Weight control behaviors of highly successful weight loss maintainers: the Portuguese Weight Control Registry

To describe key behaviors reported by participants in the Portuguese Weight Control Registry and to determine associations between these behaviors and weight loss maintenance. A total of 388 adults participated in this cross-sectional study. Assessments included demographic information, weight history, weight loss and weight maintenance strategies, dietary intake, and physical activity. Participants lost on average 18 kg, which they had maintained for ~28 months. Their average dietary intake was 2199 kcal/day, with 33 % of energy coming from fat. About 78 % of participants engaged in levels of moderate-plus-vigorous physical activity exceeding 150 min/week (51 % above 250 min/week), with men accumulating 82 more minutes than women (p < 0.05). The most frequently reported strategies for both weight loss and maintenance were keeping healthy foods at home, consuming vegetables regularly, and having daily breakfast. Greater weight loss maintenance was associated with higher levels of physical activity, walking, weight self-monitoring, establishing specific goals, and with reduced portion size use, reduced consumption of carbohydrates, and increased consumption of protein, (p < 0.05). Results indicate that weight loss maintenance is possible through the adoption of a nutritionally-balanced diet and regular participation in physical activity, but also suggest that adopting different (and, to a degree, individualized) set of behavioral strategies is key for achieving success.

Personality of the caregiver influences the use of strategies to deal with the behavior of persons with dementia

Personality of family caregiver is an important factor influencing the caregiver's burden, depression and distress. We now hypothesized that the personality is associated with specific strategies used by family caregivers to deal with the behavioral and psychological symptoms of demented relatives (BPSD). Participants were 98 consecutive persons with dementia and their family caregivers. Assessments included: Personality (NEO-FFI), Burden (ZBI), Depression (CES-D), Cognitive Function (MMSE), BPSD (NPI), Distress (NPI-D), and an open question to identify the strategies used by caregivers when faced with BPSD. Caregivers used different strategies to cope with their relatives' behavior: avoiding conflict; confronting; reassuring; orienting; responding coercively; distracting; colluding; medicating and restricting the movements. Extraversion was the only dimension of caregiver's personality that determined the use of caregiver strategies to deal with BPSD. Extroverted caregivers used the "confronting" strategy less often. Caregiver's personality should be taken into account when designing adapted intervention programs.

Policy dialogues - the "bolts and joints" of policy-making: experiences from Cabo Verde, Chad and Mali

Background

Policy processes that yield good outcomes are inherently complex, requiring interactions of stakeholders in problem identification, generation of political will and selection of practical solutions. To make policy processes rational, policy dialogues are increasingly being used as a policy-making tool. Despite their increasing use for policy-making in Africa, evidence is limited on how they have evolved and are being used on the continent or in low and middle income countries elsewhere.

Methods

This was an exploratory study using qualitative methods. It utilised data related to policy dialogues for three specific policies and strategies to understand the interplay between policy dialogue and policy-making in Cabo Verde, Chad and Mali. The specific methods used to gather data were key informant interviews and document review. Data were analysed inductively and deductively using thematic content analysis.

Results

Participation in the policy dialogues was inclusive, and in some instances bottom-up participatory approaches were used. The respondents felt that the execution of the policy dialogues had been seamless, and the few divergent views expressed often were resolved in a unanimous manner. The policies and strategies developed were seen by all stakeholders as relating to priority issues. Other specific process factors that contributed to the success of the dialogues included the use of innovative approaches, good facilitation, availability of resources for the dialogues, good communication, and consideration of the different opinions. Among the barriers were contextual issues, delays in decision-making and conflicting coordination roles and mandates.

Conclusions

Policy dialogues have proved to be an effective tool in health sector management and could be a crucial component of the governance dynamics of the sector. The policy dialogue process needs to be institutionalised for continuity and maintenance of institutional intelligence. Other essential influencing factors include building capacity for coordination and facilitation of policy dialogues, provision of sustainable financing for execution of the dialogues, use of inclusive and bottom-up approaches, and timely provision of reliable evidence. Ensuring continued participation of all the actors necessitates innovation to allow dialogue outside the formal frameworks and spaces that should feed into the formal dialogue processes.

Search Strategies Used by Older Adults in a Virtual Reality Place Learning Task

PURPOSE OF THE STUDY

Older adults often have problems finding their way in novel environments such as senior living residences and hospitals. The purpose of this study was to examine the types of self-reported search strategies and cues that older adults use to find their way in a virtual maze.

DESIGN AND METHODS

Healthy, independently living older adults (n = 129) aged 55-96 were tested in a virtual maze task over a period of 3 days in which they had to repeatedly find their way to a specified goal. They were interviewed about their strategies on days 1 and 3. Content analysis was used to identify the strategies and cues described by the participants in order to find their way. Strategies and cues used were compared among groups.

RESULTS

The participants reported the use of multiple spatial and non-spatial strategies, and some of the strategies differed among age groups and over time. The oldest age group was less likely to use strategies such as triangulation and distance strategies. All participants used visual landmarks to find their way, but the use of geometric cues (corners) was used less by the older participants.

IMPLICATIONS

These findings add to the theoretical understanding of how older adults find their way in complex environments. The understanding of how wayfinding changes with age is essential in order to design more supportive environments.

Researchers' perspectives on pediatric obesity research participant recruitment

Background

Childhood obesity prevalence has tripled over the last three decades. Pediatric obesity has important implications for both adult health as well as the United States economy. In order to combat pediatric obesity, exploratory studies are necessary to create effective interventions. Recruitment is an essential part of any study, and it has been challenging for all studies, especially pediatric obesity studies. The objective of this study was to understand barriers to pediatric obesity study recruitment and review facilitators to overcome recruitment difficulties.

Methods

Twenty four childhood obesity researchers were contacted. Complete data for 11 researchers were obtained. Interviews were transcribed and analyzed using content analysis. Grounded Theory methodological approach was used, as this was an exploratory study. Investigators YP and MM coded the interviews using 28 codes.

