Basics of research (Part 12): Qualitative research

Although both the assumptions and methods of qualitative and quantitative approaches in nursing research are different, both have the goal of furthering the scientific basis for practice. A variety of qualitative approaches are available, and which approach to use depends on the purpose of the research. In general, qualitative investigations address broad questions related to description, discovery, or theory building, and, as a consequence, the researcher is concerned with the entire context surrounding the phenomenon of interest rather than concentrating on specific variables thought to influence that phenomenon. The type of data collected and the methods of analysis differ, but qualitative research demands the same careful attention to selecting a design appropriate to answer the research question and the same assurance of rigor in conducting the research and interpreting the results as is required in quantitative studies. When these issues are thoroughly addressed, the clinician has a basis for judging both the accuracy and the applicability of qualitative research findings

Recommendations for HER2 testing in the UK

Determining the HER2 status of breast carcinomas is a prerequisite for the use of the monoclonal antibody trastuzumab (Herceptin(R)), which has recently been licensed for the treatment of metastatic disease. This necessitates a test based on archival material. The preferred analyses are immunohistochemistry with fluorescent in situ hybridisation (FISH) as a follow up test for ambiguous results. Guidelines have been developed for standardised, well controlled procedures for the provision of reliable results. A group of three reference laboratories has been established to provide advice, quality assurance, and materials, where needed

Halting indigenous biodiversity decline: ambiguity, equity, and outcomes in RMA assessment of significance

In New Zealand, assessment of ‘significance’ is undertaken to give effect to a legal requirement for local authorities to provide for protection of significant sites under the Resource Management Act (1991). The ambiguity of the statute enables different interests to define significance according to their goals: vested interests (developers), local authorities, and non-vested interests in pursuit of protection of environmental public goods may advance different definitions. We examine two sets of criteria used for assessment of significance for biological diversity under the Act. Criteria adapted from the 1980s Protected Natural Areas Programme are inadequate to achieve the maintenance of biological diversity if ranking is used to identify only highest priority sites. Norton and Roper-Lindsay (2004) propose a narrow definition of significance and criteria that identify only a few high-quality sites as significant. Both sets are likely to serve the interests of developers and local authorities, but place the penalty of uncertainty on non-vested interests seeking to maintain biological diversity, and are likely to exacerbate the decline of biological diversity and the loss of landscape-scale processes required for its persistence. When adopting criteria for assessment of significance, we suggest local authorities should consider whose interests are served by different criteria sets, and who will bear the penalty of uncertainty regarding biological diversity outcomes. They should also ask whether significance criteria are adequate, and sufficiently robust to the uncertainty inherent in the assessment of natural values, to halt the decline of indigenous biological diversity

Development and Validation of eRADAR: A Tool Using EHR Data to Detect Unrecognized Dementia.

ObjectivesEarly recognition of dementia would allow patients and their families to receive care earlier in the disease process, potentially improving care management and patient outcomes, yet nearly half of patients with dementia are undiagnosed. Our aim was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia (EHR Risk of Alzheimer's and Dementia Assessment Rule [eRADAR]).DesignRetrospective cohort study.SettingKaiser Permanente Washington (KPWA), an integrated healthcare delivery system.ParticipantsA total of 16 665 visits among 4330 participants in the Adult Changes in Thought (ACT) study, who undergo a comprehensive process to detect and diagnose dementia every 2 years and have linked KPWA EHR data, divided into development (70%) and validation (30%) samples.MeasurementsEHR predictors included demographics, medical diagnoses, vital signs, healthcare utilization, and medications within the previous 2 years. Unrecognized dementia was defined as detection in ACT before documentation in the KPWA EHR (ie, lack of dementia or memory loss diagnosis codes or dementia medication fills).ResultsOverall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 498 (49%) were unrecognized in the KPWA EHR. The final 31-predictor model included markers of dementia-related symptoms (eg, psychosis diagnoses, antidepressant fills), healthcare utilization pattern (eg, emergency department visits), and dementia risk factors (eg, cerebrovascular disease, diabetes). Discrimination was good in the development (C statistic = .78; 95% confidence interval [CI] = .76-.81) and validation (C statistic = .81; 95% CI = .78-.84) samples, and calibration was good based on plots of predicted vs observed risk. If patients with scores in the top 5% were flagged for additional evaluation, we estimate that 1 in 6 would have dementia.ConclusionThe eRADAR tool uses existing EHR data to detect patients with good accuracy who may have unrecognized dementia. J Am Geriatr Soc 68:103-111, 2019

