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ObjectiveTo explore associations among twenty formal and informal, societal and individual-level factors and quality of life (QOL) among people living with congestive heart failure (CHF) in two settings with different healthcare and social care systems and sociocultural contexts.Setting and participantsWe recruited 367 adult patients with CHF from a single heart failure clinic within two countries with different national social to healthcare spending ratios: Minneapolis, Minnesota, United States (US), and Nijmegen, Netherlands (NL).DesignCross-sectional survey study. We adapted the Social Quality Model (SQM) to organize twenty diverse factors into four categories: Living Conditions (formal-societal: e.g., housing, education), Social Embeddedness (informal-societal: e.g., social support, trust), Societal Embeddedness (formal-individual: e.g., access to care, legal aid), and Self-Regulation (informal-individual: e.g., physical health, resilience). We developed a survey comprising validated instruments to assess each factor. We administered the survey in-person or by mail between March 2017 and August 2018.OutcomesWe used Cantril's Self-Anchoring Scale to assess overall QOL. We used backwards stepwise regression to identify factors within each SQM category that were independently associated with QOL among US and NL participants (pResults367 CHF patients from the US (32%) and NL (68%) participated. Among US participants, financial status, receiving legal aid or housing assistance, and resilience were associated with QOL, and together explained 49% of the variance in QOL; among NL participants, financial status, perceived physical health, independence in activities of daily living, and resilience were associated with QOL, and explained 53% of the variance in QOL.ConclusionsFour formal and informal factors explained approximately half of the variance in QOL among patients with CHF in the US and NL.

Introduction: We embarked on a research project intending to compare healthcare and social care utilization and costs for people with congestive heart failure in the United States (US) and the Netherlands (NL). Our intention was to evaluate these characteristics at a national, regional, and person-specific level, comparing data from patients being cared for at Hennepin Healthcare (Minneapolis, MN, US) and Radboud University Medical Center (Nijmegen, NL). Because we focused on a specific clinical subpopulation in both countries, we expected to be able to make valid comparisons between these two patient populations. However, our experience with this project calls into question the accuracy and reliability of between-country healthcare comparisons. Methods: Spurious and unexpected results from the between-country database comparison prompted us to critically examine our findings. We used iterative group discussions to identify weaknesses and missing components in our comparative data. In addition to exploring specific examples from our own unpublished work, we went on to identify similar limitations in external, peer-reviewed publications. Results: We identified five domains that limited our ability to perform a valid between-country comparison. These included (1) differences in patient level characteristics both within and between countries; (2) variations in societal norms and values; (3) different systems of healthcare and social care organization and delivery; (4) variable definitions, implantation, and distribution of costs; and (5) limitations within the databases themselves. Discussion: Iterative group discussion and reflection were useful in understanding defining limitations in our between country database comparison. Acceptance of the database comparison would have led to erroneous conclusions about heart failure patients in the US and NL. Conclusions: There are five domains that limited our ability to perform a valid between-country comparison, including patient-level characteristics, societal norms and values, systems of healthcare and social care, costs, and databases. Lessons Learned: Our findings suggest that these domains should be considered prior to undertaking an international comparison of healthcare and social care. They may also provide a tool for critical analysis of published data. Limitations: The five domains we identified are based on a single study. However, we were able to identify external examples in peer-reviewed journals in each of the domains. Suggestions for future research: In order for us to continue to learn from other systems, international comparisons of healthcare and social care should continue, but particular attention must be given to ensuring that accurate and reliable comparisons are made. The domains we have identified may stimulate further research into quality assurance for international healthcare comparisons.

Background: Effective management of chronic, long-term illness largely depends on care that is shaped around the specific priorities, preferences, and routines of the individual patient. Evidence suggests that the coproduction of healthcare by patients and professionals may be effective in facilitating good health outcomes at lower costs. Furthermore, it is considered increasingly important to consider the social determinants of health and well-being. Our research team has conducted a cross-national mixed methods study to examine the health and social care needed to support people living with a chronic illness–specifically, congestive heart failure--in the United States and Netherlands. Translation of our research into practice includes a case-based teaching module to train health professionals and health professional students about coproduction of patient care. This presentation will provide: (1) an overview of our educational curriculum; (2) discuss our experiences teaching health professionals and health professional students about coproduction of healthcare services; (3) explore the individual knowledge, skills, and habits that are required to coproduce care with their patients and their patient’s families/informal caregivers; (4) summarize some of the guiding principles of coproduction. Target Audience: Health professionals, health professions students, and health professional educators Learnings/Take away: Our interactive, case-based workshop creates the foundation for healthcare professionals, educators, students, and researchers to consider new the role of coproduction in healthcare. This session will discuss an education module that can be replicated in other settings.

BackgroundIn 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis‐St. Paul. Methods and ResultsEleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and

This technical paper investigates the influence of sample size and geologic characteristics on the geotechnical design of levee embankments. Sample quality plays a vital role in quantifying engineering properties for levee embankment projects, and numerous studies have highlighted the impact of sample disturbance on such engineering properties. Despite this evidence, conventional tube and piston samplers of different diameters continue to be widely used, potentially leading to underestimation of shear strength. The paper focuses on comparing 7.6 cm and 12.7 cm diameter undisturbed Shelby tube samples and CPT data collected from three levee sites in the Greater New Orleans Area, Louisiana, USA, which encompass diverse geologic histories. The study aims to assess the effect of industry used samples size and geology on levee construction costs. The findings provide valuable insights into optimizing sample collection methods and improving geotechnical design for earthen embankments.

The enteric nervous system (ENS) plays a key role in regulating gut motility and homeostasis yet it remains a challenging system to record from. Here, the authors develop a novel abdominal window permitting simultaneous optical and electrical recording of mouse ENS system activity over prolonged time periods.

Introduction: We embarked on a research project intending to compare healthcare and social care utilization and costs for people with congestive heart failure in the United States (US) and the Netherlands (NL). Our intention was to evaluate these characteristics at a national, regional, and person-specific level, comparing data from patients being cared for at Hennepin Healthcare (Minneapolis, MN, US) and Radboud University Medical Center (Nijmegen, NL). Because we focused on a specific clinical subpopulation in both countries, we expected to be able to make valid comparisons between these two patient populations. However, our experience with this project calls into question the accuracy and reliability of between-country healthcare comparisons. Methods: Spurious and unexpected results from the between-country database comparison prompted us to critically examine our findings. We used iterative group discussions to identify weaknesses and missing components in our comparative data. In addition to exploring specific examples from our own unpublished work, we went on to identify similar limitations in external, peer-reviewed publications. Results: We identified five domains that limited our ability to perform a valid between-country comparison. These included (1) differences in patient level characteristics both within and between countries; (2) variations in societal norms and values; (3) different systems of healthcare and social care organization and delivery; (4) variable definitions, implantation, and distribution of costs; and (5) limitations within the databases themselves. Discussion: Iterative group discussion and reflection were useful in understanding defining limitations in our between country database comparison. Acceptance of the database comparison would have led to erroneous conclusions about heart failure patients in the US and NL. Conclusions: There are five domains that limited our ability to perform a valid between-country comparison, including patient-level characteristics, societal norms and values, systems of healthcare and social care, costs, and databases. Lessons Learned: Our findings suggest that these domains should be considered prior to undertaking an international comparison of healthcare and social care. They may also provide a tool for critical analysis of published data. Limitations: The five domains we identified are based on a single study. However, we were able to identify external examples in peer-reviewed journals in each of the domains. Suggestions for future research: In order for us to continue to learn from other systems, international comparisons of healthcare and social care should continue, but particular attention must be given to ensuring that accurate and reliable comparisons are made. The domains we have identified may stimulate further research into quality assurance for international healthcare comparisons. [ABSTRACT FROM AUTHOR]