The blue one takes a battering why do young adults with asthma overuse bronchodilator inhalers? A qualitative study

Objective: Overuse of short-acting bronchodilators is internationally recognised as a marker of poor asthma control, high healthcare use and increased risk of asthma death. Young adults with asthma commonly overuse short-acting bronchodilators. We sought to determine the reasons for overuse of bronchodilator inhalers in a sample of young adults with asthma. Design: Qualitative study using a purposive extreme case sample. Setting: A large urban UK general practice. Participants: Twenty-one adults with moderate asthma, aged 20-32 years. Twelve were high users of short-acting bronchodilators, nine were low users. Results: Asthma had a major impact on respondents' lives, disrupting their childhood, family life and career opportunities. High users of short-acting bronchodilators had adapted poorly to having asthma and expressed anger at the restrictions they experienced. Overuse made sense to them: shortacting bronchodilators were a rapid, effective, cheap 'quick-fix' for asthma symptoms. High users had poorer control of asthma and held explanatory models of asthma which emphasised short-term relief via bronchodilation over prevention. Both high and low users held strong views about having to pay for asthma medication, with costs cited as a reason for not purchasing anti-inflammatory inhalers. Conclusions: Young adults who were high users of short-acting bronchodilators had adapted poorly to having asthma and had poor asthma control. They gave coherent reasons for overuse. Strategies that might address high bronchodilator use in young adults include improving education to help young people accept and adapt to their illness, reducing stigmatisation and providing free asthma medication to encourage the use of anti-inflammatory inhalers

Peer review: beyond the call of duty?

The number of manuscripts submitted to most scholarly journals has increased tremendously over the last few decades, and shows no sign of leveling off. Increasingly, a key challenge faced by editors of scientific journals like the International Journal of Nursing Studies (IJNS) is to secure peer reviews in a timely fashion for the manuscripts they handle. We hear from editors of some journals that it is not uncommon to have to issue 10–15 invitations before one can secure the peer reviews needed to assess a given manuscript and although the IJNS generally fares better than this it is certainly true that a high proportion, probably a majority, of review invitations are declined.\ud \ud Most often, researchers declining invitations to review invoke the fact that they are too busy to add yet another item to their already overcommitted schedule. Some reviewers respond that administrators at their university or research center are actively discouraging them from engaging in an activity that seems to bear no tangible benefits. Yet, however one looks at it, peer reviewing is a crucial component of the publishing process. Nobody has yet come up with a viable alternative. Therefore, we need to find a way to convince our colleagues to peer review manuscripts more often. This can be done with a stick or with various types of carrots.\ud \ud One “stick”, occasionally envisaged by editors (e.g., Anon., 2009), is straightforward, at least to explain. For the peer-reviewing enterprise to function well, each researcher should be reviewing every year as many manuscripts as the number of reviews he or she is getting for his/her own papers. So, someone submitting 10 manuscripts in a given year should be willing to review 20 or 30 manuscripts during the same timeframe (assuming that each manuscript is reviewed by 2 or 3 individuals, as is commonly the case). If this person does not meet the required quota of reviews, there would be some restrictions imposed on the submission of any new manuscript for publication. Boehlert et al. (2009) have advocated such a “stick” in the case of the submission of grant proposals.\ud \ud However, the implementation of such an automatic accounting of reviewing activities is fraught with difficulties. For one thing, it would not prevent reviewers from defeating the system by writing short, useless reviews just to make the number. To eliminate that loophole, someone would have to assess whether reviews meet minimal standards of quality before they can be counted in the annual or running total. There would need to be allowances, for example to allow young researchers to get established in their career. This raises the prospect of a complex and potentially expensive system somewhat akin to carbon trading where credits for reviewing are granted and then traded with a verification system to ensure that no one cheats.\ud \ud An alternative approach, instead of sanctioning bad reviewing practices, would be to reward good ones. Currently the IJNS publishes the names of all reviewers annually. Other journals go a step further for example by giving awards to outstanding reviewers (Baveye et al., 2009). The lucky few who are so singled out by such awards see their reviewing efforts validated. But fundamentally, these awards do not change the unsupportive atmosphere in which researchers review manuscripts. The problem has to be attacked at its root, in the current culture of universities and research centers, where administrators tend to equate research productivity with the number of articles published and the amount of extramural funding brought in. Annual activity reports occasionally require individuals to mention the number of manuscripts or grant proposals reviewed, but these data are currently unverifiable, and therefore, are generally assumed not to matter at all for promotions or salary adjustments.\ud \ud There may be ways out of this difficulty. All the major publishers have information on who reviews what, how long reviewers take to respond to invitations, how long it takes them to send in their reviews. All it would take, in addition, would be for editors or associate editors who receive reviews to assess and record their usefulness, and one would have a very rich data set, which, if it were made available to universities and research centers in a way that preserves the anonymity of the peer-review process, could be used fruitfully to evaluate individuals’ reviewing performance and impact. Of course, one would have to agree on what constitutes a “useful” review. Pointing out typos and syntax errors in a manuscript is useful, but not hugely so. Identifying problems and offering ways to overcome them, proposing advice on how to analyze data better, or editing the text to increase its readability are all ways to make more substantial contributions. Generally, one might consider that there is a usefulness gradation from reviews focused on finding flaws in a manuscript to those focused on helping authors improve their text. Debate among scientists could result in a reliable set of guidelines on how to evaluate peer reviews.\ud \ud Beyond making statistics available to decision makers, other options are also available to raise the level of visibility and recognition of peer reviews (Baveye, 2010). Right or wrong, universities and research centers worldwide now rely more and more on some type of scientometric index, like the h-index (Hirsch, 2005), to evaluate the “impact” of their researchers. In other cases, such as the UK, the basis on which institutions are funded is linked to schemes which have measures such as the impact factor at their core (Nolan et al., 2008 M. Nolan, C. Ingleton and M. Hayter, The research excellence framework (REF): a major impediment to free and informed debate?, International Journal of Nursing Studies 45 (4) (2008), pp. 487–488. Article | PDF (202 K) | View Record in Scopus | Cited By in Scopus (4)Nolan et al., 2008). While many researchers see bibliometric analysis as a legitimate tool to explore discipline's activities and knowledge sources (see for example [Beckstead and Beckstead, 2006], [Oermann et al., 2008] and [Urquhart, 2006]), previous editorials in the IJNS have noted this trend and expressed disquiet at the distorting effect it could have on academic practice when used to pass judgments on quality ([Ketefian and Freda, 2009] and [Nolan et al., 2008]).\ud \ud Many of these indices implicitly encourage researchers to publish more articles, which in turn may detract researchers from engaging in peer reviewing. Certainly, none of the current indices encompass in any way the significant impact individuals can have on a discipline via their peer reviewing. But one could conceive of scientometric indexes that would include some measure of peer-reviewing impact, calculated on the basis of some of the data mentioned earlier. Clearly, such developments will not happen overnight. Before any of them can materialize, a necessary first step is for researchers to discuss with their campus administration, or the managers of their research institution, the crucial importance of peer reviewing and the need to have this activity valued in the same way that research, teaching, and outreach are. A debate along these lines is long overdue.\ud \ud Academic peer review is a necessary part of the publication process but while publication is recognised and valued, peer review is not. Even without the pressures of reward based on publication-based measures there is a potential for those less civic-minded authors to benefit from, but not contribute to, the peer-review system. Current scientometrics actively encourage and reward such behavior in a way that is, ultimately, not sustainable. Once administrators perceive that there is a need in this respect, are convinced that it will not cost a fortune to give peer reviewing more attention, and formulate a clear demand to librarians and publishers to help move things forward, there is hope that this perverse incentive in the current system can be removed. Otherwise the future of the current model of peer review looks bleak and we may indeed have to look forward to a complex bureaucratic system in which review credits are traded.\ud \ud For now, although the IJNS can count itself lucky because the problem affects this journal less than many others, in common with other journals we must thank our peer reviewers who are acting above and beyond the call of duty as it is perceived by many institutions. Without their efforts, journals like this cannot maintain their high standards. It is time for us to lend our weight to calls for a wide-ranging debate in order to ensure that these efforts are properly acknowledged and rewarded when judging the extent and quality of an academic's scientific contribution

Orthogonal polynomial kernels and canonical correlations for Dirichlet measures

We consider a multivariate version of the so-called Lancaster problem of characterizing canonical correlation coefficients of symmetric bivariate distributions with identical marginals and orthogonal polynomial expansions. The marginal distributions examined in this paper are the Dirichlet and the Dirichlet multinomial distribution, respectively, on the continuous and the N-discrete d-dimensional simplex. Their infinite-dimensional limit distributions, respectively, the Poisson-Dirichlet distribution and Ewens's sampling formula, are considered as well. We study, in particular, the possibility of mapping canonical correlations on the d-dimensional continuous simplex (i) to canonical correlation sequences on the d+1-dimensional simplex and/or (ii) to canonical correlations on the discrete simplex, and vice versa. Driven by this motivation, the first half of the paper is devoted to providing a full characterization and probabilistic interpretation of n-orthogonal polynomial kernels (i.e., sums of products of orthogonal polynomials of the same degree n) with respect to the mentioned marginal distributions. We establish several identities and some integral representations which are multivariate extensions of important results known for the case d=2 since the 1970s. These results, along with a common interpretation of the mentioned kernels in terms of dependent Polya urns, are shown to be key features leading to several non-trivial solutions to Lancaster's problem, many of which can be extended naturally to the limit as $d\rightarrow\infty$.Comment: Published in at http://dx.doi.org/10.3150/11-BEJ403 the Bernoulli (http://isi.cbs.nl/bernoulli/) by the International Statistical Institute/Bernoulli Society (http://isi.cbs.nl/BS/bshome.htm

Two qubit copying machine for economical quantum eavesdropping

We study the mapping which occurs when a single qubit in an arbitrary state interacts with another qubit in a given, fixed state resulting in some unitary transformation on the two qubit system which, in effect, makes two copies of the first qubit. The general problem of the quality of the resulting copies is discussed using a special representation, a generalization of the usual Schmidt decomposition, of an arbitrary two-dimensional subspace of a tensor product of two 2-dimensional Hilbert spaces. We exhibit quantum circuits which can reproduce the results of any two qubit copying machine of this type. A simple stochastic generalization (using a ``classical'' random signal) of the copying machine is also considered. These copying machines provide simple embodiments of previously proposed optimal eavesdropping schemes for the BB84 and B92 quantum cryptography protocols.Comment: Minor changes. 26 pages RevTex including 7 PS figure

A critical analysis of Antonovsky’s sense of coherence theory in relation to mental health and mental disorder and the effect of a lifelong learning intervention on the sense of coherence of mental health service users.

The theoretical focus of this thesis is Antonovsky’s sense of coherence theory, the research paradigm is humanistic existential and the main area of investigation is mental health. The context of this thesis is the EU’s Empowerment of Mental Illness Service Users: Lifelong Learning and Action (EMILIA) project which sought to increase the social inclusion and empowerment of mental health service users through providing formal learning and employment opportunities. Literature reviews were conducted on sense of coherence theory and on learning interventions for mental health service users. The sense of coherence literature review revealed a substantial level of research into the theory and its application. The investigation into learning interventions for mental health service users found that they can bring significant benefits. The thesis considered how Antonovsky’s sense of coherence theory related to mental health and disorder and it found that the underlying theory has relevance in understanding coping with and the existence, development and treatment of mental disorder. The analysis indicated the possible mental health benefits of seeking to strengthen sense of coherence. The implications of the findings are discussed in relation to topics such as health care and recovery. A combined research methods approach was taken to the assessment of the EMILIA project. A quantitative study was conducted using the SOC-13 (Antonovsky, 1987) measure to assess whether participation in the EMILIA project strengthened sense of coherence. The results showed that involvement in EMILIA significantly increased sense of coherence. This result supports efforts to increase the social inclusion and empowerment of mental health service users through providing learning and employment opportunities. The results also revealed that there was a strong positive correlation between SF-36-v2 mental health related quality of life and SOC-13 at baseline, follow-up and change over time. These results are in line with the majority of previous studies conducted in this area. Qualitative thematic analysis was used to assess the mechanisms and processes that led to this result. This analysis helped demonstrate that the EMILIA project strengthened participants’ ability to effectively respond to the needs and demands of their lives and it revealed insights into the mechanisms and application of SOC theory. In response to Antonovsky’s call to study the sense of coherence concept using methods other than his orientation to life questionnaire, qualitative research methods were employed. This thesis investigated how sense of coherence theory applied when mapped onto descriptions by mental health service users of how they deal with problems that they face in their lives. The thematic analysis revealed that sense of coherence theory mapped effectively onto the interview transcripts. The analysis identified various factors that can be considered to be general resistance resources in the sense of coherence model. It also revealed distinctions between concrete and relationship orientated problem solving that led to an enhanced model of sense of coherence theory. This thesis proposes that SOC theory can be regarded as a theoretical framework for designing interventions for mental health service users that seek to enhance coping, adaptability, recovery, social inclusion, and empowerment. The results suggest that programmes similar to EMILIA style opportunities should be an integrated part of recovery focused provision. Overall commonalities in the findings of the two thesis studies provided new insights into the factors, mechanisms and processes involved in coping and adaption that are essential to and intertwined with SOC strength, mental health and recovery. Social capital was indentified as a key general resistance resource and the combined findings provide support for projects and interventions for mental health service users that seek to facilitate increased social capital

The attitudes, feelings and experiences of online gamers: a qualitative analysis

The playing of massively multiplayer online role-playing games (MMORPGs) is now a highly popular leisure activity. The present study set out to explore the attitudes, experiences, and feelings of online gamers. The study entailed 71 interviews with online gamers (52 males, 19 females) from 11 different countries. Six main themes emerged from the analyses of the interview transcripts: (a) online gaming and integration into day-to-day lives; (b) online gaming, excessive play, and problems; (c) addiction; (d) psychosocial impact of online gaming; (e) online gaming, dissociation, and time loss; and (f) online gaming and the alleviation of negative feelings and mood states. These findings specifically showed how gamers used MMORPGs to alleviate negative feelings and provided detailed descriptions of personal problems that had arisen due to playing MMORPGs. The implications of these findings are discussed in relation to previous qualitative and quantitative research in the area

Recruiting ethnic minority participants to a clinical trial: a qualitative study

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non-commercial and is otherwise in compliance with the license.To compare the motives and experiences of different ethnic groups participating in a randomised double blind placebo-controlled trial of montelukast in preschool wheeze, and to assess parents' or guardians' understanding of trial procedures and their implications, including the collection of genetic material.National Institute of Health Research Efficacy and Mechanism Evaluation Stream(grant number: 08-43-03)