Nurses' views of using computerized decision support software in NHS Direct

Background. Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. Aims. To explore nurses' views of their roles and the computerized decision support software in NHS Direct. Methods. Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. Findings. Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. Conclusions. The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice

Empirically based assessment and taxonomy of psychopathology: Cross-cultural applications. A review

This paper provides an overview of empirically based assessment and taxonomy, as illustrated by cross-cultural research on psychopathology. The empirically based approach uses standardized assessment procedures to score behavioral and emotional problems from which syndromes are derived by multivariate analyses. Items and syndromes are scored quantitatively to reflect the degree to which individuals manifest them, as reported by particular informants. Although the approach to assessing problems and to constructing taxonomic groupings differs from the ICD/DSM approach, there are no inherent contradictions between either their models for disorders nor the criterial features used to define disorders. Cross-cultural comparisons have yielded relatively small differences in problem rates and syndrome structure, plus considerable similarity in associations of problems with sex and SES, as well as similar correlations between reports by different types of informants. Research on variations in problems in relation to culture, sex, age, SES, and type of informant can contribute to improving both the ICD/DSM and empirically based approaches and to a more effective synthesis between them

Survey of herbicide-resistant wild oat (Avena fatua L.) in two townships in Saskatchewan

Non-Peer ReviewedThe objective of this study was to determine the nature and occurrence of herbicide resistance in wild oat in the Grassland and Parkland regions of Saskatchewan in 1997, based on a systematic survey of fields in two randomly selected townships. The survey found that: 1) over one-half of fields in both townships had populations resistant to Group 1, 2, and/or 8 herbicides; 2) fields in the Parkland township had higher mean levels of Group 1 resistance (% resistant seeds) than fields in the Grassland township, suggesting they were subjected to more Group-1 herbicide applications; and 3) single- (Groups 1, 2, or 8) and multiple-group resistance (1,2; 1,8; 2,8; 1,2,8) were exhibited in populations in fields in both townships. The proportion of fields with populations exhibiting Group 1 (single) resistance was higher, and Group 2 and Groups 1,2 resistance were lower in the Parkland compared to that in the Grassland township. In both townships, farmers with more land (within the township or total farmed) tended to have a greater proportion of that land infested with Group 1- or 2-resistant wild oat compared to those with less land. The nature of resistance in wild oat populations in Saskatchewan is more diverse, differences in distribution and abundance of resistant biotypes between Grassland and Parkland regions are generally less apparent, and occurrence of resistance is more prevalent than previously documented

Problems reported by parents of children in multiple cultures: the Child Behavior Checklist syndrome constructs

OBJECTIVE: The purpose of this study was to compare syndromes of parent-reported problems for children in 12 cultures. METHOD: Child Behavior Checklists were analyzed for 13,697 children and adolescents, ages 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States. RESULTS: Comparisons of nine cultures for subjects ages 6 through 17 gave medium effect sizes for cross-cultural variations in withdrawn and social problems and small effect sizes for somatic complaints, anxious/depressed, thought problems, attention problems, delinquent behavior, and aggressive behavior. Scores of Puerto Rican subjects were the highest, whereas Swedish subjects had the lowest scores on almost all syndromes. With great cross-cultural consistency, girls obtained higher scores than boys on somatic complaints and anxious/depressed but lower scores on attention problems, delinquent behavior, and aggressive behavior. Although remarkably consistent across cultures, the developmental trends differed according to syndrome. Comparison of the 12 cultures across ages 6 through 11 supported these results. CONCLUSIONS: Empirically based assessment in terms of Child Behavior Checklist syndromes permits comparisons of problems reported for children from diverse cultures

Presence of nitrites, nitrates, nitrosamines in the eggs of Intensively raised layers in Abeokuta, Nigeria

In this study, the presence and concentrations of nitrosamines and their precursors  (nitrates and nitrites) in raw table eggs obtained from four layer-farms in Abeokuta,  were analysed. Nitrosamines are highly toxic and carcinogenic group of chemicals that have the potential to be formed in the body through a process called nitrosation.  Nitrates and nitrites react under acidic and /or high temperature conditions with  nitrosable substrates usually secondary amines to form several of hundreds of  N-nitroso amine compounds known. A spectrophotometric method was used to assay for nitrosamines and their precursors in eggs (n=5 from each farm), entailing separate analysis of each egg yolk and albumen. The three compounds measured, were detected in all the samples. The nitrates and nitrites levels were significantly higher in the yolk than in the albumen (P<0.05). However, there was no significant correlation observed between the levels of nitrosamines and its precursors in the eggs (P<0.05). Findings from this study reveals that nitrosamines and their precursors are present in eggs from these layer farms. These compounds can be potentially toxic, thus constituting a hazard to human and animal health.Key words: Carcinogenesis, eggs, layers, nitrates, nitrites, nitrosamines

The views of children and young people on the use of silk garments for the treatment of eczema: a nested qualitative study within the CLOTHES randomised controlled trial

Background: Many children suffer with skin diseases, but to date, most dermatological research has been done ‘on’ rather than ‘with’ children; in this study we actively sought the experiences of children and young people. Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on health and wellbeing for children and their families. The role of specialist clothing in the management of AE is poorly understood. Objectives: The aim of this study, which was nested in a randomised controlled trial was to qualitatively examine child participants’ experiences of using silk garments for the treatment of AE. Methods: Eighteen children aged 5-15, who took part in the CLOTHES trial, participated in age-appropriate individual interviews or focus groups. Results: Thematic analysis generated 4 themes directly related to the garments: i) expectations of the garments; ii) wearing the silk garments; iii) did they help? and iv) thoughts about the garments. The conclusions from this nested qualitative study are that: there was some limited improvement in eczema for some children but that the hoped for ‘miracle cure’ did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged. Conclusion: Engaging children in the evaluation of the garments provided first hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options

Hexamethonium produces both twitch and tetanic depression without fade in common African toad (Bufo regularis)

The study was designed to investigate the nature of the cholinoceptors at the sciatic nervegastrocnemius muscle junction of the common African toad (Bufo regularis). Using myographic technique, the twitch properties of the sciatic-gastrocnemius muscle preparation of the common African toad was studied. Both the twitch height and peak tetanic height were measured as a percentage of control. Hexamethonium at a concentratration of 0.1mM significantly (

Childhood Internalizing and Externalizing Problems Predict the Onset of Clinical Panic Attacks over Adolescence: The TRAILS Study

Background: Panic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence. Method: This study is part of the TRacking Adolescents' Individual Lives Survey (TRAILS), a Dutch longitudinal population cohort study (N = 1,584). Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR) and the parent-report Child Behavior Checklist (CBCL) at baseline (age 10-12). At age 18-20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI). We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10-20 years, using survival analysis in univariate and multivariate models. Results: There were N = 314 (19.8%) cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2%) who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05), and YSR Thought Problems (HR 1.15, p<.05) and Social Problems (HR 1.26, p<.01) predicted panic attack onset. Conclusion: Risk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence