Translating research into MCH service: comparison of a pilot project and a large-scale resource mothers program.

This study examines the process and effect of translating a pilot research project into a large-scale service program. In a pilot resource mothers program for pregnant teenagers, participants had fewer low birth weight infants than teenagers in the comparison group. In the corresponding large-scale service program, a similarly positive effect on low birth weight was not seen. In an effort to understand how these differences occurred, the evaluation methodologies and key characteristics that describe the background, infrastructure, components, and service providers of the two projects were compared. Important differences between the pilot project and the service program were seen in funding stability, diversity of staff, community versus health department ownership of the program, caseloads, and levels of training and supervision. It seems probable that these differences brought about changes in the intensity and character of the intervention from the pilot to the service program, leading to a reduction of the intervention's efficacy in reducing the number of low birth weight infants. The implications of these findings for researchers and program planners are discussed

Mental Stress Provokes Ischemia in Coronary Artery Disease Subjects Without Exercise- or Adenosine-Induced Ischemia

ObjectivesThe purpose of this study was to investigate the possibility that some patients with coronary artery disease (CAD) but negative exercise or chemical stress test results might have mental stress-induced ischemia. The study population consisted solely of those with negative test results.BackgroundMental stress-induced ischemia has been reported in 20% to 70% of CAD subjects with exercise-induced ischemia. Because mechanisms of exercise and mental stress-induced ischemia may differ, we studied whether mental stress would produce ischemia in a proportion of subjects with CAD who have no inducible ischemia with exercise or pharmacologic tests.MethodsTwenty-one subjects (14 men, 7 women) with a mean age of 67 years and with a documented history of CAD were studied. All subjects had a recent negative nuclear stress test result (exercise or chemical). Subjects completed a speaking task involving role playing a difficult interpersonal situation. A total of 30 mCi 99mTc-sestamibi was injected at one minute into the speech, and imaging was started 40 min later. A resting image obtained within one week was compared with the stress image. Images were analyzed for number and severity of perfusion defects. The summed difference score based on the difference between summed stress and rest scores was calculated. Severity was assessed using a semiquantitative scoring method from zero to four.ResultsSix of 21 (29%) subjects demonstrated reversible ischemia (summed difference score ≥3) with mental stress. No subject had chest pain or electrocardiographic changes during the stressor. Mean systolic and diastolic blood pressure and heart rate all increased between resting and times of peak stress.ConclusionsMental stress may produce ischemia in some subjects with CAD and negative exercise or chemical nuclear stress test results

Unimolecular decomposition kinetics of the stabilised Criegee intermediates CH₂OO and CD₂OO

Decomposition kinetics of stabilised CH2OO and CD2OO Criegee intermediates have been investigated as a function of temperature (450–650 K) and pressure (2–350 Torr) using flash photolysis coupled with time-resolved cavity-enhanced broadband UV absorption spectroscopy. Decomposition of CD2OO was observed to be faster than CH2OO under equivalent conditions. Production of OH radicals following CH2OO decomposition was also monitored using flash photolysis with laser-induced fluorescence (LIF), with results indicating direct production of OH in the v = 0 and v = 1 states in low yields. Master equation calculations performed using the Master Equation Solver for Multi-Energy well Reactions (MESMER) enabled fitting of the barriers for the decomposition of CH2OO and CD2OO to the experimental data. Parameterisations of the decomposition rate coefficients, calculated by MESMER, are provided for use in atmospheric models and implications of the results are discussed. For CH2OO, the MESMER fits require an increase in the calculated barrier height from 78.2 kJ mol−1 to 81.8 kJ mol−1 using a temperature-dependent exponential down model for collisional energy transfer with 〈ΔE〉down = 32.6(T/298 K)1.7 cm−1 in He. The low- and high-pressure limit rate coefficients are k1,0 = 3.2 × 10−4(T/298)−5.81exp(−12 770/T) cm3 s−1 and k1,∞ = 1.4 × 1013(T/298)0.06exp(−10 010/T) s−1, with median uncertainty of ∼12% over the range of experimental conditions used here. Extrapolation to atmospheric conditions yields k1(298 K, 760 Torr) = 1.1+1.5−1.1 × 10−3 s−1. For CD2OO, MESMER calculations result in 〈ΔE〉down = 39.6(T/298 K)1.3 cm−1 in He and a small decrease in the calculated barrier to decomposition from 81.0 kJ mol−1 to 80.1 kJ mol−1. The fitted rate coefficients for CD2OO are k2,0 = 5.2 × 10−5(T/298)−5.28exp(−11 610/T) cm3 s−1 and k2,∞ = 1.2 × 1013(T/298)0.06exp(−9800/T) s−1, with overall error of ∼6% over the present range of temperature and pressure. The extrapolated k2(298 K, 760 Torr) = 5.5+9.2−5.5 × 10−3 s−1. The master equation calculations for CH2OO indicate decomposition yields of 63.7% for H2 + CO2, 36.0% for H2O + CO and 0.3% for OH + HCO with no significant dependence on temperature between 400 and 1200 K or pressure between 1 and 3000 Torr

