Patients’ and physicians’ experiences of atrial fibrillation and anticoagulation therapy:a qualitative journey

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF) however it is often underutilized and sometimes refused by patients. This programme of work included a meta-synthesis and two inter-linking studies aiming to explore patients’ and physicians’ experiences of AF and OAC. Methods: A meta-synthesis of qualitative evidence was conducted which informed the empirical work. Semi-structured individual interviews were utilised. Study 1: Three AF patient sub-groups were interviewed; accepted (n=4), refused (n=4), or discontinued (n=3) warfarin. Study 2: Four physician sub-groups (n=4 each group) prescribing OAC to AF patients were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Data was analysed using interpretative phenomenological analysis. Results: Study 1: Three over-arching themes comprised patients’ experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients’ reflections. Patients commented on the relief and reassurance experienced during the consultation but they perceived the decision making process mostly led by the physician. Lack of education and take-home materials distributed during the initial consultation was highlighted. Patients who had experienced stroke themselves or were caregivers, were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Warfarin monitoring was challenging for patients, however some patients perceived it as beneficial as it served to enhance patient-physician relationship. Study 2: Two over-arching themes emerged from physicians’ experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians’ approach to the consultation style shifted through a continuum of compliance-adherence-concordance during the consultation. They aimed for concordance, however challenges such as time and the perceived patient trust in them as the expert, led to physicians adopting a paternalistic approach. Physicians also pointed out challenges associated with guideline adherence and the need to adopt a multi-disciplinary approach, where other health professionals could provide on-going education. Conclusion: This programme of work has illustrated the benefit of taking an in depth phenomenological approach to understanding the lived experience of the physician-patient consultation. Together with the meta-synthesis, this work has strengthened the evidence base and demonstrated that there is a need to target patients' and physicians' ability to communicate with each other in a comprehensible way.

Risks and benefits of selective (re)presentation of interviewees' talk:some insights from discourse analysis

Purpose: The purpose of this paper is to examine the quality of evidence collected during interview. Current UK national guidance on the interviewing of victims and witnesses recommends a phased approach, allowing the interviewee to deliver their free report before any questioning takes place, and stipulating that during this free report the interviewee should not be interrupted. Interviewers, therefore, often find it necessary during questioning to reactivate parts of the interviewee's free report for further elaboration. Design/methodology/approach: The first section of this paper draws on a collection of police interviews with women reporting rape, and discusses one method by which this is achieved - the indirect quotation of the interviewee by the interviewer - exploring the potential implications for the quality of evidence collected during this type of interview. The second section of the paper draws on the same data set and concerns itself with a particular method by which information provided by an interviewee has its meaning "fixed" by the interviewer. Findings: It is found that "formulating" is a recurrent practice arising from the need to clarify elements of the account for the benefit of what is termed the "overhearing audience" - in this context, the police scribe, CPS, and potentially the Court. Since the means by which this "fixing" is achieved necessarily involves the foregrounding of elements of the account deemed to be particularly salient at the expense of other elements which may be entirely deleted, formulations are rarely entirely neutral. Their production, therefore, has the potential to exert undue interviewer influence over the negotiated "final version" of interviewees' accounts. Originality/value: The paper highlights the fact that accurate re-presentations of interviewees' accounts are a crucial tool in ensuring smooth progression of interviews and that re-stated speech and formulation often have implications for the quality of evidence collected during significant witness interviews. © Emerald Group Publishing Limited.

Rosemary : a raw material for a new genre of bio-based antioxidants for sustainable applications

The potential replacement, partially or fully, of synthetic additives by bio-based alternatives derived from indigenous renewable non-food crop resources offers a market opportunity for a green supply of raw materials for different industrial and health products, with greater involvement of the farming community in crop production while addressing the ever more stringent environmental and pollution laws that now require the use of less potentially toxic/harmful ingredients, even if they are present in relatively small quantities. The work presented here relates to developing a new genre of environmentally-sustainable bio-based antioxidants (AO) for industrial uses that are obtained from extracts of UK-grown rosemary (Rosmarinus officinalis) plant. The performance of these AOs was tested, and their efficacy compared with some common and benchmark synthetic AOs from the same chemical class, in different products including polymers especially for packaging, as well as lubricants, cosmetics and health products. One of the main active ingredients in rosemary is Rosmarinic acid which is a water-soluble compound. This was chemically transformed into a number of ester derivatives, Rosmarinates, targeted for different applications. The parent and the modified antioxidants (the rosmarinates) were characterised and their antioxidancy were examined and tested in linear low-density polyethylene (LLDPE) and in polypropylene (PP) and compared with compounds of similar structure and with other well known synthetic antioxidants used commercially in polyolefins. The results show that antioxidants sourced from rosemary have the added benefit of being highly efficient and intrinsically more active than many synthetic and bio-based alternatives.

