLC environment during the pandemic by comparing monthly average rates of MH diagnoses and provision of MH care and as-needed psychotropics to CLC residents pre-COVID (Oct 2019 – Feb 2020) to the COVID period (Mar 2020 – Feb 2021). CLCs experienced a 26% decline in the monthly resident census. However, the monthly percentage of residents with a serious mental illness increased 13%. Pre-COVID, virtual MH encounters were received by 2% of residents; 35% received an in-person MH encounter. During COVID, 8% received a virtual MH encounter and 33% received in-person. As-needed antipsychotics remained unchanged, while as-needed benzodiazepine prescriptions decreased 15%. Despite increased MH concerns, CLC teams did not appear to respond with increased pharmacological interventions. Rather, teams seem to have maintained clinical service connection for those with MH concerns. Documenting successful approaches for addressing MH needs during this challenging time will be instructive for future care during times of crisis.

Characteristics Associated with Tumor Development in Individuals Diagnosed with Beckwith–Wiedemann Spectrum: Novel Tumor-(epi)Genotype-Phenotype Associations in the BWSp Population

Beckwith–Wiedemann Spectrum (BWSp) is the most common epigenetic childhood cancer predisposition disorder. BWSp is caused by (epi)genetic changes affecting the BWS critical region on chromosome 11p15. Clinically, BWSp represents complex molecular and phenotypic heterogeneity resulting in a range of presentations from Classic BWS to milder features. The previously reported tumor risk based on Classic BWS cohorts is 8–10% and routine tumor screening has been recommended. This work investigated the tumor risk and correlation with phenotype within a cohort of patients from Classic BWS to BWSp using a mixed-methods approach to explore phenotype and epigenotype profiles associated with tumor development through statistical analyses with post-hoc retrospective case series review. We demonstrated that tumor risk across BWSp differs from Classic BWS and that certain phenotypic features are associated with specific epigenetic causes; nephromegaly and/or hyperinsulinism appear associated with cancer in some patients. We also demonstrated that prenatal and perinatal factors that are not currently part of the BWSp classification may factor into tumor risk. Additionally, blood testing results are not necessarily synonymous with tissue testing results. Together, it appears that the current understanding from Classic BWS of (epi)genetics and phenotype correlations with tumors is not represented in the BWSp. Further study is needed in this complex population.

Caring for Older Adults During and After Critical Illness

Over half of people with critical illness are older adults, and the number of older adults admitted to intensive care units has been increasing over time. Older adults have increased vulnerability to disease, disability, and adverse outcomes across many domains. To address this most effectively, a unique, interdisciplinary approach is necessary to optimize not only survival but also functional status and quality of life. A shortage of health care professionals equipped to care for the aging population makes it imperative that all professionals become aware of basic principles of caring for older adults. To equip them to care for this complex population, this chapter provides an overview of how aging impacts multiple domains of an older person with critical illness and describes evidence-based approaches to caring for older adults with critical illness.

AdmixSim 2: a forward-time simulator for modeling complex population admixture

Background Computer simulations have been widely applied in population genetics and evolutionary studies. A great deal of effort has been made over the past two decades in developing simulation tools. However, there are not many simulation tools suitable for studying population admixture. Results We here developed a forward-time simulator, AdmixSim 2, an individual-based tool that can flexibly and efficiently simulate population genomics data under complex evolutionary scenarios. Unlike its previous version, AdmixSim 2 is based on the extended Wright-Fisher model, and it implements many common evolutionary parameters to involve gene flow, natural selection, recombination, and mutation, which allow users to freely design and simulate any complex scenario involving population admixture. AdmixSim 2 can be used to simulate data of dioecious or monoecious populations, autosomes, or sex chromosomes. To our best knowledge, there are no similar tools available for the purpose of simulation of complex population admixture. Using empirical or previously simulated genomic data as input, AdmixSim 2 provides phased haplotype data for the convenience of further admixture-related analyses such as local ancestry inference, association studies, and other applications. We here evaluate the performance of AdmixSim 2 based on simulated data and validated functions via comparative analysis of simulated data and empirical data of African American, Mexican, and Uyghur populations. Conclusions AdmixSim 2 is a flexible simulation tool expected to facilitate the study of complex population admixture in various situations.

Putting It Together: Fitting a Dynamic Model

The chapter “Putting It Together: Fitting a Dynamic Model” provides a synthesis of the material presented in the book, by presenting a worked example that embraces concepts of density dependence, complex model dynamics, parameter estimation, and model selection using the Akaike information criterion. The example chosen is the recovery of gray wolf (Canis lupus) population in Washington State since 2008. The chapter begins by explaining how to fit an observation error model. Next, it examines how to fit a process error model. It then discusses parameter estimates and model selection. The chapter concludes with discussion of how to determine whether the population given as an example exhibits complex population dynamics.