Evaluation of an exercise field test using heart rate monitors to assess cardiorespiratory fitness and heart rate recovery in an asymptomatic population.

PurposeMeasures of cardiorespiratory fitness (CRF) and heart rate recovery (HRR) can improve risk stratification for cardiovascular disease, but these measurements are rarely made in asymptomatic individuals due to cost. An exercise field test (EFT) to assess CRF and HRR would be an inexpensive method for cardiovascular disease risk assessment in large populations. This study assessed 1) the predictive accuracy of a 12-minute run/walk EFT for estimating CRF ([Formula: see text]) and 2) the accuracy of HRR measured after an EFT using a heart rate monitor (HRM) in an asymptomatic population.MethodsFifty subjects (48% women) ages 18-45 years completed a symptom-limited exercise tolerance test (ETT) (Bruce protocol) and an EFT on separate days. During the ETT, [Formula: see text] was measured by a metabolic cart, and heart rate was measured continuously by a HRM and a metabolic cart.ResultsEFT distance and sex independently predicted[Formula: see text]. The average absolute difference between observed and predicted [Formula: see text] was 0.26 ± 3.27 ml·kg-1·min-1 for our model compared to 7.55 ± 3.64 ml·kg-1·min-1 for the Cooper model. HRM HRR data were equivalent to respective metabolic cart values during the ETT. HRR at 1 minute post-exercise during ETT compared to the EFT had a moderate correlation (r=0.75, p<0.001).ConclusionA more accurate model to estimate CRF from a 12-minute run/walk EFT was developed, and HRR can be measured using a HRM in an asymptomatic population outside of clinical settings

System for the measurement of ultra-low stray light levels

An apparatus is described for measuring the effectiveness of stray light suppression light shields and baffle arrangements used in optical space experiments and large space telescopes. The light shield and baffle arrangement and a telescope model are contained in a vacuum chamber. A source of short, high-powered light energy illuminates portions of the light shield and baffle arrangement and reflects a portion of same to a photomultiplier tube by virtue of multipath scattering. The resulting signal is transferred to time-channel electronics timed by the firing of the high energy light source allowing time discrimination of the signal thereby enabling the light scattered and suppressed by the model to be distinguished from the walls and holders around the apparatus

Knowledge transfer and exchange: a look at the literature in relation to research and policy

Within the field of health policy, there have been widespread calls for the increased or improved use of evidence within policy making. This reflects an ambition to deliver better policy in terms of outcomes, resource efficiency and effectiveness, and a belief that this can be achieved through utilising the available evidence to inform and guide decision making. For those tasked with improving the uptake of a piece or body of evidence, for policy makers aiming to improve their evidence use, or for researches investigating this question, a number of conceptual questions remain on how to actually achieve this, such as: What should count as evidence for policy making? Who should govern (or steer) the use of research evidence for policy? What is ‘good evidence’ for decision making? What is the ‘good use’ of evidence from a governance perspective? How is research knowledge typically translated into policy? How can one ‘improve’ the use or uptake of evidence in policy making? The GRIP-Health Project is a 5 year, European Research Council supported programme of work that aims to improve the use of research evidence in health policy through undertaking research on the political aspects of health policy making and evidence use. The project has developed a number of working papers that engage with some of these topics.1 This current paper is concerned with the last two of the questions listed above, specifically reviewing key aspects of Knowledge Transfer and Exchange (KTE) related to getting research into policy and practice. While the health sector is increasingly motivated by a desire to get research evidence into policy, outside the field of health there is a much broader body of work that is specifically concerned with how evidence and knowledge are transferred, translated, or taken up by different policy actors. Various theories attempt to establish how KTE works, the contextual factors that influence the process, and how to achieve maximum impact for relevant bodies of evidence. Acronyms and terminology used in this field vary accordingly, and can include knowledge transfer, knowledge translation, knowledge management, and knowledge brokering. These various terms have been grouped together under the rubric ‘K*’ by some authors to reflect the multiple overlapping terms 2 Prior working papers in this series deal with aspects of: Stewardship of health evidence; hierarches and appropriateness of evidence; and institutional approaches to evidence uptake research. Working papers and other outputs of the programme are available at the GRIP-Health website http://www.lshtm.ac.uk/groups/griphealth/resources/index.html 3 (c.f. Shaxson et al., 2012). However, in this paper, we use the term KTE to refer to the general body of literature focused on issues of knowledge production, dissemination, uptake and use in policymaking. As the body of work on KTE is extensive, it was decided not to attempt a complete or systematic review of the literature. There are, however, several papers which attempt to synthesise the existing literature or systematically review elements of the KTE field. These reviews provide a starting point for mapping the field to help inform efforts to improve the use of research evidence in policy. The current paper therefore has two objectives. First, it summarises and synthesises a set of identified KTE review papers in order to undertake a comparison of their similarities and their differences on the main areas they cover, to provide a basic mapping of key KTE concepts. After this, it then explores some key themes that emerge from the KTE literature which are of particular relevance to the GRIP-Health programme and other researchers or stakeholders who are tasked with improving evidence uptake

Health system stewardship and evidence informed health policy

This Working Paper reviews the recent international debates on the role of the state in health system governance, and uses those discussions to establish the legitimate role of the state in ensuring the appropriate use of evidence for health policy making. Specifically it examines the concept of stewardship which has emerged within recent global health governance debates, applying this concept to the stewardship of evidence. The stewardship function of national ministries of health was originally introduced by the World Health Organization in the 2000 World Health Report, but has been subsequently debated by authors who have associated the concept with a range of government and service provision functions. This paper develops a clearer and more nuanced understanding of the concept of stewardship to differentiate it from the related, yet distinct, concept of governance. We argue that the unique, and therefore conceptually useful, aspect stewardship lies in the way it allocates a single ultimate responsibility for the health of the population. The WHO has further established that it is national ministries of health, specifically, which possess the legitimacy to assume the functions as stewards of population health. The stewardship concept has been established with a range of functional characteristics, including the appropriate use of information to guide health planning and decision making. Taken together, these elements have direct implications for conceptualising how to ensure appropriate use of evidence in health policy. Ministries of health, as population health stewards, tasked with appropriate information use, possess a responsibility to ensure health system decisions are appropriately informed by evidence. In order to do this, they must establish institutional structures and procedures that function to synthesise, disseminate and apply health information and research evidence for use in policy making

Unsolicited written narratives as a methodological genre in terminal illness: challenges and limitations

Stories about illness have proven invaluable in helping health professionals understand illness experiences. Such narratives have traditionally been solicited by researchers through interviews and the collection of personal writings, including diaries. These approaches are, however, researcher driven; the impetus for the creation of the story comes from the researcher and not the narrator. In recent years there has been exponential growth in illness narratives created by individuals, of their own volition, and made available for others to read in print or as Internet accounts. We sought to determine whether it was possible to identify such material for use as research data to explore the subject of living with the terminal illness amyotrophic lateral sclerosis/motor neuron disease—the contention being that these accounts are narrator driven and therefore focus on issues of greatest importance to the affected person. We encountered and sought to overcome a number of methodological and ethical challenges, which is our focus here