An exploratory study of expectant mothers’ knowledge, attitudes and beliefs about infant vaccination

Background: Childhood vaccination decision making occurs during pregnancy. However, more insight is needed to determine how expectant mothers in the United States decide whether to vaccinate their children — particularly as the first vaccine, Hepatitis B, is recommended within 24 hours of birth. Aim: This qualitative study used the foundational lens of the Theory of Reasoned Action to 1) explore how expectant mothers formulate knowledge, attitudes, and beliefs about infant vaccination, and 2) discern if differences exist regarding how first-time expectant mothers approach vaccine decision making. Methods: Eleven focus groups were conducted with pregnant participants from an obstetrics practice in the southeastern United States. Thematic analysis was undertaken, utilizing the constant comparative method. Results: Four overarching themes emerged: the need for evidence-based childhood vaccine information during pregnancy; perceptions of source trustworthiness and the social media paradox; concerns about the “one-size-fits-all” vaccine schedule; and the process of vaccine risk-benefit analysis of first-time mothers. Discussion: Practical implications highlight a need for standardized vaccine-related education during the prenatal care period. Theoretical implications reveal that the decision of whether to vaccinate one’s infant remains complex, involving a variety of factors. Conclusion: Compared to expectant mothers who had children previously, first-time expectant mothers especially reported feeling ill-informed to make infant vaccine decisions

Critical thinking development in undergraduate midwifery students: An Australian validation study using Rasch analysis

Background: Well-developed critical thinking skills are required to provide midwifery care that is safe, evidence-based, and woman-centred. A valid, reliable tool to measure is required the application of critical thinking in midwifery practice. The Carter Assessment of Critical Thinking in Midwifery (CACTiM) has previously been psychometrically assessed using classical methods at a single site. This study aims to further evaluate the properties of CACTiM tools using Rasch analysis in a diverse group of midwifery students and preceptors. Methods: The CACTiM tools were completed by undergraduate midwifery students studying at three Australian universities and their preceptors. Midwifery students’ critical thinking was evaluated separately through student self-assessment and preceptor assessment and then matched. Rasch analysis was used to evaluate the validity of the tools. Results: Rasch analysis confirmed both the preceptor and student CACTiM tools demonstrated good reliability and unidimensionality. The items can differentiate between students’ ability to apply critical thinking in midwifery practice. Person reliability and item reliability were above.92 for both scales indicating excellent reliability and internal consistency. Several improvements were identified to the tools, including enhanced wording to some items, and reduction to a 5-point Likert scale. Through analysis of lower-scoring items, midwifery programs can identify curricula enhancements. Conclusion: The CACTiM student and preceptor tools are valid and reliable measures of critical thinking in midwifery practice. The tools can assess students’ critical thinking abilities and identify areas for development for individuals and across student cohorts through curricula enhancements

The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS)

Background People suffering different types of stroke have differing demographic characteristics and survival. However, current estimates of disease burden are based on the same underlying assumptions irrespective of stroke type. We hypothesized that average Quality Adjusted Life Years (QALYs) lost from stroke would be different for ischemic stroke and intracerebral hemorrhage (ICH).Methods We used 1 and 5-year data collected from patients with first-ever stroke participating in the North East Melbourne Stroke Incidence Study (NEMESIS). We calculated case fatality rates, health-adjusted life expectancy, and quality-of-life (QoL) weights specific to each age and gender category. Lifetime \u27health loss\u27 for first-ever ischemic stroke and ICH surviving 28-days for the 2004 Australian population cohort was then estimated. Multivariable uncertainty analyses and sensitivity analyses (SA) were used to assess the impact of varying input parameters e.g. case fatality and QoL weights.Results Paired QoL data at 1 and 5 years were available for 237 NEMESIS participants. Extrapolating NEMESIS rates, 31,539 first-ever strokes were expected for Australia in 2004. Average discounted (3%) QALYs lost per first-ever stroke were estimated to be 5.09 (SD 0.20; SA 5.49) for ischemic stroke (n = 27,660) and 6.17 (SD 0.26; SA 6.45) for ICH (n = 4,291; p < 0.001). QALYs lost also differed according to gender for both subtypes (ischemic stroke: males 4.69 SD 0.38, females 5.51 SD 0.46; ICH: males 5.82 SD 0.67, females 6.50 SD 0.40).Discussion People with ICH incurred greater loss of health over a lifetime than people with ischemic stroke. This is explained by greater stroke related case fatality at a younger age, but longer life expectancy with disability after the first 12 months for people with ICH. Thus, studies of disease burden in stroke should account for these differences between subtype and gender. Otherwise, in countries where ICH is more common, health loss for stroke may be underestimated. Similar to other studies of this type, the generalisability of the results may be limited. Sensitivity and uncertainty analyses were used to provide a plausible range of variation for Australia. In countries with demographic and life expectancy characteristics comparable to Australia, our QoL weights may be reasonably applicable

Thrombin A-Chain: Activation Remnant or Allosteric Effector?

Although prothrombin is one of the most widely studied enzymes in biology, the role of the thrombin A-chain has been neglected in comparison to the other domains. This paper summarizes the current data on the prothrombin catalytic domain A-chain region and the subsequent thrombin A-chain. Attention is given to biochemical characterization of naturally occurring prothrombin A-chain mutations and alanine scanning mutants in this region. While originally considered to be simply an activation remnant with little physiologic function, the thrombin A-chain is now thought to play a role as an allosteric effector in enzymatic reactions and may also be a structural scaffold to stabilize the protease domain

Development and application of model of resource utilization, costs, and outcomes for stroke (MORUCOS): an Australian economic model for stroke

Objectives: To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]).Methods: The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions.Results: The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$15,117 versus AUD$17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997).Conclusions: MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model

Development and application of model of resource utilization, costs, and outcomes for stroke (MORUCOS): an Australian economic model for stroke

Objectives: To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]).Methods: The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions.Results: The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$15,117 versus AUD$17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997).Conclusions: MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model

Phonetic variation and change in the Cockney Diaspora: The role of place, gender, and identity

Recent research has suggested that two linguistic processes are displacing Cockney: the emergence of Multicultural London English (MLE) in inner London and dialect levelling (e.g. Kerswill & Williams 2005). This study investigates firstly whether Cockney phonetic features have ‘moved East’ to Essex (Fox 2015), and secondly the features’ indexicality in relation to place and identity. Fifty-four participants from Debden, an outpost of the Cockney Diaspora, completed a sociolinguistic interview. Vowel measurements were made from a wordlist and passage, and quantitative attitudinal and qualitative data were extracted from a questionnaire and interviews. Overall, changes in identity as a result of social change exceeded linguistic changes, and linguistic labels were not interpreted uniformly across the community. Whilst Cockney variants were largely maintained in young speakers, they were transposed onto an ‘Essex’ accent. Furthermore, some young women but no young men considered themselves Cockney, likely due to the matrifocal nature of Cockney. (Cockney, phonetic variation and change, dialect levelling, identity, indexicality, gende

Tachyon Hair on Two-Dimensional Black Holes

Static black holes in two-dimensional string theory can carry tachyon hair. Configurations which are non-singular at the event horizon have non-vanishing asymptotic energy density. Such solutions can be smoothly extended through the event horizon and have non-vanishing energy flux emerging from the past singularity. Dynamical processes will not change the amount of tachyon hair on a black hole. In particular, there will be no tachyon hair on a black hole formed in gravitational collapse if the initial geometry is the linear dilaton vacuum. There also exist static solutions with finite total energy, which have singular event horizons. Simple dynamical arguments suggest that black holes formed in gravitational collapse will not have tachyon hair of this type.Comment: 11 pages, 1 figure (not included), uses phyzzx, SU-ITP-93-1

Participant recruitment into a randomised controlled trial of exercise therapy for people with multiple sclerosis

The success of a clinical trial is often dependant on whether recruitment targets can be met in the required time frame. Despite an increase in research into the benefits of exercise in people with multiple sclerosis (PwMS), no trial has reported detailed data on effective recruitment strategies for large-scale randomised controlled trials. The main purpose of this report is to provide a detailed outline of recruitment strategies, rates and estimated costs in the Exercise Intervention for Multiple Sclerosis (ExIMS) trial to identify best practices for future trials involving multiple sclerosis (MS) patient recruitment