A 'before and after' study of nursing students' self-assessed competence in identifying the needs of older patients in hospital using an educational workbook.

Background: A core component of nurse education is clinical practice in order to support the development of clinical skills and competence. Assessment and measurement of the clinical competence of nursing students is important to gauge their professional development and educational needs.

Aim: To evaluate the impact of an Older Persons’ Assessment Educational Workbook (OPAEW) and explore second year nursing students’ competence and their opinions and use of the workbook.

Methods: A ‘before and after’ pre-experimental design was undertaken with n=6 second year nursing students. Outcome measures were the Nursing Competencies Questionnaire and the Self-efficacy in Clinical Performance Scale. Content analysis of workbooks and a survey (n=5) of opinions regarding the workbook was undertaken.

Findings: Pre and post test results for the study (n=5) were tested to determine if there was a relationship between changes in the NCQ and SECP repeated measures and use of an OPAEW. Testing identified evidence of a statistically significant difference for both SECP measures (SECP28 p=0.043; SECP7 p=0.042), with no clear statistical evidence of a difference for the NCQ (p=0.08). A weak negative association (NCQ ρ=-0.600 p=0.285; SECP28 ρ=-0.300 p=0.624; SECP7 ρ=-0.205 p=0.741), was found indicating that those participants who scored the lowest scores at the start of the study, benefited most from the workbook.

Content analysis of the OPAEW (n=5) found that 3 of the 5 participants completed all components of the workbook, with a mean of 1051 words used (SD 281.8). Through the survey (n=5) students reported the workbook as a useful guide when undertaking a patient assessment.

Conclusions: The OPAEW showed potential as an intervention to support the development of nursing students’ competence in older person assessment skills.

A 'before and after' study of nursing students' self-assessed competence in identifying the needs of older patients in hospital using an educational workbook.

Background: A core component of nurse education is clinical practice in order to support the development of clinical skills and competence. Assessment and measurement of the clinical competence of nursing students is important to gauge their professional development and educational needs.

Aim: To evaluate the impact of an Older Persons’ Assessment Educational Workbook (OPAEW) and explore second year nursing students’ competence and their opinions and use of the workbook.

Methods: A ‘before and after’ pre-experimental design was undertaken with n=6 second year nursing students. Outcome measures were the Nursing Competencies Questionnaire and the Self-efficacy in Clinical Performance Scale. Content analysis of workbooks and a survey (n=5) of opinions regarding the workbook was undertaken.

Findings: Pre and post test results for the study (n=5) were tested to determine if there was a relationship between changes in the NCQ and SECP repeated measures and use of an OPAEW. Testing identified evidence of a statistically significant difference for both SECP measures (SECP28 p=0.043; SECP7 p=0.042), with no clear statistical evidence of a difference for the NCQ (p=0.08). A weak negative association (NCQ ρ=-0.600 p=0.285; SECP28 ρ=-0.300 p=0.624; SECP7 ρ=-0.205 p=0.741), was found indicating that those participants who scored the lowest scores at the start of the study, benefited most from the workbook.

Content analysis of the OPAEW (n=5) found that 3 of the 5 participants completed all components of the workbook, with a mean of 1051 words used (SD 281.8). Through the survey (n=5) students reported the workbook as a useful guide when undertaking a patient assessment.

Conclusions: The OPAEW showed potential as an intervention to support the development of nursing students’ competence in older person assessment skills.

Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study

AZEVEDO, George Dantas de et al. Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study. Maturitas, Amsterdam, v.47, n.3, p.195-200, 2004

Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use

Thesis (Ph.D.)--University of Washington, 2016-08

Efeito da ligadura de reposicionamento do perónio em basquetebolistas adultos com instabilidade crónica da tibiotársica

