Baseline management practices at providers in better jobs better care

High turnover and difficult recruitment of direct care workers are challenges for long-term care providers. This study reports the extent and variation of the use of management practices for direct care workers and their supervisors across four long-term care settings in the Better Jobs Better Care demonstration. Overall, there is limited use of direct care worker training, career advancement opportunities, and mentoring programs. Participation in care planning, communication about tasks, and direct care worker supervisor training and development practices vary significantly across long-term care settings. The paucity of training, career advancement opportunities, and mentoring programs suggests that government policies may be needed to encourage their use.     

Identification of human-induced changes in atmospheric moisture content

Data from the satellite-based Special Sensor Microwave Imager (SSM/I) show that the total atmospheric moisture content over oceans has increased by 0.41 kg/m(2) per decade since 1988. Results from current climate models indicate that water vapor increases of this magnitude cannot be explained by climate noise alone. In a formal detection and attribution analysis using the pooled results from 22 different climate models, the simulated "fingerprint" pattern of anthropogenically caused changes in water vapor is identifiable with high statistical confidence in the SSM/I data. Experiments in which forcing factors are varied individually suggest that this fingerprint "match" is primarily due to human-caused increases in greenhouse gases and not to solar forcing or recovery from the eruption of Mount Pinatubo. Our findings provide preliminary evidence of an emerging anthropogenic signal in the moisture content of earth's atmosphere.     

Can nurses learn to let go? Issues arising from an intervention designed to improve patients’ involvement in their own care

Can nurses learn to let go? Issues arising from an intervention designed to improve patients’ involvement in their own care The aim of the paper was to explore the reasons behind a perplexing observation that an intervention designed to alter professional behaviour in general practice consultations in South Wales was poorly sustained despite initial enthusiasm among the nurses. Nurses’ baseline and continuing responses to the new approach with patients with non-insulin dependent diabetes are described, drawing on observations and interviews with the 18 practice nurses in the 15 experimental practices. The nurses fell into two groups: those showing greater understanding of the principles underlying the approach and a more reflective attitude to their work; and those who adapted the simple technology provided to their usual consultation style. This variation was related to their perception of their role and their attitudes to diabetic care, especially the challenge posed by the ‘difficult patient’. They were noticeably less willing to allow the patient freedom to decide what to do once diabetic control was deteriorating according to biochemical measures. It is concluded that the failure of the nurses to sustain behaviour change over time stems from a basic dilemma, namely, what is the extent of my responsibility and how ought I to discharge it? There is scope for more research into professional perspectives on chronic care, the strategies they use to manage patients and to cope with their own feelings, and the implications of these strategies for patients.     

Differential effectiveness of selected non‐psychotropic phytocannabinoids on human sebocyte functions implicates their introduction in dry/seborrhoeic skin and acne treatment

Acne is a common skin disease characterized by elevated sebum production and inflammation of the sebaceous glands. We have previously shown that a non‐psychotropic phytocannabinoid ((–)‐cannabidiol [CBD]) exerted complex anti‐acne effects by normalizing ‘pro‐acne agents’‐induced excessive sebaceous lipid production, reducing proliferation and alleviating inflammation in human SZ95 sebocytes. Therefore, in this study we aimed to explore the putative anti‐acne effects of further non‐psychotropic phytocannabinoids ((–)‐cannabichromene [CBC], (–)‐cannabidivarin [CBDV], (–)‐cannabigerol [CBG], (–)‐cannabigerovarin [CBGV] and (–)‐Δ⁹‐tetrahydrocannabivarin [THCV]). Viability and proliferation of human SZ95 sebocytes were investigated by MTT and CyQUANT assays; cell death and lipid synthesis were monitored by DilC₁(5)‐SYTOX Green labelling and Nile Red staining, respectively. Inflammatory responses were investigated by monitoring expressions of selected cytokines upon lipopolysaccharide treatment (RT‐qPCR, ELISA). Up to 10 μm , the phytocannabinoids only negligibly altered the viability of the sebocytes, whereas high doses (≥50 μm ) induced apoptosis. Interestingly, basal sebaceous lipid synthesis was differentially modulated by the substances: CBC and THCV suppressed it, and CBDV had only minor effects, whereas CBG and CBGV increased it. Importantly, CBC, CBDV and THCV significantly reduced arachidonic acid (AA)‐induced ‘acne‐like’ lipogenesis. Moreover, THCV suppressed proliferation, and all phytocannabinoids exerted remarkable anti‐inflammatory actions. Our data suggest that CBG and CBGV may have potential in the treatment of dry‐skin syndrome, whereas CBC, CBDV and especially THCV show promise to become highly efficient, novel anti‐acne agents. Moreover, based on their remarkable anti‐inflammatory actions, phytocannabinoids could be efficient, yet safe novel tools in the management of cutaneous inflammations.