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Process and outcome evaluation of an emergency department intervention for persons with mental health concerns using a population health approach.

PURPOSE: To evaluate an emergency department's use of a mental health triage and mental health crisis counsellor for persons presenting with mental health concerns. METHOD: Mixed method (qualitative and quantitative), multiple measures. RESULTS: Significant pre- and post-intervention reductions for wait time, security incidents and hospital admissions were found. Follow ups with a community agency, medications and a psychiatrist increased post-intervention, while follow ups with detox decreased post-intervention. CONCLUSIONS: The qualitative and quantitative findings are congruent with other studies supporting the use of properly implemented mental health triage and crisis counsellors to improve the care of persons with mental health concerns.

Adolescent↗

[Detection of oncornavirus D-induced antigen in cells by a mixed hemadsorption method].

Further study of a new oncornavirus D-induced antigen was done. Its immunological specificity and localization in cells was determined by a sensitive method of mixed hemadsorption. A continuous HEp-2 cell culture was used as the source of the new as well as virus antigen. Adsorbed specific sera to the new antigen and to oncornavirus D obtained by the previously developed method were used for the antigens detection. This method demonstrated localization of both virus antigens and oncornavirus D-induced antigens not included into the virion structure on the surface of oncornavirus D-infected cells. Mixed hemadsorption test as well as complement-fixation test gave the results identical in their specificity indicating the presence in HEp-2 cells of a new non-virion antigen.

Animals↗

Effect of test specimen cross-sectional shape on the in vitro fatigue life of acrylic bone cement.

Constant-amplitude uniaxial tension-compression fatigue tests were conducted on specimens fabricated from 12 sets of acrylic bone cements, covering cement formulations with three different viscosities (so-called "high-", "medium-" and "low-viscosity" varieties), two different methods of mixing the cement constituents (so-called "hand-" and "vacuum-mixed" methods) and two test specimen shapes (rectangular-cross-sectioned or "flat" and circular-cross-sectioned or "round"). The test results-namely, the number of fatigue stress cycles, N(f)-were analyzed using the linearized transformation of the three-parameter Weibull relationship, allowing the values of the Weibull mean, N(WM), to be determined for each set. Values ranged from 14,300 to 1,284,331 for the round specimen sets and from 2898 to 72,960 for the flat specimen sets. Statistical analysis of the ln N(f) data, together with an examination of the N(WM) values, showed that, for any combination of cement formulation and mixing method, round specimens had significantly longer fatigue lives compared to flat ones. These results are explained in terms of two factors. The first is the smaller surface area of the waisted zone in the round specimens compared to that in the flat specimens (nominal value of 157mm(2) versus nominal value of 185mm(2)), leading to the possibility of fewer crack initiation sites on the round specimens compared to the flat ones. Secondly, it is postulated that the crystallinity of the round specimens was higher than that of the flat ones, a consequence of the significantly lower measured residual liquid monomer contents of the former compared to the latter (3.40+/-1.28wt%/wt compared to 3.81+/-1.48wt%/wt). The significance of the present finding is that it indicates that, for a set of bone cement formulation and experimental conditions, discriminating fatigue test results are more likely to be obtained if flat, rather than round, test specimens are used.

Acrylic Resins↗

Fabrication and electrical conductivity of poly(methyl methacrylate) (PMMA)/carbon black (CB) composites: comparison between an ordered carbon black nanowire-like segregated structure and a randomly dispersed carbon black nanostructure.

Poly(methyl methacrylate) (PMMA)/carbon black (CB) composites were fabricated using two different mixing methods: (1) mechanical mixing and (2) solution mixing of the precursors, followed by compression molding. The microstructures obtained were examined by optical and scanning electron microscopy. Electrical properties were measured using impedance spectroscopy over a wide frequency range (10(-3) to +10(9) Hz). With the mechanical mixing method, a segregated structure is produced with PMMA particles forming faceted grains with carbon black particles aligning to form a network of 3D-interconnected nanowires. This microstructure allows percolation to occur at a low volume fraction of 0.26 vol % CB. In contrast, specimens made by the solution method have a microstructure where carbon black is distributed more randomly throughout the bulk, and thus, the percolation threshold is higher (2.7 vol % CB). The electrical properties of the PMMA/CB composites fabricated by the mechanical mixing method are comparable to those obtained with single-wall nanotubes as fillers.

