Coronary MR angiography: comparison of quantitative and qualitative data from four techniques.

OBJECTIVE: The optimal coronary MR angiography sequence has yet to be determined. We sought to quantitatively and qualitatively compare four coronary MR angiography sequences. SUBJECTS AND METHODS. Free-breathing coronary MR angiography was performed in 12 patients using four imaging sequences (turbo field-echo, fast spin-echo, balanced fast field-echo, and spiral turbo field-echo). Quantitative comparisons, including signal-to-noise ratio, contrast-to-noise ratio, vessel diameter, and vessel sharpness, were performed using a semiautomated analysis tool. Accuracy for detection of hemodynamically significant disease (> 50%) was assessed in comparison with radiographic coronary angiography. RESULTS: Signal-to-noise and contrast-to-noise ratios were markedly increased using the spiral (25.7 +/- 5.7 and 15.2 +/- 3.9) and balanced fast field-echo (23.5 +/- 11.7 and 14.4 +/- 8.1) sequences compared with the turbo field-echo (12.5 +/- 2.7 and 8.3 +/- 2.6) sequence (p < 0.05). Vessel diameter was smaller with the spiral sequence (2.6 +/- 0.5 mm) than with the other techniques (turbo field-echo, 3.0 +/- 0.5 mm, p = 0.6; balanced fast field-echo, 3.1 +/- 0.5 mm, p < 0.01; fast spin-echo, 3.1 +/- 0.5 mm, p < 0.01). Vessel sharpness was highest with the balanced fast field-echo sequence (61.6% +/- 8.5% compared with turbo field-echo, 44.0% +/- 6.6%; spiral, 44.7% +/- 6.5%; fast spin-echo, 18.4% +/- 6.7%; p < 0.001). The overall accuracies of the sequences were similar (range, 74% for turbo field-echo, 79% for spiral). Scanning time for the fast spin-echo sequences was longest (10.5 +/- 0.6 min), and for the spiral acquisitions was shortest (5.2 +/- 0.3 min). CONCLUSION: Advantages in signal-to-noise and contrast-to-noise ratios, vessel sharpness, and the qualitative results appear to favor spiral and balanced fast field-echo coronary MR angiography sequences, although subjective accuracy for the detection of coronary artery disease was similar to that of other sequences.

Missed appointments in an adolescent outpatient clinic : descriptive analyses of consultations over eight years ; et, Missed appointments in an outpatient clinic for adolescents, an approache to predict the risk of missing

Rapport de synthèse: Les rendez-vous manqués représentent un problème important, tant du point de vue de la santé des patients que du point de vue économique. Pourtant peu d'études se sont penchées sur le sujet, particulièrement dans une population d'adolescents. Les buts de cette étude étaient de caractériser les adolescents qui sont à risque de manquer ou d'annuler leurs rendez-vous dans une clinique ambulatoire de santé pour adolescents, de comparer les taux des rendez-vous manqués et annulés entre les différents intervenants et d'estimer l'efficacité d'une politique de taxation des rendez-vous manqués non excusés. Finalement, un modèle multi-niveau markovien a été utilisé afin de prédire le risque de manquer un rendez-vous. Ce modèle tient compte du passé de l'adolescent en matière de rendez-vous manqués et d'autres covariables et permet de grouper les individus ayant un comportement semblable. On peut ensuite prédire pour chaque groupe le risque de manquer ou annuler et les covariables influençant significativement ce risque. Entre 1999 et 2006, 32816 rendez-vous fixés pour 3577 patients âgés de 12 à 20 ans ont été analysés. Le taux de rendez-vous manqués était de 11.8%, alors que 10.9% avaient été annulés. Soixante pour cent des patients n'ont pas manqué un seul de leur rendezvous et 14% en ont manqué plus de 25%. Nous avons pu mettre en évidence plusieurs variables associées de manière statistiquement significative avec les taux de rendez-vous manqués et d'annulations (genre, âge, heure, jour de la semaine, intervenant thérapeutique). Le comportement des filles peut être catégorisé en 2 groupes. Le premier groupe inclut les diagnostiques psychiatriques et de trouble du comportement alimentaire, le risque de manquer dans ce groupe étant faible et associé au fait d'avoir précédemment manqué un rendez-vous et au délai du rendez-vous. Les autres diagnostiques chez les filles sont associés à un second groupe qui montre un risque plus élevé de manquer un rendez-vous et qui est associé à l'intervenant, au fait d'avoir précédemment manqué ou annulé le dernier rendez-vous et au délai du rendez-vous. Les garçons ont tous globalement un comportement similaire concernant les rendez-vous manqués. Le diagnostic au sein de ce groupe influence le risque de manquer, tout comme le fait d'avoir précédemment manqué ou annulé un rendez-vous, le délai du rendez-vous et l'âge du patient. L'introduction de la politique de taxation des rendez-vous non excusés n'a pas montré de différence significative des tàux de rendez-vous manqués, cependant cette mesure a permis une augmentation du taux d'annulations. En conclusion, les taux de présence des adolescents à leurs rendez-vous sont dépendants de facteurs divers. Et, même si les adolescents sont une population à risque concernant les rendez-vous manqués, la majorité d'entre eux ne manquent aucun de leurs rendez-vous, ceci étant vrai pour les deux sexes. Etudier les rendez-vous manqués et les adolescents qui sont à risque de rater leur rendez-vous est un pas nécessaire vers le contrôle de ce phénomène. Par ailleurs, les moyens de contrôle concernant les rendez-vous manqués devraient cibler les patients ayant déjà manqué un rendez-vous. La taxation des rendez-vous manqués permet d'augmenter les rendez-vous annulés, ce qui a l'avantage de permettre de fixer un nouveau rendez-vous et, de ce fait, d'améliorer la continuité des soins.

Patients' spontaneous discourse on the importance of significant others in the course of transplantation: A qualitative study

Background: This study explores significant ones' implication before and after transplantation. Methods: Longitudinal semi-structured interviews were conducted in 64 patients awaiting all-organ transplantation. Among them, 58 patients spontaneously discussed the importance of their significant other in their daily support. Discourse analysis was applied. Findings: During the pre-transplantation period renal patients reported that significant others took part in dialysis treatment and participated to regimen adherence. After transplantation, quality of life improved and the couple dynamics returned to normal. Patients awaiting lung or heart transplantation were more heavily impaired. Significant others had to take over abandoned roles. After transplantation resuming normal life became gradually possible, but after one year either transplantation health benefits relieved physical, emotional and social loads, or complications maintained the level of stress on significant others. Discussion: Patients reported that significant others had to take over various responsibilities and were concerned about long-term stress that should be adequately supported.

Missed appointments in an adolescent outpatient clinic: descriptive analyses of consultations over 8 years.

Missed appointments represent an important medical and economical issue. Few studies on the subject are reported in the literature, particularly regarding adolescents. Our aim was to characterize missed and cancelled appointments in a multidisciplinary outpatient clinic for adolescents, to assess the effectiveness of a policy aimed at reducing missed appointments by introducing payment for those missed appointments not cancelled in advance, and to compare the rates between staff and resident physicians. A total of 32,816 consultations (representing 35 patients aged 12-20 years, 82.4% females) between 1999 and 200 were analysed. The missed appointment rate was 11.8% whilst another 10.9% were cancellations. Females cancelled more than males (11.3% vs. 8.4%, AOR 1.31, 99% CI 1.08-1.59), but there was no difference for missed appointments (11.6% vs. 12.3%, AOR 0.88, 99% CI 0.61-1.08). April and June to October (vacation months) were associated with more missed appointments. Globally mornings had higher rates of missed appointments than afternoons (13.6% vs. 11.2%, AOR 1.25, 99% CI 1.11-1.40). There was a slight difference in missed appointment rates between staff physicians and residents (10.4%; 11.8%, AOR 1.20, 99% CI 1.08-1.33). Missed appointment rates before and after the new policy on missed appointments were similar (1999-2003: 11.9%; 2004-2006: 11.6%, AOR 0.96, 99% CI 0.83-1.10). Conversely, cancellation rates increased from 8.4% (1999-2003) to 14.5% (2004-2006) (AOR 1.83, 99% CI 1.63-2.05). Attendance rates among adolescents show variations depending on vacation and school hours. Being attentive to these factors could help prevent missed appointments. Although having to pay for missed appointments does not increase attendance, it increases cancellations with the advantage that the appointment can be rescheduled.

Host-ectoparasite specificity in a small mammal community in an area of Atlantic Rain Forest (Ilha Grande, State of Rio de Janeiro), Southeastern Brazil

The analyses of the ectoparasite species associated with a small mammal community on Ilha Grande, a coastal island in southern of the state of Rio de Janeiro, Brazil, evaluated the level of host-ectoparasite specificity. Was used the Jaccard index for qualitative data to analyse the similarity. The lowest value of similarity occurred between Proechimys iheringi and Marmosops incanus and between Sciurus aestuans and Nectomys squamipes (Cj = 0.08) and the highest between P. iheringi and Oxymycterus sp. (Cj = 0.33). This index showed a low value of similarity across the ectoparasite community. The only exception from this pattern of high host specificity occurred with P. iheringi and Oxymycterus sp., which shared five species of ectoparasites. The similarity values, for most of the cases, is smaller than 0.2.