Introdução: A instabilidade crónica da tibiotársica apresenta uma elevada incidência e prevalência nos basquetebolistas, pelo que é fundamental aprofundar as estratégias existentes para a redução das limitações funcionais e mecânicas decorrentes desta condição. Objetivo: comparar o efeito da ligadura de reposicionamento do perónio segundo Mulligan com o de uma ligadura placebo imediatamente após a sua aplicação e após o teste de corrida (Yo-Yo IRT). Metodologia: Estudo cruzado de amostras emparelhadas. Participantes: 16 basquetebolistas adultos (10 homens, 6 mulheres) com instabilidade crónica da tibiotársica com idade média de 21,50 ± 2,76 anos. Procedimentos de avaliação e intervenção: Avaliação do controlo postural estático (teste de apoio unipodal com os olhos fechados numa plataforma de forças durante 15 segundos), performance funcional (hop test em 8 e hop test lateral) e controlo neuromuscular (tempo de latência do músculo longo peronial durante o movimento de inversão repentina) em duas sessões: Mulligan e Placebo. Resultados: Em ambos Hop tests não houve um efeito significativo para o fator ligadura (p>0,17) mas houve para o fator tempo (p<0,03). No tempo de latência do músculo longo peronial, houve um efeito significativo para o fator tempo (p=0,042) e interação significativa entre os dois fatores (p=0,028). Em relação ao controlo postural, nas variáveis de deslocamento do CoP em x e y, área de deslocamento do CoP, velocidade de deslocamento do CoP, e comprimento total do CoP não houve nenhum efeito significativo (p≥0,10). Conclusão: Não há diferenças no controlo postural estático nem na performance funcional de basquetebolistas com instabilidade crónica da tibiotársica entre a ligadura de reposicionamento do perónio de Mulligan e uma ligadura placebo. Contudo, a ligadura de Mulligan parece reduzir o tempo de latência do longo peronial após a corrida quando comparada com uma ligadura placebo.

Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study

AZEVEDO, George Dantas de et al. Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study. Maturitas, Amsterdam, v.47, n.3, p.195-200, 2004

Computer-based tools for assessing micro-longitudinal patterns of cognitive function in older adults

Patterns of cognitive change over micro-longitudinal timescales (i.e., ranging from hours to days) are associated with a wide range of age-related health and functional outcomes. However, practical issues with conducting high-frequency assessments make investigations of micro-longitudinal cognition costly and burdensome to run. One way of addressing this is to develop cognitive assessments that can be performed by older adults, in their own homes, without a researcher being present. Here, we address the question of whether reliable and valid cognitive data can be collected over micro-longitudinal timescales using unsupervised cognitive tests.In study 1, 48 older adults completed two touchscreen cognitive tests, on three occasions, in controlled conditions, alongside a battery of standard tests of cognitive functions. In study 2, 40 older adults completed the same two computerized tasks on multiple occasions, over three separate week-long periods, in their own homes, without a researcher present. Here, the tasks were incorporated into a wider touchscreen system (Novel Assessment of Nutrition and Ageing (NANA)) developed to assess multiple domains of health and behavior. Standard tests of cognitive function were also administered prior to participants using the NANA system.Performance on the two “NANA” cognitive tasks showed convergent validity with, and similar levels of reliability to, the standard cognitive battery in both studies. Completion and accuracy rates were also very high. These results show that reliable and valid cognitive data can be collected from older adults using unsupervised computerized tests, thus affording new opportunities for the investigation of cognitive function.

An exploratory study of the relationship between psychosocial hazard and ambulatory physiological response in higher education employees.

Purpose: as exposure to psychosocial hazard at work represents a substantial risk factor for employee health in many modern occupations, being able to accurately assess how employees cope with their working environment is crucial. As the workplace is generally accepted as being a dynamic environment consideration should be given to the interaction between employees and the acute environmental characteristics of their workplace. The aim of this study was to investigate the effects of both acute demand and chronic work-related psychosocial hazard upon employees through ambulatory assessment of heart rate variability and blood pressure. Design: a within-subjects repeated measures design was used to investigate the relationship between exposure to work-related psychosocial hazard and ambulatory heart rate variability and blood pressure in a cohort of higher education employees. Additionally the effect of acute variation in perceived work-related demand was investigated. Results: two dimensions of the Management Standards were found to demonstrate an association with heart rate variability; more hazardous levels of “demand” and “relationships” were associated with decreased SDNN. Significant changes in blood pressure and indices of heart rate variability were observed with increased acute demand.