Journal Article↗

Mixing does not improve mechanical properties of all bone cements. Manual and centrifugation-vacuum mixing compared for 10 cement brands.

Contemporary mixing methods--centrifugation, vacuum mixing with or without precompression--were compared with manual mixing by testing strength characteristics in accordance with a proposed revision of the international standard for bone cements as applied to 10 cement brands. Simplex brands and low-viscosity cements were the strongest, and were not improved by any of the vacuum-mixing procedures. Centrifuging was found unsuitable for low-viscosity cements. Without attaining the strength of the former, the cements best suited for auxiliary mixing methods were CMW-1 and Palacos brands, which improved 6-11 percent by either of the methods. The Sterivac system was generally found unacceptable, because about 20 percent of a cement package was retained in the mixing gear, and the application of precompression had no additional effect on compressive and bending strengths.

Acrylic Resins↗

Effectiveness of interventions in reducing pesticide overexposure and poisonings.

OBJECTIVE: The objective of this paper was to review the effectiveness of interventions to reduce pesticide overexposure and poisonings in worker populations. METHODS: We used the Cochrane Collaboration search strategy to search the following databases for articles that tested the effectiveness of interventions in reducing human pesticide exposure or poisonings: MEDLINE, EMBASE, and Occupational Safety and Health (NIOSHTC). Interventions considered included comparisons of pesticide application methods, pesticide mixing methods, worker education, biological monitoring programs, personal protective equipment (PPE) use, pesticide substitutions, and legislation. The outcomes of interest included biological monitoring measures or personal exposure monitoring indicating a reduction of pesticide exposure, observed increased use of PPE, reduction in lost workdays, and where possible, evidence of changes in pesticide poisoning rates as identified by registries and population surveys. Studies were reviewed in depth with special attention to size and study design. RESULTS: Most studies evaluated exposure during differing configurations of PPE or during different mixing or handling methods. Most studies were small field tests of protective equipment involving less than 20 workers. Some studies examined biological indices of exposure such as cholinesterase or urinary metabolites. Studies showed that PPE was effective in reducing exposure. No controlled studies were found that addressed reducing pesticide poisonings. CONCLUSIONS: Changes in application procedures, packaging, mixing, use of personal protective equipment, and biological monitoring reduced pesticide exposure under controlled conditions. Cholinesterase monitoring can identify workers with a higher risk of overexposure. Most techniques were not tested in actual worksite programs. Interventions should be examined for their ability to reduce pesticide overexposure in actual working populations. No controlled evaluations of large legislative initiatives were found.

Environmental Monitoring↗

Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system.

BACKGROUND: In Catalonia a high percentage of the population remains inactive. General practices are an ideal setting to advise on physical activity (PA). However, there is a lack of evidence regarding practices, barriers and predictors of such promotion in the Catalan primary health-care system. This study set out to establish descriptive baseline data for PA promotion in Catalan general practices, and to explore the experiences of doctors/nurses in promoting PA in their day-to-day professional lives. METHODS: A mixed-method approach was adopted. A survey was conducted with 245 physicians/nurses (58% response rate). Subsequently, focus groups (n = 5) and semi-structured interviews (n = 7) were conducted with 18 physicians and 15 nurses. After coding for important themes, the final interpretation was confirmed by contributors. RESULTS: Eighty-eight percent of physicians/nurses promoted PA at least infrequently. However, work conditions were perceived as unfavourable, with the main barriers being lack of (i) time, (ii) training and (iii) protocols. Qualitative data showed that PA promotion was opportunistic, focused on selected patients, used generalized messages and was highly dependent on personal interests. Regular promotion was encouraged by direct experiences of the benefits of regular exercising, knowing patients well, being supported by medical colleagues and creating links with other community institutions. PA promotion was especially hindered by seeing PA promotion as a secondary task, and patients ignoring recommendations. CONCLUSIONS: PA promotion in Catalonia remains to be integrated into practice consultations. Therefore, strategies should be developed within public health. Using a mixed-method approach provided a broader range of evidence than most studies, which rely on quantitative methods.

Data Collection↗

The apparent fracture toughness of acrylic bone cement: effect of three variables.

In cemented arthroplasties, pores are almost invariably present at one or more of the so-called 'weak-link' zones (namely, the bone-cement interface, the cement mantle and the cement-implant interface). In the clinical milieu, arthroplasties are frequently subjected to cyclical loading. These conditions underscore the significance of the apparent fracture toughness (KISR) of the cement. The present work is an investigation of the effect of three variables on KISR of three commercial formulations of bone cement (namely, CMW3, PalacosR and Osteopal) measured using straight-sided chevron notched short rod specimens. For CMW3, the effect of mixing method was studied, with all cement constituents having been stored at ambient laboratory environment prior to being mixed. The highest KISR was obtained from material that was obtained from exposing the cement constituents to a passive vacuum for 20 s and then mixing them in a machine that subjected them to simultaneous mechanical mixing and centrifugation. For Palacos R, the effects of two variables [storage temperature of the cement constituents prior to being mixed (4 degrees C versus 21 degrees C) and mixing method (hand mixing versus vacuum mixing)] (taken individually) were studied. It was found that only mixing method exerts a significant effect on KISR. When room-temperature stored constituents were vacuum mixed, the KISR values for a low-viscosity cement (Osteopal) and a medium-viscosity cement of very similar composition (Palacos R) are not significantly different, indicating that the fracture resistance of bone cement is influenced more by its composition than its viscosity.

Acrylic Resins↗

Mixing qualitative methods: quality assurance or qualitative quagmire?

Although the advisability of combining qualitative and quantitative approaches has been questioned on the grounds of incompatibility of epistemological assumptions that underpin the two paradigms, mixing methods within the qualitative paradigm has been viewed as a more straightforward enterprise. This article challenges this view, highlighting the existence of several qualitative traditions, each with its own distinctive set of assumptions about what constitutes appropriate research questions; theoretical frameworks; research settings; relationships with those whom we study; techniques for eliciting data; form and content of data; and approaches to analyzing, presenting, and disseminating data. Multimethod qualitative approaches can be seen to occupy a contested domain. Analytical rigor would be strengthened by acknowledging and addressing the potentially contradictory assumptions on which one draws when seeking to combine qualitative methods. As qualitative researchers, it is incumbent on us to pay attention to context--not just in terms of the data collected but in terms of our own methodological positions.

Data Collection↗

Microculture method for mixed lymphocyte cultures in the horse.

A miniaturized method for the mixed lymphocyte culture test in the horse is described. The test is performed in either round- or flat-bottom microtitration tissue culture plates. Concentrations of responsing and stimulating cells are varied, depening on the experiment. Significant discrimination between isogeneic and allogenic mixtures is possible after 120 hours' culture when cells are labeled ([3H]thymidine) for the last 16 to 18 hours of the test.

Animals↗

Ethylenediamine modified bovine serum albumin as protein carrier in the production of antibody against mycotoxins.

The efficiency of conjugation of mycotoxin derivatives containing a carboxylic group or other related functional groups to bovine serum albumin (BSA) by water soluble carbodiimide method, mixed anhydride method and reductive alkylation technique, improved considerably when a modified BSA was used in which the carboxylic groups in the protein were blocked by ethylenediamine (EDA). Due to the increased efficiency, smaller amounts of the haptens were satisfactory for conjugation to EDA-BSA as compared to amounts for the unmodified protein. The mycotoxin-EDA-BSA conjugates were shown to be highly immunogenic in rabbits.

Animals↗

Functional somatic symptoms in accident and emergency--An exploratory study.