Therapeutic potential of statins and the induction of heme oxygenase-1 in preeclampsia

Heme oxygenase (Hmox) is an endogenous system that offers protection against placental cytotoxic damage associated with preeclampsia. The Hmox1/carbon monoxide (CO) pathway inhibits soluble Flt-1 (sFlt-1) and soluble Endoglin (sEng). More importantly, statins induce Hmox1 and suppress the release of sFlt-1 and sEng; thus, statins and Hmox1 activators are potential novel therapeutic agents for treating preeclampsia. The contribution of the Hmox system to the pathogenesis of preeclampsia has been further indicated by the incidence of preeclampsia being reduced by a third in smokers, who had reduced levels of circulating sFlt-1. Interestingly, preeclamptic women exhale less CO compared with women with healthy pregnancies. Hmox1 is reduced prior to the increase in sFlt-1 as Hmox1 mRNA expression in the trophoblast is decreased in the first trimester in women who go on to develop preeclampsia. Induction of Hmox1 or exposure to CO or bilirubin has been shown to inhibit the release of sFlt-1 and sEng in animal models of preeclampsia. The functional benefit of statins and Hmox1 induction in women with preeclampsia is valid not only because they inhibit sFlt-1 release, but also because statins and Hmox1 are associated with anti-apoptotic, anti-inflammatory, and anti-oxidant properties. The StAmP trial is the first randomized control trial (RCT) evaluating the use of pravastatin to ameliorate severe preeclampsia. This proof-of-concept study will pave the way for future global RCT, the success of which will greatly contribute to achieving the United Nations Millennium Development Goals (MDG4 and MDG5) and offering an affordable and easily accessible therapy for preeclampsia. © 2014 The Authors.

Induction of proteasome expression in skeletal muscle is attenuated by inhibitors of NF-κB activation

The potential for inhibitors of nuclear factor-κB (NF-κB) activation to act as inhibitors of muscle protein degradation in cancer cachexia has been evaluated both in vitro and in vivo. Activation of NF-κB is important in the induction of proteasome expression and protein degradation by the tumour factor, proteolysis-inducing factor (PIF), since the cell permeable NF-κB inhibitor SN50 (18 μM) attenuated the expression of 205 proteasome α-subunits, two subunits of the 195 regulator MSSI and p42, and the ubiquitin-conjugating enzyme, E214k, as well as the decrease in myosin expression in murine myotubes. To assess the potential therapeutic benefit of NF-κB inhibitors on muscle atrophy in cancer cachexia, two potential inhibitors were employed; curcumin (50 μM) and resveratrol (30 μM). Both agents completely attenuated total protein degradation in murine myotubes at all concentrations of PIF, and attenuated the PIF-induced increase in expression of the ubiquitin-proteasome proteolytic pathway, as determined by the 'chymotrypsin-like' enzyme activity, proteasome subunits and E2 14k. However, curcumin (150 and 300 mg kg-1) was ineffective in preventing weight loss and muscle protein degradation in mice bearing the MAC16 tumour, whereas resveratrol (1 mg kg-1) significantly attenuated weight loss and protein degradation in skeletal muscle, and produced a significant reduction in NF-κB DNA-binding activity. The inactivity of curcumin was probably due to a low bioavailability. These results suggest that agents which inhibit nuclear translocation of NF-κB may prove useful for the treatment of muscle wasting in cancer cachexia.

Representing the assessment process for psychodynamic psychotherapy within a computerized model of human classification

This research describes a computerized model of human classification which has been constructed to represent the process by which assessments are made for psychodynamic psychotherapy. The model assigns membership grades (MGs) to clients so that the most suitable ones have high values in the therapy category. Categories consist of a hierarchy of components, one of which, ego strength, is analysed in detail to demonstrate the way it has captured the psychotherapist's knowledge. The bottom of the hierarchy represents the measurable factors being assessed during an interview. A questionnaire was created to gather the identified information and was completed by the psychotherapist after each assessment. The results were fed into the computerized model, demonstrating a high correlation between the model MGs and the suitability ratings of the psychotherapist (r = .825 for 24 clients). The model has successfully identified the relevant data involved in assessment and simulated the decision-making process of the expert. Its cognitive validity enables decisions to be explained, which means that it has potential for therapist training and also for enhancing the referral process, with benefits in cost effectiveness as well as in the reduction of trauma to clients. An adapted version measuring client improvement would give quantitative evidence for the benefit of therapy, thereby supporting auditing and accountability. © 1997 The British Psychological Society.

