A mixed methods investigation of parental factors in non-attendance at general paediatric hospital outpatient appointments

Non-attendance at paediatric outpatient appointments results in delayed diagnosis and treatment, putting children at risk of avoidable ill health, and incurring considerable health service costs. Links between missed appointments and clinical, socio-demographic, and access-related factors have been indicated, but parental cognitions associated with non-attendance have yet to be investigated. The aims of this project were to evaluate the effectiveness and theoretical bases of existing interventions designed to reduce non-attendance; to consider the ways in which missed appointments are managed by healthcare providers; to explore parents’ beliefs and experiences of attending and missing appointments; and to investigate the factors underlying these beliefs. A systematic literature review focusing on non-attendance interventions was conducted Within a mixed methods framework, interviews were conducted with healthcare professionals, subsequent interviews were conducted with parents who had attended or missed a General Paediatric outpatient appointment, and a cross-sectional questionnaire study of parents’ beliefs was implemented. The systematic review revealed that text message appointment reminders are effective at reducing non-attendance rates, but that no interventions have thus far been developed using theories of behaviour. Healthcare professionals recognised both barriers and parents’ beliefs as influences on attendance, but also believed there were ‘types’ of families who miss appointments. Healthcare professionals disagreed somewhat about how non-attendance should best be managed. The parent interview study found six themes. The findings reflect parents’ perceptions about the importance of attending and of their ability to attend. The results of the questionnaire study corroborate this structure of beliefs as the analysis produced two factors, the perceived ‘worth’ of attending and anticipated ‘worry’ when attending. This thesis demonstrates an original approach to investigating non-attendance at children’s outpatient appointments, using mixed methods and adopting a psychological rather than service-use perspective. The findings contribute to Health Psychology theory and offer recommendations for healthcare providers

The Complexity of the List Partition Problem for Graphs

The k-partition problem is as follows: Given a graph G and a positive integer k, partition the vertices of G into at most k parts A1, A2, . . . , Ak, where it may be specified that Ai induces a stable set, a clique, or an arbitrary subgraph, and pairs Ai, Aj (i≠j) be completely nonadjacent, completely adjacent, or arbitrarily adjacent. The list k-partition problem generalizes the k-partition problem by specifying for each vertex x, a list L(x) of parts in which it is allowed to be placed. Many well-known graph problems can be formulated as list k-partition problems: e.g., 3-colorability, clique cutset, stable cutset, homogeneous set, skew partition, and 2-clique cutset. We classify, with the exception of two polynomially equivalent problems, each list 4-partition problem as either solvable in polynomial time or NP-complete. In doing so, we provide polynomial-time algorithms for many problems whose polynomial-time solvability was open, including the list 2-clique cutset problem. This also allows us to classify each list generalized 2-clique cutset problem and list generalized skew partition problem as solvable in polynomial time or NP-complete

Physical activity and sedentary behaviour and their associations with clinical measures in axial spondyloarthritis

Engaging in physical activity (PA) is a key aspect in the management of axial spondyloarthritis (axial SpA), however, its relationship with clinical measures is unknown. Previous research has mainly focused on subjective methods of measuring PA and sedentary behaviour (SB). The aim of this study was to explore the associations between objectively measured PA and SB with clinical measures in people with established axial SpA. Fifty participants were recruited from secondary-care rheumatology outpatient services in Glasgow, UK. Clinical measures collected included; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQOL) and the Six Minute Walk Test (6MWT). PA and SB were measured using the activPAL3 tri-axial accelerometer. Data from forty-five participants were included (23 males, average age 49 ± 12 years). Participants accumulated an average of 93.2 ± 41.5 min/day walking with an average of 7200 ± 3397 steps/day. The majority of the day (65%) was spent sitting, accumulated in prolonged bouts. Walking time and steps taken/day were associated with better BASFI (r = − 0.395, p = 0.007 and r = − 0.404, p = 0.006), ASQOL (r = − 0.375, p = 0.011 and r = − 0.361, p = 0.015) and 6MWT (r = 0.396, p = 0.007 and r = 0.421, p = 0.004); while longer walking events were associated with better BASMI (rho = − 0.352, p = 0.018), BASFI (rho = − 0.316, p = 0.034) and 6MWT (rho = 0.404, p = 0.006). SB was associated with worse ASQOL (r = 0.380, p = 0.010) and 6MWT (6MWT, r = − 0.357, p = 0.016). In people with axial SpA PA is associated with better function, exercise capacity and spinal mobility, while SB is associated with lower exercise capacity and poor quality of life. These findings support the promotion of PA and reduction of SB in people with axial SpA

