Is there a role for telemedicine in adult allergy services?

Telemedicine refers to the application of telecommunication and information technology (IT) in the delivery of health and clinical care at a distance or remotely and can be broadly considered in two modalities: store-and-forward and real-time interactive services. Preliminary studies have shown promising results in radiology, dermatology, intensive care, diabetes, rheumatology and primary care. However, the evidence is limited and hampered by small sample sizes, paucity of randomised controlled studies and lack of data relating to cost-effectiveness, health related quality of life and patient and clinician satisfaction. This review appraises the evidence from studies that have employed telemedicine tools in other disciplines and makes suggestions for its potential applications in specific clinical scenarios in adult allergy services. Possible examples include: triaging patients to determine the need for allergy tests; pre-assessment for specialised treatments such as allergen immunotherapy; follow up to assess treatment response and side effects; and education in self-management plan including training updates for self-injectable adrenaline and nasal spray use. This approach might improve access for those with limited mobility or living far away from regional centres, as well as bringing convenience and cost savings for the patient and service provider. These potential benefits need to be carefully weighed against evidence of service safety and quality. Keys to success include delineation of appropriate clinical scenarios, patient selection, training, IT support and robust information governance framework. Well-designed prospective studies are needed to evaluate its role. This article is protected by copyright. All rights reserved.

Strategies for sustaining manufacturing competitiveness:comparative case studies in Australia and Sweden

Purpose - The purpose of this paper is to report an investigation of local sustainable production in Australia and Sweden aimed at exploring the factors contributing to survival and competitiveness of manufacturing companies. Design/methodology/approach - In Australia, six companies were studied in 2010, with comparisons being made with three of them from earlier projects. In Sweden, eight manufacturing companies were studied on two occasions 30 years apart, in 1980 and 2010. To provide a valid comparative perspective a common format for data collection and analysis was used. Findings - There has been a shift in the nature of competition in both Sweden and Australia due to an increasing complexity of the global business environment as well as changes in technology and customer expectations. Despite the differences in country context, the findings suggest that all the manufacturing companies have a good awareness of the elements of the market environment and the relationships with their competitive strategy. However, in general, the Swedish companies have more experience of managing the risks and benefits from operating in the international environment. Research limitations/implications - The results of the research are based on a relatively small sample of case companies in a limited number of industrial sectors. There are methodology implications for future research in the area. Practical implications - The research results have practical implications for the manufacturing industry, especially for companies operating in a competitive international environment. Originality/value - The paper is based on original case research and comparative analysis of data from different geographical contexts. It contributes to both theory and management practice about the strategic resources, decision choices, competitive environments and firm values needed to address external market demands as well as in building internal capabilities.

The application of fixed hydrophobic patterns for confinement of aqueous solutions in proteomic microarrays

A protein microarray hybridisation system has been implemented by employing patterned hydrophobic thin films on hydrophilic substrates as a means of confinement for aqueous samples. This approach has the ability to handle, and keep separate, small sample volumes of just a few microlitres. In addition, the system is more straightforward to use than the existing multi-well gasket solution. The paper describes the fabrication method and the system is demonstrated for a model protein microarray assay. © 2011 American Institute of Physics.

The effect of an enriched learning community on success and retention in chemistry courses

Since the mid-1990s, the United States has experienced a shortage of scientists and engineers, declining numbers of students choosing these fields as majors, and low student success and retention rates in these disciplines. Learning theorists, educational researchers, and practitioners believe that learning environments can be created so that an improvement in the numbers of students who complete courses successfully could be attained (Astin, 1993; Magolda & Terenzini, n.d.; O'Banion, 1997). Learning communities do this by providing high expectations, academic and social support, feedback during the entire educational process, and involvement with faculty, other students, and the institution (Ketcheson & Levine, 1999). ^ A program evaluation of an existing learning community of science, mathematics, and engineering majors was conducted to determine the extent to which the program met its goals and was effective from faculty and student perspectives. The program provided laptop computers, peer tutors, supplemental instruction with and without computer software, small class size, opportunities for contact with specialists in selected career fields, a resource library, and Peer-Led Team Learning. During the two years the project has existed, success, retention, and next-course continuation rates were higher than in traditional courses. Faculty and student interviews indicated there were many affective accomplishments as well. ^ Success and retention rates for one learning community class ( n = 27) and one traditional class (n = 61) in chemistry were collected and compared using Pearson chi square procedures ( p = .05). No statistically significant difference was found between the two groups. Data from an open-ended student survey about how specific elements of their course experiences contributed to success and persistence were analyzed by coding the responses and comparing the learning community and traditional classes. Substantial differences were found in their perceptions about the lecture, the lab, other supports used for the course, contact with other students, helping them reach their potential, and their recommendation about the course to others. Because of the limitation of small sample size, these differences are reported in descriptive terms. ^