Electronic Presentation of Bulgarian Educational Archives: an Ontology-Based Approach

The paper presents an ongoing effort aimed at building an electronic archive of documents issued by the Bulgarian Ministry of Education in the 40ies and 50ies of the 20th century. These funds are stored in the Archive of the Ministry of the People’s Education within the State Archival Fund of the General Department of Archives at the Council of Ministers of Bulgaria. Our basic concern is not the digitization process per se, but the subsequent organization of the archive in a clear and easily-searchable way which would allow various types of users to get access to the documents of interest to them. Here we present the variety of the documents which are stored in the archival collection, and suggestions on their electronic organization. We suggest using ontologies- based presentation of the archive. The basic benefit of this approach is the possibility to search the collection according to the stored content categories.

Developing of Distributed Virtual Laboratories for Smart Sensor System Design Based on Multi-Dimensional Access Method

In the article it is considered preconditions and main principles of creation of virtual laboratories for computer-aided design, as tools for interdisciplinary researches. Virtual laboratory, what are offered, is worth to be used on the stage of the requirements specification or EFT-stage, because it gives the possibility of fast estimating of the project realization, certain characteristics and, as a result, expected benefit of its applications. Using of these technologies already increase automation level of design stages of new devices for different purposes. Proposed computer technology gives possibility to specialists from such scientific fields, as chemistry, biology, biochemistry, physics etc, to check possibility of device creating on the basis of developed sensors. It lets to reduce terms and costs of designing of computer devices and systems on the early stages of designing, for example on the stage of requirements specification or EFT-stage. An important feature of this project is using the advanced multi-dimensional access method for organizing the information base of the Virtual laboratory.

A joint approach to treating dental phobia:a re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on

Objective To audit the records of a group of patients who had previously benefited from cognitive behavioural therapy (CBT) for dental phobia.Aim To ascertain if they had returned to the use of intravenous (IV) sedation to facilitate dental treatment. Ten years ago these patients were routinely requiring IV sedation to facilitate dental treatment due to severe dental phobia.Method Sixty patients entered the original pilot project. Of those, 30 were offered CBT and 21 attended. Twenty of those patients (95.2%) were subsequently able to have dental treatment without IV sedation. In this follow-up study the electronic records of 19 of the 20 patients who had originally been successful with CBT were re-audited. Our purpose was to see if there was any record of subsequent IV sedation administration in the intervening ten years.Results Of the 19 successful CBT patients available to follow-up, 100% had not received IV sedation since the study ten years ago. This may suggest the initial benefit of CBT has endured over the ten-year period.Conclusion This study indicates that the use of CBT for patients with dental phobia proves beneficial not only in the initial treatment but that the benefits may endure over time. This results in a significant reduction in health risks to the patient from repeated IV sedation. It may also translate into significant financial savings for dental care providers. Our evidence for CBT as treatment for dental phobia suggests dental services should be implementing this approach now rather than pursuing further research. © 2011 Macmillan Publishers Limited. All rights reserved.

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.

The experiences of con sultations on oral anticoagula-tion for AF:the importance of qualitative research incardiovascular sciences

Objectives: Multiple-perspective qualitative designs can aid researchersto develop a more multifaceted account of a phenomenon and as aform of triangulation of data. Two interlinking studies aimed toexplore patients’ and physicians’ experiences of atrial fibrillation (AF)and warfarin.Methods: Audio-recorded semistructured individual interviews wereused. Study 1: Three AF patient subgroups were interviewed (n = 11);accepted, refused, or discontinued warfarin. Study 2: Four physiciansubgroups (n = 16): consultant cardiologists, consultant general physi-cians, general practitioners, and cardiology registrars. Data was ana-lyzed using interpretative phenomenological analysis, a qualitativemethodology.Results: Study 1: Three overarching themes comprised patients’ experi-ences: the initial consultation, life after the consultation, and patients’reflections. Patients commented on the reassurance experienced duringthe consultation, but they perceived the decision-making processmostly led by the physician. Lack of education and take-home materi-als during the initial consultation were highlighted. Patients’ uptake ofinformation was influenced by past experiences and knowledge ofstroke and/or bleeding. Study 2: Two overarching themes covered phy-sicians’ experiences: communicating information and challenges withwarfarin prescription for AF. Physicians’ approach to the consultationstyle shifted through a continuum of compliance-adherence-concor-dance during the consultation. Time and the perceived patient trust inthem as the expert led to physicians to adopt a paternalistic approach.Guideline adherence and the need to adopt a multidisciplinaryapproach were pointed out as current challenges.Conclusion: There is a need to target patients’ and physicians’ abilityto communicate with each other in a comprehensible way. This projecthas illustrated the benefit of using a qualitative approach to under-stand the lived experience of the physician–patient consultation.Disclosure of Interest: None declare

Helyhez kötött kapcsolatok. Egy társadalmi kapcsolathálókon alapuló magyarázat a földrajzi munkamegosztás kialakulására = Ties of locality. An explanation of the development of the geographical division of labour based on social networks

