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PubMed1986

Preparation of liposomes via detergent removal from mixed micelles by dilution. The effect of bilayer composition and process parameters on liposome characteristics.

Liposomes were prepared from mixed micelles by a dilution method. Mixed micellar solutions, containing constant octyl glucoside and egg phosphatidylcholine concentrations and varying amounts of cholesterol and/or a charged compound, were diluted at defined rates. After dilution, the resulting liposome dispersions were sequentially concentrated, washed or dialysed, and filtered. The effect of lipid composition and experimental conditions on physicochemical characteristics was studied. Fairly homogeneous liposome dispersions with mean diameters ranging from 100 to over 200 nm could be obtained. The particle size was dependent on cholesterol content and surface charge, and could be reproducibly controlled by adjustment of the dilution rate. Liposomes with a mean diameter below 100 nm could also be obtained, but were heterodisperse and unstable. The incorporation of charged compounds was monitored by microelectrophoresis. 31P-NMR measurements indicated that the liposomes were unilamellar. Dialysis appeared to be more convenient than washing to remove octyl glucoside.

Chemical Phenomena↗
PubMed2006

Communication between older women and physicians: preliminary implications for satisfaction and intention to have mammography.

OBJECTIVE: To explore the associations between physician communication styles and their older patients' intentions to get mammography and satisfaction with physician communication. METHODS: This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n=7) and their female patients aged 65 years and older (n=56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor-elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. RESULTS: The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as "deep", "trusting" and "bonding" were more satisfied with communication than women who rated physician communication as less trusting (p=0.03, 0.02 and 0.02, respectively). CONCLUSION: Physicians' communication styles affect their older female patients' satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. PRACTICE IMPLICATIONS: Improving physicians' communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.

Aged↗
PubMed2005

Cardiovascular disease prevention in Russia: challenges and opportunities.

OBJECTIVES: This paper examines the challenges that have faced the implementation of cardiovascular disease (CVD) prevention programmes in Russia since the 1980s in two regions of Russia, and identifies opportunities for improving such efforts. STUDY DESIGN AND METHODS: This study used a mixed methods design consisting of archival data review of health-related policy documents and legislation, and key informant interviews. RESULTS: CVD is the leading cause of death in Russia, with rapid increases in prevalence following the collapse of the Soviet Union in 1991. The MONICA, Tacis and CINDI programmes have played major roles in the development of non-communicable and CVD prevention policies and programmes in Russia since the 1980s. These programmes have assisted in policy and guideline development, and programme implementation. However, significant barriers in realizing such policies and sustaining prevention programmes have been encountered. CONCLUSION: Numerous barriers exist in developing and implementing CVD prevention programmes in Russia. More government engagement backed by strong public support is necessary in order to sustain and build capacity for CVD prevention in Russia.

Cardiovascular Diseases↗
PubMed2003

Macroporous biphasic calcium phosphate scaffold with high permeability/porosity ratio.

Macroporous biphasic calcium phosphate (BCP) with channel-shaped pores was produced by a novel dual-phase mixing method. The processing route includes mixing water-based BCP slurry and polymethylmethacrylate resin; shaping in a mold; and polymerization, drying, pyrolyzing, and sintering. After comparison with two other commercial macroporous BCP materials, which were produced along different routes, it was found that conventional parameters such as porosity and pore size cannot describe a macroporous structure precisely enough for the application as tissue-engineering scaffold. Instead, permeability can be seen as an intrinsic and quantitative parameter to describe the macroporous structure of various scaffolds, because it is independent of sample size and fluid used in the test. Another parameter, the permeability/porosity ratio, provides an indication of the percolative efficiency per unit porous volume of a scaffold. Structural characterizations and permeability studies of other macroporous scaffold materials were also performed, and it was found that permeability could reflect a combination of five important parameters for scaffold: (1) porosity, (2) pore size and distribution, (3) interconnectivity, (4) fenestration size and distribution, and (5) orientation of pores. Finally, the implications of relating permeability with biological performances are also discussed.

Biocompatible Materials↗
PubMed2005

Barriers to evidence-based practice in primary care nursing--why viewing decision-making as context is helpful.

AIM: This paper reports a study examining the barriers associated with research knowledge transfer amongst primary care nurses in the context of clinical decision-making. BACKGROUND: The research literature on barriers to nurses' use of research knowledge is characterized by studies that rely primarily on self-report data, making them prone to reporting biases. Studies of the barriers to evidence-based practice often fail to examine information use and behaviour in the context of clinical decision-making. METHODS: A multi-site, mixed method, case study was carried out in 2001. Data were collected in three primary care organizations by means of interviews with 82 primary care nurses, 270 hours of non-participant observation and 122 Q-sorts. Nurses were selected using a published theoretical sampling frame. Between-methods triangulation was employed and data analysed according to the principles of constant comparison. Multiple linear regression was used to explore relationships between a number of independent demographic variables (such as length of clinical experience) and the dependent variable of nurses' perspectives on the barriers to their use of research knowledge. RESULTS: Three perspectives on barriers to research information use emerged: the need to bridge the skills and knowledge gap for successful knowledge transfer; information formats need to maximize limited opportunities for consumption; and limited access in the context of limited time for decision-making and information consumption. Demographic variables largely failed to predict allegiance to any of the perspectives identified. CONCLUSIONS: Researchers should consider using decision-making as a contextual backdrop for exploring information use and behaviour, avoid relying solely on self-reported behaviour as data, and use a variety of research methods to provide a richer picture of information-related behaviour. Practice developers need to recognize that understanding the decisions to which research knowledge is to be applied should be a characteristic of any strategy to increase research uptake by nurses.

Adult↗
PubMed2006

Patterns and frequency of anxiety in women undergoing gynaecological surgery.

AIMS: Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients' perspective, that may increase or decrease anxiety in the pre- and postoperative periods. BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. METHOD: The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge. RESULTS: State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. CONCLUSION: This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications. RELEVANCE TO CLINICAL PRACTICE: Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.

Adolescent↗
PubMed2006

Maturity and adherence in adolescent and young adult heart recipients.

BACKGROUND: Pediatric transplant (txp) teams note high rates of non-adherence and risky behaviors linked to morbidity and mortality among adolescent and young adult recipients. Clinicians and parents alike report symptoms of social immaturity and failure to appreciate consequences of risky behavior; relationships between the two have not been studied in this population. METHOD: This two-phase mixed method study examined adherence, high-risk behaviors, and maturity in a sample of 27 heart recipients, aged 15-31, who underwent transplantation in childhood or adolescence at Children's Hospital of Pittsburgh. All subjects completed a projective ego development measure and a questionnaire about adherence to the post-txp regimen. Nine recipients, purposely selected for good or poor adherence according to criteria determined by the transplant team and matched on age, participated in phase 2 qualitative interviews and mood assessments. RESULTS: Sixty-three percent of the phase 1 sample missed medications, 67% missed appointments, 11% smoked, 37% had difficulty with diet, 89% exercised infrequently, 33% had tattoos, 26% had more than two body piercings, and 11% used street drugs. Six themes and a core construct of maturity were identified with qualitative methodology. Poor adherers were less mature on every theme and consistently scored at a less mature level on the projective measure of ego development. Chronological age was not related to the level of maturity in qualitative or projective data. Most interview subjects reported high levels of anxiety, and two reported clinically significant levels of depression and anger; mood was not related to adherence. CONCLUSIONS: Non-adherence and high-risk behaviors are prevalent among adolescent and young adult heart recipients. Level of maturity appears to be associated with ability to adhere to the treatment regimen and avoid high-risk behaviors.

Adolescent↗
PubMed2005

An exploration of family carers' experience of respite services in one specialist palliative care unit.

BACKGROUND: Changing patterns of care for terminally ill people mean that 90% of patients in the UK now spend the majority of their last year of life at home. It is now widely accepted that supporting individuals to die at home relies heavily on the availability of family carers to provide the majority of the care needed. However, one of the most common reasons for unplanned admissions near the end of life is carers' inability to provide continuing care. One strategy to overcome these challenges has been to offer planned respite care. Despite recent studies, in reality little is known about respite services for patients with life limiting illness, in particular how respite is experienced by the caregivers or to what extent respite services address their needs. METHODS: This prospective study, comprising mixed methods of data collection, explored the experiences of 25 family carers whose relative had been admitted to the local hospice for inpatient respite care. Semi-structured interviews were conducted at two time points: pre- and post-respite. The Relative Stress Scale Inventory was administered at both interviews. RESULTS: Just over half of the sample were caring for a relative with a diagnosis of cancer (n=13); the majority of the others had a number of neurological conditions (n = 12). The data demonstrate that managing care for relatives with a life limiting illness was perceived to be hard work, both physically and mentally. Inpatient respite care was considered important as it enabled family carers to have a break from the ongoing care-giving responsibilities, as well as being an opportunity to experience 'normal life' independently. The majority of family carers felt that their expectations of respite for themselves had been achieved. The respite service was well evaluated in relation to: standard of nursing care; alternative facilities on offer, atmosphere; and other care homes. DISCUSSION: Currently, inpatient respite services are provided to two patient groups--those in the last year of life and those with a chronic life limiting illness. However, on closer analysis, the current model of service delivery, a two-week inpatient stay, may not be best suited to those caring for a relative in the last year of life. Similarly, it might be questioned whether an inpatient hospice is the most suitable setting for those patients needing supportive care, rather than specialist palliative care. The study has raised many issues that need to be considered in the support of carers caring for relatives with a life limiting illness with uncertain trajectories.

Adult↗
PubMedDate not supplied

'Breaking it down': patient-clinician communication and prenatal care among African American women of low and higher literacy.

PURPOSE: Low literacy has been associated with poor medical adherence, but its role in maternal care utilization has not been explored. METHODS: We undertook a concurrent mixed methods study among 202 African American women of low (< or = 6th grade) and higher literacy receiving Medicaid. Poor use of prenatal care was defined by (1) starting care after the first trimester and (2) inadequate care utilization according to the Adequacy of Prenatal Care Utilization Index (APNCU). Participant-derived themes regarding prenatal care and care utilization were identified and explored through individual interviews (free listing and cultural consensus analysis; n = 40), and 4 confirmatory focus groups stratified by literacy. RESULTS: Thirty-three women (16%) had low-literacy levels, 120 (61%) women started prenatal care after the first trimester, and 101 (50%) had inadequate utilization of prenatal care. Neither measure varied by literacy (P >.05). Cultural consensus analysis identified a single prenatal care factor that was comprised of 9 items, shared by women of low and higher literacy (eigenvalue 0.881, SD 0.058). Focus groups confirmed these items among participants from both literacy groups. Communication with clinicians was a central theme linking all of the factor items. Effective communication, exemplified by "breaking it down," was described as encouraging, whereas ineffective communication discouraged use of care. CONCLUSION: Women who had both low- and higher-literacy skills had high rates of poor prenatal care utilization and reported that communication with clinicians influenced their use of prenatal care. Improving the clarity of communication by breaking down information into simple parts should be a priority for prenatal clinicians.

Adolescent↗
PubMedDate not supplied

Unwritten rules of talking to doctors about depression: integrating qualitative and quantitative methods.

PURPOSE: We wanted to understand concordance and discordance between physicians and patients about depression status by assessing older patient's views of interactions with their physicians. METHODS: We used an integrated mixed methods design that is both hypothesis testing and hypothesis generating. Patients aged 65 years and older, who identified themselves as being depressed, were recruited from the offices of primary care physicians and interviewed in their homes using a semistructured interview format. We compared patients whose physicians rated them as depressed with those whose physicians who did not according to personal characteristics (hypothesis testing). Themes regarding patient perceptions of their encounters with physicians were then used to generate further hypotheses. RESULTS: Patients whose physician rated them as depressed were younger than those whose physician did not. Standard measures, such as depressive symptoms and functional status, did not differentiate between patients. Four themes emerged in interviews with patients regarding how they interacted with their physicians; namely, "My doctor just picked it up," "I'm a good patient," "They just check out your heart and things," and "They'll just send you to a psychiatrist." All patients who thought the physician would "just pick up" depression and those who thought bringing up emotional content would result in a referral to a psychiatrist were rated as depressed by the physician. Few of the patients who discussed being a "good patient" were rated as depressed by the physician. CONCLUSIONS: Physicians may signal to patients, wittingly or unwittingly, how emotional problems will be addressed, influencing how patients perceive their interactions with physicians regarding emotional problems.

Age Factors↗
PubMed1975

Contraceptive practice required to meet a prescribed crude birth rate target: a proposed macro-model (TABRAP) and hypothetical illustrations.

TABRAP (TArget Birth Rate Acceptor Program) is a computer programmed model that provides a direct solution to the problem of determining the total annual numbers of contraceptive acceptors required to achieve a prescribed crude birth rate target path. Applied to an initial population for which age structure, the fertility schedule, and expected trends in life expectancy and age-specific proportions of females married are known, TABRAP incorporates the following factors: age at acceptance, with acceptors drawn from currently married nonusers; age-method-specific attrition rates of users; a potential fertility schedule of acceptors that allows for aging and sterility; and allowance both for postpartum anovulation and nine months for gestation to time properly the averted births. TABRAP generates annual data on acceptors, couple-years of use, births averted and age-specific fertility rates that meet the crude birth rate target. Resulting changes in population size, age structure and crude vital rates, also yielded, are invariant with respect to acceptor age and method mix. Assuming a target to reduce the crude birth rate from 45 to 30 in ten years, TABRAP is illustrated for seven mixes of acceptor age-method combinations applied to a population approximately that of Thailand, circa 1965.

Adolescent↗
PubMed2002

Effect of catalyst preparation conditions on the hydrodesulfurization of thiophene over Co-Mo/gamma-Al2O3.

The purpose of this research was to study the effects of preparation conditions on the catalytic properties of the Co-Mo/gamma-Al2O3 catalyst. The work included catalyst preparations and reactions. In the preparations, cobalt-impregnated Mo/gamma-Al2O3 (designated as IcIM) was found to have a promoting effect on the hydrodesulfurization (HDS) of thiophene. Activity and stability of IcIM was higher than that of Mo/gamma-Al2O3. Conversely, when cobalt was added onto Mo/gamma-Al2O3 by the mechanical mixing method, no promoting effect was observed. Mo/gamma-Al2O3 was also prepared using the two different methods (incipient impregnation or mechanical mixing). The differently prepared Mo/gamma-Al203 resulted in no obvious difference in activity of IcIM. It was further found that Co-Mo/gamma-Al2O3 activity initially increased appreciably with Mo content and leveled off at Mo contents above 9 wt.%. The catalyst exhibited a maximum activity at Co/Mo ratio 0.3. The order in which metal species were added had a great influence on the activity of the Co-Mo/gamma-Al2O3 catalyst. Higher activity was obtained when Co was added into Mo/gamma-Al2O3 as opposed to Mo added into Co/gamma-Al2O3.

Aluminum Oxide↗
PubMed2005

Barriers to racial/ethnic minority application and competition for NIH research funding.

BACKGROUND: Despite recognition of the need to increase the pool of racial/ethnic minority investigators, racial/ethnic minority representation among National Institutes of Health (NIH)-funded investigators remains low. Racial/ethnic minority investigators bring unique perspectives and experiences that enhance the potential for understanding factors that underlie racial/ethnic variation in health and health status. Identification of barriers to successful minority competition for NIH funding and suggestions for strategies to overcome them were obtained from a concept mapping project and a meeting of minority investigators and investigators at minority-serving institutions. METHODS: Concept mapping, a mixed-methods planning approach that integrates common data collection processes with multivariate statistical analyses, was used in this exploratory project. The concept mapping approach generated a series of related "concept maps" that were used for data interpretation and meeting discussions. RESULTS: Barriers to minority investigator competition for NIH funding identified by concept mapping participants include: (1) inadequate research infrastructure, training and development; (2) barriers to development as independent researchers; (3) inadequate mentoring; (4) insensitivity, misperceptions and miscommunication about the specific needs of investigators involved in research with minority communities; (5) institutional bias in NIH policies; (6) unfair competitive environment; (7) lack of institutional support; (8) lack of support for research topics/methods relevant to research with minority communities; and (9) social, cultural and environmental barriers. DISCUSSION: Data from both the concept mapping and the meeting discussions suggest the need to use a multilevel approach to increase minority representation among funded NIH investigators. Specifically, the NIH should use strategies that overcome barriers at the home institution, within NIH and at the investigator level.

Data Collection↗