Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

The effects of a simplified tai-chi exercise program (STEP) on the physical health of older adults living in long-term care facilities : a single group design with multiple time points

Background
Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
Objective
To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.
Design
A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.
Settings
Two 300–400 bed veteran homes in Taiwan.
Participants
The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.
Methods
The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.
Results
A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).
Conclusions
Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

What can prevalence studies tell us about female sexual difficulty and dysfunction?

Introduction. Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction.
Aim. Investigate female sexual difficulty/dysfunction using data from prevalence studies.
Methods. We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100.
Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more.
Results. Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16–75%) experienced desire difficulty, 35% (range 16– 48%) experienced orgasm difficulty, 31% (range 12–64%) experienced arousal difficulty, and 26% (range 7–58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62–89% persisted for at least several months and 25–28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21–67%).
Conclusions. Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.

Play and cultural transition

In many countries, early childhood educators have to confront the issue of how to assist immigrant children adapt to life in a new context. For example, in 2007-08, 44 771 children aged 0- 14 years old came to Australia with their familes to start life afresh (Australian Government 2009). Countries need to put into place policies and Practices that minimise the dislocation that immigrant families and their children face. Knowledge of what other countries are doing to educationally support immigrant children can assist professionals to better understand what is sound practice and what should be avoided. This chapter discusses some of the identified immigration issues of a small sample of Chinese children who have PMR parents/caregivers in Hong Kong. This chapter also examines how the
role of play in early childhood settings can help immigrant children adjust to their new teaching and learning context. Seven early childhood teachers and the principal of a local childcare centre were invited to participate in a small scalc study that is reported on in this chapter. Using convenience sampling, interviews were conducted for qualitative data collection.

"They all work...when you stick to them" : a qualitative investigation of dieting, weight loss, and physical exercise, in obese individuals

Background
To explore the extent to which people living with obesity have attempted to lose weight, their attitudes towards dieting, physical exercise and weight loss solutions, why their weight loss attempts have failed, and their opinions about what would be most beneficial to them in their struggle with their weight.

Method
Qualitative study, using open-ended interviews, of 76 people living with obesity in Victoria, Australia in 2006/7. Individuals with a BMI of 30 or over were recruited using articles in local newspapers, convenience sampling, and at a later stage purposive sampling techniques to diversify the sample. Data analysis was conducted by hand using a constant, comparative method to develop and test analytical categories. Data were interpreted both within team meetings and through providing research participants the chance to comment on the study findings.

Results
Whilst participants repeatedly turned to commercial diets in their weight loss attempts, few had used, or were motivated to participate in physical activity. Friends or family members had introduced most individuals to weight loss techniques. Those who took part in interventions with members of their social network were more likely to report feeling accepted and supported. Participants blamed themselves for being unable to maintain their weight loss or 'stick' to diets. Whilst diets did not result in sustained weight loss, two thirds of participants felt that dieting was an effective way to lose weight.

Conclusion
Individuals with obesity receive numerous instructions about what to do to address their weight, but very few are given appropriate long term guidance or support with which to follow through those instructions. Understanding the positive role of social networks may be particularly important in engaging individuals in physical activity. Public health approaches to obesity must engage and consult with those currently living with obesity, if patterns of social change are to occur.

The contribution of job and partner satisfaction to the homeostatic defense of subjective wellbeing

Two studies investigate subjective wellbeing (SWB) homeostasis. The first investigates the contribution of job satisfaction (JS) and partner satisfaction (PS) to the homeostatic defense of SWB. The extant model of homeostasis does not include either variable. The second study investigates the relationship between Homeostatically Protected Mood (HPMood) and other factors involved in the homeostatic model. It has been proposed that HPMood is the basic, biologically determined, positive mood that saturates SWB and other related variables, and forms the basis of the SWB set-point. Thus, if HPMood is an individual difference and it perfuses other homeostatic variables, then HPMood should be responsible for much of the shared variance between such variables. Two comparative samples are involved. One is a group of 171 Hong Kong Chinese recruited through convenience sampling. The other is a group of 343 Australians recruited via a general population survey. Results indicate that both JS and PS predict significant variance in Global Life Satisfaction beyond the existing factors in the homeostatic model. It is also found that, after controlling for the effect of HPMood, the strength of correlations between SWB and other homeostatic variables is significantly diminished. The implications of these findings are discussed.

