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Return of the question "why": advantages of exploring pre-existing explanations.

We suggest that there are many advantages in thoroughly exploring the causal explanations given by clients or members of their social network to account for their problems. Specific interviewing techniques are presented to uncover clients' causal explanations or their impressions about the causal explanations of others. Various advantages of exploring these explanations are discussed. They include improved cooperation, development of "systemic empathy," detachment from the explanations of other professionals, recognition and avoidance of coalitions, loosening of firmly held explanations, dilution of noxious explanations, generation of new and positive explanations toward solutions, and taking a bird's-eye view or meta position about such explanations. We conclude that acceptance and appreciation of the human tendency to believe in causal explanations is a fruitful way to enhance interaction between clinicians and clients.

Communication↗

Therapist-parent interaction patterns in home-based treatments: exploring family therapy process.

At the current stage of development in the family therapy field, exploratory, small-scale process studies are necessary in order to understand through what interpersonal processes child and family change occur. The goal of this article is to show how relevant therapist-parent interactions within family-based approaches can be explored and linked to the reduction in childrearing and behavior problems. Sequential analyses on 13 treatments using the Family Project Approach revealed that, within the most successful treatments, therapist and parent interact in a collaborative way in the phase of Direct Influence. In the beginning of this treatment phase, the therapist must activate the parents to tackle the problems actively. Further explorations indicated that a collaborative interaction pattern between therapist and mother during the first three sessions of therapy contributes to a better outcome.

Adult↗

Exploring the subconcepts of the Wittmann-Price theory of emancipated decision-making in women's health care.

PURPOSE: To explore the subconcepts of the Wittmann-Price Theory of Emancipated Decision-Making (EDM); which is proposed as a new theoretical model for the nursing care of women to increase women's satisfaction with decision-making about healthcare issues. Infant feeding method was used as the clinical exemplar. DESIGN AND METHOD: A descriptive correlational design was used to test the five identified subconcepts of EDM (empowerment, flexible environment, personal knowledge, reflection, and social norms) in women's healthcare. The relationship of emancipated decision-making and satisfaction were explored with the Subject Demographic Questionnaire (SDQ), the Wittmann-Price Theory of Emancipated Decision-making Scale (EDMS), and the Satisfaction with Decision (SWD) scale. The research design was retrospective, without random sampling of subjects. Four research questions were posed for this investigation. Women who had uncomplicated deliveries and met the selected criteria were enrolled (N=97). FINDINGS: All five subconcepts of EDM were scored on subscales on the EDMS; flexible environment and personal knowledge had the highest mean scores. Pearson correlations showed that all five subscales were significantly related to each other except reflection with personal knowledge and reflection with social norms. A significant relationship was found between the EDM and satisfaction with the decision. Personal knowledge and flexible environment were the best predictors of satisfaction with the decision. CONCLUSIONS: The Wittmann-Price Theory of EDM is a theoretical model with implications for nursing care of women who are involved in a healthcare decision, such as choice of infant feeding. Further studies are needed to determine the importance of each of the subconcepts in relation to emancipated decision-making.

Adolescent↗

Exploring the influence of skin perfusion on transepidermal water loss.

BACKGROUND: Eventual relationships between the vascular function and transepidermal water loss (TEWL), in vivo,have not been entirely explored. By promoting local perfusion alterations through a well-known challenge test, the'tourniquet-cuff occlusion' manoeuvre, the present study searches for other dynamical factors influencing the cutaneous barrier, further exploring the applicability of these flow-related variables in dermatological research. METHODS: By applying the tourniquet-cuff manoeuvre to a group of healthy volunteers (n= 20), transcutaneous (tc)gases (pO2-pCO2), LDF (laser doppler flowmetry) and TEWL were considered as representing the dynamical aspects under study and measured non-invasively. RESULTS AND CONCLUSION: An haemodynamical relationship between tcpO2 and LDF in the post-occlusive period was clearly identified, defining the autoregulatory index as a numerical descriptor of the local metabolic-flow adjustment under stress. TEWL was also significantly affected by the manoeuvre, especially during the post-occlusive period,although no significant relationships between TEWL and other tc variables could be found. The present findings seem to suggest that, under the present experimental conditions, local haemodynamics may also influence TEWL measurements and the skin barrier.

