Patients' perspectives on self-testing of oral anticoagulation therapy: Content analysis of patients' internet blogs

<p>Abstract</p> <p>Background</p> <p>Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.</p> <p>Methods</p> <p>Internet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages.</p> <p>Results</p> <p>The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT.</p> <p>Conclusions</p> <p>Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum particularly for patients with chronic illness.</p

3D analysis of anatomical reactions in conifers after mechanical wounding: first qualitative insights from X-ray computed tomography

The ability of trees to recover from damage beyond the last-formed periderm as well as the drivers and nature of associated wound reactions have been studied for more than two centuries using macroscopic (desiccation, aeration or discoloration of wood) and microscopic approaches (anatomical and chemical reactions). However, no studies currently exist which address large-scale macroscopic and microscopic reactions surrounding wounds in the tangential, axial, and radial directions over continuous segments of tree stems. This note explores the potential of 3D X-ray computed tomography in assessing effects of wounding under natural conditions in European conifers (Abies alba, Larix decidua, Picea abies). We present results from a pilot study and qualitatively evaluate the potential of the approach used in assessing and illustrating the formation and spread of de-differentiated xylem parenchyma cells, xylem decay compartmentalization, resin ducts, and stabilizing compression wood cells

The effects of elevated atmospheric CO₂ on freshwater periphyton in a temperate stream

This study examines the effects of elevated CO 2 on the benthic biology of a temperate freshwater stream. We tested the hypotheses that elevated CO 2 would increase periphyton biomass, alter elemental composition, and change community composition by increasing the frequency of algal taxa most limited by CO 2 availability. Carbon dioxide was bubbled into reservoirs of stream water, increasing the ambient pCO 2 by approximately 1100 ppm. The CO 2 -enriched water then flowed into artificial stream channels. Ceramic tiles were placed into the channels to allow for periphyton colonization. Dissolved inorganic carbon increased and pH decreased with added CO 2 . Measurements of biological parameters including periphyton biomass, algal C:N:P ratios, and community composition suggest that the periphyton were unaffected by the changes in stream water chemistry. We infer that rising atmospheric CO 2 will impact stream water chemistry but that periphyton may not be the first to respond to these changes. Impacts to alkaline freshwater streams from elevated CO 2 initially may be due to changes to terrestrial inputs that affect microbial decomposition and grazer activity, rather than through increases in periphyton carbon fixation. However, environmental characteristics of freshwater systems vary considerably, and additional studies are needed for accurate predictive modeling and monitoring of the effects of increasing atmospheric CO 2 on freshwater streams

Fungal Decomposers in Freshwater Environments

Streams, rivers, and freshwater marshes often depend on plant litter as a source of carbon, nutrients, and energy that drive ecosystem processes. Decomposition of this organic matter, such as leaves, wood, or emergent macrophytes, is mediated mostly by fungi, whereas the role of bacteria is minor. Fungal colonization leads to enzymatic breakdown of major plant polymers and fungal biomass accrual (often around 10% of total detrital dry mass), which makes decaying plant material more palatable to detritivorous invertebrates. Representatives of almost all major groups of fungi can be isolated from decaying plant litter collected in freshwater ecosystems or detected using molecular techniques; however, ascomycetes, including their asexual stages (e.g., aquatic hyphomycetes in streams), predominate. In recent years, utilization of radioisotopic approaches (e.g., acetate incorporation into ergosterol) to estimate fungal growth rates and production has facilitated the construction of partial carbon budgets for decaying plant litter that illustrate the importance of fungal decomposers in both lotic and lentic systems. For example, some estimates suggest that 23–60% of leaf litter carbon loss in streams can be explained by fungal assimilation (production plus respiration), which does not include fungal-mediated losses as fine particulate or dissolved organic carbon. Estimates of fungal contribution to plant carbon loss can be even higher (47–65%) in standing-dead emergent macrophyte systems in wetlands. The effects of environmental variables on fungal activity and plant litter decomposition in freshwaters, including inorganic nutrient availability and eutrophication, have also received considerable attention in the recent years. Molecular approaches are now becoming increasingly important in both streams and wetlands to assess the effects of environmental variables on litter-associated fungal assemblages. However, there are considerable differences in fungal dynamics and assemblages between streams and freshwater wetlands, which are discussed here in detail