Patterns of genetic variation in native America

Journal ArticleAllele frequencies from seven polymorphic red cell antigen loci (ABO, Rh, MN, S, P, Duffy, and Diego) were examined in 144 Native American populations. Mean genetic distances (Nei's D) and the fixation index FST are approximately equal for the North and South American samples but are reduced in the Central American geographic area

Consumers' confidence in competitive positions of products : antecedents and effect on purchase intention

University of Technology Sydney. Faculty of Business.A product’s competitive position signals to the consumer the product’s salient value amongst its competitors. It is one of the cornerstones of marketing success, yet there has been little focus in the literature on the consumer side of the positioning equation – the consumers’ perception of the product’s position. This thesis concentrates on the latter by examining the antecedents and effects of consumers’ confidence in their positioning perception. With support from other areas of marketing, it is proposed that better insight into consumer behaviour can be gained by measuring positioning confidence, compared to the common measurement practice of using perceptual mapping in isolation. The relevance of positioning confidence is enhanced by the wavering consumer reliance on information derived from outside the company, thus inherently increasing the risk of fuzzy or mismatched positioning signals that the consumer needs to untangle. Furthermore, research suggests weak consumer perceptions of product differentiation in many categories, which isn’t surprising given how crowded many categories have become. This thesis primarily proposes that consumers’ confidence in their perception of the product’s position acts as a moderator between the well-established relationship of perceived differentiation and purchase intention in cases where there is a poorer match between the consumers’ perception of the product and their purchase goal. A weaker match between what the consumer believes the product stands for and what the consumer ultimately seeks from the product presents a riskier purchasing decision. Thus, it is here where metacognition, in the form of confidence, is more likely to play a role. This thesis also offers antecedents of positioning confidence, with the first being the alignment between the initial and post (information search) perceived positions. This antecedent refers to the cognitive uniformity between the passively-held positioning perception with which the consumer may enter the information search phase and the more active positioning judgment the consumer makes after consulting various information sources. Secondly, it suggests that perceived clarity acts as a positive moderator between perceived consistency and confidence. Perceived clarity and consistency of positioning messages takes into account how consumers currently conduct their information search, encompassing both the organisation’s positioning signals (actual position) and that from consumers and opinion leaders (external position). Perceived clarity relates to how obviously the product’s position is portrayed, whereas perceived consistency relates to the level of similarity in the positioning depiction between the two information source types. Lastly, the thesis hypothesises how various combinations of the actual and external position impacts perceived clarity and consistency. The methodology comprises two studies with a total of 574 Australian consumers obtained via a commissioned panel. The research design is in the form of experiments, with thorough pre-testing determining the product categories and focal brands chosen. The findings show strong statistical support for the proposed role of confidence on the relationship between perceived differentiation and purchase as a function of consumers’ purchase goal match, across both studies. There was moderate support shown for the suggested antecedents of positioning confidence, and convincing overall support for the joint impact of the interaction between the actual and external position on perceived clarity and consistency. There are several implications that have emerged from this dissertation. Firstly, it further develops the theory of positioning perception by introducing a moderator to the well-established relationship between differentiation and purchase and, thus, offering an additional measure of positioning implementation success. It also presents further theoretical support for the role of metacognition when a decision is categorised by higher risk. From a management perspective, this thesis offers brand managers direction on how to increase the confidence of consumers’ perception of their product’s position, which can increase the likelihood of purchase from consumers who are typically hard to attain (those who identify a weaker match between what the product offers and what they want). Lastly, the limitations associated with the studies are outlined and future research avenues are suggested

Utilisation of respiratory substrates in resting and concanavalin A-activated rat splenocytes

The in vitro culture of resting and Concanavalin A activated rat spleen lymphocytes has been carried out with the aim of identifying respiratory substrates used in the generation of additional energy required for lymphocyte activation. Previous work in this field had concentrated on the role of glucose but very little is known of the contribution of alternative substrates. The long term (72h) and short term (24h) culture of rat splenocytes necessitated a prior investigation of the effect of empirical culture conditions onmitogenic stimulation. Cell activation was assessed by the incorporation of [H]-thymidine into DNA in long term cultures, and by [h]-leucine incorporation into protein in short term cultures. Patterns of consumption of glucose, glutamine acetoacetate and D3-hydroxybutyrate were assessed in long term cultures; the uptake of glucose and glutamine was shown to alter on mitogenic stimulation. In addition, the presence of glutamine was shown to be obligatory to long term activation. The ketone bodies showed very little uptake at physiological concentrations; this was not affected by Con A or by prior starvation of the cells. The metabolism of glucose in 72h cultures was shown to be profoundly affected by the prevailing culture conditions. Conventional activation of the cells was demonstrated under conditions which were associated with both aerobic and partially anaerobic glucose metabolism; the consumption of glucose by splenocytes could thus not be used as an index of mitogenic stimulation. The detailed examination of glucose and glutamine metabolism was carried out using radiolabelled substrates in 24h cultures. The complete oxidation of glucose may contribute up to 70% of glucose derived ATP and that of glutamine up to 65% of glutamine derived ATP.<p

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in home care and supportive living

<p>Abstract</p> <p>Background</p> <p>Although considerable evidence exists about the effectiveness of audit coupled with feedback, very few audit-with-feedback interventions have been done in either home care or supportive living settings to date. With little history of audit and feedback in home care or supportive living there is potential for greater effects, at least initially. This study extends the work of an earlier study designed to assess the effects of an audit-with-feedback intervention. It will be delivered quarterly over a one-year period in seven home care offices and 11 supportive living sites. The research questions are the same as in the first study but in a different environment. They are as follows:</p> <p>1. What effects do feedback reports have on processes and outcomes over time?</p> <p>2. How do different provider groups in home care and supportive living sites respond to feedback reports based on quality indicator data?</p> <p>Methods</p> <p>The research team conducting this study includes researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of quarterly feedback reports in 19 home care offices and supportive living sites across Alberta. Data for the feedback reports are based on the Resident Assessment Instrument Home Care tool, a standardized instrument mandated for use in home care and supportive living environments throughout Alberta. The feedback reports consist of one page, printed front and back, presenting both graphic and textual information. Reports are delivered to all employees working in each site. The primary evaluation uses a controlled interrupted time-series design, both adjusted and unadjusted for covariates. The concurrent process evaluation includes observation, focus groups, and self-reports to assess uptake of the feedback reports. The project described in this protocol follows a similar intervention conducted in our previous study, Data for Improvement and Clinical Excellence--Long-Term Care. We will offer dissemination strategies and spread of the feedback report approach in several ways suited to various audiences and stakeholders throughout Alberta.</p> <p>Significance</p> <p>This study will generate knowledge about the effects of an audit with feedback intervention in home care and supportive living settings. Our dissemination activities will focus on supporting sites to continue to use the Resident Assessment Instrument data in their quality improvement activities.</p

An Outbreak of Pseudomonas aeruginosa Pneumonia and Bloodstream Infection Associated With Intermittent Otitis Externa in a Healthcare Worker

Arstract Objectives: To investigate an outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection among four neonates, determine risk factors for infection, and implement preventive strategies. Design: Retrospective case finding; prospective surveillance cultures of patients, personnel, and environmental sites; molecular typing by pulsed-field gel electrophoresis; and a matched case-control study. Patients and Setting: Neonates in the level-III neonatal intensive care unit of a tertiary-care pediatric institution. Interventions: Cohorting of patients with positive results for P. aeruginosa, work restrictions for staff with positive results, implementation of an alcohol-based hand product, review of infection control policies and procedures, and closure of the unit until completion of the investigation. Results: Seven (4%) of 190 environmental cultures and 5 (3%) of 178 cultures of individual healthcare workers' hands grew P. aeruginosa. All four outbreak isolates and one previous bloodstream isolate were genotypically identical, as were the P. aeruginosa isolates from the hands and external auditory canal of a healthcare worker with intermittent otitis externa. Four of 5 case-patients versus 5 of 15 matched control-patients had been cared for by this healthcare worker (P = .05). The healthcare worker was treated and no further cases occurred. Conclusions: These findings suggest that a healthcare worker with intermittent otitis externa may have caused this cluster of fatal P. aeruginosa infections, adding the external ear to the list of colonized body sites that may serve as a source of potentially pathogenic organism

Research priorities for homecare for older people: a multi-stakeholder consultation.

Homecare is generally understood to refer to services that support people to continue living in their own homes. Older people are the primary users and many countries report an increase in the number using homecare services and greater spending on such provision, driven in part by investment in ‘ageing in place’ policies. Despite this, and reflecting social care more generally, homecare is relatively under-researched. However, in the UK at least, there is growing interest and investment in social care research. In order that this investment is not wasted, it is essential that research addresses what stakeholders identify as research priorities. This study reports work undertaken in the UK during 2021/22 to identify research priorities for homecare for older people, and a broad scoping of existing evidence. A two-stage consultation process was used. First, topic areas for research were identified through consultations with stakeholders. Second, a survey ascertained agreement and differences between groups regarding the relative importance of topic areas as research priorities. Over 50 people participated including older people (n = 7), family members (n = 11), homecare workers (n = 16), homecare providers (n = 9) and national policy, evidence and advocacy leads (n = 13). Twenty discrete research topic areas were identified. Only one topic area (Joint working between homecare and health services) was a ‘Top 5’ research priority for all stakeholder groups. Timely engagement with homecare and Workforce: recruitment and retention were ‘Top 5’ priorities for three stakeholder groups. Scoping of existing research indicates that topic areas receiving the most research attention to date are not among those identified as being of high priority for research. To our knowledge, this is the first time research priorities for homecare have been generated. Findings will be of value to research funders, organisations using research evidence and the research community

Predictors of Adherence to a Structured Exercise Program and Physical Activity Participation in Community Dwellers after Stroke

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult

Predictors of Adherence to a Structured Exercise Program and Physical Activity Participation in Community Dwellers after Stroke

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult

The 4AT, a rapid delirium detection tool, in hospice inpatient units:Findings from a validation study

Background: Delirium is a serious neuropsychiatric syndrome with adverse outcomes, which is common but often undiagnosed in terminally ill people. The 4 ‘A’s test or 4AT (www.the4AT.com), a brief delirium detection tool, is widely used in general settings, but validation studies in terminally ill people are lacking. Aim: To determine the diagnostic accuracy of the 4AT in detecting delirium in terminally ill people, who are hospice inpatients.Design: A diagnostic test accuracy study in which participants underwent the 4AT and a reference standard based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The reference standard was informed by Delirium Rating Scale Revised-98 and tests assessing arousal and attention. Assessments were conducted in random order by pairs of independent raters, blinded to the results of the other assessment.Setting/participants: Two hospice inpatient units in Scotland, UK. Participants were 148 hospice inpatients aged ≥18. Results: 137/148 participants completed both assessments. Three participants had an indeterminate reference standard diagnosis and were excluded, yielding a final sample of 134. Mean age was 70.3 (SD 10.6) years. 33% (44/134) had reference standard delirium. The 4AT had a sensitivity of 89% (95% CI 79-98%) and a specificity of 94% (95% CI 90-99%). The area under the receiver operating characteristic curve was 0.97 (95% CI 0.94-1).Conclusion: The results of this validation study support use of the 4AT as a delirium detection tool in hospice inpatients, and adds to the literature evaluating methods of delirium detection in palliative care settings.Trial registry: ISCRTN 97417474<br/