Improved estimation of postmortem interval with Cardiac Troponin T and improved analytical methods

Accurate knowledge of the time since death, or postmortem interval (PMI), has enormous legal, criminological, and psychological impact. In this study, an investigation was made to determine whether the relationship between the degradation of the human cardiac structure protein Cardiac Troponin T and PMI could be used as an indicator of time since death, thus providing a rapid, high resolution, sensitive, and automated methodology for the determination of PMI. ^ The use of Cardiac Troponin T (cTnT), a protein found in heart tissue, as a selective marker for cardiac muscle damage has shown great promise in the determination of PMI. An optimized conventional immunoassay method was developed to quantify intact and fragmented cTnT. A small sample of cardiac tissue, which is less affected than other tissues by external factors, was taken, homogenized, extracted with magnetic microparticles, separated by SDS-PAGE, and visualized with Western blot by probing with monoclonal antibody against cTnT. This step was followed by labeling and available scanners. This conventional immunoassay provides a proper detection and quantitation of cTnT protein in cardiac tissue as a complex matrix; however, this method does not provide the analyst with immediate results. Therefore, a competitive separation method using capillary electrophoresis with laser-induced fluorescence (CE-LIF) was developed to study the interaction between human cTnT protein and monoclonal anti-TroponinT antibody. ^ Analysis of the results revealed a linear relationship between the percent of degraded cTnT and the log of the PMI, indicating that intact cTnT could be detected in human heart tissue up to 10 days postmortem at room temperature and beyond two weeks at 4C. The data presented demonstrates that this technique can provide an extended time range during which PMI can be more accurately estimated as compared to currently used methods. The data demonstrates that this technique represents a major advance in time of death determination through a fast and reliable, semi-quantitative measurement of a biochemical marker from an organ protected from outside factors. ^

Prenatal environmental exposure and neurodevelopmentally important gene expression in malformed brain tissue from pediatric intractable epilepsy patients

The primary objective of this proposal was to determine whether mitochondrial oxidative stress and variation in a particular mtDNA lineage contribute to the risk of developing cortical dysplasia and are potential contributing factors in epileptogenesis in children. The occurrence of epilepsy in children is highly associated with malformations of cortical development (MCD). It appears that MCD might arise from developmental errors due to environmental exposures in combination with inherited variation in response to environmental exposures and mitochondrial function. Therefore, it is postulated that variation in a particular mtDNA lineage of children contributes to the effects of mitochondrial DNA damage on MCD phenotype. Quantitative PCR and dot blot were used to examine mitochondrial oxidative damage and single nucleotide polymorphism (SNP) in the mitochondrial genome in brain tissue from 48 pediatric intractable epilepsy patients from Miami Children’s Hospital and 11 control samples from NICHD Brain and Tissue Bank for Developmental Disorders. Epilepsy patients showed higher mtDNA copy number compared to normal health subjects (controls). Oxidative mtDNA damage was lower in non-neoplastic but higher in neoplastic epilepsy patients compared to controls. There was a trend of lower mtDNA oxidative damage in the non-neoplastic (MCD) patients compared to controls, yet, the reverse was observed in neoplastic (MCD and Non-MCD) epilepsy patients. The presence of mtDNA SNP and haplogroups did not show any statistically significant relationships with epilepsy phenotypes. However, SNPs G9804A and G9952A were found in higher frequencies in epilepsy samples. Logistic regression analysis showed no relationship between mtDNA oxidative stress, mtDNA copy number, mitochondrial haplogroups and SNP variations with epilepsy in pediatric patients. The levels of mtDNA copy number and oxidative mtDNA damage and the SNPs G9952A and T10010C predicted neoplastic epilepsy, however, this was not significant due to a small sample size of pediatric subjects. Findings of this study indicate that an increase in mtDNA content may be compensatory mechanisms for defective mitochondria in intractable epilepsy and brain tumor. Further validation of these findings related to mitochondrial genotypes and mitochondrial dysfunction in pediatric epilepsy and MCD may lay the ground for the development of new therapies and prevention strategies during embryogenesis.