Environmental invitingness for transport-related cycling in middle-aged adults: a proof of concept study using photographs

Introduction: Current evidence on associations between modifiable environmental characteristics and transport-related cycling remains inconsistent. Most studies on these associations used questionnaires to determine environmental perceptions, but such tools may be subject to bias due to unreliable recall. Moreover, questionnaires only measure separate environmental characteristics, while real environments are a combination of different characteristics. To overcome these limitations, the present proof of concept study used panoramic photographs of cycling environments to capture direct responses to the physical environment. We examined which depicted environmental characteristics were associated to environments' invitingness for transportation cycling. Furthermore, interactions with gender and participants' cycling behavior were examined. Methods: Fifty-nine middle-aged adults were recruited through purposeful convenience sampling. During a home visit, participants took part in a structured interview assessing demographics and PA during the preceding seven days, followed by an intuitive choice task and a (cognitive) rating task, which both measured 40 photographed environments' invitingness to cycle along. Multi-level cross-classified analyses were conducted using MLwiN 2.26. Results: Both tasks' multivariate results showed that presence of vegetation was identified as the most important environmental characteristic to invite people for engaging in transportation cycling, even when the amount of vegetation was relatively small. In the bivariate analyzes, some differences between results of the cognitive rating task and the intuitive choice task were found, showing that invitingness measured by the rating task was associated with environmental maintenance and cycling infrastructure, whereas invitingness determined by the choice task was associated with more traffic-oriented characteristics. Moreover, only for the choice task's results, moderating effects of gender and participants' cycling behavior in the preceding week were observed. Conclusion: The present study provides proof of concept that capturing people's less cognitive, more intuitive responses to an environment's invitingness for transport-related cycling may be important for revealing environment-behavior associations. If replicated in future studies using larger samples, results of our innovative measurements with photographs, especially those on vegetation, can complete the existing knowledge on which environmental characteristics are important for transportation cycling in adults and could form a basis to inform health promoters and local policy makers. However, future studies replicating our study method in larger samples and other population subgroups are highly encouraged. Moreover, causal relationships should be explored.

Reducing the risk of heart disease among Indian Australians: knowledge, attitudes, and beliefs regarding food practices - a focus group study

BACKGROUND: Australia has a growing number of Asian Indian immigrants. Unfortunately, this population has an increased risk for coronary heart disease (CHD). Dietary adherence is an important strategy in reducing risk for CHD. This study aimed to gain greater understanding of the knowledge, attitudes and beliefs relating to food practices in Asian Indian Australians. METHODS: Two focus groups with six participants in each were recruited using a convenience sampling technique. Verbatim transcriptions were made and thematic content analysis undertaken. RESULTS: Four main themes that emerged from the data included: migration as a pervasive factor for diet and health; importance of food in maintaining the social fabric; knowledge and understanding of health and diet; and elements of effective interventions. DISCUSSION: Diet is a complex constructed factor in how people express themselves individually, in families and communities. There are many interconnected factors influencing diet choice that goes beyond culture and religion to include migration and acculturation. CONCLUSIONS: Food and associated behaviors are an important aspect of the social fabric. Entrenched and inherent knowledge, attitudes, beliefs and traditions frame individuals' point of reference around food and recommendations for an optimal diet.

Determinants of best HR practices in Chinese SMEs

Abstract
Purpose– The purpose of this paper is to examine the factors which determine the adoption of best HR practices in Chinese small- and medium-sized enterprises (SMEs).
Design/methodology/approach – Regression analysis was utilized to analyse survey data obtained from 345 enterprises operating across China in a wide range of industrial sectors.
Findings – Enterprises with greater resources in terms of their size, their relationships with external organizations, their cooperation with foreign partners and the human capital of their CEO were found to be more likely to adopt best HR practices. Contrary to the findings of the existing literature no relationship was found of a relationship between family ownership and the use of best HR practices.
Research limitations/implications – The cross-sectional design is an obvious limitation of the study. Other limitations relate to the generalizability of the study findings outside the context in which the research was undertaken, and the use of convenience sampling.
Practical implications – Enterprises should consider building strategic relationships with external organizations and developing cooperation with foreign partners as a way of leveraging human resource expertise at a limited cost.
Originality/value – This is the first study to examine how differences in the resource endowments of Chinese SMEs influence their adoption of best HR practices.

Attending to risk in sequential sampling plans

Researchers typically tackle questions by constructing powerful, highlyreplicated sampling protocols or experimental designs. Such approaches often demand large samples sizes and are usually only conducted on a once-off basis. In contrast, many industries need to continually monitor phenomena such as equipment reliability, water quality, or the abundance of a pest. In such instances, costs and time inherent in sampling preclude the use of highlyintensive methods. Ideally, one wants to collect the absolute minimum number of samples needed to make an appropriate decision. Sequential sampling, wherein the sample size is a function of the results of the sampling process itself, offers a practicable solution. But smaller sample sizes equate to less knowledge about the population, and thus an increased risk of making an incorrect management decision. There are various statistical techniques to account for and measure risk in sequential sampling plans. We illustrate these methods and assess them using examples relating to the management of arthropod pests in commercial crops, but they can be applied to any situation where sequential sampling is used.

Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults

Background: This study aimed to investigate relationships between environmental aesthetics, convenience, and walking companions and walking for exercise or recreation and to investigate differences in these relationships by sex and by reported physical and mental health.

Methods: Analyses of cross-sectional self-report data from a statewide population survey of 3,392 Australian adults were used.

Results: Men and women reporting a less aesthetically pleasing or less convenient environment were less likely to report walking for exercise or recreation in the past 2 weeks. Those respondents, particularly women, reporting no company or pet to walk with were also less likely to walk for exercise or recreation. Associations with environmental and social influences were observed for men and women reporting both good and poor physical and mental health.

Conclusions: Perceived environmental aesthetics and convenience and walking companions are important correlates of walking for exercise among urban Australians. Acknowledging the cross-sectional nature of these data, findings support a case for evaluation of environmental policies to promote physical activity.

Selected Ranked Set Sampling

This paper proposes a sampling procedure called selected ranked set sampling (SRSS), in which only selected observations from a ranked set sample (RSS) are measured. This paper describes the optimal linear estimation of location and scale parameters based on SRSS, and for some distributions it presents the required tables for optimal selections. For these distributions, the optimal SRSS estimators are compared with the other popular simple random sample (SRS) and RSS estimators. In every situation the estimators based on SRSS are found advantageous at least in some respect, compared to those obtained from SRS or RSS. The SRSS method with errors in ranking is also described. The relative precision of the estimator of the population mean is investigated for different degrees of correlations between the actual and erroneous ranking. The paper reports the minimum value of the correlation coefficient between the actual and the erroneous ranking required for achieving better precision with respect to the usual SRS estimator and with respect to the RSS estimator.

Rural parents, teenagers and alcohol: what are parents thinking?

INTRODUCTION: The fundamental role of alcohol in the lives of young Australians is mirrored in the level of drinking by adolescents. In 2001, more than one in four Australian adolescents aged 14-19 years consumed alcohol weekly. Teenagers in rural areas are more likely to consume alcohol than their metropolitan counterparts. Parents are key 'gatekeepers' of adolescent behaviour and as such are a salient group to consider in relation to adolescent alcohol use. The aim of this study was to explore parents' attitudes, beliefs, concerns and receptiveness to harm minimisation strategies with respect to teenage use of alcohol.

METHODS: A convenience sample of parents with adolescent children attended a series of focus groups across the north and north-western area of the State of Victoria, Australia. Schools were approached to advertise the project and invite parents to participate. Snowball sampling was used to enhance recruitment.

RESULTS: Parents described patterns of alcohol use such as 'drinking to get drunk' and the influence of both parents and peers on the consumption of alcohol by adolescents. Few parents were concerned about the long-term risks of alcohol use by teenagers; rather they were more concerned about the short-term harms, for example, road trauma and other accidents and risky behaviours such as binge drinking. Parents indicated that they perceived alcohol to be less harmful than other drugs and many indicated that alcohol was often not perceived to be a drug. A number of strategies were adopted by parents to negotiate teenagers' drinking and to minimise the risks associated with alcohol use. These included transporting teenagers to parties, providing teenagers with a mobile phone, setting clear guidelines about alcohol use and/or providing teenagers with a small amount of alcohol. These were seen by parents as strategies for reducing the risks associated with alcohol consumption. Many parents reported that they do not feel well informed about alcohol use and how and when to use harm reduction strategies.

CONCLUSIONS: Rural parents are unsure how to respond to teenagers' alcohol use and drunkenness. While some parental strategies for harm reduction (such as supplying adolescents with a small amount of alcohol) may have good face validity in reducing alcohol consumption among adolescents, these strategies are not supported by previous research findings.

Reaching the invisible : overcoming sampling barriers in GLB research via web surveys

Sampling is fundamental to the credibility of any empirical investigation, and this is no different for the area of Gay, Lesbian and Bisexual (GLB) research. In fact, it would not be an overstatement to say that publication of GLB research into high quality and mainstream journals has been limited in part because of sampling issues. The purpose of this paper is to raise awareness of the unique sampling problems posed by GLB resaerch and to offer solutions to these through the use of web surveys and recruitment strategies. In particular, we provide data which show that, contrary to voiced concerns, when employed with a rigorous recruitment strategy, web surveys increase rather than reduce sampling coverage. Further, we provide evidence that the web survey technique can yield data of comparable quality to that obtained with a hard-copy survey. The paper concludes with strategies researchers can adopt to overcome barriers in obtaining a diverse GLB sample.