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Kidney supportive care (KSC) is a patient-centered model of multidisciplinary care designed for patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Our goal was to characterize the types, frequencies, and costs of services accessed by patients enrolled in a KSC program. We analyzed health care utilization data prospectively collected from 102 patients who enrolled in the KSC program during the first 52 weeks of its existence. The data comprised program appointments, emergency department presentations, ambulance service use, outpatient visits, inpatient episodes, and dialysis treatments made within the Brisbane area of Metro North. Costs of resource use were estimated using Queensland Health funding principles and guidelines. Analyses included descriptive statistics, correlations, and multivariate regressions. During the median program participation of 22 weeks, patients had 3975 contacts with health care, with the total value of services amounting to nearly A$3 million. Dialysis treatments accounted for 70% of visits and 49% of costs. Patients receiving dialysis had higher utilization of outpatient services and associated cost, compared to patients who were not dialyzed. The presence of diabetes and the choice of conservative pathway were both predictors of higher frequency and cost of services. Longer program participation was associated with lower weekly utilization and cost. The program attracted patients representing various characteristics, pathways, needs, and outcomes. Exploring these patterns will enable better understanding of the patient population and improved service planning, in KSC and similar programs that aim to comprehensively address the needs of patients with advanced CKD and ESKD. [ABSTRACT FROM AUTHOR]

Context: The ability to engage in interprofessional and collaborative practice (IPCP) has been identified as one of the Institute of Medicine's core competencies required of all health care professionals. Objective: To determine the perceptions of athletic trainers (ATs) in the collegiate setting regarding IPCP and current practice patterns. Design: Cross-sectional study. Patients or Other Participants: Of 6313 ATs in the collegiate setting, 739 (340 men, 397 women, 2 preferred not to answer; clinical experience=10.97±9.62 years) responded (11.7%). Main Outcome Measure(s): The Online Clinician Perspectives of Interprofessional Collaborative Practice survey section 1 assessed ATs' perceptions of working with other professionals (construct 1), ATs engaged in collaborative practice (construct 2), influences of collaborative practice (construct 3), and influences on roles, responsibilities, and autonomy in collaborative practice (construct 4). Section 2 assessed current practice patterns of ATs providing patient care and included the effect of communication on collaborative practice (construct 5) and patient involvement in collaborative practice (construct 6). Between-groups differences were assessed using a Kruskal- Wallis H test and Mann-Whitney U tests (P < .05). Results: Athletic trainers in the collegiate setting agreed with IPCP constructs 1 through 4 (construct 1 = 3.56±0.30, construct 2=3.36±0.467, construct 3=3.48±0.39, construct 4=3.20±0.35) and indicated that the concepts of constructs 5 and±(1.99±0.46, 1.80±0.50, respectively) were sometimes true in their setting. Athletic trainers functioning in a medical model reported lower scores for construct 5 (1.88±0.44) than did those in an athletic model (2.03±0.45, U = 19 522.0, P = .001). A total of 42.09% of the ATs' patient care was performed in collaborative practice. Conclusions: Athletic trainers in the collegiate setting agreed that IPCP concepts were beneficial to patient care but were not consistently practicing in this manner. Consideration of a medical model structure, wherein more regular interaction with other health care professionals occurs, may be beneficial to increase the frequency of IPCP. [ABSTRACT FROM AUTHOR]

Water scarcity, land use conversion and cultural and ecosystem changes threaten the way of life for traditional irrigation communities of the semi-arid southwestern United States. Traditions are strong, yet potential upheaval is great in these communities that rely on acequia irrigation systems. Acequias are ancient ditch systems brought from the Iberian Peninsula to the New World over 400 years ago; they are simultaneously gravity flow water delivery systems and shared water governance institutions. Acequias have survived periods of drought and external shocks from changing economics, demographics, and resource uses. Now, climate change and urbanization threaten water availability, ecosystem functions, and the acequia communities themselves. Do past adaptive practices hold the key to future sustainability, or are new strategies required? To explore this issue we translated disciplinary understanding into a uniform format of causal loop diagrams to conceptualize the subsystems of the entire acequia-based human-natural system. Four subsystems are identified in this study: hydrology, ecosystem, land use/economics, and sociocultural. Important linkages between subsystems were revealed as well as variables indicating community cohesion (e.g., total irrigated land, intensity of upland grazing, mutualism). Ongoing work will test the conceptualizations with field data and modeling exercises to capture tipping points for non-sustainability and thresholds for sustainable water use and community longevity [ABSTRACT FROM AUTHOR]

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Commentary to: The case for investigating social context in laboratory studies of smoking [ABSTRACT FROM AUTHOR]