Expanding the evidence within evidence-based healthcare:thinking about the context, acceptability and feasibility of interventions

Evidence-based medicine is crucial to contemporary healthcare. It is dependent on systematic review methodology modelled on an arguably inadequate hierarchy of evidence. There has been a significant increase in medical and health research using qualitative and mixed method designs. The perspective taken in this article is that we need to broaden our evidence base if we are to fully take account of issues of context, acceptability and feasibility in the development and implementation of healthcare interventions. One way of doing this is to use a range of methods that better fit the different aspects of intervention development and implementation. Methods for the systematic review of evidence, other than randomised-controlled trials, are available and there is a readiness to incorporate these other types of evidence into good-practice guidance, but we need a clear methodology to translate these advances in research into the world of policy.

Sensory processing, reading, IQ, and attention

Detection thresholds for two visual- and two auditory-processing tasks were obtained for 73 children and young adults who varied broadly in reading ability. A reading-disabled subgroup had significantly higher thresholds than a normal-reading subgroup for the auditory tasks only. When analyzed across the whole group, the auditory tasks and one of the visual tasks, coherent motion detection, were significantly related to word reading. These effects were largely independent of ADHD ratings; however, none of these measures accounted for significant variance in word reading after controlling for full-scale IQ. In contrast, phoneme awareness, rapid naming, and nonword repetition each explained substantial, significant word reading variance after controlling for IQ, suggesting more specific roles for these oral language skills in the development of word reading. © 2004 Elsevier Inc. All rights reserved.

Acceptability of Lean Six Sigma in a developing economy:results from exploratory research in Nigerian consulting companies

The application of Lean Six Sigma (LSS) varies in different regions of the world in terms of both level of understanding and acceptability. Employing a qualitative methodological approach, this paper aims to explore factors hindering the acceptability of the LSS initiative in organizations and list factors required for successful application and implementation in a developing economy from the perspective of LSS consultants. Using Nigeria as a case study, primary data were collected though a number of semi-structured interviews with representatives of leading continuous improvement consultancy firms in Nigeria. Finding draws out links between major factors such as drivers and motivation, LSS performance, marketability and challenges to the acceptability and applicability of LSS in Nigeria. Further findings highlight major factors such as lack of management buy-in, level of awareness, certification driven market, Nigerian environment and culture, etc as problems that hinder successful implementation of LSS in Nigeria. This paper contributes to the theoretical foundation of critical success factors required for the implementation of Lean Six Sigma, with results from the experience of a developing economy.

Brief report:effects of sensory sensitivity and intolerance of uncertainty on anxiety in mothers of children with autism spectrum disorder

This study examined the relations between anxiety and individual characteristics of sensory sensitivity (SS) and intolerance of uncertainty (IU) in mothers of children with ASD. The mothers of 50 children completed the Hospital Anxiety and Depression Scale, the Highly Sensitive Person Scale and the IU Scale. Anxiety was associated with both SS and IU and IU was also associated with SS. Mediation analyses showed direct effects between anxiety and both IU and SS but a significant indirect effect was found only in the model in which IU mediated between SS. This is the first study to characterize the nature of the IU and SS interrelation in predicting levels of anxiety.

A longitudinal evaluation of the acceptability and impact of a diet diary app for older adults with age-related macular degeneration

Ongoing advances in technology are increasing the scope for enhancing and supporting older adults’ daily living. The digital divide between older and younger adults raises concerns, however, about the suitability of technological solutions for older adults, especially for those with impairments. Taking older adults with Age-Related Macular Degeneration (AMD) as a case study, we used user-centred and participatory design approaches to develop an assistive mobile app for self-monitoring their intake of food [12,13]. In this paper we report on findings of a longitudinal field evaluation of our app that was conducted to investigate how it was received and adopted by older adults with AMD and its impact on their lives. Demonstrating the benefit of applying inclusive design methods for technology for older adults, our findings reveal how the use of the app raises participants’ awareness and facilitates self-monitoring of diet, encourages positive (diet) behaviour change, and encourages learning.

