Reflecting on reflections of Reflexive Thematic Analysis (RTA): exemplar experiences and recommendations for new researchers in sport and coaching

There is a growing body of research in sport and sports coaching in particular, being conducted with qualitative methods. Critics have however, identified a philosophical misalignment of methods being used. Many of these studies employ Thematic Analysis (TA) to probe and analyse their data without a clear appreciation of how the different stages of the process associate to the three different TA options: i. Codebook, ii. Reliability Coding, or iii. Reflexive Thematic Analysis. Thus, the purpose of our article is to provide neophyte sports coaching researchers with an in depth understanding of one TA method; Reflexive Thematic Analysis (RTA) and guidance on how to conduct an RTA study that is coherent with the philosophy that underpins it. In doing so, an exemplar of a sports coaching RTA study is provided by the lead author (PhD student) with reflections to illustrate the challenges and learning development that engaging in the RTA study provided. These are supplemented by further reflections on the process by the second author (his PhD supervisor) to further explore related issues to aid the learning process. Consequently, this paper offers an original ‘double hermeneutic’ insight into RTA that in turn provides knowledge and guidance for those considering this method. Recommendations are made to maximise the quality of future studies in sport and coaching and avoid any potential criticism of philosophical misalignmen

Doxycycline inhibits elastin degradation and reduces metalloproteinase activity in a model of aneurysmal disease

AbstractPurpose: Abdominal aortic aneurysms are characterized by degradation of the extracellular matrix, with a reduction in the elastin concentration of the arterial media. These changes are mediated by increased levels of endogenous metalloproteinases (MMPs) within the aorta, which provide a potential therapeutic target for pharmacologic agents aimed at reducing the growth rate of small aneurysms. In this study, the ability of doxycycline—an MMP inhibitor—to reduce matrix degradation was assessed in a previously described model of aneurysmal disease that used a brief pulse of elastase to induce MMP production and elastin degradation in arterial organ cultures. Methods: Porcine aortic segments (n = 8) were preincubated in exogenous pancreatic elastase for 24 hours before culture in standard conditions for 13 days with both 1 and 10 mg/L doxycycline. Control segments were cultured both without doxycycline and without elastase. At the termination of culture, MMPs were extracted from the tissue and quantified by a combination of substrate gel enzymography and immunoblotting. The volume fractions of elastin and collagen were determined by stereologic analysis of sections stained with Miller's elastin and van Gieson's stain. Results: Stereologic analysis demonstrated a significant preservation of elastin in aorta treated with doxycycline 10 mg/L (p < 0.001) and demonstrated that this preservation was accompanied by a significant reduction in MMP-9 activity (p < 0.02). Immunoblotting for tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) showed no decreased production in the doxycycline-treated groups. Conclusions: Therapeutic ranges of doxycycline significantly inhibited elastin degradation and MMP-9 production within aortic organ cultures. These data suggest that doxycycline may have a potential application in reducing the growth rates of small abdominal aortic aneurysms. (J Vasc Surg 1998;27:354-61.

The Cognitive Mediating Process of Diabetes among African-American College Students

Diabetes places a tremendous burden of health inequity on African-American women in the United States. Behavioral risk factors for diabetes underscore the importance of determining to what extent African-American college students are motivated to adhere to protective behaviors that may decrease the likelihood of diabetes onset. The purpose of this study was to evaluate threat and coping appraisal of diabetes among African-American women enrolled in college, using the Protection Motivation Theory (PMT) as a theoretical framework. Questionnaires were administered to 128 African-American women between the ages of 18 and 25 who were enrolled at Florida A & M University, the nation’s largest historically Black university. Bivariate correlations were performed to determine associations involving protection motivation factors (coping and threat appraisals), diabetes knowledge, and demographic characteristics. Statistically significant associations were found between the demographic and knowledge of diabetes variables, and the coping appraisal process. Significant associations were not found with the threat appraisal variables. Furthermore, there was a significant relationship for the maladaptive response of the PMT model between dietary intake levels and perceived severe diabetes threat. For this sample of African-American female students, efforts that articulate active coping strategies may be more effective than those that focus on threat perception. Culturally competent and age appropriate nutrition, physical activity and diabetes education should be increased, given the high percentage of misconceptions about health protection behaviors among study participants. Continuous health education interventions and research focusing on African-American women of college age are needed

Examining the clinical use of hemochromatosis genetic testing

BACKGROUND: Hereditary hemochromatosis leads to an increased lifetime risk for end-organ damage due to excess iron deposition. Guidelines recommend that genetic testing be performed in patients with clinical suspicion of iron overload accompanied by elevated serum ferritin and transferrin saturation levels. OBJECTIVE: To evaluate guideline adherence and the clinical and economic impact of HFE genetic testing. METHODS: The electronic charts of patients submitted for HFE testing in 2012 were reviewed for genetic testing results, biochemical markers of iron overload and clinical history of phlebotomy. RESULTS: A total of 664 samples were sent for testing, with clinical, biochemical and phlebotomy data available for 160 patients. A positive C282Y homozygote or C282Y/H63D compound heterozygote test result was observed in 18% of patients. Patients with an at-risk HFE genotype had significantly higher iron saturation, serum iron and hemoglobin (P\u3c0.001), without higher ferritin or liver enzyme levels. Fifty percent of patients referred for testing did not have biochemical evidence of iron overload (transferrin saturation \u3e45% and ferritin level \u3e300μg/L). Patients were four times more likely to undergo phlebotomy if they were gene test positive (RR 4.29 [95% CI 2.35 to 7.83]; P\u3c0.00001). DISCUSSION: One-half of patients referred for testing did not exhibit biochemical evidence of iron overload. Many patients with biochemical evidence of iron overload, but with negative genetic test results, did not undergo phlebotomy. A requisition to determine clinical indication for testing may reduce the use of the HFE genetic test. Finally, improvement of current genetic test characteristics would improve rationale for the test. CONCLUSION: A significant proportion of hemochromatosis genetic testing does not adhere to current guidelines and would not alter patient management

An Exploratory Study of the Likelihood of Adopting Genetic Counseling and Testing for Lynch Syndrome-related Colorectal Cancer Among Primary Care Physicians in Florida

Genetic counseling and testing for inherited cancer syndromes have the potential to save lives and may be an avenue for addressing health care disparities among African Americans newly diagnosed with colorectal cancer (CRC); and their close relatives. African Americans are more likely to be diagnosed with CRC at younger ages (under age 50 years), and diagnosed at later stages when cancer is more aggressive and difficult to treat, which are factors associated with hereditary cancers such as Lynch syndrome-related CRC. Considering the benefits of genetic testing for hereditary cancer syndromes - risk stratification, preventive surveillance, targeted treatment, and subsequent reduction in morbidity and mortality among patients by up to 60% - it appears that genetic testing may have a role in prevention, early intervention and reduction of CRC disparities in African Americans. Primary care physicians (PCPs), often the access point to the healthcare system, were anticipated to be at the forefront of genetic counseling and testing. However, a growing body of literature indicates that PCPs see genetic testing as the role of a specialist. This quantitative survey research study, based on the constructs of the Diffusion of Innovation Theory (Rogers, 2003), explored the factors which influence the likelihood of adoption of genetic counseling and testing for Lynch syndrome-related colorectal cancer among PCPs in Florida

Exploring the Association of Physician Characteristics to Patient Requests for Genetic Testing

Background: Cancer genomic testing improves health outcomes for individuals at risk, drives cost-efficiency, and facilitates healthcare equity; however, little is known about how physician demographic and practice characteristics influence patient requests for genetic testing. Purpose: To explore whether (and to what extent) physician demographic and practice characteristics are associated with patient requests for cancer genetic testing. Methods: A cross-sectional quantitative design survey was distributed to 1240 primary care physicians registered with the state health department who had active licenses and main practices in Florida. Primary care physicians were defined as those who practice family medicine, internal medicine, obstetrics, and gynecology. The survey tool was developed from a search of the literature and two previously validated surveys. It was administered using a modified Dillmanstrategy. The study sample size was 317 physicians, with an 85% response rate based upon a targeted sample of 372. Statistical calculations were performed using SPSS version 27 and STATA release 17.Results: Logistic regression model found significant associations between patient requests and physicians\u27 race and professional practice size. Physicians identified as White were 1.840 times as likely to have patient requests for genetic testing (p=.036) than physicians whose race was other than White. Physicians whose professional practices were solo or small groups were 2.39 times as likely to have patient requests (p=.001) than physicians affiliated with larger practices. Discussion: Patient requests may be leveraged by physicians, other healthcare providers, and public health professionals; patient requests present a significant opportunity for increasing genetic testing and thus promoting better health outcomes for patients with Lynch syndrome-related colorectal cancer

A FUSE Survey of Interstellar Molecular Hydrogen in the Small and Large Magellanic Clouds

We describe a moderate-resolution FUSE survey of H2 along 70 sight lines to the Small and Large Magellanic Clouds, using hot stars as background sources. FUSE spectra of 67% of observed Magellanic Cloud sources (52% of LMC and 92% of SMC) exhibit absorption lines from the H2 Lyman and Werner bands between 912 and 1120 A. Our survey is sensitive to N(H2) >= 10^14 cm^-2; the highest column densities are log N(H2) = 19.9 in the LMC and 20.6 in the SMC. We find reduced H2 abundances in the Magellanic Clouds relative to the Milky Way, with average molecular fractions = 0.010 (+0.005, -0.002) for the SMC and = 0.012 (+0.006, -0.003) for the LMC, compared with = 0.095 for the Galactic disk over a similar range of reddening. The dominant uncertainty in this measurement results from the systematic differences between 21 cm radio emission and Lya in pencil-beam sight lines as measures of N(HI). These results imply that the diffuse H2 masses of the LMC and SMC are 8 x 10^6 Msun and 2 x 10^6 Msun, respectively, 2% and 0.5% of the H I masses derived from 21 cm emission measurements. The LMC and SMC abundance patterns can be reproduced in ensembles of model clouds with a reduced H2 formation rate coefficient, R ~ 3 x 10^-18 cm^3 s^-1, and incident radiation fields ranging from 10 - 100 times the Galactic mean value. We find that these high-radiation, low-formation-rate models can also explain the enhanced N(4)/N(2) and N(5)/N(3) rotational excitation ratios in the Clouds. We use H2 column densities in low rotational states (J = 0 and 1) to derive a mean kinetic and/or rotational temperature = 82 +/- 21 K for clouds with N(H2) >= 10^16 cm^-2, similar to Galactic gas. We discuss the implications of this work for theories of star formation in low-metallicity environments. [Abstract abridged]Comment: 30 pages emulateapj, 14 figures (7 color), 7 tables, accepted for publication in the Astrophysical Journal, figures 11 and 12 compressed at slight loss of quality, see http://casa.colorado.edu/~tumlinso/h2/ for full version