OBJECTIVES: To identify the extent and nature of functional somatic symptoms (FSS) in a UK Accident and Emergency (A&E) Department. METHODS: A mixed method design was used. Data on the number and outcomes of attendances of patients who had attended A&E four or more times in a 6-month period, and who had not received a medical diagnosis were collected. Levels of anxiety and depression were explored and patients were invited to attend an interview with a clinical psychologist. RESULTS: One hundred frequent attendees made 595 visits to A&E in 6 months, with 20% of visits resulting in a hospital admission. Participants revealed high levels of health anxiety, with over half of participants reporting a perceived link between psychological factors and their experience of symptoms. Over 80% of participants attending the interview wanted further help to manage their symptoms and health care utilisation. CONCLUSIONS: Functional somatic symptoms are highly distressing for patients and place high demands on health care resources. An alternative care pathway to assess and manage FSS in A&E may need to be developed to help patients to manage their health anxiety.

Adult↗

Improving the quality of home visitation: an exploratory study of difficult situations.

OBJECTIVE: The primary purpose of this study was to use an ecological assessment model to obtain a better understanding of difficult situations that home visitors confront when implementing home visitation services. METHOD: A mixed method study was used which included conducting focus groups to identify specific situations faced by home visitors who implement the Healthy Families America model of child abuse and neglect prevention. The results of the focus groups were used to design a survey. The survey had 91 Healthy Families home visitors rate situations according to frequency and difficulty. RESULTS: The results revealed that situations that were ranked most difficult included working with families where there are limited resources, where family mental illness is present (e.g., threatening suicide), where there is substance use in the home, and where families are unmotivated. A factor analysis of the situations produced five factors that reflect the difficulty of doing home visitation: having a lack of clinical skill, addressing family difficulties, addressing parenting difficulties, resolving personal difficulties, and having a lack of experience. CONCLUSION: The situations identified in this study can assist in developing the competencies needed by home visitors. The factor analysis results can be conceptualized into an inventory for staff supervision, with workers completing the inventory to identify individual areas of training needs.

Adolescent↗

Research as a therapeutic experience? An investigation of women's participation in research on ending IVF treatment.

BACKGROUND: Women participate in research for many reasons, some of them therapeutic. This paper retrospectively analyses women's motivations for participating in a study on decision making at the end of in vitro fertilization (IVF) treatment. METHODS: A mixed methods study conducted by a practising midwife had focused on women's experiences of stopping IVF treatment after one or more unsuccessful attempts, and raised awareness of women's motivations for participating. Thematic analysis of interview transcripts permitted issues raised by the participants in the context of 'research as a therapeutic experience' to be explored. RESULTS: Reasons for participating in the study included: (1) altruism; (2) appreciation/gratitude for care received; (3) the need to debrief; and (4) gaining self-awareness and readjustment, which challenged the acceptance of childlessness. Reasons for using the research study as 'a therapeutic experience' in the context of failed IVF may be attributed to: (1) access to direct clinical care and advice; (2) opportunity for self-reflection and rationalization; (3) acceptance of reality; (4) resolution of conflict; and (5) opportunity to unburden themselves. CONCLUSION: Women appeared to use the interview process to reassure themselves about decisions made, and to seek direct clinical advice on whether to continue IVF using donor gametes.

Adult↗

Maternal management behaviors for young children with type 1 diabetes.

PURPOSE: To describe the process that mothers raising young (0-4 years old) children who are newly diagnosed with type 1 diabetes move through to attain the necessary skills to care for their children. STUDY DESIGN AND METHODS: A mixed methods design was used, including qualitative interviews with 28 mothers of young children with type 1 diabetes. Principles of naturalistic inquiry were used to guide the data collection process, management, and analysis of the qualitative findings. RESULTS: The process paralleled two of three management approaches and associated behaviors previously described by Gallo and Knafl. Strict adherence behaviors included rigidly following the team recommendations and avoiding strange environments outside the home. Flexible adherence behaviors strove to bring spontaneity back into family life. Selective adherence was not used by this population. CLINICAL IMPLICATIONS: Nurses working with these mothers can provide information and support to help them transition from using strict adherence to the more user-friendly flexible adherence, while avoiding the pitfalls of the possibly harmful third approach of selective adherence. Nurses need to remember to praise the parents' efforts at managing their children's diabetes, for our acknowledgment of their work is empowering and affirming.

Adaptation, Psychological↗