The epidemiology of prostate cancer among multiethnic men

The research goal was to document differences in the epidemiology of prostate cancer among multicultural men [non-Hispanic White (NHW), Hispanic (H), non-Hispanic Black (NHB)], and Black subgroups, particularly among NHB subgroups [US-born (USB) and Caribbean-born (CBB)]. Study findings will be useful in supporting further research into Black subgroups. Aim 1 explored changes over time in reported prostate cancer prevalence, by race/ethnicity and by birthplace (within the Black subgroups). Aim 2 investigated relationships between observed and latent variables. The analytical approaches included confirmatory factor analysis (CFA for measurement models) and structural equation modeling (SEM for regression models). National Center for Health Statistics, National Health Interview Survey (NHIS) data from 1999–2008 were used. The study sample included men aged 18 and older, grouped by race/ethnicity. Among the CBB group, survey respondents were limited to the English-speaking Caribbean. Prostate cancer prevalence, by race showed a higher trend among NHB men than NHW men overall, however differences over time were not significant. CBB men reported a higher proportion of prostate cancer among cancers diagnosed than USB men overall. Due to small sample sizes, stable prostate cancer prevalence trends could not be assessed over time nor could trends in the receipt of a PSA exam among NHB men when stratified by birthplace. USB and CBB men differ significantly in their screening behavior. The effect of SES on PSA screening adjusted for risk factors was statistically significant while latent variable lifestyle was not. Among risk factors, family history of cancer exhibited a consistent positive effect on PSA screening for both USB and CBB men. Among the CBB men, the number of years lived in the US did not significantly affect PSA screening behavior. When NHB men are stratified by birthplace, CBB men had a higher overall prevalence of prostate cancer diagnoses than USB men although not statistically significant. USB men were 2 to 3 times more likely to have had a PSA exam compared to CBB men, but among CBB men birthplace did not make a significant difference in screening behavior. Latent variable SES, but not lifestyle, significantly affected the likelihood of a PSA exam.

Achievement of generic baccalaureate student nurses using computer -assisted instruction simulations during a nursing review course

The use of computer assisted instruction (CAI) simulations as an instructional strategy provides nursing students with a critical thinking approach for evaluating risks and benefits and choosing correct alternatives in "safe" patient care situations. It was hypothesized that using CAI simulations during an upper level nursing review course would have a positive effect on the students' posttest scores. Subjects (n = 36) were senior nursing students enrolled in a nursing review course in an undergraduate baccalaureate program. A limitation of the study was the small sample size. The study employed a modified group experimental design using the t test for independent samples. The group who received the CAI simulations during the physiological system review demonstrated a significant increase (p $<$.01) in the posttest score mean when compared to the lecture-discussion group score mean. There was no significant difference between high and low clinical grade point average (GPA) students in the CAI and lecture-discussion groups and their score means on the posttest. However, score mean differences of the low clinical GPA students showed a greater increase for the CAI group than the lecture-discussion group. There was no significant difference between the groups in their system content subscore means on the exit examination completed three weeks later. It was concluded that CAI simulations are as effective as lecture-discussion in assisting upper level students to process information for clinical decision making. CAI simulations can be considered as an instructional strategy to supplement or replace lecture content during a review course, allowing more efficient use of faculty time. It is recommended that the study be repeated using a larger sample size. Further investigations are recommended in comparing the effectiveness of computer software formats and various instructional strategies for other learning situations and student populations. ^

Holocene Mg/Ca, alkenones, and light stable isotope measurements on the outer North Iceland shelf, sediment core MD99-2269

We present new Holocene century to millennial-scale proxies for the well-dated piston core MD99-2269 from Húnaflóadjúp on the North Iceland Shelf. The core is located in 365 mwd and lies close to the fluctuating boundary between Atlantic and Arctic/Polar waters. The proxies are: alkenone-based SST°C, and Mg/Ca SST°C estimates and stable d13C and d18O values on planktonic and benthic foraminifera. The data were converted to 60 yr equi-spaced time-series. Significant trends in the data were extracted using Singular Spectrum Analysis and these accounted for between 50% and 70% of the variance. A comparison between these data with previously published climate proxies from MD99-2269 was carried out on a data set which consisted of 14-variable data set covering the interval 400-9200 cal yr BP at 100 yr time steps. This analysis indicated that the 1st two PC axes accounted for 57% of the variability with high loadings clustering primarily into "nutrient" and "temperature" proxies. Clustering on the 100 yr time-series indicated major changes in environment at ~6350 and ~3450 cal yr BP, which define early, mid- and late Holocene climatic intervals. We argue that a pervasive freshwater cap during the early Holocene resulted in warm SST°s, a stratified water column, and a depleted nutrient supply. The loss of the freshwater layer in the mid-Holocene resulted in high carbonate production, and the late Holocene/neoglacial interval was marked by significantly more variable sea surface conditions.

Evaluation of a One-Day Meditech Magic Training Program for Registered Nurses and Licensed Practical Nurses in a long term care program

Background: An evaluation was completed on the One-Day Meditech Magic Training Program for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) developed for the Long Term Care (LTC) Program. Methods: Both a literature review and consultation with stakeholders were completed to determine possible evaluation methods, expected outcomes, and ways to measure the effectiveness of the education program. A pretest/posttest design and questionnaire were chosen as the evaluation tools for this project. Results: No significant difference was found between the pretest and posttest total scores indicating that learners retained information from the orientation session (Z = -1.820, p = 0.069). Additional Wilcoxon matched-pairs signed rank tests were performed on the individual sections of the tests and revealed a significant decrease in the posttest scores for entering a Diagnostic Imaging requisition (Z = -1.975, p = 0.048). No other significant findings were present. Questionnaires were also analyzed revealing that most participants were pleased with the Meditech documentation education they received and did not indicate barriers that would affect electronic documentation. Conclusions: Further testing is required to ensure reliability and validity of the evaluation tools. Finally, caution is needed due to a small sample size. However, problematic documentation tasks were identified during the evaluation, and as a result both the training session and support materials will be improved as a result of this project.

Bayesian adaptive estimation of arbitrary points on a psychometric function

Bayesian adaptive methods have been extensively used in psychophysics to estimate the point at which performance on a task attains arbitrary percentage levels, although the statistical properties of these estimators have never been assessed. We used simulation techniques to determine the small-sample properties of Bayesian estimators of arbitrary performance points, specifically addressing the issues of bias and precision as a function of the target percentage level. The study covered three major types of psychophysical task (yes-no detection, 2AFC discrimination and 2AFC detection) and explored the entire range of target performance levels allowed for by each task. Other factors included in the study were the form and parameters of the actual psychometric function Psi, the form and parameters of the model function M assumed in the Bayesian method, and the location of Psi within the parameter space. Our results indicate that Bayesian adaptive methods render unbiased estimators of any arbitrary point on psi only when M=Psi, and otherwise they yield bias whose magnitude can be considerable as the target level moves away from the midpoint of the range of Psi. The standard error of the estimator also increases as the target level approaches extreme values whether or not M=Psi. Contrary to widespread belief, neither the performance level at which bias is null nor that at which standard error is minimal can be predicted by the sweat factor. A closed-form expression nevertheless gives a reasonable fit to data describing the dependence of standard error on number of trials and target level, which allows determination of the number of trials that must be administered to obtain estimates with prescribed precision.

Beam Angle Optimization for Automated Coplanar IMRT Lung Plans

Purpose: To investigate the effect of incorporating a beam spreading parameter in a beam angle optimization algorithm and to evaluate its efficacy for creating coplanar IMRT lung plans in conjunction with machine learning generated dose objectives.

Methods: Fifteen anonymized patient cases were each re-planned with ten values over the range of the beam spreading parameter, k, and analyzed with a Wilcoxon signed-rank test to determine whether any particular value resulted in significant improvement over the initially treated plan created by a trained dosimetrist. Dose constraints were generated by a machine learning algorithm and kept constant for each case across all k values. Parameters investigated for potential improvement included mean lung dose, V20 lung, V40 heart, 80% conformity index, and 90% conformity index.

