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PubMed2006

Stress reactions and perceived difficulties of lay responders to a medical emergency.

BACKGROUND: Bystander CPR rates remain low. One reason may be that the thought of responding to an emergency is so stressful that it decreases the willingness of laypersons to respond. PURPOSE: The purpose of this study was to quantify the amount of stress experienced by lay responders to a medical emergency and to identify barriers that may have impeded their response to the event. METHODS: Responses from 1243 laypersons responding to an emergency during the Public Access Defibrillation Trial were analyzed in a mixed methods study. Stress related to the event was recorded using a 0 (none) to 5 (severe) scale. Qualitative responses to the question of "What was most difficult?" about the event were analyzed using content analysis. RESULTS: Reported stress levels were low overall (mean 1.2, median 1.0). Laypersons responding to an emergency presumed to be a cardiac arrest had higher stress than those involved in other events (median 2.0 versus 1.0). Stress levels were higher in residential than in public settings (mean 1.41, median 1.0 versus mean 1.13, median 1.0). Those who fit a certain profile (females, non-native English speakers) reported statistically higher stress levels than others. A total of 614 qualitative responses were studied and aggregated into four major categories of difficulty: practical issues; characteristics of the victim; interpersonal issues; thoughts and feelings of the lay responder. Most difficulties were in the category of practical issues. CONCLUSIONS: Among these study volunteer lay responders, low levels of stress were reported. Incorporating descriptions of the difficulties experienced by lay responders in CPR/AED training curricula may make courses more realistic and useful.

Adult↗

PubMed2004

Qualitative sample extensiveness in health education research.

The use of qualitative methods is increasing in the health education literature, and there is need for more information on these methods and their use. This investigation looks at qualitative sampling practices as reported in the 93 qualitative or mixed-method studies published in Health Education & Behavior from 1980 to 2000. It focuses particularly on the extensiveness of sampling in this research (i.e., the volume and diversity of information collected about the phenomenon of interest). Among these studies, individual interviews averaged 104 +/- 134 informants (range 2 to 720) and 92 +/- 39 minutes. Focused group interviews averaged 10 groups (range 1 to 40) and 90 +/- 25 minutes. Observational studies usually occurred in multiple sites and involved approximately 16 to 24 months of fieldwork. Document analysis extensiveness varied considerably on a variety of indicators. Future qualitative research would benefit from more complete consideration and fuller reporting of sample extensiveness.

Bibliometrics↗

PubMed2004

Single-tube method for nucleic acid extraction, amplification, purification, and sequencing.

BACKGROUND: The hepatitis C virus (HCV) genotype determines patient prognosis and duration of treatment, but sequencing of the gene is lengthy and labor-intensive. We used a commercially available nucleic acid extraction system to develop a single-tube extraction-to-sequencing (STETS) method for HCV genotyping. METHODS: HCV RNA was purified and amplified in tubes coated with a solid-phase matrix that irreversibly bound nucleic acid during the extraction step. After reverse transcription-PCR, the amplicon was adsorbed to the original extraction matrix for purification and use in the subsequent sequencing reactions. RESULTS: The STETS method generated genotyping-quality sequence for a range of HCV titers from 500 to 6,000,000 IU/mL. If a viral sample was detected during real-time reverse transcription-PCR, it could be sequenced and genotyped. Read lengths >600 bases were observed with the STETS method. Mixed infections were detected and genotyped if at least 15% of the minor species was present. Combining the STETS method with consecutive sequencing provided a means of performing both forward and reverse sequencing in a single tube. CONCLUSIONS: A single-tube nucleic acid extraction-to-sequencing method, which requires less time and labor than conventional methods, generates HCV sequence data that are equivalent to conventional methods and can be used to genotype HCV.

Genotype↗

PubMed2005

Extended multilocus sequence typing system for Campylobacter coli, C. lari, C. upsaliensis, and C. helveticus.

A multilocus sequence typing (MLST) system has been reported previously for Campylobacter jejuni to both differentiate strains and identify clonal lineages. However, sequence variation at the MLST loci prevents its use for closely related Campylobacter species. We describe herein an expanded MLST method to include three clinically relevant Campylobacter species, C. coli, C. lari, and C. upsaliensis, and a fourth Campylobacter species, C. helveticus. The C. coli and C. helveticus methods use the same seven C. jejuni loci (aspA, atpA, glnA, gltA, glyA, pgm, and tkt); however, adk and pgi were substituted for aspA and gltA in C. lari and for gltA and pgm in C. upsaliensis. Multiple C. coli (n = 57), C. lari (n = 20), C. upsaliensis (n = 78), and C. helveticus (n = 9) isolates, representing both clinical and environmental sources, were typed. All four species were genetically diverse: the majority (> 80%) of the isolates had unique sequence types (STs). Using this method, mixed C. lari, C. upsaliensis, and C. helveticus isolates were identified; upon separation, each isolate was shown to contain two strains of the same species with distinct STs. Additionally, the expanded MLST method was able to detect potential lateral transfer events between C. jejuni and either C. coli or C. lari and between C. upsaliensis and C. helveticus. Thus, the expanded MLST method will prove useful in differentiating strains of five Campylobacter species, identifying mixed Campylobacter cultures, and detecting genetic exchange within the genus.

Base Sequence↗

PubMed2003

The effect of different methods of collecting data: mail, telephone and filter data collection issues in utility measurement.

When collecting data researchers can interview participants, conduct telephone interviews, or mailout questionnaires. Often mixed methods are used. Whether these methods produce equivalent data is under-researched in the health-related quality of life (HRQoL) field. In addition, the effect of using filter questions has not been researched among HRQoL multi-attribute utility instruments. This study randomly sampled from Melbourne, Australia, and employed a test-retest design to investigate whether mail or telephone interview made any difference to Assessment of Quality of Life (AQoL) instrument utility scores. A filter question AQoL version investigated the effect of filters on scores. There was no significant difference in standard AQoL scores between mail self-completion and telephone interview, regardless of which was administered first. Inclusion of filter questions encouraged respondents to select the best response category thereby screening out minor health conditions. The effect was to increase utility scores by 0.06 or 7%. This effect has not been previously reported in utility instruments and has profound implications for economic evaluations using cost-utility analysis; there are implications for researchers using filter questions in general. In conclusion, researchers should feel confident that utility scores elicited from the standard AQoL through self-completion mail and telephone interview administrations are directly comparable.

Adult↗

PubMedDate not supplied

A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness.

BACKGROUND: Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging. METHODS: Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 +/- 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness. RESULTS: Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources). CONCLUSION: An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.

Communication↗

PubMedDate not supplied

An assessment of encapsulated versus hand-mixed glass ionomer restoratives.

Capsulation should enable uniform proportioning and mixing of dental restoratives so that functional properties of the cementitious mass will not be susceptible to clinically induced variability. Mechanical mixing induces a definite pore distribution determined by the viscosity of the system. This study evaluated the mixing process on the performance of a range of glass ionomer dental restoratives. Mean compressive fracture strengths and standard deviations and the associated Weibull Moduli (m) were determined for six glass ionomer restoratives that were either encapsulated or mixed by hand. Working characteristics were assessed using an oscillating rheometer. Scanning electron microscopy and image analysis was used to investigate the influence of the mixing method on pore distribution. The fracture strength data for some encapsulated restoratives resulted in significant differences compared with hand-mixing. Rotomix (compared with the Capmix mechanical agitator) resulted in increased Weibull moduli and 10% failure stress for the two restoratives that were investigated. Encapsulated restoratives that were prepared utilizing Rotomix or Capmix resulted in no significant differences for working characteristics; however, the setting time for the ChemFlex in Caps was extended compared with the hand-mixed ChemFlex. Not all restoratives had reduced porosity and improved performance following mixing with a Rotomix. This suggested that optimization of the initial viscosity of the system by manipulating the individual proportions of the constituents may not have been appropriate for all the restoratives investigated. The increased viscosity for hand-mixed ChemFlex prepared to a consistency of 3.8 g/ml compared with encapsulated ChemFlex in Caps prepared to a consistency of 3.5 g/ml was responsible for the reduced setting time.

Analysis of Variance↗

PubMed1999

Tear mixing under a soft contact lens: effects of lens diameter.

PURPOSE: Tear exchange under a soft contact lens is modest, and higher exchange rates may be necessary to reduce extended-wear complications; what is not known is the optimal soft lens design to increase tear mixing. We explored the effect of lens diameter on tear mixing. METHODS: Twenty-three subjects wore four different soft contact lenses with diameters of 12.0, 12.5, 13.0, and 13.5 mm. Tear mixing was quantified by placing fluorescein isothiocyanate-dextran on the posterior lens surface, inserting the lens, and monitoring the changes in fluorescence intensity in the postlens tear film. Tear mixing, expressed as the percentage decrease in fluorescence intensity per blink, was estimated using an exponential model. Lens movement was videotaped and lens comfort was graded on a 50-point scale (50 = excellent comfort). Subjects reporting a comfort level of less than 35 were excluded. RESULTS: The mean +/- SE tear mixing rates were 1.82% +/- 0.17%, 1.61% +/- 0.16%, 1.34% +/- 0.17%, and 1.24% +/- 0.17% per blink for the 12.0-, 12.5-, 13.0-, and 13.5-mm diameter lenses, respectively. By regression analysis we found that, on average, mixing under the 12.0-mm lens was 0.59% per blink greater than with the 13.5-mm lens (P = .0024). Lens diameter was a significant predictor of lens comfort, and adjusting for the effects of comfort weakened the relationship between diameter and tear replenishment rate, although the mean rate under the 12.0-mm lens was still 0.43% per blink greater than with the 13.5-mm lens (P = .0468). CONCLUSIONS: These data suggest that smaller-diameter soft lenses provide substantially better tear mixing than larger lenses; however, even small lenses provide modest tear mixing compared with rigid contact lenses.

Adult↗

PubMedDate not supplied

Barriers and enablers to changing organizational culture in nursing homes.

PURPOSE: To discuss the barriers and enablers of changing organizational culture in 3 nursing homes undergoing a culture change initiative, and suggest actions for program enhancement. METHODS: Interview data with staff (n = 64) and families (n = 14) from 3 culture-change facilities in a larger mixed-methods pilot study were used to identify barriers and enablers. FINDINGS: The 3 sites ranged from 120 to 139 beds and did not differ in staff characteristics. Barriers included exclusion of nurses from culture-change activities, perceived corporate emphasis on regulatory compliance and the "bottom line," and high turnover of administrators and caregivers. Enablers included a critical mass of "change champions," shared values and goals, resident/family participation, and empowerment at the facility level. RECOMMENDATIONS: Involve all levels of staff, residents, and community in culture-change activities. Align incentives and rewards with the new values. Empower individual homes to make decisions at the facility level. Work with corporate partners to enable rapid translation and implementation of recommendations based on the findings.

Attitude of Health Personnel↗

PubMed1977

["Mixed" follicles in the rat thyroid gland (electron microscopic findings)].

The thyroid gland of the rats 3, 5, 7, 11 days and 1 month old has been studied by electron microscopy method. Mixed follicles with walls consisting of usual thyrocytes and unusual stratified epithelium have been observed. Particularly large cells containing glycogen are described in stratified zones. Structural relation of basal cells with marginal cells has been traced. Mitosis of basal cells has been demonstrated. The origin of mixed follicles is discussed and some doubts arise as to their ultimobranchial nature.

Animals↗

PubMed1981

A "spiral test" applied to bacterial mutagenesis assays.

A new procedure (the spiral test) has been set up and validated for the distribution of chemicals in bacterial mutagenesis assays. This method involves the use of a special instrument (spiral plater), which dispenses, along a spiral track, decreasing volumes of liquid samples, from the near centre to the periphery of a rotating agar plate. A gradient of concentration of a compound up to about 1500:1 is thus formed on a single plate. The activity of 18 mutagens of various potencies and chemical classes was checked in the Salmonella/microsome test by dispensing their solutions either on the surface of top agar (method A) or of the minimal-glucose agar medium, before the addition of molten top agar incorporating bacteria and eventually S9 mix (method B). Compared with the spot test, the gradient of concentration of a compound produced by the spiral diluter was much wider and more gradual. Even nondiffusible chemicals (e.g. benzo[a]pyrene and benz[a]anthracene) were efficiently detected in the spiral test, as well as very weak (e.g. mebanazine and trimethylphosphate) or borderline (e.g. perylene, 1,1-dimethylhydrazine and procarbazine) mutagens, which were negative in the spot test. Method B was at least as sensitive as the plate-incorporation test, such a goal being achieved in a single plate instead of in serial plates. Technical problems made method A less sensitive, but it was more efficient in detecting unstable mutagens (e.g. beta-propiolactone). Like the plate test, the spiral test appeared to be suitable for a semi-quantitative assessment of mutagenicity data, and was efficient in demonstrating both the activation of promutagens and the deactivation of some directly acting mutagens. Preliminary assays were also carried out with repair-proficient (WP2) or -deficient (TM1080: lexA-/polA-/R391, and CM871: lexA-/uvrA-/recA-) trp- strains of E. coli.