Adult↗

The invitational conference: a strategy for exploring ethical issues.

The author describes an invitational conference format with prepared participants and Socratic questioning techniques used to facilitate exploration of the ethical implications of using unlicensed assistive personnel (UAP). Examples of the issues discussed are failure to treat UAP with respect, nurses not used to their fullest potential, and professional nurses' claims that UAP lack the knowledge and skills to permit effective delegation. The author recommends this strategy to facilitate exploration of other ethical issues.

Ethics, Nursing↗

Symptom perception: a concept exploration.

The topic of this paper is a concept analysis of symptom perception using the theoretical phase of the Schwartz-Barcott Hybrid Model. The purpose of this paper is to explore symptom perception and related concepts and formulate a working definition. Sources of information include symptom perception and related concepts models and studies using the concepts as well as sources pertaining to related measurement tools. The conclusion of this exploration reveals several overlapping concepts. These concepts are synthesized into a working definition of symptom perception.

Attitude to Health↗

Deviations on exploration, attachment, and fear of strangers in high-risk and control infants at one year of age.

Exploratory behavior and deviations on three dimensions--fear of strangers, attachment to mother, and exploration--were studied in 46 infants of mothers with a history of psychosis and 80 control infants. While high-risk infants did not differ from controls on exploration alone, they showed multiple deviations on the three dimensions more frequently than did controls, especially in the case of offspring of schizophrenic mothers.

Affective Disorders, Psychotic↗

Phenomenological psychology and schizophrenia as explored by Erwin Strauss.

This paper is concerned with an attempt to return to the earliest principles of the phenomenological method by exploring the psychology of Erwin Strauss, with particular reference to his studies of schizophrenia. Strauss's analysis of the peculiarly subjective relationship between the schizophrenic and the no-longer-neutral outside world is particularly investigated with specific reference to the physiognomic quality of everyday experience. It is suggested that the existential categories utilized in this method can offer an additional perspective in the attempt to explore the world of the schizophrenic; particularly in understanding his idiosyncratic fears and his autistic I-world interpretation.

England↗

Exploration of inorganic C and N assimilation by soil microbes with time-of-flight secondary ion mass spectrometry.

Stable C and N isotopes have long been used to examine properties of various C and N cycling processes in soils. Unfortunately, relatively large sample sizes are needed for accurate gas phase isotope ratio mass spectrometric analysis. This limitation has prevented researchers from addressing C and N cycling issues on microbially meaningful scales. Here we explored the use of time-of-flight secondary ion mass spectrometry (TOF-SIMS) to detect 13C and 15N assimilation by individual bacterial cells and to quantify N isotope ratios in bacterial samples and individual fungal hyphae. This was accomplished by measuring the relative abundances of mass 26 (12C14N-) and mass 27 (13C14N- and 12C15N-) ions sputtered with a Ga+ probe from cells adhered to an Si contact slide. TOF-SIMS was successfully used to locate and quantify the relative 15N contents of individual hyphae that grew onto Si contact slides in intimate contact with a model organomineral porous matrix composed of kaolin, straw fragments, and freshly deposited manure that was supplemented with 15NO3-. We observed that the 15N content of fungal hyphae grown on the slides was significantly lower in regions where the hyphae were influenced by N-rich manure than in regions influenced by N-deficient straw. This effect occurred over distances of tens to hundreds of microns. Our data illustrate that TOF-SIMS has the potential to locate N-assimilating microorganisms in soil and to quantify the 15N content of cells that have assimilated 15N-labeled mineral N and shows promise as a tool with which to explore the factors controlling microsite heterogeneities in soil.

Carbon↗

Explorative multivariate analyses of 16S rRNA gene data from microbial communities in modified-atmosphere-packed salmon and coalfish.

