Venous leg ulcer recurrence : deciphering long term patient adherence to preventive treatments and activities

To better understand long term adherence to self-care activities to prevent the recurrence of venous leg ulcers, participants (n=80) were recruited to a prospective longitudinal study after experiencing healing of a venous leg ulcer. Data on demographics, health, psychosocial measures and adherence to prevention strategies (compression therapy, leg elevation and lower leg exercise) were collected every three months for one year after healing. Multivariable regression modelling was used to identify the factors that were independently associated with adherence. Over the year, a significant decline in adherence to all three strategies was observed, predominantly between 6–12 months after healing (p<0.01). Several factors were associated with adherence to more than one preventive activity. Regular follow-up care and a history of multiple previous ulcers were related to improved adherence (p<0.05), while scoring at higher risk for depression and restricted mobility were related to decreasing adherence over time (p<0.05). Patients with osteoarthritis had significantly reduced adherence to compression hosiery (p=0.026). These results provide information to assist care providers plan strategies for prevention of recurrent venous leg ulcers; and suggest a need for regular follow-up care which addresses both the physical and mental health of this population.

Why trust the head? Key practices for transformational school leaders to build a purposeful relationship of trust

Trust is widely recognized as one of the key qualities that a successful leader needs to bring about change within his/her organization. Literature has also shown that trust plays a pivotal role in effective school leadership. However, little research has been undertaken to identify specific actions of a transformational school leader enabling him/her to develop purposeful relationships of trust with his/her staff and Chair of the school’s governing body. Using a theoretical framework of transformational leadership in the context of the independent schooling sector in Australia, a multicase study of four highly trusted, transformational school leaders revealed 10 key trust building practices in the Head–staff dyad and three practices in the Head–Chair dyad. These practices were independent of the leader’s personal attributes. The study also revealed an inextricable link between trust and transformational leadership.

Experimental and numerical analysis of the relationship between indoor and outdoor airborne particles in an operating room

This work investigated the impact of the HVAC filtration system and indoor particle sources on the relationship between indoor and outdoor airborne particle size and concentrations in an operating room. Filters with efficiency between 65% and 99.97% were used in the investigation and indoor and outdoor particle size and concentrations were measured. A balance mass model was used for the simulation of the impact of the surgical team, deposition rate, HVAC exhaust and air change rates on indoor particle concentration. The experimental results showed that high efficiency filters would not be expected to decrease the risk associated with indoor particles larger than approximately 1 µm in size because normal filters are relatively efficient for these large particles. A good fraction of outdoor particles were removed by deposition on the HVAC system surfaces and this deposition increased with particle size. For particles of 0.3-0.5 µm in diameter, particle reduction was about 23%, while for particles >10 µm the loss was about 78%. The modelling results showed that depending on the type of filter used, the surgical team generated between 93-99% of total particles, while the outdoor air contributed only 1-6%.

Capable but not able : the effect of institutional context and search breadth on the absorptive capacity-corporate entrepreneurship relationship

This study investigates how the interaction of institutional market orientation and external search breadth influence the ability to use absorptive capacity to raise the level of corporate entrepreneurship. The findings of a sample of 331 supplier companies providing products and services to the mining industry of Australia and Iran indicate that the positive association between absorptive capacity and corporate entrepreneurship is stronger for companies with greater external knowledge search breadth. Moreover, operating in a less market-oriented institutional context such as, Iran diminishes the ability to utilise a firm’s absorptive capacity to raise their level of corporate entrepreneurship. Yet, firms operating in such contexts are able to overcome these disadvantages posed by their institutional context by engaging in broader external search of knowledge.

The moderating role of entrepreneurial management in the relationship between absorptive capacity and corporate entrepreneurship : an attention-based view

Building on the attention-based view, we argue that companies need a challenging mechanism to focus their absorptive capacity attention on corporate entrepreneurship versus mainstream activities or other purposes. We suggest entrepreneurial management as the attential driver for deploying absorptive capacity towards corporate entrepreneurship. From our analysis of a sample of 331 supplier companies providing products and services to the mining industry of Australia and Iran, we observe that absorptive capacity positively affects corporate entrepreneurship. The data also demonstrate that the effect of absorptive on corporate entrepreneurship increases when firms adopt the entrepreneurial culture and reward systems. However, the entrepreneurial growth and resource orientations negatively moderate the relationship between absorptive capacity and corporate entrepreneurship.

Genetic secrets and the family

The issue of how individual patients and their doctors should act in relation to the knowledge that the patient has a genetic condition— specifically, whether the patient and/or the doctor should or must inform relevant members of the patient’s family—is a looming area of medicolegal controversy. Over the last fifteen years or so, the issue of confidentiality versus disclosure has been particularly controversial in relation to HIV/AIDS patients.1 It has been argued that medical information about genetic disease gives rise to special problems vis-à-vis blood relatives. Because genetic disease is transmitted only by way of procreation, information about genetic disease is unique in that there is a propensity (which is highly variable and depends upon a variety of factors) for the condition to be shared by members of a family who are biologically related. Thus, genetic information about an individual may reveal information about relatives of that individual which is ‘specific (that the person has or will develop a genetic disease); or predictive (that the person has an unspecified risk of developing the disease)’

Task-relationship-self : a framework for understanding service encounter behaviors

Research conducted over past decades has investigated selected service encounter behaviors from either a customer or service provider perspective. However, a comprehensive, dual-perspective framework is lacking. Such a framework is needed to organize knowledge of these behaviors, and thereby provide structure, clarity, and parsimony to the field. This paper describes a three-tier framework of service encounter behavior that was developed by applying grounded theory principles to interviews with customers, service employees, and other stakeholders. These informants described many ways in which they behave when executing service exchanges, dealing with service difficulties, and managing themselves in the process. Using an iterative inductive approach, a conceptual framework was developed in which specific (Tier 1) behaviors were placed within broader (Tier 2) categories, and these lower classification levels were, in turn, interpreted within a conceptual space defined by the (Tier 3) dimensions of task, relationship, and self. This framework was then elaborated and refined by reference to the psychology and marketing literature, a set of 157 audio-recorded service interactions, and an expert panel study. The paper includes comparisons between the framework and those previously proposed, propositions regarding service encounter processes and outcomes, and implications for future research and practice.

The relevance of shared experiences : a multi-level study of collective efficacy as a moderator of job control in the stressor-strain relationship

Karasek's Job Demand-Control model proposes that control mitigates the positive effects of work stressors on employee strain. Evidence to date remains mixed and, although a number of individual-level moderators have been examined, the role of broader, contextual, group factors has been largely overlooked. In this study, the extent to which control buffered or exacerbated the effects of demands on strain at the individual level was hypothesized to be influenced by perceptions of collective efficacy at the group level. Data from 544 employees in Australian organizations, nested within 23 workgroups, revealed significant three-way cross-level interactions among demands, control and collective efficacy on anxiety and job satisfaction. When the group perceived high levels of collective efficacy, high control buffered the negative consequences of high demands on anxiety and satisfaction. Conversely, when the group perceived low levels of collective efficacy, high control exacerbated the negative consequences of high demands on anxiety, but not satisfaction. In addition, a stress-exacerbating effect for high demands on anxiety and satisfaction was found when there was a mismatch between collective efficacy and control (i.e. combined high collective efficacy and low control). These results provide support for the notion that the stressor-strain relationship is moderated by both individual- and group-level factors.

Collagen induced MMP-2 activation in human breast cancer

Matrix metalloproteinase-2 (MMP-2), a zymogen requiring proteolytic activation for catalytic activity, has been implicated broadly in the invasion and metastasis of many cancer model systems, including human breast cancer (HBC). MMP-2 has been immunolocalized to carcinomatous human breast, where the degree of activation of MMP-2 correlates well with tumor grade and patient prognosis. Using Matrigel assays, we have stratified HBC cell lines for invasiveness in vitro, and compared this to their potential for metastatic spread in nude mice. HBC cell lines expressing the mesenchymal marker protein vimentin were found to be highly invasive in vitro, and tended to form metastases in nude mice. We have further discovered that culture on collagen-I gels (Vitrogen(TM): Vg) induces MMP-2-activator in highly invasive but not poorly invasive HBC cell lines. As seen for other MMP-2-activator inducing regimens, this induction requires protein synthesis and an intact MMP-2 hemopexin-like domain, appears to be mediated by a cell surface activity, and can be inhibited by metalloproteinase inhibitors. The induction is highly specific to collagen I, and is not seen with thin coatings of collagen I, collagen IV, laminin, or fibronectin, or with 3-dimensional gels of laminin, Matrigel, or gelatin. This review focuses on collagen I and MMP- 2, their localization and source in HBC, and their relationship(s) to MMP-2 activation and HBC metastasis. The relevance of collagen I in activation of MMP-2 in vivo is discussed in terms of stromal cell: tumor cell interaction for collagen I deposition, MMP-2 production and MMP-2-activation. Such cooperativity may exist in vivo for MMP-2 participation in HBC dissemination. A more complete understanding of the regulation of MMP-2-activator by type I collagen may provide new avenues for improved diagnosis and prognosis of human breast cancer.

Input from the amygdala to the rat nucleus accumbens : its relationship with tyrosine hydroxylase immunoreactivity and identified neurons.

Both tyrosine hydroxylase-positive fibres from the mesolimbic dopamine system and amygdala projection fibres from the basolateral nucleus are known to terminate heavily in the nucleus accumbens. Caudal amygdala fibres travelling dorsally via the stria terminalis project densely to the nucleus accumbens shell, especially in the dopamine rich septal hook. The amygdala has been associated with the recognition of emotionally relevant stimuli while the mesolimbic dopamine system is implicated with reward mechanisms. There is behavioural and electrophysiological evidence that the amygdala input to the nucleus accumbens is modulated by the mesolimbic dopamine input, but it is not known how these pathways interact anatomically within the nucleus accumbens. Using a variety of neuroanatomical techniques including anterograde and retrograde tracing, immunocytochemistry and intracellular filling, we have demonstrated convergence of these inputs on to medium-sized spiny neurons. The terminals of the basolateral amygdala projection make asymmetrical synapses predominantly on the heads of spines which also receive on their necks or adjacent dendrites, symmetrical synaptic input from the mesolimbic dopamine system. Some of these neurons have also been identified as projection neurons, possibly to the ventral pallidum. We have shown a synaptic level how dopamine is positioned to modulate excitatory limbic input in the nucleus accumbens.

Obesity and comorbid risk factors for cardiovascular disease among physically inactive patients with musculoskeletal disorders : a targeted intervention for this priority patient group is warranted

Introduction The benefits of physical activity are established and numerous; not the least of which is reduced risk of negative cardiovascular events. While sedentary lifestyles are having negative impacts across populations, people with musculoskeletal disorders may face additional challenges to becoming physically active. Unfortunately, interventions in ambulatory hospital clinics for people with musculoskeletal disorders primarily focus on their presenting musculoskeletal complaint with cursory attention given to lifestyle risk factors; including physical inactivity. This missed opportunity is likely to have both personal costs for patients and economic costs for downstream healthcare funders. Objectives The objective of this study was to investigate the presence of obesity, diabetes, diagnosed cardiac conditions, and previous stroke (CVA) among insufficiently physically active patients accessing (non-surgical) ambulatory hospital clinics for musculoskeletal disorders to indicate whether a targeted risk-reducing intervention is warranted. Methods A sub-group analysis of patients (n=110) who self-reported undertaking insufficient physical activity level to meet national (Australian) minimum recommended guidelines was conducted. Responses to the Active Australia Survey were used to identify insufficiently active patients from a larger cohort study being undertaken across three (non-surgical) ambulatory hospital clinics for musculoskeletal disorders. Outcomes of interest included body mass index, Type-II diabetes, diagnosed cardiac conditions, previous CVA and patients’ current health-related quality of life (Euroqol-5D). Results The mean (standard deviation) age of inactive patients was 56 (14) years. Body mass index values indicated that n=80 (73%) were overweight n=26 (24%), or obese n=45 (49%). In addition to their presenting condition, a substantial number of patients reported comorbid diabetes n=23 (21%), hypertension n=25 (23%) or an existing heart condition n=14 (13%); 4 (3%) had previously experienced a CVA as well as other comorbid conditions. Health-related quality of life was also substantially impacted, with a mean (standard deviation) multi-attribute utility score of 0.51 (0.32). Conclusion A range of health conditions and risk factors for further negative health events, including cardiovascular complications, consistent with physically inactive lifestyles were evident. A targeted risk-reducing intervention is warranted for this high risk clinical group.

Patient perspectives of the impact and long-term management of lymphoedema

Lymphoedema following cancer treatment is characterized by swelling, and adversely influences mobility, function and quality of life. There is no cure, but without treatment lymphedema may progress. Since lymphedema treatment options are costly and time consuming, understanding the influence of these, and other potential barriers, on treatment adherence is vital in reducing the public health burden of lymphedema. Complex physical therapy and compression are supported by scientific evidence and patients also perceive these treatments as effective for improving symptoms and function. Multiple treatments may be required to treat all aspects of the condition. Patients and health professionals should consider effect and costs when identifying optimal treatment strategies.

Cell adhesion molecule uvomorulin expression in human breast cancer cell lines : relationship to morphology and invasive capacities

Loss of cell-cell adhesion in carcinoma cells may be an important step in the acquisition of an invasive, metastatic phenotype. We have examined the expression of the epithelial-specific cell adhesion molecule uvomorulin (E-cadherin, cell-CAM 120/80, L-CAM) in human breast cancer cell lines. We find that fibroblastoid, highly invasive, vimentin-expressing breast cancer cell lines do not express uvomorulin. Of the more epithelial-appearing, less invasive, keratin-expressing breast cancer cell lines, some express uvomorulin, and some do not. We examined the morphologies of the cell lines in the reconstituted basement membrane matrix Matrigel and measured the ability of the cells to traverse a Matrigel-coated filter as in vitro models for detachment of carcinoma cells from neighboring cells and invasion through basement membrane into surrounding tissue. Colonies of uvomorulin-positive cells have a characteristic fused appearance in Matrigel, whereas uvomorulin-negative cells appear detached. Cells which are uvomorulin negative and vimentin positive have a stellate morphology in Matrigel. We show that uvomorulin is responsible for the fused colony morphology in Matrigel since treatment of uvomorulin-positive MCF-7 cells with an antibody to uvomorulin caused the cells to detach from one another but did not induce invasiveness in these cells, as measured by their ability to cross a Matrigel-coated polycarbonate filter in a modified Boyden chamber assay. Two uvomorulin-negative, vimentin-negative cell lines are also not highly invasive as measured by this assay. We suggest that loss of uvomorulin-mediated cell-cell adhesion may be one of many changes involved in the progression of a carcinoma cell to an invasive phenotype.

Physical activity and overweight in children aged 3-5 : relationship to parental activity and obesity

OBJECTIVE To compare the physical activity levels of overweight and non overweight 3- to 5-y-old children while attending preschool. A secondary aim was to evaluate weight-related differences in hypothesized parental determinants of child physical activity behavior. DESIGN Cross-sectional study. SUBJECTS A total of 245, 3- to 5-y-olds (127 girls, 118 boys) and their parent(s) (242 mothers, 173 fathers) recruited from nine preschools. Overweight status determined using the age- and sex-specific 85th percentile for body mass index (BMI) from CDC Growth Charts. MEASUREMENTS Physical activity during the preschool day was assessed on multiple days via two independent objective measures direct observation using the observation system for recording activity in preschools (OSRAP) and real-time accelerometry using the MTI/CSA 7164 accelerometer. Parents completed a take-home survey assessing sociodemographic information, parental height and weight, modeling of physical activity, support for physical activity, active toys and sporting equipment at home, child’s television watching, frequency of park visitation, and perceptions of child competence. RESULTS Overweight boys were significantly less active than their nonoverweight peers during the preschool day. No significant differences were observed in girls. Despite a strong association between childhood overweight status and parental obesity, no significant differences were observed for the hypothesized parental influences on physical activity behavior. CONCLUSIONS Our results suggest that a significant proportion of overweight children may be at increased risk for further gains in adiposity because of low levels of physical activity during the preschool day.