An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability

Health-related quality-of-life (HRQL) measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age  =  26.00  ±  8.19 years) undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES), Constant score) preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1) a major recurrence of instability, (2) a single episode of subluxation, (3) any postoperative episode of instability. Eight (20%) patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- (P<0.001) and 12-month (P=0.011) evaluations. The ASES showed improvement at 6 months (P=0.003), while the Constant score did not report significant improvement until 12 months postoperatively (P=0.001). Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID). Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair

Design and baseline data from the vanguard of the Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS) randomized controlled trial

This paper describes the rationale and design of the vanguard for the Comparison of Depression Interventions after Acute Coronary Syndrome (CODIACS), a multicenter, randomized, controlled trial of a patient preference‐based, stepped care protocol for persistent depressive symptoms after acute coronary syndrome (ACS). The overall aim of the vanguard phase was to determine whether the patient-preference, stepped care protocol, which is based on the intervention used in the recent Coronary Psychosocial Evaluation Studies (COPES) trial, was feasible in patients with recent ACS who were recruited from 5 geographically diverse sites. Innovative design features of this trial include randomization to either initial patient-preference of treatment or to a referred care arm in which the primary care provider decided upon care. Additionally, delivery of psychotherapy was accomplished by telephone, or webcam, depending upon patient preference. The vanguard phase provides estimates of eligibility and screening/enrollment ratios, patient acceptance of screening, and retention. In this report, we describe the innovative features and the baseline results of the vanguard phase of CODIACS. The data from this vanguard study will be used to finalize planning for a large, phase III clinical trial designed to evaluate the effect of treatment on depressive symptoms, coronary events, and death

Seasonality of Formic Acid (HCOOH) in London during the ClearfLo Campaign

Following measurements in the winter of 2012, formic acid (HCOOH) and nitric acid (HNO3) were measured using a chemical ionization mass spectrometer (CIMS) during the Summer Clean Air for London (ClearfLo) campaign in London, 2012. Consequently, the seasonal dependence of formic acid sources could be better understood. A mean formic acid concentration of 1.3 ppb and a maximum of 12.7 ppb was measured which is significantly greater than that measured during the winter campaign (0.63 ppb and 6.7 ppb, respectively). Daily calibrations of formic acid during the summer campaign gave sensitivities of 1.2 ion counts s-1 parts per trillion (ppt) by volume-1 and a limit of detection of 34 ppt. During the summer campaign, there was no correlation between formic acid and anthropogenic emissions such as NOx and CO or peaks associated with the rush hour as was identified in the winter. Rather, peaks in formic acid were observed that correlated with solar irradiance. Analysis using a photochemical trajectory model has been conducted to determine the source of this formic acid. The contribution of formic acid formation through ozonolysis of alkenes is important but the secondary production from biogenic VOCs could be the most dominant source of formic acid at this measurement site during the summer

Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature

We report an unusual case of femoral fracture from minimal trauma, due to the rapid disappearance of a bioabsorbable interference screw used for reconstruction of the posterolateral corner of the knee. The literature on bone tunnel fractures following knee ligament reconstruction surgery is also reviewed

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited