What promotes or prevents greater use of appropriate compression in people with venous leg ulcers? A qualitative interview study with nurses in the north of England using the Theoretical Domains Framework

OBJECTIVES: To investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers. DESIGN: Qualitative interview study with nurses using the Theoretical Domains Framework (TDF). SETTING: Three National Health Service Trusts in England. PARTICIPANTS: Purposive sample of 15 nurses delivering wound care. RESULTS: Nurses described factors which made provision of compression therapy challenging. Organisational barriers (TDF domains environmental context and resources/knowledge, skills/behavioural regulation) included heavy/increasing caseloads; lack of knowledge/skills and the provision of training; and prescribing issues (variations in bandaging systems/whether nurses could prescribe). Absence of specialist leg ulcer services to refer patients into was perceived as a barrier to providing optimal care by some community-based nurses. Compression use was perceived to be facilitated by clinics for timely initial assessment; continuity of staff and good liaison between vascular/leg ulcer clinics and community teams; clear local policies and care pathways; and opportunities for training such as ‘shadowing’ in vascular/leg ulcer clinics. Patient engagement barriers (TDF domains goals/beliefs about consequences) focused on getting patients ‘on board’ with compression, and supporting them in using it. Clear explanations were seen as key in promoting compression use. CONCLUSIONS: Rising workload pressures present significant challenges to enhancing leg ulcer services. There may be opportunities to develop facilitated approaches to enable community nursing teams to make changes to practice, enhancing quality of patient care. The majority of venous leg ulcers could be managed in the community without referral to specialist community services if issues relating to workloads/skills/training are addressed. Barriers to promoting compression use could also be targeted, for example, through the development of clear patient information leaflets. While the patient engagement barriers may be easier/quicker to address than organisational barriers, unless organisational barriers are addressed it seems unlikely that all people who would benefit from compression therapy will receive it

Challenging Social Cognition Models of Adherence:Cycles of Discourse, Historical Bodies, and Interactional Order

Attempts to model individual beliefs as a means of predicting how people follow clinical advice have dominated adherence research, but with limited success. In this article, we challenge assumptions underlying this individualistic philosophy and propose an alternative formulation of context and its relationship with individual actions related to illness. Borrowing from Scollon and Scollon’s three elements of social action – “historical body,” “interaction order,” and “discourses in place” – we construct an alternative set of research methods and demonstrate their application with an example of a person talking about asthma management. We argue that talk- or illness-related behavior, both viewed as forms of social action, manifest themselves as an intersection of cycles of discourse, shifting as individuals move through these cycles across time and space. We finish by discussing how these dynamics of social action can be studied and how clinicians might use this understanding when negotiating treatment with patients

Storm-induced inner-continental shelf circulation and sediment transport : Long Bay, South Carolina

This paper is not subject to U.S. copyright. The definitive version was published in Continental Shelf Research 42 (2012): 51–63, doi:10.1016/j.csr.2012.05.001.Long Bay is a sediment-starved, arcuate embayment located along the US East Coast connecting both South and North Carolina. In this region the rates and pathways of sediment transport are important because they determine the availability of sediments for beach nourishment, seafloor habitat, and navigation. The impact of storms on sediment transport magnitude and direction were investigated during the period October 2003–April 2004 using bottom mounted flow meters, acoustic backscatter sensors and rotary sonars deployed at eight sites offshore of Myrtle Beach, SC, to measure currents, water levels, surface waves, salinity, temperature, suspended sediment concentrations, and bedform morphology. Measurements identify that sediment mobility is caused by waves and wind driven currents from three predominant types of storm patterns that pass through this region: (1) cold fronts, (2) warm fronts and (3) low-pressure storms. The passage of a cold front is accompanied by a rapid change in wind direction from primarily northeastward to southwestward. The passage of a warm front is accompanied by an opposite change in wind direction from mainly southwestward to northeastward. Low-pressure systems passing offshore are accompanied by a change in wind direction from southwestward to southeastward as the offshore storm moves from south to north. During the passage of cold fronts more sediment is transported when winds are northeastward and directed onshore than when the winds are directed offshore, creating a net sediment flux to the north–east. Likewise, even though the warm front has an opposite wind pattern, net sediment flux is typically to the north–east due to the larger fetch when the winds are northeastward and directed onshore. During the passage of low-pressure systems strong winds, waves, and currents to the south are sustained creating a net sediment flux southwestward. During the 3-month deployment a total of 8 cold fronts, 10 warm fronts, and 10 low-pressure systems drove a net sediment flux southwestward. Analysis of a 12-year data record from a local buoy shows an average of 41 cold fronts, 32 warm fronts, and 26 low-pressure systems per year. The culmination of these events would yield a cumulative net inner-continental shelf transport to the south–west, a trend that is further verified by sediment textural analysis and bedform morphology on the inner-continental shelf.This research was funded by the South Carolina Coastal Erosion Project(http://pubs.usgs.gov/fs/2005/3041/), a cooperative study supported by the US Geological Survey and the South Carolina Sea Grant Consortium(Sea Grant Project no:R/CP-11)

The Allen Telescope Array: The First Widefield, Panchromatic, Snapshot Radio Camera for Radio Astronomy and SETI

The first 42 elements of the Allen Telescope Array (ATA-42) are beginning to deliver data at the Hat Creek Radio Observatory in Northern California. Scientists and engineers are actively exploiting all of the flexibility designed into this innovative instrument for simultaneously conducting surveys of the astrophysical sky and conducting searches for distant technological civilizations. This paper summarizes the design elements of the ATA, the cost savings made possible by the use of COTS components, and the cost/performance trades that eventually enabled this first snapshot radio camera. The fundamental scientific program of this new telescope is varied and exciting; some of the first astronomical results will be discussed.Comment: Special Issue of Proceedings of the IEEE: "Advances in Radio Telescopes", Baars,J. Thompson,R., D'Addario, L., eds, 2009, in pres

The prevalence of caries and tooth loss among participants in the Hispanic Community Health Study/Study of Latinos

ABSTRACT: Background.: The Hispanic and Latino population is projected to increase from 16.7 percent to 30.0 percent by 2050. Previous U.S. national surveys had minimal representation of Hispanic and Latino participants other than Mexicans, despite evidence suggesting that Hispanic or Latino country of origin and degree of acculturation influence health outcomes in this population. In this article, the authors describe the prevalence and mean number of cavitated, decayed and filled surfaces, missing teeth and edentulism among Hispanics and Latinos of different national origins. Methods.: Investigators in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)—a multicenter epidemiologic study funded by the National Heart, Lung, and Blood Institute with funds transferred from six other institutes, including the National Institute of Dental and Craniofacial Research—conducted in-person examinations and interviews with more than 16,000 participants aged 18 to 74 years in four U.S. cities between March 2008 and June 2011. The investigators identified missing, filled and decayed teeth according to a modified version of methods used in the National Health and Nutrition Examination Survey. The authors computed prevalence estimates (weighted percentages), weighted means and standard errors for measures. Results.: The prevalence of decayed surfaces ranged from 20.2 percent to 35.5 percent, depending on Hispanic or Latino background, whereas the prevalence of decayed and filled surfaces ranged from 82.7 percent to 87.0 percent, indicating substantial amounts of dental treatment. The prevalence of missing teeth ranged from 49.8 percent to 63.8 percent and differed according to Hispanic or Latino background. Significant differences in the mean number of decayed surfaces, decayed or filled surfaces and missing teeth according to Hispanic and Latino background existed within each of the age groups and between women and men. Conclusions.: Oral health status differs according to Hispanic or Latino background, even with adjustment for age, sex and other characteristics. Practical Implications.: These data indicate that Hispanics and Latinos in the United States receive restorative dental treatment and that practitioners should consider the association between Hispanic or Latino origin and oral health status. This could mean that dental practices in areas dominated by patients from a single Hispanic or Latino background can anticipate a practice based on a specific pattern of treatment needs