MF2278

Sponsored by: K-State Research and Extension, Community Health in cooperation with the Kansas Department of Health and Environment Bureau of Disease Control, Operation Immunize.Cameron Ruttman et al., Making immunizations easier: a guide for reducing your child’s fear, Kansas State University, August 1997

School media specialist and school technology specialist: partners in information technology?

Public schools in North Carolina are experiencing a dramatic increase in the availability of technology. This phenomenon has changed the role of the media specialist and, for some school systems, created a new specialty, the technology specialist. This study examines the role of the school media specialist and the technology specialist in supporting information technology within North Carolina public schools and identifies areas of overlap. One area of strong overlap identified within this study is support for students using technology. Factors that enhance or inhibit collaboration between these two "information educators" (Pappas & Tepe, 1995) are also identified. Three factors identified as enhancements to collaboration include available planning time, previous experience collaborating, and professional development as a team. It is hoped that continued research on the emerging roles of these two information specialists will foster greater recognition of their shared goals and the beginnings of a strong collaborative relationship

Role of lipid peroxidation and antioxidant enzymes in omega 3 fatty acids induced suppression of breast cancer xenograft growth in mice

BACKGROUND: Supplementing mice with high levels of dietary n-3 polyunsaturated fatty acids (PUFAs) increases the n-3 PUFAs in cell membranes, increases the susceptibility of the cells for lipid peroxidation (LPO) and decreases the growth rate of mammary and other tumors. However, the results of an earlier study indicated that a factor in addition to LPO was involved in the reduction in tumor growth in n-3 PUFAs fed mice. Athymic mice bearing MDA-MB-231 human breast carcinoma xenografts, were fed fish oil concentrate (FOC) or control diets, with and without supplemental Vitamin E (2000 IU /kg diet) and were sacrificed both before and after doxorubicin (DOX) treatment to evaluate factors involved in tumor growth suppression. RESULTS: Prior to DOX, basal LPO in the tumor of 3% FOC fed mice was slightly higher than in the control fed mice and was decreased in mice consuming FOC with vitamin E. Vitamin E suppressed the DOX induced increase in LPO in the tumors of control mice, however, vitamin E was not sufficient to suppress a DOX induced increase in LPO in the tumors of FOC fed mice. The mean growth rate of tumors of FOC fed mice was significantly less than the mean growth rate of the tumors of control mice. Multiple regression analyses indicated that suppression of glutathione peroxidase (GPX) activity by FOC prior to DOX therapy was more important than increased LPO as an explanation of tumor growth suppression. Tumor induced cachexia was decreased in mice consuming FOC. CONCLUSIONS: It appears that the increased sensitivity to DOX was related to an FOC induced reduction in GPX activity. FOC reduced tumor induced cachexia

Rituals surrounding the care of the dying previable baby in labour ward: a critical interpretive synthesis of the literature

The thesis begins with an exploration of my experiences of caring for dying babies which considers the way in which the care given to dying babies differs according to the care environment. This sets the scene for an exploration of rituals surrounding their care. Critical Interpretive Synthesis was selected as a research design for the study because it offered the opportunity to take an interpretive approach to a range of data and allowed the creation of new arguments. Documentary data including professional literature, professional textbooks and professional guidelines were analysed and interpreted using methods which guideline analysis, critical appraisal and rhetorical analysis. The diverse range of analyses facilitated both the rigour and meaning of the data to interrogated. Performance Theory was used as the theoretical framework in the thesis to allow the rituals to be revealed and explored as dramatic performances. The thesis demonstrated that the origin of the rituals was rooted in the need for the baby to be treated with compassion and dignity and to provide parents with the opportunity to form meaningful attachments in the brief period between the previable baby’s birth and death. The rituals were devised by parents who had been bereaved and were incorporated into guidelines. The guidelines practised the rhetoric of choice but the data demonstrated that the rituals appear to have been adopted as routines which were then used indiscriminately, robbing them of their meaning.The findings reveal how care to meet the physical needs of the dying previable baby requires to be made more explicit to enable the ideology and of ‘comfort care’ to be realised in practice. The thesis also demonstrated a need for inclusiveness to represent the spectrum of parents affected by the death of a previable baby when researching perinatal loss and formulating policy.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Role of Lipid Peroxidation and Antioxidant Enzymes in Omega 3 Fatty Acids Induced Suppression of Breast Cancer Xenograft Growth in Mice

Background: Supplementing mice with high levels of dietary n-3 polyunsaturated fatty acids (PUFAs) increases the n-3 PUFAs in cell membranes, increases the susceptibility of the cells for lipid peroxidation (LPO) and decreases the growth rate of mammary and other tumors. However, the results of an earlier study indicated that a factor in addition to LPO was involved in the reduction in tumor growth in n-3 PUFAs fed mice. Athymic mice bearing MDA-MB-231 human breast carcinoma xenografts, were fed fish oil concentrate (FOC) or control diets, with and without supplemental Vitamin E (2000 IU /kg diet) and were sacrificed both before and after doxorubicin (DOX) treatment to evaluate factors involved in tumor growth suppression. Results: Prior to DOX, basal LPO in the tumor of 3% FOC fed mice was slightly higher than in the control fed mice and was decreased in mice consuming FOC with vitamin E. Vitamin E suppressed the DOX induced increase in LPO in the tumors of control mice, however, vitamin E was not sufficient to suppress a DOX induced increase in LPO in the tumors of FOC fed mice. The mean growth rate of tumors of FOC fed mice was significantly less than the mean growth rate of the tumors of control mice. Multiple regression analyses indicated that suppression of glutathione peroxidase (GPX) activity by FOC prior to DOX therapy was more important than increased LPO as an explanation of tumor growth suppression. Tumor induced cachexia was decreased in mice consuming FOC. Conclusions: It appears that the increased sensitivity to DOX was related to an FOC induced reduction in GPX activity. FOC reduced tumor induced cachexia

Dietary Fish Oil Sensitizes A549 Lung Xenografts to Doxorubicin Chemotherapy

A549 xenografts were allowed to grow in nude mice to about 5 mm in diameter, then diets were changed to modified AIN-76 diets containing 19% wt/wt. fish oil (FO) or 20% wt./wt. com oil (CO). Ten days later dietary ferric citrate (0.3% wt./dry wt.) was added and doxoribicin (DOX) treatment (3.6 mg/kg i.v. each of the 5 days for 18 days) commenced. Treatment with DOX halted the growth of tumors in the CO fed mice. However, in those mice, which consumed FO or FO with ferric citrate, treatment with DOX caused significant tumor regression

Endothelial cell pseudopods and angiogenesis of breast cancer tumors

BACKGROUND: A neoplastic tumor cannot grow beyond a millimeter or so in diameter without recruitment of endothelial cells and new blood vessels to supply nutrition and oxygen for tumor cell survival. This study was designed to investigate formation of new blood vessels within a human growing breast cancer tumor model (MDA MB231 in mammary fat pad of nude female mouse). Once the tumor grew to 35 mm(3), it developed a well-vascularized capsule. Histological sections of tumors greater than 35 mm(3 )were stained with PAS, with CD-31 antibody (an endothelial cell maker), or with hypoxia inducible factor 1α antibody (HIF). The extent of blood vessel and endothelial cell pseudopod volume density was measured by ocular grid intercept counting in the PAS stained slides. RESULTS: The tumor area within 100–150 μm of the well-vascularized capsule had few blood vessels and only occasional endothelial cell pseudopods, whereas the area greater than 150 μm from the capsule had more blood vessels, capillaries, and a three-fold increase in volume density of pseudopods sprouting from the capillary endothelial cells. This subcortical region, rich in pseudopods, some of which were observed to have vacuoles/lumens, was strongly positive for presence of HIF. In some larger tumors, pseudopods were observed to insinuate for mm distances through hypoxic regions of the tumor. CONCLUSION: The positive correlation between presence of HIF and the increased extent of pseudopods suggests volume density measure of the latter as a quantifiable marker of tumor hypoxia. Apparently, hypoxic regions of the tumor produce HIF leading to production of vascular endothelial growth factors that stimulate sprouting of capillary endothelial cells and formation of endothelial cell pseudopods