Results

Barriers to recruitment included: family and study logistics, family economics, lack of provider interest, invasive protocols, stigma, time restraints of clinicians, lack of patient motivation/interest, groupthink of students in a classroom, and participants who do not accept his or her own weight status. Facilitators to enhance recruitment practices included accommodating participants outside of regular clinic hours, incentivizing participants, cultivating relationships with communities, schools and clinics prior to study recruitment, emphasizing benefits of a study for the patient, and shifting language to focus on health rather than obesity.

Conclusions

Pediatric obesity researchers face many standard and some unique challenges to recruitment, reflecting challenges common to clinical research as well as some specific to pediatrics and some specific to obesity research. Both pediatric studies as well as obesity studies are an added challenge to the already-difficult task of general study recruitment. Our findings can be used to make researchers more aware of potential difficulties, approaches and on-going needs for enhancing recruitment and enrollment practices, and in turn if applied, may result in increased study efficiency.

Experiences and coping strategies of oncology patients undergoing oral chemotherapy: First steps of a grounded theory study

PURPOSE

Chemotherapies are increasingly available for oral application. Previous studies have focussed on differences between orally and intravenously administered chemotherapies, mostly following quantitative designs surveying patients' preferences and adherence. The lived experience of patients undergoing oral chemotherapy has been rarely explored. Therefore, this study investigates how patients experience oral chemotherapy.

METHOD

We conducted open interviews with six patients and two spouses. Recruitment took place in the outpatient clinic of an urban Swiss hospital. Data collection and analysis followed the principles of Straussian grounded theory.

RESULTS

The participants reported physical and emotional reluctance towards oral chemotherapy as well as toxic side effects. Feeling responsible emerged as a core phenomenon. All participants intended to adhere to the therapy although this was challenging because of the complex medication regimen. Belief in the effectiveness of the therapy was a strengthening factor.

CONCLUSIONS

All participants reported to be highly adherent to oral chemotherapy. Although they experienced some toxic side effects, they did not react. Monitoring toxicities and support in everyday life should be a core feature of care.

Nanomedicine of synergistic drug combinations for cancer therapy - Strategies and perspectives

Nanomedicine of synergistic drug combinations has shown increasing significance in cancer therapy due to its promise in providing superior therapeutic benefits to the current drug combination therapy used in clinical practice. In this article, we will examine the rationale, principles, and advantages of applying nanocarriers to improve anticancer drug combination therapy, review the use of nanocarriers for delivery of a variety of combinations of different classes of anticancer agents including small molecule drugs and biologics, and discuss the challenges and future perspectives of the nanocarrier-based combination therapy. The goal of this review is to provide better understanding of this increasingly important new paradigm of cancer treatment and key considerations for rational design of nanomedicine of synergistic drug combinations for cancer therapy.

Spatiotemporal differences of brain activation between internal and external strategies in mental rotation: A behavioral and ERD/ERS study

Subjects may voluntarily implement an internal or external strategy during mental rotation (MR) task. However, few studies have reported the spatiotemporal differences of brain activation between the two MR strategies. This study aims to compare the two strategies from the perspective of behavioral performance and spatiotemporal brain activations in each cognitive sub-stage using EEG measurements. Both the internal (IN) and external (EX) groups showed a significant 'angle effect' on reaction time (RT) and accuracy (ACC). However, a smaller increase of RT with rotation angle was observed in the EX group. Event-related (de)synchronization in the beta band revealed similar temporal patterns of brain activation in the two groups, but with a stronger activation in the MR sub-stage in the EX group. We speculate that MR of 3D abstract objects is easier when an external strategy is used, and would be promoted by an additional visual-spatial process involving the parietal-occipital areas. Our results suggested that the differences between the two strategies were mainly induced by main MR rather than other cognitive processes.

Health personnel retention strategies in a peri-urban community: an exploratory study on Epworth, Zimbabwe

BACKGROUND

The need to retain health personnel is a policy challenge undermining health system reform of the 21st century. The need to resolve this global health workforce crisis resulted in the First Global Forum on Human Resources for Health in 2008 from which the Kampala Declaration and Agenda for Global Action was formulated. However, whilst there have been several studies exploring the retention of health personnel towards this end, available literature does not provide a detailed narrative on strategies used in peri-urban communities. The aim of this study was to explore retention strategies implemented in a Zimbabwean peri-urban community between 2009 and 2014 and implications for peri-urban communities towards the health system reform agenda.

METHODS

The study was carried out in Epworth, a peri-urban community in Harare, Zimbabwe. The research design was a cross-sectional survey, in which qualitative methods were used in sampling, data collection, reporting and analysis. Qualitative tools were used to collect data through in-depth interviews with purposively selected health personnel managers at 10 local clinics and sample interviews with purposively selected healthcare workers who included registered general nurses, state-certified nurses, midwives, environmental health technicians, nurse aids and community health volunteers at each clinic. Two focus group discussions were carried out with community health volunteers. Qualitative data was subjected to thematic analysis, with coding being performed manually.

RESULTS

A programme-specific strategic partnership between the government and donor community contributed towards the mobilisation of more health personnel, health facilities, worker development and remuneration. To complement this, the Ministry of Health intervened through the review and payment of salaries, support towards post-basic training and development, and protection. The local board, mission and donors contributed through the payment of top-up allowances and provision of non-monetary incentives.

CONCLUSIONS

The review of salaries, engagement of international strategic partners, payment of top-up allowances, support towards post-basic training and development, mobilisation of more health personnel, non-monetary incentives and healthcare worker protection were critical towards the retention of health personnel in the Epworth peri-urban community between 2009 and 2014.

