Shared understandings of dementia? : An application of the Common Sense Self Regulation Model to a case study

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Applying psychological theory to evidence-based clinical practice : identifying factors predictive of managing upper respiratory tract infections without antibiotics

Background: Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. Methods: Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results: All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. Cnclusion: The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the reation of a replicable methodology for identifying factors that predict clinical behaviour. Hwever, a number of conceptual and methodological challenges remain

Principal and Teacher Reports of Principal Leadership: An Examination of Congruence and Predictive Validity

Principals influence school characteristics including morale and teacher turnover, but the utility of different methods of measuring principal behavior is unclear. Using data from public schools in the National Study of Delinquency Prevention in Schools, I examined relations between school-level teacher reports and principal self-reports of leadership, which better predicted student-reported rule clarity and fairness, and whether agreement or congruence between reports of principal leadership predicted school morale, organizational focus, and teacher turnover. The data used are from 263 schools and thousands of respondents; limitations of the study include the measures of principal leadership used, which are not strictly parallel and the age of the data used. I hypothesized that correlations between teacher and principal reports would be small and positive, that teacher reports of leadership would better predict rule clarity and fairness, and that congruence between reports would predict better school morale, better organizational focus, and lower teacher turnover

Do reviews of healthcare interventions teach us how to improve healthcare systems?

Planners, managers and policy makers in modern health services are not without ingenuity e they will always try, try and try again. They face deep-seated or ‘wicked’ problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the ‘typological review’. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a ‘theory-driven review’ underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare

Stress-Induced Variation in Host Susceptibility to Parasitic Freshwater Mussel Larvae

An increasing number of studies demonstrate the critical role of the host–parasite relationship for the persistence and distribution of freshwater mussels. Laboratory experiments are a powerful tool for quantifying the physiological compatibility between parasitic mussel larvae and fish hosts and are clearly applicable to species conservation. Recent findings, however, indicate potential need to control for biases caused by infection intensity and host stress responses. We tested glochidia metamorphosis success and host plasma cortisol response using Lampsilis siliquoidea glochidia on Lepomis macrochirus. The main aims were to (1) compare metamorphosis success in response to infection intensity (number of attached glochidia per fish) and (2) compare metamorphosis success between typical and reduced-stress approaches to the handling and infection of host fish. We found no effect of the glochidia bath density used to infect the fish (1000–4000–8000 glochidia l−1) or the resulting infection intensity on metamorphosis success, although host plasma cortisol was correlated with infection intensity at 24 h post infection. Small but statistically significant differences in metamorphosis success were observed between the typical and reduced-stress approaches. Overall, typical host compatibility testing methods appear to be robust to these variables, but more emphasis on standardizing laboratory protocols may provide more repeatable data

Toxicity of Chromium (VI) to Two Mussels and an Amphipod in Water-Only Exposures With or Without a Co-stressor of Elevated Temperature, Zinc, or Nitrate

The objectives of the present study were to develop methods for propagating western pearlshell (Margaritifera falcata) for laboratory toxicity testing and evaluate acute and chronic toxicity of chromium VI [Cr(VI)] to the pearlshell and a commonly tested mussel (fatmucket, Lampsilis siliquoidea at 20 °C or in association with a co-stressor of elevated temperature (27 °C), zinc (50 µg Zn/L), or nitrate (35 mg NO3/L). A commonly tested invertebrate (amphipod, Hyalella azteca) also was tested in chronic exposures. Newly transformed pearlshell (~1 week old) were successfully cultured and tested in acute 96 h Cr exposures (control survival 100%). However, the grow-out of juveniles in culture for chronic toxicity testing was less successful and chronic 28-day Cr toxicity tests started with 4 month-old pearlshell failed due to low control survival (39-68%). Acute median effect concentration (EC50) for the pearlshell (919 µg Cr/L) and fatmucket (456 µg Cr/L) tested at 20 °C without a co-stressor decreased by a factor of \u3e 2 at elevated temperature but did not decrease at elevated Zn or elevated NO3. Chronic 28-day Cr tests were completed successfully with the fatmucket and amphipod (control survival 83-98%). Chronic maximum acceptable toxicant concentration (MATC) for fatmucket at 20 °C (26 µg Cr/L) decreased by a factor of 2 at elevated temperature or NO3 but did not decrease at elevated Zn. However, chronic MATC for amphipod at 20 °C (13 µg Cr/L) did not decrease at elevated temperature, Zn, or NO3. Acute EC50s for both mussels tested with or without a co-stressor were above the final acute value used to derive United States Environmental Protection Agency acute water quality criterion (WQC) for Cr(VI); however, chronic MATCs for fatmucket at elevated temperature or NO3 and chronic MATCs for the amphipod at 20 °C with or without elevated Zn or NO3 were about equal to the chronic WQC. The results indicate that (1) the elevated temperature increased the acute Cr toxicity to both mussel species, (2) fatmucket was acutely more sensitive to Cr than the pearlshell, (3) elevated temperature or NO3 increased chronic Cr toxicity to fatmucket, and (4) acute WQC are protective of tested mussels with or without a co-stressor; however, the chronic WQC might not protect fatmucket at elevated temperature or NO3 and might not protect the amphipod at 20 °C with or without elevated Zn or NO3

Three closely-related cyclohexanols (C35H27X2N3O3; X = F, Cl or Br): similar molecular structures but different crystal structures

Three highly-substituted cyclohexanol derivatives have been prepared from 2-acetylpyridine and 4-halogenobenzaldehydes under mild conditions. (1RS,2SR,3SR,4RS,5RS)-3,5-Bis(4fluoropheny1)-2,4-bis(pyridine-2-carbony1)-1 -(pyridin-2-yl)cyclohexanol, C35H27F2N3O3, (I), (1RS,2SR,3SR,4RS,5RS)-3,5bis(4-chloropheny1)-2,4-bis(pyridine-2-carbony1)-1 -(pyridin-2yl)cyclohexanol acetone 0.951-solvate, C35H27Cl2N3O3 center dot 0.951C(3)H(6)O, (II), and (1RS,2SR,3SR,4RS,5RS)-3,5-bis(4bromopheny1)-2,4-bis(pyridine-2-carbony1)-1-(pyridin-2-y1)cy- clohexanol, C35H27Br2N3O3, (III), all crystallize in different space groups, viz. Pbca, Fdd2 and Pit, respectively. In compound (II), the acetone molecule is disordered over two sets of atomic sites having occupancies of 0.690 (13) and 0.261 (13). Each of the cyclohexanol molecules contains an intramolecular O-H center dot center dot center dot N hydrogen bond and their overall molecular conformations are fairly similar. The molecules of (I) are linked by two independent C-H center dot center dot center dot O hydrogen bonds to form a C(5)C(10)[R-2(2)(15)] chain of rings, and those of (III) are linked by a combination of C-H center dot center dot center dot O and C-H center dot center dot center dot N hydrogen bonds, forming a chain of alternating Ri(16) and R-2(2)(18) rings. The cyclohexanol molecules in (II) are linked by a single C-H center dot center dot center dot N hydrogen bond to form simple C(4) chains and these chains are linked by a pi-pi stacking interaction to form sheets, to which the disordered acetone molecules are weakly linked via a number of C-H center dot center dot center dot O contacts.</p

Applying psychological theories to evidence-based clinical practice : Identifying factors predictive of managing upper respiratory tract infections without antibiotics

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