Culture Media↗

PubMed1991

Effectiveness and acceptibility of the symptothermal method of natural family planning in Germany.

Throughout Germany, 851 women who were instructed in natural family planning participated in a prospective study. Of these, 255 women with 3174 cycles used only natural family planning for family planning and 274 women with 3995 cycles occasionally used barrier methods in the fertile phase. For natural family planning--only users, the Pearl rate for unplanned pregnancy was 2.3 and for mixed-method users 2.1. Most pregnancies resulted from unprotected intercourse during the fertile phase, and the use of barrier methods does not reduce risk-taking.

Body Temperature↗

PubMed1996

Induction of specific tolerance through mixed hematopoietic chimerism prevents chronic renal allograft rejection in a rat model.

BACKGROUND: Chronic rejection is the leading cause of late graft loss in kidney transplantation. We tested the ability of mixed hematopoietic chimerism to prevent chronic renal allograft rejection in an established rat model and described possible mechanisms responsible for this tolerance. METHODS: Mixed hematopoietic chimerism was established in lethally irradiated F-344 rats by reconstitution with Lewis bone marrow. Four groups (n = 5 each) received orthotopic kidney transplants: (1) allograft controls, (2) isograft controls, (3) experimental chimeras, and (4) specificity control. After 120 days kidney grafts were examined histologically, immunohistochemically, and for cytokine interferon-gamma, interleukin-2 (IL-2), IL-4, and IL-10 gene transcripts by means of reverse transcriptase polymerase chain reaction techniques. RESULTS: Allograft control group exhibited severe parenchymal fibrosis; isograft control and chimera groups failed to develop this lesion. Immunohistochemical analysis revealed increased CD8+ lymphocytes and ED-1+ monocyte-macrophages infiltrating the tubulointerstitium of control allografts. Interferon-gamma and IL-2 were absent in isografts. IL-4 was absent and IL-10 was positive in all grafts. Chimeras promptly rejected third-party allografts. CONCLUSIONS: Induction of specific tolerance through mixed hematopoietic chimerism prevents chronic renal allograft rejection. These results support the hypothesis of an immunologic basis of chronic rejection and advance previous observations that the induction of specific tolerance enables long-term solid organ transplantation without the use of immunosuppression.

Animals↗

PubMed2006

A polarizable continuum approach for the study of heterogeneous dielectric environments.

We present a computational method, exploiting some features of the polarizable continuum model (PCM) to describe heterogeneous media; it belongs to the family of electrostatic embedding mixed methods, such as the more common quantum-mechanical (QM)/molecular mechanics approaches, with the electrostatic long range effects accounted for by a polarized continuum instead of atomic point charges. Provided effective dielectric constants are determined for the various parts of the system, the method is much faster than its atomistic counterpart, and allows for high-level QM calculations on the fragment of interest, using all the highly efficient computational tools developed for homogeneous PCM. Two case studies (the calculation of the pKa of solvent exposed acidic residues in a model protein, and the calculation of the electron spin resonance spectrum of a typical spin probe partially embedded in a membrane) are analyzed in some detail, to illustrate the application of the method to complex systems.

Algorithms↗

PubMed2000

Women's acceptance of an injectable progestin-only contraceptive in a free-choice environment in Turkey.

A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman clinic in Turkey. During the period from 1st December 1996 to 1st December 1997, among 3545 new method acceptors at the clinic, 254 women decided to use the injectable, giving an initial acceptance rate of 7%. Continuation rates, however, were quite low: 43.7% at 6 months and only 18.5% at 12 months. Though all the side-effects were mentioned during the counselling sessions, side-effects such as amenorrhea and spotting might have been underestimated by the potential users of this method, which was new in the country. A more detailed counselling with a strong emphasis on frequent side-effects might lower the initial acceptance rate, but can help to increase the continuation rates.

Adult↗

PubMed2004

Mind the gap: responding to the global funding crisis in family planning.

The widening gap between the cost of meeting family planning needs and the funding available for commodities and programmes is a concern among policymakers and reproductive health professionals. The gap could reach US dollars 210 million by 2015. Its causes are clear; its solutions are not. While changes in programme method mix and cost shifting could address this gap, an often-overlooked alternative is the development and introduction of effective, low-cost methods. The Standard Days Method (SDM) has a first-year failure rate of only 4.8 (correct use) and is acceptable to many women around the world. It is easily integrated into programmes. Many SDM users rely on CycleBeads to help identify the days when pregnancy is likely. Though already meeting couples' needs in many places, the SDM responds in a unique way to needs in settings with high use of traditional methods, high levels of unmet need, and chronic depletion of commodities. The donor gap could have negative consequences, but it also facilitates reassessing family planning programme policies to include other effective, low-cost methods.

Contraception↗

PubMed1992

A simple device to inject indicator gas for wash-out tests during mechanical ventilation.

OBJECTIVE: To evaluate a simple device which injects a constant fraction of indicator gas to the inspiratory mixture for performing multi-breath wash-out tests during controlled ventilation. DESIGN: the technique in which the indicator gas is injected at the mouth of the patient (post-mix) is compared with the technique where the indicator gas is administered in the bellows of the ventilator (pre-mix). SETTING: Surgical Intensive Care Unit of a University Hospital. PATIENTS: 10 post-operative mechanically ventilated patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: 3 wash-out tests with the post-mix and 3 wash-out tests with the pre-mix method were performed within an hour on every patient. The calculated mean end expiratory lung volume (EEV) was 1.91 +/- 0.871 with the post-mix technique and 1.89 +/- 0.881 with the pre-mix technique. There was a good agreement with a mean difference of -1.9 +/- 6.5% in the calculated EEV values by the two different techniques. CONCLUSION: The described injector is an affordable device, is easy to assemble and can be incorporated in most electronically regulated ventilators to perform multi-breath indicator gas wash-out tests for pulmonary monitoring at the bed side of ICU patients.

Aged↗

PubMed2006

Improving the supervision of therapy assistants in Western Australia: the Therapy Assistant Project (TAP).

INTRODUCTION: Multidisciplinary therapy assistants (TAs) are increasingly seen as a model suited to the provision of allied health services in rural and remote areas. Supervision is a key aspect of therapy assistant practice. The rural context presents many challenges in supervising TAs including: a multidisciplinary TA role, outreach service delivery models, inexperienced allied health professionals (AHPs) and a high turnover of AHPs. At present there are no accepted standards for supervising TAs in this context. This study aimed to improve the supervision of TAs by AHPs in a rural setting. Improving supervision formed one aspect of the Therapy Assistant Project (TAP). METHODS: Minimum standards for supervision were developed, a process for recording TA supervision introduced, and training in supervision skills was delivered to AHPs. A mixed method study design was used to determine the impact of introducing minimum standards and supervisor training on supervision practices. RESULTS: Minimum supervision standards included: program and administrative discussion, observation, and demonstration of therapy sessions. Methods recommended for supervising allowed regular supervision of TAs in small, distant rural towns. Developing minimum standards for supervision, a process for recording supervision, and training in supervisory skills resulted in increased supervision between AHPs and TAs. AHP and TA participants expressed satisfaction with minimum supervision standards. The frequency and amount of supervision increased although videoconferencing for supervising TAs in distant towns was not widely used for supervision. CONCLUSION: This study provides a new resource for supervision practices for rural TAs. The minimum standards for supervision would be a suitable resource to assist health services seeking to improve supervision of TAs or commencing a TA program. Further exploration of the use of videoconferencing for supervising TAs in distant rural towns is suggested. Training in supervision skills for AHPs should include introductory and complex supervision methods. This study represents one step in defining standards for rural and remote TA practice.

Allied Health Personnel↗