The perceived benefits and challenges of attending a Death Review meeting from an interdisciplinary perspective.

Background: The principles and philosophy of palliative care are grounded in person-centred and family-centred care. Clinical practice in caring for individuals who are dying, and their families, is complex. In an attempt to guide this practice, numerous theoretical approaches have been developed to assist in understanding the various considerations and challenges encountered by dying patients and their families. Health care professionals encounter many challenges themselves—particularly in relation to pain and symptom management, psychosocial and spiritual care—while also attempting to protect themselves in the midst of complex caring, grief and loss. Reflective practice, in the form of Death Reviews, provides an ideal forum for interdisciplinary team members to examine the intricacies of caring, so that the practices of end of life care can be enhanced. Aim: The primary aim of this study is to gain an understanding of the lived experience of two Irish interdisciplinary Community Palliative Care teams’ perceptions of attending a monthly Death Review meeting. Methodology: A qualitative approach, specifically Interpretive Phenomenological Analysis was used in this study. Semi-structured interviews were utilised to extrapolate participants’ experiences. Results: The findings suggest that all ten participants could see the benefit of this type of reflective practice meeting. One out of the ten participants did not feel that it was beneficial personally, but could see the benefit for others on the team. Lack of participation and time constraints were perceived as challenges associated with Death Reviews. Conclusion: Death reviews provide a useful forum to reflect on practice and remember and acknowledge the patients and families who have died. They also bring a sense of closure, while highlighting the importance of self-care when caring for individuals who are dying and their families. Diverse coping mechanisms with regard to responding to exposure to death and dying emerged from the findings. The importance of learning from our experiences was highlighted in this study with the ultimate aim of improving patient care

The perceived benefits and challenges of attending a Death Review meeting from an interdisciplinary perspective.

Background: The principles and philosophy of palliative care are grounded in person-centred and family-centred care. Clinical practice in caring for individuals who are dying, and their families, is complex. In an attempt to guide this practice, numerous theoretical approaches have been developed to assist in understanding the various considerations and challenges encountered by dying patients and their families. Health care professionals encounter many challenges themselves—particularly in relation to pain and symptom management, psychosocial and spiritual care—while also attempting to protect themselves in the midst of complex caring, grief and loss. Reflective practice, in the form of Death Reviews, provides an ideal forum for interdisciplinary team members to examine the intricacies of caring, so that the practices of end of life care can be enhanced. Aim: The primary aim of this study is to gain an understanding of the lived experience of two Irish interdisciplinary Community Palliative Care teams’ perceptions of attending a monthly Death Review meeting. Methodology: A qualitative approach, specifically Interpretive Phenomenological Analysis was used in this study. Semi-structured interviews were utilised to extrapolate participants’ experiences. Results: The findings suggest that all ten participants could see the benefit of this type of reflective practice meeting. One out of the ten participants did not feel that it was beneficial personally, but could see the benefit for others on the team. Lack of participation and time constraints were perceived as challenges associated with Death Reviews. Conclusion: Death reviews provide a useful forum to reflect on practice and remember and acknowledge the patients and families who have died. They also bring a sense of closure, while highlighting the importance of self-care when caring for individuals who are dying and their families. Diverse coping mechanisms with regard to responding to exposure to death and dying emerged from the findings. The importance of learning from our experiences was highlighted in this study with the ultimate aim of improving patient care

Undergraduate experiences with and attitudes toward international teaching assistants

Since the mid-1980s, controversy has surrounded the issue of undergraduate instruction at large research universities by teaching assistants who are not native speakers of English and who have received their undergraduate training outside the United States. Despite administrative endorsement of the importance of diversity on campus, the interaction between undergraduates and teaching assistants from abroad (now commonly called international teaching assistants or ITAs ) is a strained one, often threatened by misunderstandings and miscommunication;The current study used a survey, Questionnaire about International Teaching Assistants (QUITA), developed by Fox (1991), to collect background information about undergraduate students; inquire about their depth of experience with ITAs; and assess their attitudes toward teaching by ITAs, their cross-cultural awareness, and their willingness to take some of the responsibility for the interaction in ITA classes. The survey was administered in 62 sections of required communication courses (n = 1,819). A subset of survey respondents participated in focus group interviews (n = 20) in which they discussed their experiences with ITAs and offered opinions about how ITAs could be better prepared and how they would rank the ITA issue in a list of other possible academic problems;This study was modeled on an earlier Ph.D. investigation by Wanda Fox (August 1991, Purdue University). Findings at Iowa State University were compared with Fox\u27s data and many similarities found. Over 72% of undergraduates in the sample had had courses with one or more ITAs. Based on an attitude scale of 21 statements (to be agreed or disagreed with), the effects of 16 student background characteristics (e.g., year of enrollment, academic college, age group, sex, hometown size, etc.) were tested and found to be statistically significant;Synthesis and interpretation of the findings led to recommendations for intervention strategies with undergraduate subsets most likely to encounter ITAs and/or who held negative attitudes toward ITAs. Ideas for future research included a four-year longitudinal study and the replication of the study at universities in different geographical regions

Histidine phosphorylation of P-selectin upon stimulation of human platelets: A novel pathway for activation-dependent signal transduction

AbstractTransient phosphorylation of histidine characterizes the two-component systems in prokaryotes that control important physiological functions, but analogous events have not been implicated in signal transduction in mammalian cells. To explore histidine phosphorylation during activation of human cells, stimulated platelets were analyzed for the formation of protein phosphohistidine in a model system employing P-selectin. P-selectin, a leukocyte adhesion molecule, undergoes rapid phosphorylation and selective dephosphorylation of tyrosine, serine, and threonine. We now establish that phosphorylation following platelet activation with thrombin or collagen generates phosphohistidine at histidines on the cytoplasmic tail of P-selectin. With thrombin stimulation, the kinetics of phosphohistidine appearance and disappearance on P-selectin are very rapid. Platelets exhibit a novel ligand-induced signaling pathway to generate phosphohistidine. These results provide direct biochemical evidence for the induction of rapid and reversible histidine phosphorylation in mammalian cells upon cell activation and represent a novel paradigm for mammalian cell signaling

Comparing treatment fidelity between study arms of a randomized controlled clinical trial for stroke family caregivers

OBJECTIVE: To compare treatment fidelity among treatment arms in the Telephone Assessment and Skill-Building Kit study for stroke caregivers (TASK II) with respect to: 1) protocol adherence; 2) intervention dosage and 3) nurse intervener perspectives. DESIGN: A randomized controlled clinical trial design. SETTING: Urban, community, midwestern United States. SUBJECTS: A total of 254 stroke caregivers (mean ±SD age, 54.4 ±11.8 years), 55 (22.0%) males and 199 (78.4%) females) randomized to the TASK II intervention (n=123) or an Information, Support, and Referral comparison group (n=131). INTERVENTIONS: TASK II participants received the TASK II Resource Guide; Information, Support, and Referral participants received a standard caregiver brochure. At approximately 8 weeks after discharge, both groups received 8 weekly calls from a nurse, with a booster call 4 weeks later. MEASURES: Protocol adherence was evaluated with the TASK II Checklist for Monitoring Adherence. Intervention dosage was measured by the number of minutes caregivers spent reading materials and talking with the nurse. Nurse intervener perspectives were obtained through focus groups. RESULTS: Protocol adherence was 80% for the TASK II and 92% for the Information, Support, and Referral. As expected, intervention dosage differed between TASK II and Information, Support, and Referral with respect to caregiver time spent reading materials (t=-6.49; P<.001) and talking with the nurse (t=-7.38; P<.001). Focus groups with nurses yielded further evidence for treatment fidelity and recommendations for future trials. CONCLUSIONS: These findings substantiate treatment fidelity in both study arms of the TASK II stroke caregiver intervention trial (NIH R01NR010388; ClinicalTrials.govNCT01275495)

Using small-angle X-ray scattering to investigate the compaction behaviour of a granulated clay

