1,023 research outputs found
General practitioner views on the determinants of test ordering: a theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care.
BACKGROUND: Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP's views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care. METHODS: Qualitative semi-structured interviews were conducted with GPs requesting laboratory tests at Cork University Hospital or University Hospital Kerry in the South of Ireland. GPs were identified using a Health Service Executive laboratory list of GPs in the Cork-Kerry region. A random sample of GPs (stratified by GP requesting patterns) was generated from this list. GPs were purposively sampled based on the criteria of location (urban/rural); length of time qualified; and practice size (single-handed/group). Interviews were carried out between December 2014 and February 2015. Interviews were transcribed verbatim using NVivo 10 software and analysed using the framework analysis method. Emerging themes were mapped to the theoretical domains framework (TDF), which outlines 12 domains that can enable or inhibit behaviour change. The behaviour change wheel and behaviour change technique (BCT) taxonomy were then used to identify potential intervention strategies. RESULTS: Sixteen GPs were interviewed (ten males and six females). Findings suggest that intervention strategies should specifically target the key barriers to effective test ordering, while considering the context of primary care practice. Seven domains from the TDF were perceived to influence immunoglobulin test ordering behaviours and were identified as 'mechanisms for change' (knowledge, environmental context and resources, social/professional role and identity, beliefs about capabilities, beliefs about consequences, memory, attention and decision-making processes and behavioural regulation). Using these TDF domains, seven BCTs emerged as feasible 'intervention content' for targeting GPs' ordering behaviour. These included instructions on how to effectively request the test (how to perform behaviour), information on GPs' use of the test (feedback on behaviour), information about patient consequences resulting from not doing the test (information about health consequences), laboratory/consultant-based advice/education (credible source), altering the test ordering form (restructuring the physical environment), providing guidelines (prompts/cues) and adding interpretive comments to the results (adding objects to the environment). These BCTs aligned to four intervention functions: education, persuasion, environmental restructuring and enablement. CONCLUSIONS: This study has effectively applied behaviour change theory to identify feasible strategies for improving immunoglobulin test use in primary care using the TDF, 'behaviour change wheel' and BCT taxonomy. The identified BCTs will form the basis of a theory-based intervention to improve the use of immunoglobulin tests among GPs. Future research will involve the development and evaluation of this intervention
The sedimentology, architecture and depositional setting of the fluvial Spireslack 1 Sandstone of the Midland Valley, Scotland: insights from Spireslack surface coal mine.
Spireslack surface coal mine exposes a section in the Carboniferous Lawmuir Formation (Brigantian) into the Upper Limestone Formation (Arnsbergian). This paper describes the stratigraphy exposed at Spireslack for the first time and, in so doing, names the Spireslack Sandstone, a distinctive erosively based, sandstone-dominated unit in the Upper Limestone Formation. The Spireslack Sandstone comprises two fluvial sandstone channel sets and an upper possibly fluvio-estuarine succession. From an analysis of their internal architectural elements, the channel sets are interpreted as a low sinuosity, sand-dominated, mixed load fluvial system in which avulsion and variations in sediment load played a significant role. The lower channel set appears confined to erosional palaeovalleys of limited lateral extent and significant relief. The upper channel set is much more laterally extensive and displays evidence of a generally lower sediment load with a greater degree of lateral accretion and flooding. Consequently, the Spireslack Sandstone may represent a system responding to base level changes of higher magnitude and longer duration than the glacioeustatic scale commonly attributed to Carboniferous fluvio-deltaic cycles. Spireslack Sandstone may represent an important correlative marker in the Carboniferous of the Midland Valley, and may provide an alternative analogue for some Carboniferous fluvial sandstone stratigraphical traps
Default policies for global optimisation of noisy functions with severe noise
Global optimisation of unknown noisy functions is a daunting task that appears in domains ranging from games to control problems to meta-parameter optimisation for machine learning. We show how to incorporate heuristics to Stochastic Simultaneous Optimistic Optimization (STOSOO), a global optimisation algorithm that has very weak requirements from the function. In our case, heuristics come in the form of Covariance Matrix Adaptation Evolution Strategy (CMA-ES). The new algorithm, termed Guided STOSOO (STOSOO-G), combines the ability of CMA-ES for fast local convergence (due to the algorithm following the “natural” gradient) and the global optimisation abilities of STOSOO. We compare all three algorithms in the “harder” parts of the Comparing Continuous Optimisers on Black-Box Optimization Benchmarking benchmark suite, which provides a default set of functions for testing. We show that our approach keeps the best of both worlds, i.e. the almost optimal exploration/exploitation of STOSOO with the local optimisation strength of CMA-ES
Motor coordination deficits in Alpk1 mutant mice with the inserted piggyBac transposon
<p>Abstract</p> <p>Background</p> <p>ALPK1 (α-kinase 1) is a member of an unconventional alpha-kinase family, and its biological function remains largely unknown. Here we report the phenotypic characterization of one mutant line, in which the <it>piggyBac </it>(<it>PB</it>) transposon is inserted into the <it>Alpk1 </it>gene.</p> <p>Results</p> <p>The <it>piggyBac</it>(<it>PB</it>) insertion site in mutants was mapped to the first intron of the <it>Alpk1 </it>gene, resulting in the effective disruption of the intact <it>Alpk1 </it>transcript expression. The transposon-inserted <it>Alpk1 </it>homozygous mutants (<it>Alpk1<sup>PB/PB</sup></it>) displayed severe defects in motor coordination in a series of behavioral analysis, including dowel test, hanging wire test, rotarod analysis and footprint analysis. However, the cerebellar architecture, Purkinje cell morphology and electrophysiology of the Purkinje cells appeared normal in mutants. The motor coordination deficits in the <it>Alpk1<sup>PB/PB </sup></it>mice were rescued by transgenic mice expressing the full-length <it>Alpk1</it>-coding sequence under the control of the ubiquitous expression promoter.</p> <p>Conclusions</p> <p>Our results indicate that ALPK1 plays an important role in the regulation of motor coordination. <it>Alpk1<sup>PB/PB </sup></it>mice would be a useful model to provide a clue to the better understanding of the cellular and molecular mechanisms of ALPK1 in the control of fine motor activities.</p
Lesional-targeting of neuroprotection to the inflammatory penumbra in experimental multiple sclerosis
The authors would like to thank the support of the National Multiple Sclerosis Society (USA) and the Multiple Sclerosis Society of Great Britain and Northern Ireland
When One Size Does Not Fit All: A Simple Statistical Method to Deal with Across-Individual Variations of Effects
In science, it is a common experience to discover that although the investigated effect is very clear in some individuals, statistical tests are not significant because the effect is null or even opposite in other individuals. Indeed, t-tests, Anovas and linear regressions compare the average effect with respect to its inter-individual variability, so that they can fail to evidence a factor that has a high effect in many individuals (with respect to the intra-individual variability). In such paradoxical situations, statistical tools are at odds with the researcher’s aim to uncover any factor that affects individual behavior, and not only those with stereotypical effects. In order to go beyond the reductive and sometimes illusory description of the average behavior, we propose a simple statistical method: applying a Kolmogorov-Smirnov test to assess whether the distribution of p-values provided by individual tests is significantly biased towards zero. Using Monte-Carlo studies, we assess the power of this two-step procedure with respect to RM Anova and multilevel mixed-effect analyses, and probe its robustness when individual data violate the assumption of normality and homoscedasticity. We find that the method is powerful and robust even with small sample sizes for which multilevel methods reach their limits. In contrast to existing methods for combining p-values, the Kolmogorov-Smirnov test has unique resistance to outlier individuals: it cannot yield significance based on a high effect in one or two exceptional individuals, which allows drawing valid population inferences. The simplicity and ease of use of our method facilitates the identification of factors that would otherwise be overlooked because they affect individual behavior in significant but variable ways, and its power and reliability with small sample sizes (<30–50 individuals) suggest it as a tool of choice in exploratory studies
Aging and health: Self-efficacy for Self-direction in Health Scale
ABSTRACT OBJECTIVE To validate the Escala de Autoeficácia para a Autodireção na Saúde (EAAS – Self-efficacy for Self-direction in Health Scale). METHODS Non-experimental quantitative study of EAAS validation, by confirmatory factorial analyses, evaluating a sample of 508 older adults from the north and the center of Portugal with mean age of 71.67 (from 51 to 96 years), to whom the Self-efficacy for Self-direction in Health Scale, the Rosenberg Self-esteem Scale, the Positive and Negative Affect Schedule, the Satisfaction with Life Scale, and the Instrumental Activities of Daily Living Scale were applied. The EAAS was developed from the theoretical constructs of self-efficacy and from self-directed learning within the PALADIN European project framework, aiming to develop an instrument able to assess the extent to which older adults take good care of their health. RESULTS The internal consistency was 0.87 (Cronbach’s alpha) and confirmatory factorial analyses enabled to find a model near the one theoretically proposed, indicating a structure consisting of four dimensions: physical exercise, healthy diet, engaging in health-related learning, and visits to health professionals. From the psychometric point of view, the model in four factors showed quite satisfactory fit indicators. CONCLUSIONS The Self-efficacy for Self-direction in Health Scale, with 16 items, is adequate to evaluate to what extent older adults have confidence in their ability to take care of their own health, with high degree of autonomy
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