Geographical information retrieval with ontologies of place

Geographical context is required of many information retrieval tasks in which the target of the search may be documents, images or records which are referenced to geographical space only by means of place names. Often there may be an imprecise match between the query name and the names associated with candidate sources of information. There is a need therefore for geographical information retrieval facilities that can rank the relevance of candidate information with respect to geographical closeness of place as well as semantic closeness with respect to the information of interest. Here we present an ontology of place that combines limited coordinate data with semantic and qualitative spatial relationships between places. This parsimonious model of geographical place supports maintenance of knowledge of place names that relate to extensive regions of the Earth at multiple levels of granularity. The ontology has been implemented with a semantic modelling system linking non-spatial conceptual hierarchies with the place ontology. An hierarchical spatial distance measure is combined with Euclidean distance between place centroids to create a hybrid spatial distance measure. This is integrated with thematic distance, based on classification semantics, to create an integrated semantic closeness measure that can be used for a relevance ranking of retrieved objects

A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first (‘minimal’) step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second (‘expanded’) step assesses the nutritional composition of each organization’s products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third (‘optimal’) step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention

Monitoring the impacts of trade agreements on food environments

The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable ‘minimal’, ‘expanded’ and ‘optimal’ measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition.The following organizations provided funding support for the travel of participants to Italy for this meeting and the preparation of background research papers: The Rockefeller Foundation, International Obesity Taskforce (IOTF), University of Auckland, Deakin University, The George Institute, University of Sydney, Queensland University of Technology, University of Oxford, University of Pennsylvania Perelman School of Medicine, World Cancer Research Fund International, University of Toronto, and The Australian National University. The Faculty of Health at Deakin University kindly supported the costs for open access availability of this paper, and the Australian National Health and Medical Research Council Centre for Research Excellence in Obesity Policy and Food Systems (APP1041020) supported the coordination and finalizing of INFORMAS manuscripts

The RR Lyrae variables and Horizontal Branch of NGC6656 (M22)

The first calibrated broadband UBVI time-series photometry is presented for the RR Lyrae variable stars in NGC6656 (M22), with observations spanning a range of twenty-two years. We have also redetermined the variability types and periods for the RR Lyrae stars identified previously by photographic observations, revising the number of fundamental-mode RR Lyrae variables (RR0) to 10 and the number of first-overtone variables (RR1) to 16. The mean periods of the RR0 and RR1 variables are _{RR0}=0.66 \pm 0.02 d and _{RR1}=0.33 \pm 0.01 d, respectively, supporting an Oosterhoff II classification for the cluster. The number ratio of RR1- to all RR-type variables is N_1/N_{RR}=0.61, also consistent with an Oosterhoff II designation. Both the RR Lyrae stars' minimum light colors and the blue edge of the RR Lyrae instability strip suggest E(B-V)=0.36 \pm 0.02 mag toward M22. Regarding the HB morphology of M22, we find (B-R)/(B+V+R)=+0.97 \pm 0.1 and at least one "gap" located in an unusual part of the blue HB, in the middle of the so-called hot HB stars.Comment: accepted to A

Cluster AgeS Experiment (CASE): RR Lyrae stars from the globular cluster Omega Centauri as standard candles

New photometry of RRab and RRc stars in Omega Cen is used to calibrate their absolute magnitudes M_V as a function of: a) metallicity; and b) the Fourier parameters of light curves in the V band. The zero point of both calibrations relies on the distance modulus to the cluster derived earlier by the CASE project based on observations of the detached eclipsing binary OGLE GC17. For RRab variables we obtained a relation of M_V=(0.26\pm 0.08)[Fe/H]+(0.91\pm 0.13). A dereddened distance modulus to the LMC based on that formula is $\mu_{0}=18.56\pm 0.14$ mag. The second calibration of M_V, which is based on Fourier coefficients of decomposed light curves, results in the LMC distance of $\mu_{0}=18.51\pm 0.07$ mag.Comment: accepted for publication in MNRAS, 13 pages, 8 figure

Correlations in the cotunneling regime of a quantum dot

Off-resonance conductance through weakly coupled quantum dots ("valley conductance") is governed by cotunneling processes in which a large number of dot states participate. Virtually the same states participate in the transport at consecutive valleys, which leads to significant valley-valley conductance correlations. These correlations are calculated within the constant interaction model. Comparison with experiment shows that these correlations are less robust in reality. Among the possible reasons for this is the breakdown of the constant interaction model, accompanied by "scrambling" of the dot as the particle number is varied.Comment: 10 pages, 4 eps-figures; reference adde