Understanding and validating accelerometry as a measure of physical activity in children with intellectual disabilities

Background Physical activity in children with intellectual disabilities is a neglected area of study, which is most apparent in relation to physical activity measurement research. Although objective measures, specifically accelerometers, are widely used in research involving children with intellectual disabilities, existing research is based on measurement methods and data interpretation techniques generalised from typically developing children. However, due to physiological and biomechanical differences between these populations, questions have been raised in the existing literature on the validity of generalising data interpretation techniques from typically developing children to children with intellectual disabilities. Therefore, there is a need to conduct population-specific measurement research for children with intellectual disabilities and develop valid methods to interpret accelerometer data, which will increase our understanding of physical activity in this population. Methods Study 1: A systematic review was initially conducted to increase the knowledge base on how accelerometers were used within existing physical activity research involving children with intellectual disabilities and to identify important areas for future research. A systematic search strategy was used to identify relevant articles which used accelerometry-based monitors to quantify activity levels in ambulatory children with intellectual disabilities. Based on best practice guidelines, a novel form was developed to extract data based on 17 research components of accelerometer use. Accelerometer use in relation to best practice guidelines was calculated using percentage scores on a study-by-study and component-by-component basis. Study 2: To investigate the effect of data interpretation methods on the estimation of physical activity intensity in children with intellectual disabilities, a secondary data analysis was conducted. Nine existing sets of child-specific ActiGraph intensity cut points were applied to accelerometer data collected from 10 children with intellectual disabilities during an activity session. Four one-way repeated measures ANOVAs were used to examine differences in estimated time spent in sedentary, moderate, vigorous, and moderate to vigorous intensity activity. Post-hoc pairwise comparisons with Bonferroni adjustments were additionally used to identify where significant differences occurred. Study 3: The feasibility on a laboratory-based calibration protocol developed for typically developing children was investigated in children with intellectual disabilities. Specifically, the feasibility of activities, measurements, and recruitment was investigated. Five children with intellectual disabilities and five typically developing children participated in 14 treadmill-based and free-living activities. In addition, resting energy expenditure was measured and a treadmill-based graded exercise test was used to assess cardiorespiratory fitness. Breath-by-breath respiratory gas exchange and accelerometry were continually measured during all activities. Feasibility was assessed using observations, activity completion rates, and respiratory data. Study 4: Thirty-six children with intellectual disabilities participated in a semi-structured school-based physical activity session to calibrate accelerometry for the estimation of physical activity intensity. Participants wore a hip-mounted ActiGraph wGT3X+ accelerometer, with direct observation (SOFIT) used as the criterion measure. Receiver operating characteristic curve analyses were conducted to determine the optimal accelerometer cut points for sedentary, moderate, and vigorous intensity physical activity. Study 5: To cross-validate the calibrated cut points and compare classification accuracy with existing cut points developed in typically developing children, a sub-sample of 14 children with intellectual disabilities who participated in the school-based sessions, as described in Study 4, were included in this study. To examine the validity, classification agreement was investigated between the criterion measure of SOFIT and each set of cut points using sensitivity, specificity, total agreement, and Cohen’s kappa scores. Results Study 1: Ten full text articles were included in this review. The percentage of review criteria met ranged from 12%−47%. Various methods of accelerometer use were reported, with most use decisions not based on population-specific research. A lack of measurement research, specifically the calibration/validation of accelerometers for children with intellectual disabilities, is limiting the ability of researchers to make appropriate and valid accelerometer use decisions. Study 2: The choice of cut points had significant and clinically meaningful effects on the estimation of physical activity intensity and sedentary behaviour. For the 71-minute session, estimations for time spent in each intensity between cut points ranged from: sedentary = 9.50 (± 4.97) to 31.90 (± 6.77) minutes; moderate = 8.10 (± 4.07) to 40.40 (± 5.74) minutes; vigorous = 0.00 (± .00) to 17.40 (± 6.54) minutes; and moderate to vigorous = 8.80 (± 4.64) to 46.50 (± 6.02) minutes. Study 3: All typically developing participants and one participant with intellectual disabilities completed the protocol. No participant met the maximal criteria for the graded exercise test or attained a steady state during the resting measurements. Limitations were identified with the usability of respiratory gas exchange equipment and the validity of measurements. The school-based recruitment strategy was not effective, with a participation rate of 6%. Therefore, a laboratory-based calibration protocol was not feasible for children with intellectual disabilities. Study 4: The optimal vertical axis cut points (cpm) were ≤ 507 (sedentary), 1008−2300 (moderate), and ≥ 2301 (vigorous). Sensitivity scores ranged from 81−88%, specificity 81−85%, and AUC .87−.94. The optimal vector magnitude cut points (cpm) were ≤ 1863 (sedentary), ≥ 2610 (moderate) and ≥ 4215 (vigorous). Sensitivity scores ranged from 80−86%, specificity 77−82%, and AUC .86−.92. Therefore, the vertical axis cut points provide a higher level of accuracy in comparison to the vector magnitude cut points. Study 5: Substantial to excellent classification agreement was found for the calibrated cut points. The calibrated sedentary cut point (ĸ =.66) provided comparable classification agreement with existing cut points (ĸ =.55−.67). However, the existing moderate and vigorous cut points demonstrated low sensitivity (0.33−33.33% and 1.33−53.00%, respectively) and disproportionately high specificity (75.44−.98.12% and 94.61−100.00%, respectively), indicating that cut points developed in typically developing children are too high to accurately classify physical activity intensity in children with intellectual disabilities. Conclusions The studies reported in this thesis are the first to calibrate and validate accelerometry for the estimation of physical activity intensity in children with intellectual disabilities. In comparison with typically developing children, children with intellectual disabilities require lower cut points for the classification of moderate and vigorous intensity activity. Therefore, generalising existing cut points to children with intellectual disabilities will underestimate physical activity and introduce systematic measurement error, which could be a contributing factor to the low levels of physical activity reported for children with intellectual disabilities in previous research.

Efeitos da tilápia do Nilo (Oreochromis niloticus) e do enriquecimento por nutrientes sobre a comunidade planctônica em um lago artificial no semi-árido brasileiro

The major aim of this study was to test the hypothesis that the introduction of the Nile tilapia (Oreochromis niloticus) and the enrichment with nutrients (N and P) interact synergistically to change the structure of plankton communities, increase phytoplankton biomass and decrease water transparency of a semi-arid tropical reservoir. One field experiment was performed during five weeks in twenty enclosures (8m3) to where four treatments were randomly allocated: with tilapia addition (T), with nutrients addition (NP), with tilapia and nutrients addition (T+NP) and a control treatment with no tilapia or nutrients addition (C). A two-way repeated measures ANOVA was done to test for time (t), tilapia (T) and nutrient (NP) effects and their interaction on water transparency, total phosphorus, total nitrogen, phytoplankton and zooplankton. The results show that there was no effect of nutrient addition on these variables but significant fish effects on the biomass of total zooplankton, nauplii, rotifers, cladocerans and calanoid copepods, on the biovolume of Bacillariophyta, Zygnemaphyceae and large algae (GALD ≥ 50 μm) and on Secchi depth. In addition, we found significant interaction effects between tilapia and nutrients on Secchi depth and rotifers. Overall, tilapia decreased the biomass of most zooplankton taxa and large algae (diatoms) and decreased the water transparency while nutrient enrichment increased the biomass of zooplankton (rotifers) but only in the absence of tilapia. In conclusion, the influence of fish on the reservoir plankton community and water transparency was greater than that of nutrient loading. This finding suggests that biomanipulation should be a greater priority in the restoration of eutrophic reservoirs in tropical semi-arid regions

Effects of various salt purity levels on lipid oxidation and sensory characteristics of ground turkey and pork

Salt use in meat products is changing. Consumers desire sea salt which may also contain trace metals and the government is demanding a reduction in sodium. Therefore a need exists to understand how varying impurity levels in salt affect meat quality. This study evaluated the effects of various salt preparations on lipid oxidation, sensory characteristics, protein extractability, and bind strength of ground turkey and pork. This study was a completely randomized design with 5 treatment groups and 6 replications in 2 species. Ground, turkey and pork meat was formulated into one hundred and fifty gram patties with sodium chloride (1%) containing varying amounts of metal impurities (copper, iron, and manganese). Samples were randomly assigned to frozen storage periods of 0, 3, 6, and 9 weeks. After storage, samples were packaged in PVC overwrap and stored under retail display for 5 days. Samples were evaluated for proximate analysis to ensure the fat content was similar for all of the starting material.Thiobarbituric acid reactive substances (TBARS) were determined on raw and cooked samples to evaluate lipid oxidation. A trained six member sensory panel evaluated the samples at each storage period for saltiness, off flavor, and oxidized odor. Break strength was conducted using a Texture Analyzer and compared with salt soluble proteins (increasing salt concentrations) to evaluate protein extractability characteristics. Statistical analyses were conducted using the MIXED procedure of SAS within repeated measures over time where appropriate. No significant differences were observed among the salt treatments for raw and cooked TBARS when the control group was removed (P>0.05). Sensory panelists detected increased levels of off flavor and oxidized odor over the entire storage duration. Less force was required to break the patties from the control group when compared with the salt treatments (P<0.05). As salt concentration increased salt-soluble protein extraction increased, but there was no effect of salt type. Overall, no meaningful statistical differences among the various salt treatments were observed for all of the parameters evaluated for turkey and pork. Salt at a 1% inclusion rate containing varying levels of copper, iron, and manganese impurities in ground turkey thigh meat and ground pork served as a prooxidant. However, if a meat processor uses a 1% inclusion rate of salt in turkey and pork regardless of impurities included, it is unlikely that differences in shelf life or protein functionality would be observed.

Evaluating consumer price perception: a mental accounting and frame dependent perspective

In this thesis, we evaluate consumer purchase behaviour from the perspective of heuristic decision making. Heuristic decision processes are quick and easy mental shortcuts, adopted by individuals to reduce the amount of time spent in decision making. In particular, we examine those heuristics which are caused by framing – prospect theory and mental accounting, and examine these within price related decision scenarios. The impact of price framing on consumer behaviour has been studied under the broad umbrella of reference price, which suggests that decision makers use reference points as standards of comparison when making a purchase decision. We investigate four reference points - a retailer's past prices, a competitor's current prices, a competitor's past prices, and consumers' expectation of immediate future price changes, to further our understanding of the impact of price framing on mental accounting, and in turn, contribute to the growing body of reference price literature in Marketing research. We carry out experiments in which levels of price frame and monetary outcomes are manipulated in repeated measures analysis of variance (ANOVA). Our results show that where these reference points are clearly specified in decision problems, price framing significantly affects consumers' perceptions of monetary gains derived through discounts, and leads to reversals in consumer preferences. We also found that monetary losses were not sensitive to price frame manipulations.

Odour flux from litter of broiler chickens fed diets differing in protein levels and additives

The effect of dietary crude protein (CP) and additives on odour flux from broiler litter was investigated using 180 day-old Ross 308 male chicks randomly allocated to five dietary treatments with three replications of 12 birds each. A 5×3 factorial arrangement of treatments was employed. Factors were: diet (low CP, high CP, high CP+antibiotic, high CP+probiotic, high CP+saponin) and age (15, 29, 35 days). Low CP (LCP) and high CP (HCP) diets differed in CP levels by 4.5-5%. The low CP diets were supplemented with L-valine, L-isoleucine, L-arginine, L-lysine, D,L-methionine and L-threonine. The antibiotic used was Zn Bacitracin, the probiotic was a blend of three Bacillus subtilis strains and the saponin came from a blend of Yucca and Quillaja. Odorants were measured from litter headspace using a flux hood and selective ion flow tube mass spectrometry (SIFT-MS). Results were log tranformed and analysed by two-way ANOVA with repeated measures using JMP statistical software v.8, and means were separated by Tukey's HSD test at P<0.05.The results showed that LCP group produced lower flux of dimethyl amine, trimethyl amine, H2S, NH3 and phenol in litter compared to HCP group (P<0.05). Similarly, HCP+probiotic group produced lower flux of H2S (P<0.05) and HCP+saponin group produced lower flux of trimethylamine and phenol in litter compared to HCP group (P<0.05). The dietary treatments tended (P=0.065) to have higher flux of methanethiol in HCP group compared to others. There was a diet x age interaction for litter flux of diacetyl, acetoin, 3-methyl-1-butanol, 3-methylbutanal, ethanethiol, propionic acid and hexane (P<0.05). Concentrations of diacetyl, acetoin, propionic acid and hexane in litter were higher from LCP group compared to all other treatments on d 35 (P<0.05) but not on days 15 and 29. Thus, the low CP diet, Bacillus subtilis based probiotic and Yucca/Quillaja based saponin were effective in reducing the emissions of some key odorants from broiler litter.

Programa de prevención del consumo de drogas Saluda: evaluación de una nueva versión en adolescentes españoles

En la actualidad se han evaluado numerosas intervenciones preventivas de drogodependencias en el medio escolar. Sin embargo, en España son pocos los estudios que analizan la influencia precisa de cada uno de los componentes específicos a los programas con el fin de determinar cuáles se consideran cruciales para el cambio de conducta de consumo. El objetivo del presente estudio fue evaluar los efectos de una nueva versión del programa de prevención del consumo de drogas Saluda en la que se prescinde del componente fomento del ocio saludable y las tareas para casa. Esta versión reducida fue dirigida a una muestra de 106 escolares (44.6 % chicos) entre 14 y 17 años (M = 15.20; DT = 0.92) de un centro de Educación Secundaria. Se trata de un estudio exploratorio de tipo cuasi experimental y un diseño pre-post de un único grupo. Se realizó diferencia de proporciones mediante la prueba Z y diferencia de medias mediante la prueba T para muestras relacionadas. Los resultados muestran una reducción en el porcentaje de episodios de embriaguez, así como un efecto de mejora significativa sobre las variables protectoras del consumo. Se discuten estos hallazgos y se realizan propuestas para la mejora de futuras intervenciones.

Comparison of two field methods for estimating body fat in different Spanish Dance disciplines

The purpose of the present study was to investigate percentage body fat (%BF) differences in three Spanish dance disciplines and to compare skinfold and bioelectrical impedance predictions of body fat percentage in the same sample. Seventy-six female dancers, divided into three groups, Classical (n=23), Spanish (n=29) and Flamenco (n=24), were measured using skinfold measurements at four sites: triceps, subscapular, biceps and iliac crest, and whole body multi-frequency bioelectrical impedance (BIA). The skin-fold measures were used to predict body fat percentage via Durnin and Womersley's and Segal, Sun and Yannakoulia equations by BIA. Differences in percent fat mass between groups (Classical, Spanish and Flamenco) were tested by using repeated measures analysis (ANOVA). Also, Pearson's product-moment correlations were performed on the body fat percentage values obtained using both methods. In addition, Bland-Altman plots were used to assess agreement, between anthropometric and BIA methods. Repeated measures analysis of variance did not found differences in %BF between modalities (p<0.05). Fat percentage correlations ranged from r= 0.57 to r=0.97 (all, p<0.001). Bland-Altman analysis revealed differences between BIA Yannakoulia as a reference method with BIA Segal (-0.35 ± 2.32%, 95%CI: -0.89to 0.18, p=0.38), with BIA Sun (-0.73 ± 2.3%, 95%CI: -1.27 to -0.20, p=0.014) and Durnin-Womersley (-2.65 ± 2,48%, 95%CI: -3.22 to -2.07, p<0.0001). It was concluded that body fat percentage estimates by BIA compared with skinfold method were systematically different in young adult female ballet dancers, having a tendency to produce underestimations as %BF increased with Segal and Durnin-Womersley equations compared to Yannakoulia, concluding that these methods are not interchangeable.