The compaction behaviour of a commercial granulated clay (magnesium aluminium smectite, gMgSm) was investigated using macroscopic pressure-density measurements, X-ray diffraction (XRD), scanning electron microscopy (SEM), X-ray microtomography (XμT) and small-angle X-ray scattering (SAXS). This material was studied as a potential compaction excipient for pharmaceutical tabletting, but also as a model system demonstrating the capabilities of SAXS for investigating compaction in other situations. Bulk compaction measurements showed that the gMgSm was more difficult to compact than polymeric pharmaceutical excipients such as spheronised microcrystalline cellulose (sMCC), corresponding to harder granules. Moreover, in spite of using lubrication (magnesium stearate) on the tooling surfaces, rather high ejection forces were observed, which may cause problems during commercial tabletting, requiring further amelioration. Although the compacted gMgSm specimens were more porous, however, they still exhibited acceptable cohesive strengths, comparable to sMCC. Hence, there may be scope for using granular clay as one component of a tabletting formulation. Following principles established in previous work, SAXS revealed information concerning the intragranular structure of the gMgSm and its response to compaction. The results showed that little compression of the intragranular morphology occurred below a relative density of 0 · 6, suggesting that granule rearrangements or fragmentation were the dominant mechanisms during this stage. By contrast, granule deformation became considerably more important at higher relative density, which also coincided with a significant increase in the cohesive strength of compacted specimens. Spatially-resolved SAXS data was also used to investigate local variations in compaction behaviour within specimens of different shape. The results revealed the expected patterns of density variations within flat-faced cylindrical specimens. Significant variations in density, the magnitude of compressive strain and principal strain direction were also revealed in the vicinity of a debossed feature (a diametral notch) and within bi-convex specimens. The variations in compaction around the debossed notch, with a small region of high density below and low density along the flanks, appeared to be responsible for extensive cracking, which could also cause problems in commercial tabletting

Recruitment of Women in the National Children's Study Initial Vanguard Study

The initial Vanguard Study of the National Children's Study was conducted during 2009–2010 in 7 locations in the United States. A goal was to evaluate the feasibility and yield of a household-based sampling design to recruit pregnant women. A multistage area probability sampling design was used to identify study locations (generally, counties) that were subsequently divided into smaller geographical units, termed segments. Between 7 and 18 segments were selected in each location, and dwelling units within segments were listed. A household-based recruitment process was implemented, which included enumeration of households to identify age-eligible women, pregnancy screening to identify pregnant women eligible for immediate enrollment and nonpregnant women for telephone follow-up, and administration of informed consent to eligible women. After a recruitment period of 17–20 months, 67,181 (89%) households were enumerated, which identified 34,172 (88%) age-eligible women to whom the pregnancy screener was administered. Among those who completed the screener, 2,285 women became eligible for enrollment, of whom 1,399 (61%) enrolled. Although response rates were fairly high at initial contact and among pregnant women, the overall yield was lower than anticipated. In particular, telephone follow-up of nonpregnant women was not a practicable strategy for prospective recruitment of newly pregnant women

Association of Accelerometry-Measured Physical Activity and Cardiovascular Events in Mobility-Limited Older Adults: The LIFE (Lifestyle Interventions and Independence for Elders) Study.

BACKGROUND:Data are sparse regarding the value of physical activity (PA) surveillance among older adults-particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. METHODS AND RESULTS:Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home-based activity data were collected by hip-worn accelerometers at baseline and at 6, 12, and 24&nbsp;months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [SD] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500&nbsp;steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84-0.96; P=0.001). At baseline, every 30&nbsp;minutes spent performing activities ≥500&nbsp;counts per minute (hazard ratio, 0.75; confidence interval, 0.65-0.89 [P=0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow-up (6, 12, and 24&nbsp;months), both the number of steps per day (per 500&nbsp;steps; hazard ratio, 0.90, confidence interval, 0.85-0.96 [P=0.001]) and duration of activity ≥500&nbsp;counts per minute (per 30&nbsp;minutes; hazard ratio, 0.76; confidence interval, 0.63-0.90 [P=0.002]) were significantly associated with lower cardiovascular event rates. CONCLUSIONS:Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score &gt;10 on the Short Physical Performance Battery) both using baseline and longitudinal data. CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT01072500