Sex differences in visuospatial and navigational working memory: the role of mood induced by background music

Sex differences in visuospatial abilities are long debated. Men generally outperform women, especially in wayfinding or learning a route or a sequence of places. These differences might depend on women's disadvantage in underlying spatial competences, such as mental rotation, and on the strategies used, as well as on emotions and on self-belief about navigational skills, not related to actual skill-levels. In the present study, sex differences in visuospatial and navigational working memory in emotional contexts were investigated. Participants' mood was manipulated by background music (positive, negative or neutral) while performing on the Corsi Block-tapping Task (CBT) and Walking Corsi (WalCT) test. In order to assess the effectiveness of mood manipulation, participants filled in the Positive and Negative Affect Schedule before and after carrying out the visuospatial tasks. Firstly, results showed that after mood induction, only the positive affect changed, whereas the negative affect remained unconfounded by mood and by sex. This finding is in line with the main effect of 'group' on all tests used: the positive music group scored significantly higher than other groups. Secondly, although men outperformed women in the CBT forward condition and in the WalCT forward and backward conditions, they scored higher than women only in the WalCT with the negative background music. This means that mood cannot fully explain sex differences in visuospatial and navigational working memory. Our results suggest that sex differences in the CBT and WalCT can be better explained by differences in spatial competences rather than by emotional contexts.

Automatic and controlled processing and the Broad Autism Phenotype

Research related to verbal fluency in the Broad Autism Phenotype (BAP) is limited and dated, but generally suggests intact abilities in the context of weaknesses in other areas of executive function (Hughes et al., 1999; Wong et al., 2006; Delorme et al., 2007). Controlled processing, the generation of search strategies after initial, automated responses are exhausted (Spat, 2013), has yet to be investigated in the BAP, and may be evidenced in verbal fluency tasks. One hundred twenty-nine participants completed the Delis-Kaplan Executive Function System Verbal Fluency test (D-KEFS; Delis et al., 2001) and the Broad Autism Phenotype Questionnaire (BAPQ; Hurley et al., 2007). The BAP group (n=53) produced significantly fewer total words during the 2nd 15" interval compared to the Non-BAP (n=76) group. Partial correlations indicated similar relations between verbal fluency variables for each group. Regression analyses predicting 2nd 15" interval scores suggested differentiation between controlled and automatic processing skills in both groups. Results suggest adequate automatic processing, but slowed development of controlled processing strategies in the BAP, and provide evidence for similar underlying cognitive constructs for both groups. Controlled processing was predictive of Block Design score for Non-BAP participants, and was predictive of Pragmatic Language score on the BAPQ for BAP participants. These results are similar to past research related to strengths and weaknesses in the BAP, respectively, and suggest that controlled processing strategy use may be required in instances of weak lower-level skills.

[Methodology for the development and update of practice guidelines: current state]

The current scenario of health services in Mexico reveals as a priority the implementation of strategies that allow us to better respond to the needs and expectations of individuals and society as a whole, through the provision of efficient and effective alternatives for the prevention, diagnosis and treatment of diseases. In this context, clinical practice guidelines constitute an element of management in the health care system, whose objective is to establish a national bechmark for encouraging clinical and management decision making, based on recommendations from the best available evidence, in order to contribute to the quality and effectiveness of health care. The purpose of this document is to show the methodology used for the development and updating of clinical practice guidelines that the Instituto Mexicano del Seguro Social has developed in line with the sectorial model in order to serve the user of these guidelines.

Interventions to increase the uptake of seasonal influenza vaccination among pregnant women: A systematic review

BACKGROUND

Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population.

METHODS

We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies.

RESULTS

Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied.

CONCLUSIONS

There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.

Baboons (Papio papio), but not humans, break cognitive set in a visuomotor task

Cognitive set can be both helpful and harmful in problem solving. A large set of similar problems may be solved mechanically by applying a single-solution method. However, efficiency might be sacrificed if a better solution exists and is overlooked. Despite half a century of research on cognitive set, there have been no attempts to investigate whether it occurs in nonhuman species. The current study utilized a nonverbal, computer task to compare cognitive set between 104 humans and 15 baboons (Papio papio). A substantial difference was found between humans' and baboons' abilities to break cognitive set. Consistent with previous studies, the majority of humans were highly impaired by set, yet baboons were almost completely unaffected. Analysis of the human data revealed that children (aged 7-10) were significantly better able to break set than adolescents (11-18) and adults (19-68). Both the evolutionary and developmental implications of these findings are discussed.

Coping Strategies to Hinder Intention to Leave in Iranian Nurses: A Qualitative Content Analysis

BACKGROUND

Due to the high clinical challenges, differences in coping strategies, and high workload in nurses, there is a need to develop strategies to keep them in the profession. The aim of the present study was to explore the Iranian nurses' coping strategies to deal with intention to leave.

METHODS

A qualitative content analysis was used to obtain rich data. We performed 13 in-depth face-to-face semi-structured interviews with nurses working in hospitals affiliated to Tabriz and Urmia Universities of Medical Sciences in Iran, selected through purposive sampling. Constant comparative method was used for data analysis.

RESULTS

Three categories and eleven subcategories emerged during data analysis. The extracted categories and sub-categories consisted of (I) Self-empowerment (practical knowledge increase, responsibility, finding identification of the nurse, balancing work and life, seek support and humanitarian interests), (II) Self-controlling (tolerance, avoidance, the routine-based performance), and (III) Pursuing opportunities for advancement and promotion (community development, planning for higher education).

CONCLUSION

Nurses make attempts to individually manage problems and stressors perceived from bedside that have led them to leave the bedside; these efforts have been effective in some cases but sometimes they are ineffective due to discontinuous training and relative competence in terms of how to manage and deal with problems. It is suggested that nurses should learn strategies scientifically to meet the challenges of bedside. Through enabling and supporting behaviors and creating opportunities for growth and professional development, nursery managers can help nurses to stay and achieve improvement of the quality of cares.

Antimicrobial Stewardship in the Emergency Department

The literature contains robust evidence on the positive impact of antimicrobial stewardship programs (ASP) in the inpatient setting. With national policies shifting toward provisions of quality health care, the impetus to expand ASP services becomes an important strategy for institutions. However data on stewardship initiatives in other settings are less characterized. For organizations with an established ASP team, it is rational to consider expanding these services to the emergency department (ED). The ED serves as an interface between the inpatient and community settings. It is often the first place where patients present for medical care, including for common infections. Challenges inherent to the fast-paced nature of the environment must be recognized for successful ASP implementation in the ED. Based on the current literature, a combination of strategies for initiating ASP services in the ED will be described. Furthermore, common scenarios and management approaches are proposed for respiratory tract, skin and soft tissue, and urinary tract infections. Expansion of ASP services across the health care continuum may improve patient outcomes with a potential associated decrease in health care costs while preventing adverse effects including the development of antibiotic resistance.

Which hospitalisations are ambulatory care-sensitive, to what degree, and how could the rates be reduced? Results of a group consensus study in Germany

BACKGROUND

Much has been written lately regarding hospitalisations for ambulatory care-sensitive conditions (ACSH) and their strengths and weaknesses as a quality management indicator. The idea underlying ambulatory care-sensitive conditions (ACSC) is that effective treatment of acute conditions, good management of chronic illnesses and immunisation against infectious diseases can reduce the risk of a specified set of hospitalisations.

METHODS

The present paper applies group consensus methods to synthesise available evidence with expert opinion, thus identifying relevant ACSC. It contributes to the literature by evaluating the degree of preventability of ACSH and surveying the medical and systemic changes needed to increase quality for each diagnosis group. Forty physicians proportionally selected from all medical disciplines relevant to the treatment of ACSC participated in the three round Delphi survey. The setting of the study is Germany.

RESULTS

The proposed core list is a subset of 22 ACSC diagnosis groups, covering 90% of all consented ACSH and conditions with a higher than 85% estimated degree of preventability. Of all 18.6 million German hospital cases in the year 2012, the panelists considered 5.04 million hospitalisations (27%) to be sensitive to ambulatory care, of which 3.72 (20%) were estimated to be actually preventable. If only emergencies are considered, the ACSH share reduces to less than 8%. The geographic distribution of ACSH indicates significant regional variation with particularly high rates and potential for improvement in the North Rhine region, in Thuringia, Saxony-Anhalt, northern and eastern Bavaria and the Saarland. The average degree of preventability was 75% across all diagnosis groups. By far the most often mentioned strategy for reducing ACSH was 'improving continuous care'.

CONCLUSION

There are several good reasons why process indicators prevail in the assessment of ambulatory care. ACSH rates can however provide a more complete picture by adding useful information related to the overall patient outcome. The results of our analysis should be used to encourage debate and as a basis for further confirmatory work.

Strategies for addressing vaccine hesitancy - A systematic review

The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts.

METHODS

A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager.

RESULTS

Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions. Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context.

Strategies intended to address vaccine hesitancy: Review of published reviews

When faced with vaccine hesitancy, public health authorities are looking for effective strategies to address this issue. In this paper, the findings of 15 published literature reviews or meta-analysis that have examined the effectiveness of different interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance are presented and discussed. From the literature, there is no strong evidence to recommend any specific intervention to address vaccine hesitancy/refusal. The reviewed studies included interventions with diverse content and approaches that were implemented in different settings and targeted various populations. Few interventions were directly targeted to vaccine hesitant individuals. Given the paucity of information on effective strategies to address vaccine hesitancy, when interventions are implemented, planning a rigorous evaluation of their impact on vaccine hesitancy/vaccine acceptance will be essential.

Strategies for addressing vaccine hesitancy - A systematic review

The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts.

METHODS

A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager.

RESULTS

Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions. Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context.

Challenges and Opportunities for Customizing Polyhydroxyalkanoates

Polyhydroxyalkanoates (PHAs) as an alternative to synthetic plastics have been gaining increasing attention. Being natural in their origin, PHAs are completely biodegradable and eco-friendly. However, consistent efforts to exploit this biopolymer over the last few decades have not been able to pull PHAs out of their nascent stage, inspite of being the favorite of the commercial world. The major limitations are: (1) the high production cost, which is due to the high cost of the feed and (2) poor thermal and mechanical properties of polyhydroxybutyrate (PHB), the most commonly produced PHAs. PHAs have the physicochemical properties which are quite comparable to petroleum based plastics, but PHB being homopolymers are quite brittle, less elastic and have thermal properties which are not suitable for processing them into sturdy products. These properties, including melting point (Tm), glass transition temperature (Tg), elastic modulus, tensile strength, elongation etc. can be improved by varying the monomeric composition and molecular weight. These enhanced characteristics can be achieved by modifications in the types of substrates, feeding strategies, culture conditions and/or genetic manipulations.

Peripartum pubic symphysis separation--Current strategies in diagnosis and therapy and presentation of two cases

BACKGROUND

During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation.

METHODS

This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered.

RESULTS

Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions.

SUMMARY

Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.

Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit

Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management.

The Threat-Strategy Interview

Operators in dynamic work environments use strategies to manage threats in order to achieve task goals. We introduce a structured interview method, the Threat-Strategy Interview (TSI), and an accompanying qualitative analysis to induce operator-level threats, strategies, and the cues that give rise to them. The TSI can be used to elicit knowledge from operators who are on the front line of managing threats to provide an understanding of strategic thinking, which in turn can be applied toward a variety of problems.

Clearing the Air: A Qualitative Investigation of Genetic Counselors' Experiences of Counselor-Focused Patient Anger

Patient anger is challenging for healthcare professionals to manage, particularly when it is directed at them. This study comprises the first in-depth investigation of genetic counselors' experiences with patient anger. Using a brief survey and interview methods, this study explored prevalence and context of patient anger directed at the genetic counselor, how genetic counselors manage patient anger directed at them, and possible thematic differences due to genetic counseling experience. Individuals enrolled in the National Society of Genetic Counselors (NSGC) listserv were invited to participate in a study of their experiences with patient anger directed at them. A majority of survey respondents (95.7 %, 243/254) reported experiencing patient anger directed at them, and 19.4 % reported having feared for their safety because of patient anger. Twenty-two survey respondents were purposively selected to participate in individual interviews. Inductive and cross case analysis yielded prevalent themes concerning patient triggers for anger, including bad news, logistical mishaps, and perceived counselor characteristics. Interview results further suggest unaddressed patient anger negatively affected patient and counselor emotional well-being and hindered genetic counseling goals. Prevalent challenges included genetic counselor attempts to accurately recognize, understand, and effectively manage patient anger without taking it personally. Commonly recommended strategies for addressing anger were empathy (i.e., understanding origins of patient anger), anticipating and acknowledging anger, maintaining personal, professional and legal protection, and debriefing with colleagues. Themes were quite similar across counselor experience levels. The findings underscore the importance of training and continuing education regarding patient anger. Additional findings, practice implications, and research recommendations are presented.

The barrier-belief approach in the counseling of physical activity

OBJECTIVE

To understand inactivity and relapse from PA, and to develop theory-based behavior change strategies to stimulate and support maintenance of PA.

METHODS

We conducted a literature search to explore barriers to PA. Social cognitive theories and empirical evidence were evaluated and guided the process developing a theoretical framework and counseling strategies.

RESULTS

A theoretical framework is presented to understand why people do not engage in PA and often relapse once they started PA. A distinction is made between three related types of BBs. In PA counseling these three beliefs are addressed using four different BB behavior change strategies.

CONCLUSION

BB counseling aims to develop an individual pattern of PA for the long term that is adapted to the (often limited) motivation of the client, thereby preventing the occurrence of BBs. The client will learn to cope with factors that may inhibit PA in the future.

PRACTICE IMPLICATIONS

The BBs approach composes a way of counseling around the central construct of barrier-beliefs to stimulate engagement in PA independently, in the long term.

ABCs of Evidence-based Anterior Cruciate Ligament Injury Prevention Strategies in Female Athletes

Anterior cruciate ligament (ACL) injury is a major concern in physically active females. Although ACL reconstruction techniques have seen significant advances in recent years, risk associated with re-injury and future osteoarthritis remains a major concern. Thus, prevention of ACL injury is a logical step to protect and preserve healthy knee joints in young athletes. The current report aims to summarize a list of evidence-based prevention strategies to reduce ACL injury in female athletes. A list of six critical principles, which come from documented, large scale clinical trial studies and further analyses, were presented with ABC format including age, biomechanics, compliance, dosage, exercise, and feedback. Also, a grade for evidence and implications of future research is noted. Finally, in the conclusion section, importance of collaborative efforts from healthcare practitioners, researchers, and personnel associated with athletics is addressed.

[Potential role of rilpivirine in simplification regimens]

Antiretroviral simplification is a useful strategy to improve adherence and quality of life and prevent or reverse adverse effects in patients with HIV infection. The availability of new drugs with high efficacy and better tolerability in once-daily formulations or in fixed-dose combinations may be a better option for prolonged treatment. Rilpivirine, a new nonnucleoside reverse transcriptase inhibitor (NNRTI), has shown high antiviral efficacy in clinical trials with treatment-naïve patients, with a lower incidence of adverse effects and good tolerability. Its use in simplification regimens has been evaluated after the switch from efavirenz, demonstrating that dose adjustment is not required. In a large randomized study in patients who were receiving protease inhibitors, virological efficacy was maintained, with a lower incidence of adverse effects and improved lipid parameters and cardiovascular risk score. Given the ease of administration and good tolerability of this drug, recent communications at congresses have shown the rapid applicability of the results of studies in daily clinical practice in this scenario.

Enamel regeneration - current progress and challenges

Dental Enamel is the outermost covering of teeth. It is hardest mineralized tissue present in the human body. Enamel faces the challenge of maintaining its integrity in a constant demineralization and remineralization within the oral environment and it is vulnerable to wear, damage, and decay. It cannot regenerate itself, because it is formed by a layer of cells that are lost after the tooth eruption. Conventional treatment relies on synthetic materials to restore lost enamel that cannot mimic natural enamel. With advances in material science and understanding of basic principles of organic matrix mediated mineralization paves a way for formation of synthetic enamel. The knowledge of enamel formation and understanding of protein interactions and their gene products function along with the isolation of postnatal stem cells from various sources in the oral cavity, and the development of smart materials for cell and growth factor delivery, makes possibility for biological based enamel regeneration. This article will review the recent endeavor on biomimetic synthesis and cell based strategies for enamel regeneration.

Parental self-support: A study of parents' confront strategy when giving birth to premature infants

BACKGROUND

This study aimed to understand the confront strategies of parents of premature infants hospitalized in NICU.

METHODS

This study was performed using qualitative content analysis approach. Twelve participants including nine parents whose infants were hospitalized in NICU, two nurses and one physician, all selected by purposive sampling method were interviewed by a female expert occupational therapist. Data were gathered by semistructured interviews. Data were analyzed by inductive content analysis approach.

RESULTS

One category, six subcategories and twenty one themes emerged from data analysis expressed confront strategies of parents of premature infants admitted in NICU. These categories were: taking assurance, stop thinking to bad things, diverting mind, taking supports, emotional expression, complaining from staff.

CONCLUSION

Premature infant's parents announced that they do not receive adequate formal support to manage their feelings and needs. So, they seek for other informal resources of support and apply some special strategies including self-support.

Rainfed areas and animal agriculture in Asia: the wanting agenda for transforming productivity growth and rural poverty

The importance of rainfed areas and animal agriculture on productivity enhancement and food security for economic rural growth in Asia is discussed in the context of opportunities for increasing potential contribution from them. The extent of the rainfed area of about 223 million hectares and the biophysical attributes are described. They have been variously referred to inter alia as fragile, marginal, dry, waste, problem, threatened, range, less favoured, low potential lands, forests and woodlands, including lowlands and uplands. Of these, the terms less favoured areas (LFAs), and low or high potential are quite widely used. The LFAs are characterised by four key features: i) very variable biophysical elements, notably poor soil quality, rainfall, length of growing season and dry periods, ii) extreme poverty and very poor people who continuously face hunger and vulnerability, iii) presence of large populations of ruminant animals (buffaloes, cattle, goats and sheep), and iv) have had minimum development attention and an unfinished wanting agenda. The rainfed humid/sub-humid areas found mainly in South East Asia (99 million ha), and arid/semi-arid tropical systems found in South Asia (116 million ha) are priority agro-ecological zones (AEZs). In India for example, the ecosystem occupies 68% of the total cultivated area and supports 40% of the human and 65% of the livestock populations. The area also produces 4% of food requirements. The biophysical and typical household characteristics, agricultural diversification, patterns of mixed farming and cropping systems are also described. Concerning animals, their role and economic importance, relevance of ownership, nomadic movements, and more importantly their potential value as the entry point for the development of LFAs is discussed. Two examples of demonstrated success concern increasing buffalo production for milk and their expanded use in semi-arid AEZs in India, and the integration of cattle and goats with oil palm in Malaysia. Revitalised development of the LFAs is justified by the demand for agricultural land to meet human needs e.g. housing, recreation and industrialisation; use of arable land to expand crop production to ceiling levels; increasing and very high animal densities; increased urbanisation and pressure on the use of available land; growing environmental concerns of very intensive crop production e.g. acidification and salinisation with rice cultivation; and human health risks due to expanding peri-urban poultry and pig production. The strategies for promoting productivity growth will require concerted R and D on improved use of LFAs, application of systems perspectives for technology delivery, increased investments, a policy framework and improved farmer-researcher-extension linkages. These challenges and their resolution in rainfed areas can forcefully impact on increased productivity, improved livelihoods and human welfare, and environmental sustainability in the future.

Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods

The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which goats, with a capacity to cope with heat tolerance, can be the entry point for development. Networks and networking are very important for the diffusion of information and can add value to R and D. Well formulated projects with clear priority setting and participatory R and D ensure success and the realisation of food security, improved livelihoods and self-reliance in the future.

Determining heavy metals in spent compact fluorescent lamps (CFLs) and their waste management challenges: some strategies for improving current conditions

From environmental viewpoint, the most important advantage of compact fluorescent lamps (CFLs) is reduction of green house gas emissions. But their significant disadvantage is disposal of spent lamps because of containing a few milligrams of toxic metals, especially mercury and lead. For a successful implementation of any waste management plan, availability of sufficient and accurate information on quantities and compositions of the generated waste and current management conditions is a fundamental prerequisite. In this study, CFLs were selected among 20 different brands in Iran. Content of heavy metals including mercury, lead, nickel, arsenic and chromium was determined by inductive coupled plasma (ICP). Two cities, Tehran and Tabriz, were selected for assessing the current waste management condition of CFLs. The study found that waste generation amount of CFLs in the country was about 159.80, 183.82 and 153.75 million per year in 2010, 2011 and 2012, respectively. Waste generation rate of CFLs in Iran was determined to be 2.05 per person in 2012. The average amount of mercury, lead, nickel, arsenic and chromium was 0.417, 2.33, 0.064, 0.056 and 0.012 mg per lamp, respectively. Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. For improving the current conditions, we propose by considering the successful experience of extended producer responsibility (EPR) in other electronic waste management. The EPR program with advanced recycling fee (ARF) is implemented for collecting and then recycling CFLs. For encouraging consumers to take the spent CFLs back at the end of the products' useful life, a proportion of ARF (for example, 50%) can be refunded. On the other hand, the government and Environmental Protection Agency should support and encourage recycling companies of CFLs both technically and financially in the first place.

On compensatory strategies and computational models: the case of pure alexia

The article is concerned with inferences from the behaviour of neurological patients to models of normal function. It takes the letter-by-letter reading strategy common in pure alexic patients as an example of the methodological problems involved in making such inferences that compensatory strategies produce. The evidence is discussed on the possible use of three ways the letter-by-letter reading process might operate: "reversed spelling"; the use of the phonological input buffer as a temporary holding store during word building; and the use of serial input to the visual word-form system entirely within the visual-orthographic domain such as in the model of Plaut [1999. A connectionist approach to word reading and acquired dyslexia: Extension to sequential processing. Cognitive Science, 23, 543-568]. The compensatory strategy used by, at least, one pure alexic patient does not fit with the third of these possibilities. On the more general question, it is argued that even if compensatory strategies are being used, the behaviour of neurological patients can be useful for the development and assessment of first-generation information-processing models of normal function, but they are not likely to be useful for the development and assessment of second-generation computational models.

Decongestion in acute heart failure

Congestion is a major reason for hospitalization in acute heart failure (HF). Therapeutic strategies to manage congestion include diuretics, vasodilators, ultrafiltration, vasopressin antagonists, mineralocorticoid receptor antagonists, and potentially also novel therapies such as gut sequesterants and serelaxin. Uncertainty exists with respect to the appropriate decongestion strategy for an individual patient. In this review, we summarize the benefit and risk profiles for these decongestion strategies and provide guidance on selecting an appropriate approach for different patients. An evidence-based initial approach to congestion management involves high-dose i.v. diuretics with addition of vasodilators for dyspnoea relief if blood pressure allows. To enhance diuresis or overcome diuretic resistance, options include dual nephron blockade with thiazide diuretics or natriuretic doses of mineralocorticoid receptor antagonists. Vasopressin antagonists may improve aquaresis and relieve dyspnoea. If diuretic strategies are unsuccessful, then ultrafiltration may be considered. Ultrafiltration should be used with caution in the setting of worsening renal function. This review is based on discussions among scientists, clinical trialists, and regulatory representatives at the 9th Global Cardio Vascular Clinical Trialists Forum in Paris, France, from 30 November to 1 December 2012.

Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis

OBJECTIVE

To quantify the effect of strategies to improve retention in randomised trials.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units.

REVIEW METHODS

Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy.

RESULTS

38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a 'package' of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); 'enhanced' letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04).

CONCLUSIONS

Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.

Necrotizing enterocolitis: the road to zero

Necrotizing enterocolitis (NEC) continues to be the most severe gastrointestinal emergency facing the preterm neonate. The pathogenesis of NEC is still a complex and poorly understood process, but with increasing understanding of the role of enteral feeding, gut immunity and the altered gut microbiota, new opportunities to reduce overall NEC rates are now possible. Prevention strategies continue to lead as the most suitable approaches to reducing NEC, as early diagnosis and rapid effective treatment of NEC are still not optimal. Programmatic changes are equally important as subscribing to individual prevention strategies. The primary focus of this review is to summarize the best strategies we currently have to eliminate NEC within an institution.

Cognitive Impairment Assessment through Visuospatial Memory Can Be Performed with a Modified Walking Corsi Test Using the 'Magic Carpet'

Background

Subjects with mild cognitive impairment (MCI) have disturbances in their spatial navigation abilities and exhibit early deficits in visuospatial short-term memory. The purpose of the present study was to determine whether a quantitative (span score) and qualitative (evaluating navigation strategies used) analysis of the Corsi test (usual condition and complex navigation task) would be useful to reveal cognitive decline.

Methods

We evaluated the performance of 15 young adults, 21 healthy elderly subjects and 15 subjects with MCI using the electronic version of the Corsi test (the Modified Corsi Block-Tapping Test, MCBT) and the complex navigation task (the Modified Walking Corsi Test, MWCT). The MWCT, which is an adaptation of the Corsi test, assesses spatial memory when the subject walks in a complex environment. We used Richard et al.'s model [Cogn Sci 1993;17:497-529] to investigate problem-solving strategies during the Corsi tests.

Results

The span scores obtained on the MCBT and the MWCT were significantly lower in the healthy elderly subjects (MCBT = 5.0 ± 0.7; MWCT = 4.0 ± 0.7) and the subjects with MCI (MCBT = 4.7 ± 0.8; MWCT = 4.1 ± 0.9) than in the younger adults (MCBT = 6.2 ± 0.6; MWCT = 5.3 ± 1.0). The visuospatial working memory was more impaired in the complex navigation task (MWCT = 4.3 ± 0.9) than in the modified Corsi test (MCBT = 5.3 ± 0.8). Finally, the subjects with greater cognitive impairment were more likely to have inadequate or absence of problem-solving strategies.

Conclusions

Investigating the problem-solving strategies used during the MWCT appears to be a promising way to differentiate between the subjects with MCI and the healthy elderly subjects.

Workshop report: strategies for setting occupational exposure limits for engineered nanomaterials

Occupational exposure limits (OELs) are important tools for managing worker exposures to chemicals; however, hazard data for many engineered nanomaterials (ENMs) are insufficient for deriving OELs by traditional methods. Technical challenges and questions about how best to measure worker exposures to ENMs also pose barriers to implementing OELs. New varieties of ENMs are being developed and introduced into commerce at a rapid pace, further compounding the issue of OEL development for ENMs. A Workshop on Strategies for Setting Occupational Exposure Limits for Engineered Nanomaterials, held in September 2012, provided an opportunity for occupational health experts from various stakeholder groups to discuss possible alternative approaches for setting OELs for ENMs and issues related to their implementation. This report summarizes the workshop proceedings and findings, identifies areas for additional research, and suggests potential avenues for further progress on this important topic.

Costs and benefits of automatization in category learning of ill-defined rules

Learning ill-defined categories (such as the structure of Medin & Schaffer, 1978) involves multiple learning systems and different corresponding category representations, which are difficult to detect. Application of latent Markov analysis allows detection and investigation of such multiple latent category representations in a statistically robust way, isolating low performers and quantifying shifts between latent strategies. We reanalyzed data from three experiments presented in Johansen and Palmeri (2002), which comprised prolonged training of ill-defined categories, with the aim of studying the changing interactions between underlying learning systems. Our results broadly confirm the original conclusion that, in most participants, learning involved a shift from a rule-based to an exemplar-based strategy. Separate analyses of latent strategies revealed that (a) shifts from a rule-based to an exemplar-based strategy resulted in an initial decrease of speed and an increase of accuracy; (b) exemplar-based strategies followed a power law of learning, indicating automatization once an exemplar-based strategy was used; (c) rule-based strategies changed from using pure rules to rules-plus-exceptions, which appeared as a dual processes as indicated by the accuracy and response-time profiles. Results suggest an additional pathway of learning ill-defined categories, namely involving a shift from a simple rule to a complex rule after which this complex rule is automatized as an exemplar-based strategy.

What is the optimum social marketing mix to market energy conservation behaviour: an empirical study

This study attempts to identify the optimum social marketing mix for marketing energy conservation behaviour to students in Malaysian universities. A total of 2000 students from 5 major Malaysian universities were invited to provide their preferred social marketing mix. A choice-based conjoint analysis identified a mix of five social marketing attributes to promote energy conservation behaviour; the mix is comprised of the attributes of Product, Price, Place, Promotion, and Post-purchase Maintenance. Each attribute of the mix is associated with a list of strategies. The Product and Post-purchase Maintenance attributes were identified by students as the highest priority attributes in the social marketing mix for energy conservation behaviour marketing, with shares of 27.12% and 27.02%, respectively. The least preferred attribute in the mix is Promotion, with a share of 11.59%. This study proposes an optimal social marketing mix to university management when making decisions about marketing energy conservation behaviour to students, who are the primary energy consumers in the campus. Additionally, this study will assist university management to efficiently allocate scarce resources in fulfilling its social responsibility and to overcome marketing shortcomings by selecting the right marketing mix.

What leads to failure of joint-preserving surgery for ankle osteoarthritis?: when this surgery fails, what next?

This article discusses the lack of scientific evidence regarding the treatment of failed joint-preserving surgery. Most of the concepts of treatment derive from treatment modalities in trauma and orthopedic surgery. The main question for the foot and ankle specialist is whether the joint can be salvaged. The definition of failure is difficult. Therefore pain reported by the patient is the main symptom that dictates the course of treatment. Whenever possible the joint should be maintained. However, if pain is associated with global radiographic osteoarthritis, total ankle replacement or fusions are the only means to solve the problem.