Genetic Analyses Reveal a Role for Vitamin D Insufficiency in HCV-Associated Hepatocellular Carcinoma Development.

BACKGROUND: Vitamin D insufficiency has been associated with the occurrence of various types of cancer, but causal relationships remain elusive. We therefore aimed to determine the relationship between genetic determinants of vitamin D serum levels and the risk of developing hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). METHODOLOGYPRINCIPAL FINDINGS: Associations between CYP2R1, GC, and DHCR7 genotypes that are determinants of reduced 25-hydroxyvitamin D (25[OH]D3) serum levels and the risk of HCV-related HCC development were investigated for 1279 chronic hepatitis C patients with HCC and 4325 without HCC, respectively. The well-known associations between CYP2R1 (rs1993116, rs10741657), GC (rs2282679), and DHCR7 (rs7944926, rs12785878) genotypes and 25(OH)D3 serum levels were also apparent in patients with chronic hepatitis C. The same genotypes of these single nucleotide polymorphisms (SNPs) that are associated with reduced 25(OH)D3 serum levels were found to be associated with HCV-related HCC (P = 0.07 [OR = 1.13, 95% CI = 0.99-1.28] for CYP2R1, P = 0.007 [OR = 1.56, 95% CI = 1.12-2.15] for GC, P = 0.003 [OR = 1.42, 95% CI = 1.13-1.78] for DHCR7; ORs for risk genotypes). In contrast, no association between these genetic variations and liver fibrosis progression rate (P>0.2 for each SNP) or outcome of standard therapy with pegylated interferon-α and ribavirin (P>0.2 for each SNP) was observed, suggesting a specific influence of the genetic determinants of 25(OH)D3 serum levels on hepatocarcinogenesis. CONCLUSIONSSIGNIFICANCE: Our data suggest a relatively weak but functionally relevant role for vitamin D in the prevention of HCV-related hepatocarcinogenesis.

Comparative analysis of ten assesment grids of quality criteria in qualitative research

The authors present 10 grids which are widely used in Health Sciences for the assessment of quality in research. They proceed through a comparative thematic analysis of these grids and show which points of view are preferred. They insist on the issues that differentiate these grids from each other and suggest the analysis of their differences by distinguishing the theoretical perspectives that underpin each one of these grids. Whilst the authors of the assessment grids rarely refer to the implicit theoretical backgrounds that guide their work, findings show that these grids convey varied epistemologies and research models. This gap renders the comparison of quality assessment in qualitative research a very difficult task, unless we shift our focus on the relationship between the grids, their theoretical backgrounds and their specific research subjects.

Water-filtered infrared-A radiation (wIRA) is not implicated in cellular degeneration of human skin

Rapport de synthèse : Introduction : le vieillissement cutané est un processus biologique complexe auquel participe une exposition excessive au rayonnement ultraviolet du soleil. En particulier, les longueurs d'onde des rayons ultraviolets A et B (UV-A et UV-B) peuvent induire une augmentation de la synthèse de protéases, comme la métalloprotéinase matricielle 1 (MMP-1), qui est impliquée dans le processus de vieillissement. La thermothérapie par infrarouges, dont les longueurs d'onde sont plus longues que celles des UV, est largement utilisée à des fins thérapeutiques ou cosmétiques. Or, il a été démontré que les infrarouges en filtration aqueuse (IRFA) pouvaient induire une augmentation de la production de MMP-1 et par conséquent être nocifs. Il serait donc intéressant d'évaluer les effets des IRFA au niveau cellulaire et moléculaire. But Expérimental : étudier les effets des lampes à infrarouges en filtration aqueuse utilisées en clinique sur des fibroblastes cutanés humains en culture, afin d'analyser l'expression du gène codant pour la protéine MMP-1. Méthode : des fibroblastes cutanés humain ont été irradiés d'une part avec approximativement 88% d'IRFA (780-1400 nm) et 12% de lumière rouge (LR, 665-780 nm) avec 380 mW/cm2 IRFA(+LR) (333 mW/cm2 IRFA) et d'autre part avec des UV-A comme contrôle. Des courbes de survie cellulaire ont été établies après une exposition allant de 15 minutes à 8 heures au IRFA(+LR) (340-10880 J/cm2 wIRA(+RL), 300-9600 J/cm2 wIRA) ou de 15 à 45 minutes aux UV-A(+BL) (25-75 J/cm2 UV-A(+BL). L'induction de l'ARNm du gène de la MMP-1 a été analysé dans les fibroblastes cutanés humain à deux températures physiologiques (30°C et 37°C) lors d'expositions uniques de 15 à 60 minutes aux IRFA(+LR) (340-1360 J/cm2 IRFA(+LR), 300-1200 J/cm2 IRFA) ou de 30 minutes aux UV-A(+BL) (50 J/cm2 UVA(+BL)). De plus, nous avons effectué des irradiations répétées, une a chaque passage cellulaire jusqu'au passage. 10 de 15 minutes d'IRFA(+LR) 340 J/cm2 IRFA(+LR), 300 J/cm2 IRFA) . Résultats : une exposition unique aux UV-A (+BL) entraîne chez des fibroblastes cutanés humains une augmentation de la mort cellulaire, ainsi qu'une forte augmentation de l'expression du gène codant pour la MMP-1. L'augmentation mise en évidence pour cet ARNm varie en fonction de la technique utilisée : elle est de 11 ± 1 fois par RT-PCR classique, de 76 ± 2 fois par RT-PCR quantitative à 30°C, et de 75 ± 1 fois par RT-PCR quantitative à 37°C. Par contre, une exposition unique ou répétée aux IRFA (+LR) n'induit aucune augmentation de la mort cellulaire, ni de l'expression de l'ARNm de la MMP-1 chez ces fibroblastes. Conclusions : les résultats de cette étude montrent que, contrairement aux rayons ultraviolets, les IRFA (+LR) ne semblent impliqués ni dans le vieillissement, ni dans la mort cellulaire, même utilisés à des doses très élevées. Ces résultats sont en accord avec certaines investigations in vivo montrant une induction de MMP-1 par des UV et non des infrarouges. Ces dernières études suggèrent d'ailleurs plutôt un rôle protecteur des IRFA (+LR).

A Mind of their Own. A Qualitative Study of Drug Education from a Young Person's Perspective: Exploring their Experiences, Views and Opinions

The main aims of the research are to explore young people's experiences and opinions of drug education and to discover whether it is, in their opinion, meeting their needs. The study was conducted with twenty young people aged fifteen to nineteen years in two towns in North County Dublin. The principal school teachers from three secondary schools in the area were also interviewed. The findings reveal there is a lack of planned drug education in the schools mainly, according to principal school teachers, due to timetable constraints. Another key finding is the need expressed by the young people for accurate and balanced drug education. The study also shows that there is a conflict between young people's negative opinion of teachers as drug educators and that of the literature and research, which identifies teachers as the most appropriate drug educators. In view of these findings the following recommendations are recommendations are suggested. Firstly, the role of teachers as drug educators needs further research. Secondly, the Substance Abuse Prevention Programme needs to be extended to include the over fifteen year's age group with a harm reduction/safety module as part of the programme. Thirdly, the Social, Personal and Health Education as a core subject needs to be fully implemented in the schools. Finally, the inclusion of young peoples' views in the form of a 'reference' or 'representative' group in each school would be a positive recommendation. This would give young consumers of drug education programmes some input into drug policy within the schools they attend.This resource was contributed by The National Documentation Centre on Drug Use.

Archiving and Accessing Qualitative Data Programme

There is a growing body of qualitative research data being made available in data archives in both Ireland and the UK. Examples of Irish qualitative data currently available for further analysis include Growing Up in Ireland (GUI) and Life Histories and Social Change in 20th Century Ireland. The Timescapes Research Programme, at the University of Leeds, hosts a wide variety of economic and social research data relevant to child and family researchers; data which is available to researchers in both Northern Ireland and the Republic of Ireland. Access to this data provides researchers with greater opportunities to explore the issues that affect children, their families and their  communities and which may ultimately contribute to informing children's policy. In this the second master class of the Children's Research Network for Ireland and Northern Ireland, participants will learn about the various qualitativ edatasets that are publicly-available for research purposes in the Republic of Ireland and Northern Ireland.

Growing up in Ireland data in the Irish Qualitative Data Archive

Brian Merriman's presentation on the Growing up in Ireland data in the Irish Qualitative Data Archive

CDI Tallaght RACCER data in the Irish Qualitative Data Archive

Tara Murphy's presentation on preparing RACCER data for the Irish Qualitative Data Archive

The Irish Qualitative Data Archive

Jane Gray's presentation on the Irish Qualitative Data Archive

Webcast Archiving and Accessing Qualitative Data

View the webcast of the presentations at the Archiving and Accessing Qualitative data master class, February 2012.