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Objectives To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions.Design We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting.Setting Australian primary care.Participants Registered physiotherapists who are members of a practice-based research network (n=31).Results The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application.Conclusion High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems.

The quest to find extraterrestrial life is a critical scientific endeavor with civilization-level implications. Icy moons in our solar system are promising targets for exploration because their liquid oceans make them potential habitats for microscopic life. However, the lack of a precise definition of life poses a fundamental challenge to formulating detection strategies. To increase the chances of unambiguous detection, a suite of complementary instruments must sample multiple independent biosignatures (e.g., composition, motility/behavior, and visible structure). Such an instrument suite could generate 10,000× more raw data than is possible to transmit from distant ocean worlds like Enceladus or Europa. To address this bandwidth limitation, Onboard Science Instrument Autonomy (OSIA) is an emerging discipline of flight systems capable of evaluating, summarizing, and prioritizing observational instrument data to maximize science return. We describe two OSIA implementations developed as part of the Ocean World Life Surveyor (OWLS) prototype instrument suite at the Jet Propulsion Laboratory. The first identifies life-like motion in digital holographic microscopy videos, and the second identifies cellular structure and composition via innate and dye-induced fluorescence. Flight-like requirements and computational constraints were used to lower barriers to infusion, similar to those available on the Mars helicopter, “Ingenuity.” We evaluated the OSIA's performance using simulated and laboratory data and conducted a live field test at the hypersaline Mono Lake planetary analog site. Our study demonstrates the potential of OSIA for enabling biosignature detection and provides insights and lessons learned for future mission concepts aimed at exploring the outer solar system.

Self-care of a chronic illness is a lifelong management process that includes taking medications, monitoring symptoms, and coping with emotional and lifestyle changes. Human-Computer Interaction (HCI) research has often responded to these needs by developing technologies that help an individual quantify aspects of their chronic illness, like daily pain, flare ups, or personal behaviours like diet and exercise. But this quantification fails to account for the ongoing needs of understanding ones disease and maintaining a balanced lifestyle. To understand these needs, we interviewed 12 people about their lived experience with Rheumatoid Arthritis (RA). We performed a thematic analysis of collected data and identified three types of support currently lacking for RA: (1) psychosocial care (2) patient agency, and (3) lifestyle adaptations. Our results highlight the need to support long term uncertainty while living with a chronic illness and identify needs the HCI community should consider when developing self-care technologies.

Obesity is increasing in developing countries. Population studies show a relationship between affluence and obesity. Changing food intake patterns with affluence such as preference for foods with less astringent polyphenolic compounds and dietary fibers may increase risk of metabolic dysfunctions due to caloric imbalance. Animal models of obesity consistently show that grape seed procyanidins prevent increases in body and abdo- minal adipose weight gain, plasma cholesterol, liver weight gain and inflammation in animals on high fat diets. The mechanisms are not clear because the oral intake of procyanidins results in pleiotropic interactions with proteins in the mouth, stomach, small intestine, cecum and colon that affect the rate of digestion of bioavailability of macronutrients, sterols, and dietary fiber. Procyanidins also bind bile acids and reduce intestinal permeability to inflammatory bacterial cell wall fragment. Procyanidins are not degraded or metabolized until reaching the lower gut where they can be metabolized into phenolic acids by gut bacteria. While they are metabolized by gut bacteria, they also alter total numbers and distribution of phyla and species of gut bacteria. Gut bacteria are recognized as significant contributors to obesity and obesity related metabolic diseases. The review examines the different pleiotropic effects of grape seed procyanidins that have a significant effect on metabolic disease in animal models of obesity.