Psychophysical factors that have been applied to clinical perimetry

Perimetry is the most common clinical diagnostic test procedure for evaluating the status of peripheral visual function in the management of ocular and neurologic diseases. This procedure has an extended history, and its design, implementation and interpretation is dependent on many principles that have been developed through visual psychophysical studies of target size, target duration, background adaptation level, chromatic characteristics and other stimulus properties (see Greve, 1973; Johnson, 1994, chap. 17, 1996, 2008, 2010, chap. 23; Johnson & Keltner, 1998, chap. 7; Johnson & Sample, 2002, chap. 22; Johnson & Wall, 2011, chap. 35; Wall & Johnson, 2005, chap. 2 for reviews). This paper will provide a general overview of the history of perimetry, selection of stimulus parameters, development of test strategies, clinical testing conditions, new procedures and approaches to perimetry, experimental design, analysis and interpretation methods, hypothesis testing, prediction and forecasting procedures, and other related topics. It is somewhat paradoxical that although there have been major advances in all of these areas that have significantly enhanced the utility and value of this clinical diagnostic test, the fundamental methodology has remained mostly unchanged for thousands of years. It is hoped that this overview will be of assistance to investigators and clinicians who wish to use or modify this diagnostic procedure for their ongoing career activities.

Characterizing researchers by strategies used for retaining minority participants: results of a national survey

Limited attention has been given to the optimal strategies for retaining racial and ethnic minorities within studies and during the follow-up period. High attrition limits the interpretation of results and reduces the ability to translate findings into successful interventions. This study examined the retention strategies used by researchers when retaining minorities in research studies. From May to August 2010, we conducted an online survey with researchers (principal investigators, research staff, and IRB members) and examined their use of seven commonly used retention strategies. The number and type of retention strategies used, how these strategies differ by researcher type, and other characteristics (e.g., funding) were explored. We identified three clusters of researchers: comprehensive retention strategy researchers - utilized the greatest number of retention strategies; moderate retention strategy researchers - utilized an average number of retention strategies; and limited retention strategy researchers - utilized the least number of retention strategies. The comprehensive and moderate retention strategy researchers were more likely than the limited retention strategy researchers to conduct health outcomes research, work with a community advisory board, hire minority staff, use steps at a higher rate to overcome retention barriers, develop new partnerships with the minority community, modify study materials for the minority population, and allow staff to work flexible schedules. This study is a novel effort to characterize researchers, without implying a value judgment, according to their use of specific retention strategies. It provides critical information for conducting future research to determine the effectiveness of using a combination of retention strategies.

High burden of protein-energy malnutrition in Nigeria: beyond the health care setting

There is still a high burden of protein–energy malnutrition in Nigeria. The severe forms of the disease are usually associated with high level of mortality even in the tertiary health facilities. To review the cost-effective health promotional strategies at community levels that could aid prevention, early detection, and prompt treatment of protein–energy malnutrition. The strategy used for locating articles used for this review was to search databases like Google, Google scholar, relevant electronic journals from the universities’ libraries, including PubMed and Scirus, Medline, Cochrane library and WHO's Hinari. We believe that strategies beyond the health care setting have potential of significantly reducing the morbidity and mortality associated with protein–energy malnutrition in Nigeria.

Dynamics of nutrient uptake strategies: lessons from the tortoise and the hare

Many autotrophs vary their allocation to nutrient uptake in response to environmental cues, yet the dynamics of this plasticity are largely unknown. Plasticity dynamics affect the extent of single versus multiple nutrient limitation and thus have implications for plant ecology and biogeochemical cycling. Here we use a model of two essential nutrients cycling through autotrophs and the environment to determine conditions under which different plastic or fixed nutrient uptake strategies are adaptive. Our model includes environment-independent costs of being plastic, environment-dependent costs proportional to the rate of plastic change, and costs of being mismatched to the environment, the last of which is experienced by both fixed and plastic types. In equilibrium environments, environment-independent costs of being plastic select for tortoise strategies-fixed or less plastic types-provided that they are sufficiently close to co-limitation. At intermediate levels of environmental fluctuation forced by periodic nutrient inputs, more hare-like plastic strategies prevail because they remain near co-limitation. However, the fastest is not necessarily the best. The most adaptive strategy is an intermediate level of plasticity that keeps pace with environmental fluctuations, but is not faster. At high levels of environmental fluctuation, the environment-dependent cost of changing rapidly to keep pace with the environment becomes prohibitive and tortoise strategies again dominate. The existence and location of these thresholds depend on plasticity costs and rate, which are largely unknown empirically. These results suggest that the expectations for single nutrient limitation versus co-limitation and therefore biogeochemical cycling and autotroph community dynamics depend on environmental heterogeneity and plasticity costs.Electronic supplementary material The online version of this article (doi:10.1007/s12080-010-0110-0) contains supplementary material, which is available to authorized users.

Innovations in clinical research design and conduct in psychiatry: shifting to pragmatic approaches

The classically structured clinical trial does not offer enough flexibility to make use of continuously emerging knowledge that is generated as the trial progresses. In this regard, there are consistent issues impeding effective psychiatric research, including limitations in efficiency, difficulty demonstrating significant differences between treatment arms, poor external validity, and ethical constraints. For example, research in the field of psychiatry shows that it is growing increasingly more challenging to demonstrate superiority of interventions to placebo in part related to the increasing placebo response rates. Various design innovations and other tricks of the trade have surfaced to improve sensitivity towards detecting drug-placebo differences and reduce sources of bias in psychiatric research. Diverse strategies have been developed to address these obstacles and improve the outcomes of clinical research in psychiatry. The current review highlights many of these innovations and describes examples of their practical use, mainly focusing on the study design and conduct perspectives. In the study design issues, adaptive, equipoise stratified, sequential parallel and effectiveness design will be explored. The proper strategies for pragmatic and ethical conduction of clinical trials will be also discussed in-depth.