An exploration of the help-seeking experiences of men and women referred to a rapid access chest pain clinic (a cardiac physiologist-managed clinic)

Background Coronary Heart Disease (CHD) is one of the leading causes of death in both men and women worldwide. It is well documented that early diagnosis and treatment of CHD is associated with better outcomes. This has led to the establishment of targets to ensure prompt access to services for potential CHD (e.g. Rapid Access Chest Pain Clinics). Research has shown that these public health targets have caused decreases in morbidity and mortality rates for CHD in the UK. However, despite these improvements health services are still limited by help-seeking practices of patients as they can only act once a patient has presented for treatment. A number of studies have explored the reasons why patients delay help-seeking for CHD symptoms in an emergency context (i.e. having a heart attack). Many studies have focused on gender and have often suggested that women with emergency CHD symptoms delay help-seeking, although this is controversial. Other studies have suggested help-seeking delay is influenced by multiple intersecting factors (e.g. age, ethnicity and contextual influences) and not just gender. No studies have examined help-seeking for suspected CHD symptoms in the context of accessing Rapid Access Chest Pain Clinics (RACPC). Given the lack of understanding in this area, an explorative qualitative study was undertaken to answer the research question: what are the help-seeking experiences of men and women referred to a rapid access chest pain clinic? Methods A total of 30 men and women with a range of ages and ethnicities referred to a RACPC for the investigation of their symptoms were enrolled in this study. Participants took part in semi-structured interviews that focused on attribution of symptoms and how that, amongst other things, influenced help-seeking decisions for their symptoms. The data was analysed thematically to explore men’s and women’s experiences and the help-seeking decisions they made. The study findings and relevant literature were used to inform the development of a patient information leaflet to assist with recognition of potential CHD symptoms and to promote help-seeking. Results The study found, in general, that: attribution of symptoms was linked to contextual factors; reluctance to seek help and response to symptoms contributed to delay; the influence of others acted as enablers of help-seeking; and barriers were linked to accessibility of GP services and time off work. Additionally, some participants had mixed reactions to a negative diagnosis at the end of RACPC assessment (i.e. symptoms not of CHD origin). Some participants expressed frustration at not having an answer for their symptoms, whereas others said they felt like a ‘fraud’ for wasting NHS resources. Not all participants had negative reactions and many were delighted that their symptoms were not heart-related. When it came to perceptions of risk of CHD, most believed the ‘male lifestyle’ was more risky and therefore increased CHD risks in men, but that increasingly women were living ‘male-like lifestyles’ (e.g. working full time, smoking, drinking and eating a poor diet), thus increasing their risk of CHD. Conclusion This novel study based in the RACPC context has produced important findings in this previously unexplored area. Earlier qualitative research based in the emergency CHD context has highlighted the challenges around symptom attribution, attitudes to help-seeking and response to symptoms, and how these factors contribute to delay. This current study showed that there were many similarities between the two different contexts (emergency and non-emergency). These findings can be used to produce health promotion literature to encourage early help-seeking for non-emergency CHD in the RACPC context in both men and women. The output of the current research makes a contribution to practice in my profession through the development of a lay patient resource to promote help-seeking in the RACPC context

Stain, Stanley

https://dh.howard.edu/prom_corres/1136/thumbnail.jp

Tracking the Trickster: Critical Comparison of Ancient Greek, African, and African-American Trickster Figures and Myths

From the Washington University Senior Honors Thesis Abstracts (WUSHTA), Spring 2018. Published by the Office of Undergraduate Research. Joy Zalis Kiefer, Director of Undergraduate Research and Associate Dean in the College of Arts & Sciences; Lindsey Paunovich, Editor; Helen Human, Programs Manager and Assistant Dean in the College of Arts and Sciences Mentor: Timothy Moor

Gender comparisons in non-acute cardiac symptom recognition and subsequent help-seeking decisions: a mixed methods study protocol

Introduction: Coronary heart disease (CHD) is one of the leading causes of death in both men and women worldwide. Despite the common misconception that CHD is a ‘man's disease’, it is now well accepted that women endure worse clinical outcomes than men following CHD-related events. A number of studies have explored whether or not gender differences exist in patients presenting with CHD, and specifically whether women delay seeking help for cardiac conditions. UK and overseas studies on help-seeking for emergency cardiac events are contradictory, yet suggest that women often delay help-seeking. In addition, no studies have looked at presumed cardiac symptoms outside an emergency situation. Given the lack of understanding in this area, an explorative qualitative study on the gender differences in help-seeking for a non-emergency cardiac events is needed. Methods and analysis: A purposive sample of 20–30 participants of different ethnic backgrounds and ages attending a rapid access chest pain clinic will be recruited to achieve saturation. Semistructured interviews focusing on help-seeking decision-making for apparent cardiac symptoms will be undertaken. Interview data will be analysed thematically using qualitative software (NVivo) to understand any similarities and differences between the way men and women construct help-seeking. Findings will also be used to inform the preliminary development of a cardiac help-seeking intentions questionnaire. Ethics and dissemination: Ethical approvals were sought and granted. Namely, the University of Westminster (sponsor) and St Georges NHS Trust REC, and the Trust Research and Development Office granted approval to host the study on the Queen Mary's Roehampton site. The study is low risk, with interviews being conducted on hospital premises during working hours. Investigators will disseminate findings via presentations and publications. Participants will receive a written summary of the key findings

An Exploration of the Help-Seeking Experiences of Patients in an Allied Professions-Led Rapid Access Chest Pain Pathway – A Qualitative Study

Objective: A number of studies have explored delayed help-seeking practices for acute coronary syndrome (ACS) and have cited multiple intersecting factors which may play a role (e.g. attributing symptoms, age, gender, ethnicity and contextual influences). However, the pathway to diagnosis for suspected Coronary Heart Disease (CHD) symptoms in a Rapid Acess Chest Pain Clinic (RACPC) context is underexplored. The objective of this study was to explore patients’ help-seeking experiences of accessing RACPC services: from the point at which they notice and interpret symptoms to their decision to seek help from their GP, attend a RACPC, and receive a diagnosis Design: Qualitative study Setting: Interviews were conducted in RACPC at Queen Mary’s Roehampton Hospital, London, United Kingdom Participants: Maximium Variation sampling was used to recruit 30 participants referred to a RACPC, including 15 men and 15 women utilising sampling dimensions of age, ethnicity and occupation. Methods: Semi-structured interviews that focused on the patient experience of their pathway to diagnosis in RACPC. Thematic analysis was used to interpret the interview data. Results: The interpretation of symptoms was shaped by multiple factors; reluctance to seek help contributed to delay; with various factors acting as drivers as well as barriers to help-seeking; and referrals to RACPC were based on symptoms as well as patient need reassurance. Conclusion: We found complex issues shaped the patient decision-making when accessing the RACPC, including making sense of symptoms and help-seeking practices. These findings can be used to develop health promotion literature to encourage early help-seeking and improve of RACPC services

Slow-release RGD-peptide hydrogel monoliths

We report on the formation of hydrogel monoliths formed by functionalized peptide Fmoc-RGD (Fmoc: fluorenylmethoxycarbonyl) containing the RGD cell adhesion tripeptide motif. The monolith is stable in water for nearly 40 days. The gel monoliths present a rigid porous structure consisting of a network of peptide fibers. The RGD-decorated peptide fibers have a β-sheet secondary structure. We prove that Fmoc-RGD monoliths can be used to release and encapsulate material, including model hydrophilic dyes and drug compounds. We provide the first insight into the correlation between the absorption and release kinetics of this new material and show that both processes take place over similar time scales

Pengembangan Materi Ajar Bahasa Inggris untuk Agen Travel (Sebuah Kajian English for Occupational Purposes)

This study is an effort to fulfill a need for appropriate English materials for the travel agent. The aims of this study are to design English materials for the travel agent as well as to validate English materials for the travel agent. This study used Research & Development method which was conducted in three stages; namely the exploration stage, prototype development stage, and experts’ validation stage. The data were collected from in-depth interview, document analysis, and expert judgment. The data were then analyzed using descriptive-qualitative and interactive analysis.The results of the research indicated that the English materials for the travel agent were really needed. The materials needed include daily conversation, focusing on speaking skill, informal classroom atmospheres, and no homework. Meanwhile, in the prototype development stage, the draft of the English materials for the travel agent was designed using functional-based, authentic and semi-authentic materials, and cultivating character building. Finally, the results of experts’ judgment showed that English materials for the travel agent textbook was valid.These findings recommend that the English materials for the travel agent are urgently be implemented in order to give an excellent service to the public.Keywords: materi ajar, travel agen, EO

Analisis Sistem Pemilihan Rektor Dengan Metode AHP (Analitycal Hierarchy Process) ( Studi kasus: Sekolah Tinggi Agama Islam Pamekasan )

Abstract - Selection of Rector of Islamic University Pamekasan routinely done in 4 years once the process through the Senate by way of consensus. If the proceedings did not reach consensus then it will be voting. With the objectivity of the electoral system against the consensus figure of prospective low. While the voting system will bring friction due to a conflict of interest. To overcome this problem should be a system that is Rector of the electoral system. Rector Election Systems with AHP method. AHP method is a method that calculates the value of the ratio in determining the priority ranking candidates produce Rector.Keywords: Priority, AHP, Analitycal, Hierarchy, Election, Chancellor Abstrak - Pemilihan Rektor Sekolah Tinggi Agama Islam Pamekasan rutin dilakukan dalam 4 tahun sekali yang prosesnya melalui senat dengan cara musyawarah mufakat. Jika pada proses sidang tidak mencapai mufakat maka akan dilakukan voting. Dengan sistem pemilihan musyawarah mufakat objektifitas terhadap sosok calon rendah. Sedangkan dengan sistem voting akan memunculkan gesekan-gesekan akibat konflik kepentingan. Untuk mengatasi masalah tersebut harus adanya sistem yaitu sistem pemilihan Rektor. Sistem Pemilihan Rektor dengan Metode AHP. Metode AHP merupakan metode yang menghitung nilai rasio dalam menentukan prioritas yang menghasilkan rangking kandidat Rektor.Keywords: Prioritas, AHP, Analitycal,Hierarchy, Pemilihan, Rekto

In vivo label-free mapping of the effect of a photosystem II inhibiting herbicide in plants using chlorophyll fluorescence lifetime

Background In order to better understand and improve the mode of action of agrochemicals, it is useful to be able to visualize their uptake and distribution in vivo, non-invasively and, ideally, in the field. Here we explore the potential of plant autofluorescence (specifically chlorophyll fluorescence) to provide a readout of herbicide action across the scales utilising multiphoton-excited fluorescence lifetime imaging, wide-field single-photon excited fluorescence lifetime imaging and single point fluorescence lifetime measurements via a fibre-optic probe. Results Our studies indicate that changes in chlorophyll fluorescence lifetime can be utilised as an indirect readout of a photosystem II inhibiting herbicide activity in living plant leaves at three different scales: cellular (~μm), single point (~1 mm2) and macroscopic (~8 × 6 mm2 of a leaf). Multiphoton excited fluorescence lifetime imaging of Triticum aestivum leaves indicated that there is an increase in the spatially averaged chlorophyll fluorescence lifetime of leaves treated with Flagon EC—a photosystem II inhibiting herbicide. The untreated leaf exhibited an average lifetime of 560 ± 30 ps while the leaf imaged 2 h post treatment exhibited an increased lifetime of 2000 ± 440 ps in different fields of view. The results from in vivo wide-field single-photon excited fluorescence lifetime imaging excited at 440 nm indicated an increase in chlorophyll fluorescence lifetime from 521 ps in an untreated leaf to 1000 ps, just 3 min after treating the same leaf with Flagon EC, and to 2150 ps after 27 min. In vivo single point fluorescence lifetime measurements demonstrated a similar increase in chlorophyll fluorescence lifetime. Untreated leaf presented a fluorescence lifetime of 435 ps in the 440 nm excited chlorophyll channel, CH4 (620–710 nm). In the first 5 min after treatment, mean fluorescence lifetime is observed to have increased to 1 ns and then to 1.3 ns after 60 min. For all these in vivo plant autofluorescence lifetime measurements, the plants were not dark-adapted. Conclusions We demonstrate that the local impact of a photosystem II herbicide on living plant leaves can be conveniently mapped in space and time via changes in autofluorescence lifetime, which we attribute to changes in chlorophyll fluorescence. Using portable fibre-optic probe instrumentation originally designed for label-free biomedical applications, this capability could be deployed outside the laboratory for monitoring the distribution of herbicides in growing plants

Mass spectrometry imaging of glucosinolates in arabidopsis flowers and siliques

Glucosinolates are multi-functional plant secondary metabolites which play a vital role in plant defence and are, as dietary compounds, important to human health and livestock well-being. Knowledge of the tissue-specific regulation of their biosynthesis and accumulation is essential for plant breeding programs. Here, we report that in Arabidopsis thaliana, glucosinolates are accumulated differentially in specific cells of reproductive organs. Using matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI), distribution patterns of three selected compounds, 4-methylsulfinylbutyl (glucoraphanin), indol-3-ylmethyl (glucobrassicin), and 4-benzoyloxybutyl glucosinolates, were mapped in the tissues of whole flower buds, sepals and siliques. The results show that tissue localization patterns of aliphatic glucosinolate glucoraphanin and 4-benzoyloxybutyl glucosinolate were similar, but indole glucosinolate glucobrassicin had different localisation, indicating a possible difference in function. The high resolution images obtained by a complementary approach, cryo-SEM Energy Dispersive X-ray analysis (cryo-SEM-EDX), confirmed increased concentration of sulphur in areas with elevated amounts of glucosinolates, and allowed identifying the cell types implicated in accumulation of glucosinolates. High concentration of sulphur was found in S-cells adjacent to the phloem in pedicels and siliques, indicating the presence of glucosinolates. Moreover, both MALDI MSI and cryo-SEM-EDX analyses indicated accumulation of glucosinolates in cells on the outer surface of the sepals, suggesting that a layer of glucosinolate-accumulating epidermal cells protects the whole of the developing flower, in addition to the S-cells, which protect the phloem. This research demonstrates the high potential of MALDI MSI for understanding the cell-specific compartmentation of plant metabolites and its regulation