Modified-atmosphere packaging (MAP) of foods in combination with low-temperature storage extends product shelf life by limiting microbial growth. We investigated the microbial biodiversity of MAP salmon and coalfish by using an explorative approach and analyzing both the total amounts of bacteria and the microbial group composition (both aerobic and anaerobic bacteria). Real-time PCR analyses revealed a surprisingly large difference in the microbial loads for the different fish samples. The microbial composition was determined by examining partial 16S rRNA gene sequences from 180 bacterial isolates, as well as by performing terminal restriction fragment length polymorphism analysis and cloning 92 sequences from PCR products of DNA directly retrieved from the fish matrix. Twenty different bacterial groups were identified. Partial least-squares (PLS) regression was used to relate the major groups of bacteria identified to the fish matrix and storage time. A strong association of coalfish with Photobacterium phosphoreum was observed. Brochothrix spp. and Carnobacterium spp., on the other hand, were associated with salmon. These bacteria dominated the fish matrixes after a storage period. Twelve Carnobacterium isolates were identified as either Carnobacterium piscicola (five isolates) or Carnobacterium divergens (seven isolates), while the eight Brochothrix isolates were identified as Brochothrix thermosphacta by full-length 16S rRNA gene sequencing. Principal-component analyses and PLS analysis of the growth characteristics (with 49 different substrates) showed that C. piscicola had distinct substrate requirements, while the requirements of B. thermosphacta and C. piscicola were quite divergent. In conclusion, our explorative multivariate approach gave a picture of the total microbial biodiversity in MAP fish that was more comprehensive than the picture that could be obtained previously. Such information is crucial in controlled food production when, for example, the hazard analysis of critical control points principle is used.

Animals↗

Muscular damage and intravascular haemolysis during an 18 hour subterranean exploration in a cave of 700 m depth.

OBJECTIVE: To verify presence and severity of muscular and/or intravascular damage during a subterranean exploration of long duration. METHODS: We measured serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) as markers of muscular damage. We also measured haptoglobin as a marker of intravascular haemolysis, and platelets and leucocytes as markers of inflammation. RESULTS: We found in all the participants an increase in CK, LDH, and platelets and leucocytes (mainly due to neutrophilia and monocytosis), and a decrease in the level of haptoglobin and circulating lymphocytes. CONCLUSIONS: The observed data suggest that continuous effort during long alpine subterranean explorations, environmental conditions, sleep deprivation, multiple impacts on rocks, and compression caused by bindings of the caving harness cause muscle damage, intravascular haemolysis, inflammation response, and immunological changes.

Adult↗

Exploring performance issues for a clinical database organized using an entity-attribute-value representation.

BACKGROUND: The entity-attribute-value representation with classes and relationships (EAV/CR) provides a flexible and simple database schema to store heterogeneous biomedical data. In certain circumstances, however, the EAV/CR model is known to retrieve data less efficiently than conventionally based database schemas. OBJECTIVE: To perform a pilot study that systematically quantifies performance differences for database queries directed at real-world microbiology data modeled with EAV/CR and conventional representations, and to explore the relative merits of different EAV/CR query implementation strategies. METHODS: Clinical microbiology data obtained over a ten-year period were stored using both database models. Query execution times were compared for four clinically oriented attribute-centered and entity-centered queries operating under varying conditions of database size and system memory. The performance characteristics of three different EAV/CR query strategies were also examined. RESULTS: Performance was similar for entity-centered queries in the two database models. Performance in the EAV/CR model was approximately three to five times less efficient than its conventional counterpart for attribute-centered queries. The differences in query efficiency became slightly greater as database size increased, although they were reduced with the addition of system memory. The authors found that EAV/CR queries formulated using multiple, simple SQL statements executed in batch were more efficient than single, large SQL statements. CONCLUSION: This paper describes a pilot project to explore issues in and compare query performance for EAV/CR and conventional database representations. Although attribute-centered queries were less efficient in the EAV/CR model, these inefficiencies may be addressable, at least in part, by the use of more powerful hardware or more memory, or both.

Database Management Systems↗

Using human error theory to explore the supply of non-prescription medicines from community pharmacies.

BACKGROUND: The importance of theory in underpinning interventions to promote effective professional practice is gaining recognition. The Medical Research Council framework for complex interventions has assisted in promoting awareness and adoption of theory into study design. Human error theory has previously been used by high risk industries but its relevance to healthcare settings and patient safety requires further investigation. This study used this theory as a framework to explore non-prescription medicine supply from community pharmacies. The relevance to other healthcare settings and behaviours is discussed. METHOD: A 25% random sample was made of 364 observed consultations for non-prescription medicines. Each of the 91 consultations was assessed by two groups: a consensus group (stage 1) to identify common problems with the consultation process, and an expert group (stages 2 and 3) to apply human error theory to these consultations. Paired assessors (most of whom were pharmacists) categorised the perceived problems occurring in each consultation (stage 1). During stage 2 paired assessors from an expert group (comprising patient safety experts, community pharmacists and psychologists) considered whether each consultation was compliant with professional guidelines for the supply of pharmacy medicines. Each non-compliant consultation identified during stage 2 was then categorised as a slip/lapse, mistake, or violation using human error theory (stage 3). RESULTS: During stage 1 most consultations (n = 75, 83%) were deemed deficient in information exchange. At stage 2, paired assessors varied in attributing non-compliance to specific error types. Where agreement was achieved, the error type most often selected was "violation" (n = 27, 51.9%, stage 3). Consultations involving product requests were less likely to be guideline compliant than symptom presentations (OR 0.30, 95% CI 0.10 to 0.95, p = 0.05). CONCLUSIONS: The large proportion of consultations classified as violations suggests that either pharmacy staff are unaware of professional guidelines and thus do not follow them (therefore these acts would not be violations), or that they knowingly violate the guidelines due to reasons that need further research. The methods presented here could be used in other healthcare settings to explore healthcare professional behaviour and to develop strategies to promote patient safety and effective professional practice.

Clinical Competence↗

Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room.

This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of "vulnerable system syndrome", Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a critical insight into key trends in the interview data, including team members' definition of error as the breaching of standards of practice, nurses' sense of scope of practice as a constraint on their reporting behaviours, and participants' reports of the forces influencing tacit agreements to work around safety regulations. However, the relational factors underlying unsafe practice routines are poorly accounted for in these theoretical approaches. Incorporating an additional theoretical construct such as "relational coordination" to account for the emotional human features of team practice would provide a more comprehensive theoretical approach for use in exploring unsafe practice routines and the forces that sustain them in healthcare team settings.

Anesthesiology↗

Exploring the impact of foreign direct investment on tobacco consumption in the former Soviet Union.

BACKGROUND: Tobacco is the single largest cause of morbidity and mortality in the developed world; in the former socialist bloc tobacco kills twice as many men as in the west. Although evidence shows that liberalisation of the cigarette trade through the elimination of import barriers leads to significant increases in consumption, far less is known about the impact of foreign direct investment on cigarette consumption. This paper seeks to explore the impact that the substantial transnational tobacco company investments have had on patterns of tobacco trade and consumption in the former Soviet Union. DESIGN: Routine data were used to explore trends in cigarette trade and consumption in the 15 countries of the former Soviet Union from the 1960s to the present day. Comparisons were made between trends in countries that have received substantial investment from the tobacco transnationals and countries that have not. RESULTS: Between 1991 and 2000 cigarette production increased by 96% in countries receiving industry investment and by 11% in countries that did not. Over the same period cigarette consumption increased by 40%; the increase was concentrated in countries receiving investments. Despite these investments, cigarette imports still outweigh exports and no trade surplus has yet to result. CONCLUSIONS: The findings suggest that liberalisation of inward investment has a significant and positive impact on cigarette consumption and that without appropriate safeguards, market liberalisation may have long term negative impacts on health. Specific trade rules are needed to govern trade and investment in this uniquely harmful product. Implementation of effective tobacco control policies should precede tobacco industry privatisation. International financial organisations pressing for privatisation should ensure this occurs.

Commerce↗

Glycosylation of proteins: a computer based method for the rapid exploration of conformational space of N-glycans.

Inspection of protein databases suggests that as many as 70% of proteins have potential N-glycosylation sites. Unfortunately glycoproteins often refuse to crystallize and NMR techniques do not allow an unambiguous determination of the complete conformation of the sugar part. Therefore, time-consuming complex simulation methods are often used to explore the conformational space of N-glycans. The generation of a comprehensive data base describing the conformational space of larger fragments of N-glycans taking into account the effects of branching is presented. High-temperature molecular dynamics simulations of essential N-glycan fragments are performed until conformational equilibrium has been reached. Free energy landscapes are calculated for each glycosidic linkage. All possible conformations for each N-glycan fragment are automatically assigned, ranked according to their relative population and stored in a database. These values are recalled for the generation of a complete set of all possible conformations for a given N-glycan topology. The constructed conformations are ranked according to their energy content. Since this approach allows to explore the complete conformational space of a given N-glycan within a few minutes of CPU-time on a standard PC, it is well suited to be used as a Web-Based application.

Carbohydrate Conformation↗

Exploring parameter space in detailed single neuron models: simulations of the mitral and granule cells of the olfactory bulb.

1. Detailed compartmental computer simulations of single mitral and granule cells of the vertebrate olfactory bulb were constructed using previously published geometric data. Electrophysiological properties were determined by comparing model output to previously published experimental data, mainly current-clamp recordings. 2. The passive electrical properties of each model were explored by comparing model output with intracellular potential data from hyperpolarizing current injection experiments. The results suggest that membrane resistivity in both cells is nonuniform, with somatas having a substantially lower resistivity than the dendrites. 3. The active properties of these cells were explored by incorporating active ion channels into modeled compartments. On the basis of evidence from the literature, the mitral cell model included six channel types: fast sodium, fast delayed rectifier (Kfast), slow delayed rectifier (K), transient outward potassium current (KA), voltage- and calcium-dependent potassium current (KCa), and L-type calcium current. The granule cell model included four channel types: rat brain sodium, K, KA, and the non-inactivating muscarinic potassium current (KM). Modeled channels were based on the Hodgkin-Huxley formalism. 4. Representative kinetics for each of the channel classes above were obtained from the literature. The experimentally unknown spatial distributions of each included channel were obtained by systematic parameter searches. These were conducted in two ways: large-scale simulation series, in which each parameter was varied in turn, and an adaptation of a multidimensional conjugate gradient method. In each case, the simulated results were compared wtih experimental data using a curve-matching function evaluating mean squared differences of several aspects of the simulated and experimental voltage waveforms. 5. Systematic parameter variations revealed a single distinct region of parameter space in which the mitral cell model best fit the data. This region of parameter space was also very robust to parameter variations. Specifically, optimum performance was obtained when calcium and slow K channels were concentrated in the glomeruli, with a lower density in the soma and proximal secondary dendrites. The distribution of sodium and fast potassium channels, on the other hand, was highest at the soma and axon, with a much lighter distribution throughout the secondary dendrites. The KA and KCa channels were also concentrated near the soma. 6. The parameter search of the granule cell model was much less restrained by experimental data. Several parameter regimes were found that gave a good match to the data.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Active tactile exploration influences the functional maturation of the somatosensory system.

1. The hypothesis that active exploration of objects is required for the functional maturation of neuronal circuits subserving tactile perception was tested by subjecting 8- to 11-day old rats to a complete unilateral section of the facial nerve. This procedure selectively abolished whisker protraction movements without affecting the sensory innervation of the facial vibrissae, the tactile organs used by rats to discriminate object texture and shape. 2. Six to 14 mo after the facial nerve section, simultaneous recordings of neuronal ensembles located in the ventral posterior medial nucleus (VPM) of the thalamus revealed a marked reduction in receptive field (RF) size (in terms of number of whiskers), and the formation of abnormal RF surrounds, spanning the face and contiguous body regions. In addition, the directional organization of VPM RFs, represented by caudal to rostral shifts in RF centers over 30 ms following whisker stimulation, was greatly reduced in these animals. 3. These results suggest that neonatal active tactile exploration is required to establish normal spatiotemporal patterning of neuronal RFs within the somatosensory system, and consequently, to develop normal tactile perception.

Animals↗