A sensory-guided surgical micro-drill

This article describes a surgical robotic device that is able to discriminate tissue interfaces and other controlling parameters ahead of the drill tip. The advantage in such a surgery is that the tissues at the interfaces can be preserved. A smart tool detects ahead of the tool point and is able to control the interaction with respect to the flexing tissue, to avoid penetration or to control the extent of protrusion with respect to the position of the tissue. For surgical procedures, where precision is required, the tool offers significant benefit. To interpret the drilling conditions and the conditions leading up to breakthrough at a tissue interface, a sensing scheme is used that discriminates between the variety of conditions posed in the drilling environment. The result is a fully autonomous system, which is able to respond to the tissue type, behaviour, and deflection in real-time. The system is also robust in terms of disturbances encountered in the operating theatre. The device is pragmatic. It is intuitive to use, efficient to set up, and uses standard drill bits. The micro-drill, which has been used to prepare cochleostomies in the theatre, was used to remove the bone tissue leaving the endosteal membrane intact. This has enabled the preservation of sterility and the drilling debris to be removed prior to the insertion of the electrode. It is expected that this technique will promote the preservation of hearing and reduce the possibility of complications. The article describes the device (including simulated drill progress and hardware set-up) and the stages leading up to its use in the theatre. © 2010 Authors.

The functional neuroanatomy of auditory sensory gating and its behavioural implications

Auditory sensory gating (ASG) is the ability in individuals to suppress incoming irrelevant sensory input, indexed by evoked response to paired auditory stimuli. ASG is impaired in psychopathology such as schizophrenia, in which it has been proposed as putative endophenotype. This study aims to characterise electrophysiological properties of the phenomenon using MEG in time and frequency domains as well as to localise putative networks involved in the process at both sensor and source level. We also investigated the relationship between ASG measures and personality profiles in healthy participants in the light of its candidate endophenotype role in psychiatric disorders. Auditory evoked magnetic fields were recorded in twenty seven healthy participants by P50 ‘paired-click’ paradigm presented in pairs (conditioning stimulus S1- testing stimulus S2) at 80dB, separated by 250msec with inter trial interval of 7-10 seconds. Gating ratio in healthy adults ranged from 0.5 to 0.8 suggesting dimensional nature of P50 ASG. The brain regions active during this process were bilateral superior temporal gyrus (STG) and bilateral inferior frontal gyrus (IFG); activation was significantly stronger in IFG during S2 as compared to S1 (at p<0.05). Measures of effective connectivity between these regions using DCM modelling revealed the role of frontal cortex in modulating ASG as suggested by intracranial studies, indicating major role of inhibitory interneuron connections. Findings from this study identified a unique event-related oscillatory pattern for P50 ASG with alpha (STG)-beta (IFG) desynchronization and increase in cortical oscillatory gamma power (IFG) during S2 condition as compared to S1. These findings show that the main generator for P50 response is within temporal lobe and that inhibitory interneurons and gamma oscillations in the frontal cortex contributes substantially towards sensory gating. Our findings also show that ASG is a predictor of personality profiles (introvert vs extrovert dimension).

A geometriai Brown-mozgás feltevésének elfogadhatósága a reálopciók értékelésében (The acceptability of the assumption of geometric brownian motion in the valuation of real options)

A reálopciók a döntési rugalmasság megtestesítőiként jelen vannak a vállalatvezetők mindennapjaiban, és cégtől függően jelentős értéket képviselhetnek. Értékelésük a hagyományos diszkontált pénzáramlás módszerekkel csak korlátozottan lehetséges, ezért alternatívaként felmerül a pénzügyi opcióárazás módszertana, amelynek hagyományos változatai az alaptermék alakulásáról geometriai Brown-mozgást feltételeznek. A cikk ezt a feltevést veszi górcső alá a reálopciókra történő alkalmazás szempontjából, és megmutatja, hogy habár önkényesnek tűnhet, valójában nem pusztán egy matematikai szempontból kényelmes megoldás, hanem pénzügyileg is elfogadható feltétel. _______ Real options represent the fl exibility of decision-making, and are thus part of the everyday work of corporate executives, often having great value. Valuing them with the use of traditional Discounted Cash Flow models has limited relevance, therefore arises the alternative methodology of fi nancial option pricing, the traditional versions of which assume that the price of the underlying asset follows Geometric Brownian Motion. The paper examines this assumption from the aspect of real option valuation and shows that although it might seem arbitrary, it is not only a mathematically convenient choice, but also a fi nancially acceptable one.

The acceptability and utility of voir dire questionnaires in Florida Circuit Civil Court

This study examined the acceptability and utility of the content of an extensive automobile tort voir dire questionnaire in Florida Circuit Civil Court. The ultimate purpose was to find questionnaire items from established measures that have demonstrated utility in uncovering biases that were at the same time not objectionable to the courts. The survey instrument included a venireperson questionnaire that used case-specific attitudinal and personality measures as well as typical information asked about personal history. The venireperson questionnaire incorporated measures that have proven reliable in other personal injury studies (Hans, & Lofquist, 1994). In order to examine judges' ratings, the questionnaire items were grouped into eight categories. Claims Consciousness scale measures general attitudes towards making claims based on one's legal rights. Belief in a Just World measures how sympathetic the juror would be to people who have suffered injuries. Political Efficacy is another general attitude scale that identifies attitudes towards the government. Litigation Crisis scales elicits attitudes about civil litigation. Case Specific Beliefs about Automobile Accidents and Litigation were taken from questionnaires developed and used in auto torts and other personal injury cases. Juror's personal history was divided into Demographics and Trial Relevant Attitudes. Ninety-seven circuit civil judges critiqued the questionnaire for acceptability, relevance to the type of case presented, and usefulness to attorneys for determining peremptories. ^ The majority of judges' responses confirmed that the central dimension in judicial thinking is juror qualification rather than juror partiality. Only three of the eight voir dire categories were considered relevant by more than 50 percent of the judges: Trial Relevant Experiences, Juror Demographics, and Tort Reform. Additionally, several acceptable items from generally disapproved categories were identified among the responses. These were general and case specific attitudinal items that are related to tort reform. We discuss the utility of voir dire items for discerning juror partiality. ^

Understanding the Effect of Protein Tyrosine Phosphatase Receptor Type 0 on Mammalian Sensory Development: Behavioral Studies on PTPRO Knockout Mice

Nerve development, which includes axon outgrowth and guidance, is regulated by many protein families, including receptor protein tyrosine phosphatases (RPTP's).Protein tyrosine phosphatase receptor type 0 (PTPRO) is a type III RPTP that is important for axon growth and guidance, as observed in chicks and flies. In order to examine the effects ofPTPRO on mammalian development, standard behavioral tests were used to compare mice lacking the gene for PTPRO (ROKO mice) to wild-type (WT) mice. The ROKO mice showed a significant delay in reacting to a thermal noxious stimulus, hotplate analgesia, when compared to the WT mice suggesting deficient nociceptive function. In a rotarod test for proprioceptive function the ROKO mice exhibited a significant decrease in the amount of time spent on the rotating rod than did the WT mice. Additional proprioception tests were performed including the climb, step reflex, beam, and mesh walk tests. In the climb and step (place) test, the ROKO group had a significantly lower accuracy in performing the tests than did the WT mice. Thus, mice lacking the PTPRO gene showed behavioral deficiencies that reflect impairment in sensory function, specifically for nociception and proprioception.

A comparison of fixed-step-size and Bayesian staircases for sensory threshold estimation

Fixed-step-size (FSS) and Bayesian staircases are widely used methods to estimate sensory thresholds in 2AFC tasks, although a direct comparison of both types of procedure under identical conditions has not previously been reported. A simulation study and an empirical test were conducted to compare the performance of optimized Bayesian staircases with that of four optimized variants of FSS staircase differing as to up-down rule. The ultimate goal was to determine whether FSS or Bayesian staircases are the best choice in experimental psychophysics. The comparison considered the properties of the estimates (i.e. bias and standard errors) in relation to their cost (i.e. the number of trials to completion). The simulation study showed that mean estimates of Bayesian and FSS staircases are dependable when sufficient trials are given and that, in both cases, the standard deviation (SD) of the estimates decreases with number of trials, although the SD of Bayesian estimates is always lower than that of FSS estimates (and thus, Bayesian staircases are more efficient). The empirical test did not support these conclusions, as (1) neither procedure rendered estimates converging on some value, (2) standard deviations did not follow the expected pattern of decrease with number of trials, and (3) both procedures appeared to be equally efficient. Potential factors explaining the discrepancies between simulation and empirical results are commented upon and, all things considered, a sensible recommendation is for psychophysicists to run no fewer than 18 and no more than 30 reversals of an FSS staircase implementing the 1-up/3-down rule.

Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

Acknowledgements This study was funded by the Chief Scientist Office of the Scottish Government, grant CZH_4_495.

Breast pumps as an incentive for breastfeeding : a mixed methods study of acceptability

Funding acknowledgement This project was funded by the NIHR Health Technology Assessment Programme (10/31/02) and is published in full in Health Technology Assessment.. Further information available at: http://www.nets.nihr.ac.uk/projects/hta/103102 This paper presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HTA programme or the Department of Health. NIHR were not involved in the study design, collection, analysis and interpretation of data or in the writing of the articles for publication.