A „földrajzi munkamegosztás” vagy „elhelyezkedés probléma” arra a kérdésre utal, miért alakulnak ki egy-egy gazdasági tevékenységre szakosodott földrajzi egységek, regionális gazdasági rendszerek. A hagyományos közgazdasági megközelítések a területek racionálisan kalkulálható komparatív előnyeit, a nyersanyagok vagy a piac közelségét, infrastrukturális adottságokat, útfüggőséget stb. szokták hangsúlyozni. A tanulmány szerzője a társadalmi kapcsolatok jelentőségét emeli ki, azt sugallja, hogy a területi specializálódás az egymással kapcsolatban álló, hasonlóan specializálódott többi szereplő nyomására alakul ki. A hipotézist két külföldön végzett eset tanulmány tapasztalatai alapján járja körül. ______________________ The question of "regional economic systems", "geographical division of labour" or "location problem" has an important literature. Economic approaches emphasize the rationally calculated advantages of the specialized industrial areas: the benefit of the exploitation of discovered resources, more cooperative relations, etc. The paper stresses the role of social networks in the location problem: economically specialized areas formed because of the suggestions and tips of connected enterprises, cooperative partners. The hypothesis is based on the experiences of two case studies, made in a Peruvian rural area and a Mexican modern industrial area.

The Architecture of 3D Administration

The objective of this article is to introduce the main blocks in building virtual front and back offices of public administration. Virtual administration is probably kind of an ultimate or top stage of ICT platforms of e-government. First a justification is given why 3D government fits in the recent EU directives of e-government development. The relevant scholarship contains a brief description of the visualized e-government, and then a fully illustrated, step by step survey reveals the itinerary to construct virtual government which is the main result of the study. The article concludes with a discussion on the practical benefit of such a research if there is one.

Effects of phonetic/phonics instruction on reading pronunciation (French level I)

Pronunciation training has been traditionally viewed as of limited importance in a communicatively oriented foreign language curriculum (Pennington & Richards, 1986). Many language instructors seemingly deny the usefulness of phonetic training and rely on a listen-and-repeat method with the use of audiotapes (Bate, 1989; Callamand & Pedoya, 1984; Jones, 1997). Beginners in French classes face the challenge of mastering a complex sound and grapheme-phoneme correspondence system without the benefit of specific instruction. Their pronunciation errors develop mostly from bad habits while decoding from print to sound (Dansereau, 1995). ^ The purpose of this study was to investigate the effectiveness of basic phonetic/phonics instruction on reading pronunciation accuracy in a French I language course. ^ The sample consisted of two groups of French I students from Florida International University, who received the same instruction in French language and culture during the fall semester of 1999. Only the experimental group received additional phonetic/phonics training. ^ The instrument consisted of three recorded reading tasks: isolated familiar words, isolated unfamiliar words, and dialogue. Research questions were analyzed using a one-way multivariate analysis of variance. Significant differences were found between the two groups on scores for each of the three sections of the instrument, and on the total scores. These findings support the hypothesis of the study and reveal the effectiveness of phonetic/phonics training for beginners of French. ^ The findings imply that beginning language students should receive the minimum knowledge they need to master the French phoneme-grapheme (sound-spelling) system. ^

Predictors of first semester attrition and their relation to retention of generic associate degree nursing students

In community college nursing programs the high rate of attrition was a major concern to faculty and administrators. Since first semester attrition could lead to permanent loss of students and low retention in nursing programs, it was important to identify at-risk students early and develop proactive approaches to assist them to be successful. The goal of nursing programs was to graduate students who were eligible to take the national council licensing examination (RN). This was especially important during a time of critical shortage in the nursing workforce. ^ This study took place at a large, multi-campus community college, and used Tinto's (1975) Student Integration Model of persistence as the framework. A correlational study was conducted to determine whether the independent variables, past academic achievement, English proficiency, achievement tendency, weekly hours of employment and financial resources, could discriminate between the two grade groups, pass and not pass. Establishing the relationship between the selected variables and successful course completion might be used to reduce attrition and improve retention. Three research instruments were used to collect data. A Demographic Information form developed by the researcher was used to obtain academic data, the research questionnaire Measure of Achieving Tendency measured achievement motivation, and the Test of Adult Basic Education (TABE), Form 8, Level A, Tests 1, 4, and 5 measured the level of English proficiency. The Department of Nursing academic policy, requiring a minimum course grade of “C” or better was used to determine the final course outcome. A stepwise discriminant analysis procedure indicated that college language level and pre-semester grade point average were significant predictors of final course outcome. ^ Based on the findings of the study recommendations focused on assessing students' English proficiency prior to admission into the nursing program, an intensive remediation plan in language comprehension for at-risk students, and the selection of alternate textbooks and readings that more closely matched the English proficiency level of the students. A pilot study should be conducted to investigate the benefit of raising the admission grade point average. ^