Results: With a confidence level of 5%, treatment plans created with this method resulted in significantly better conformity indices. Dose coverage to the PTV was improved by an average of 12% over the initial plans. At the same time, these treatment plans showed no significant difference in mean lung dose, V20 lung, or V40 heart when compared to the initial plans; however, it should be noted that these results could be influenced by the small sample size of patient cases.

Conclusions: The beam angle optimization algorithm, with the inclusion of the beam spreading parameter k, increases the dose conformity of the automatically generated treatment plans over that of the initial plans without adversely affecting the dose to organs at risk. This parameter can be varied according to physician preference in order to control the tradeoff between dose conformity and OAR sparing without compromising the integrity of the plan.

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

The Effect of Authentic Literacy Experiences as Book Buddies with Hispanic Fourth Graders on Preservice Teachers’ Literacy Content Knowledge and Reading Maturity

From a sociocultural perspective, individuals learn best from contextualized experiences. In preservice teacher education, contextualized experiences include authentic literacy experiences, which include a real reader and writer and replicate real life communication. To be prepared to teach well, preservice teachers need to gain literacy content knowledge and possess reading maturity. The purpose of this study was to examine the effect of authentic literacy experiences as Book Buddies with Hispanic fourth graders on preservice teachers’ literacy content knowledge and reading maturity. The study was a pretest/posttest design conducted over 12 weeks. Preservice teacher participants, the focus of the study, were elementary education majors taking the third of four required reading courses in non-probabilistic convenience groups, 43 (n = 33 experimental, n = 10 comparison) Elementary Education majors. The Survey of Preservice Teachers’ Knowledge of Teaching and Technology (SPTKTT), specifically designed for preservice teachers majoring in elementary or early childhood education and the Reading Maturity Survey (RMS) were used in this study. Preservice teachers chose either the experimental or comparison group based on the opportunity to earn extra credit points (experimental = 30 points, comparison = 15). After exchanging introductory letters preservice teachers and Hispanic fourth graders each read four books. After reading each book preservice teachers wrote letters to their student asking higher order thinking questions. Preservice teachers received scanned copies of their student’s unedited letters via email which enabled them to see their student’s authentic answers and writing levels. A series of analyses of covariance were used to determine whether there were significant differences in the dependent variables between the experimental and comparison groups. This quasi-experimental study tested two hypotheses. Using the appropriate pretest scores as covariates for adjusting the posttest means of the subcategory Literacy Content Knowledge (LCK), of the SPTKTT and the RMS, the mean adjusted posttest scores from the experimental group and comparison group were compared. No significant differences were found on the LCK dependent variable using the .05 level of significance, which may be due to Type II error caused by the small sample size. Significant differences were found on RMS using the .05 level of significance.

Pollen from 50 lake surface samples in Brandenburg, Germany, in 2009

Past changes in plant and landscape diversity can be evaluated through pollen analysis, however, pollen based diversity indexes are potentially biased by differential pollen production and deposition. Studies examining the relationship between pollen and landscape diversity are therefore needed. The aim of this study is to evaluate how different pollen based indexes capture aspects of landscape diversity. Pollen counts were obtained from surface samples of 50 small to medium sized lakes in Brandenburg (Northeast Germany) and compiled into two sets, with one containing all pollen counts from terrestrial plants and the second restricted to wind-pollinated taxa. Both sets were adjusted for the pollen production/dispersal bias using the REVEALS model. A high resolution biotope map was used to extract the density of total biotopes and different biotopes per area as parameters describing landscape diversity. In addition tree species diversity was obtained from forest inventory data. The Shannon index and the number of taxa in a sample of 10 pollen grains are highly correlated and provide a useful measure of pollen type diversity which corresponds best to landscape diversity within one km of the lake and the proportion of non-forested area within seven km. Adjustments of the pollen production/dispersal bias only slightly improve the relationships between pollen diversity and landscape diversity for the restricted dataset as well as for the forest inventory data and corresponding pollen types. Using rarefaction analysis, we propose the following convention: pollen type diversity is represented by the number of types in a small sample (low count e.g. 10), pollen type richness is the number of types in a large sample (high count e.g. 500) and pollen sample evenness is characterized by the ratio of the two. Synthesis. Pollen type diversity is a robust index that captures vegetation structure and landscape diversity. It is ideally suited for between site comparisons as it does not require high pollen counts. In concert with pollen type richness and evenness, it helps evaluating the effect of climate change and human land use on vegetation structure on long timescales.