1
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Barnard A, Petra H, Owen L, Goffe K, Bergbaum C, Wickham H, Fox O, Pleming J, Steel A. 1286 IS VIRTUAL ADVANCE CARE PLANNING SIMULATION AS EFFECTIVE AS FACE-TO-FACE LEARNING? Age Ageing 2023. [DOI: 10.1093/ageing/afac322.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
Introduction
Advance care planning (ACP) is about what matters to patients, enabling their wishes to be respected, even when they become unable to engage in decision-making. Evidence shows ACP improves end of life care for patients and reduces relatives’ bereavement reactions (Detering KM et al. BMJ. 2010; 340:1345). A simulation course for multidisciplinary healthcare professionals, using actors, was developed to improve understanding of ACP, and confidence in having these conversations. In response to the COVID-19 pandemic, the course was adapted to an online format.
Method
Participants were asked about their ACP confidence and understanding pre- and post-course, using a Likert scale (1-Not at all to 5-Very confident). Data between 2018-2022 was analysed to compare face-to-face and online course responses. Free-text responses to ‘How do you feel about attending the course online?’ were analysed qualitatively. Ethics approval was not required.
Results
Five face-to-face and five virtual sessions trained 128 and 133 attendees respectively. Confidence in having ACP discussions improved significantly following the course in both cohorts; from a mean Likert rating of 2.77 (95% CI 2.60-2.94, n=132) to 4.11 following face-to-face training (95% CI 3.97-4.25, n=128), and from 2.79 (95% CI 2.66-2.91, n=149) to 4.11 following the online course (95% CI 4.01-4.21, n=133). Additionally, 97% (n=132) of face-to-face attendees and 99.2% (n=133) of virtual attendees said their practice would change because of the course. Following the training, 100% of participants across both cohorts reported that they ‘fully understood’ what was meant by ACP, from a baseline of 77.3% (n=132) in the face-to-face cohort and 81.9% (n=149) of virtual participants. Free-text analysis highlighted the convenience of attending online (n=22, 21%), and only a minority reported technical difficulties (n=8,8%).
Conclusion
This course was successfully adapted to a virtual format, improving participants’ ACP confidence and understanding as effectively as in-person training, whilst being more accessible.
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Affiliation(s)
- A Barnard
- East Surrey Hospital Dept of Respiratory
| | - H Petra
- Barnet Hospital Dept of Acute Medicine
| | - L Owen
- Barnet Hospital Dept of Geriatric Medicine
| | - K Goffe
- Barnet Hospital Dept of Neurology
| | - C Bergbaum
- Barnet Hospital Dept of Geriatric Medicine
| | - H Wickham
- Royal Free Hospital Dept of Geriatric Medicine
| | - O Fox
- University College London
| | - J Pleming
- Barnet Hospital Dept of Geriatric Medicine
| | - A Steel
- Barnet Hospital Dept of Geriatric Medicine
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2
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Newman AM, Zaka M, Zhou P, Blain AE, Erhorn A, Barnard A, Crossland RE, Wilkinson S, Enshaei A, De Zordi J, Harding F, Taj M, Wood KM, Televantou D, Turner SD, Burke GAA, Harrison CJ, Bomken S, Bacon CM, Rand V. TP53 STATUS RISK STRATIFIES PATIENTS WITH CLINICALLY DEFINED HIGH-RISK DISEASE PAEDIATRIC B-CELL NON-HODGKIN LYMPHOMA. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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Barnard A, Winiecki CM, Picou K, Santana A. Abstract TP38: Evaluation Of A Stroke Survivor To Survivor Program. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Since 2015 a Primary Stroke Center in the Midwest has had a Stroke Survivor to Survivor Program (SS2S). The SS2S program was developed by a local non-profit organization whose mission is to provide advocacy, support, education and resources to stroke survivors and their families. SS2S is a telephone-based peer support program that aims to encourage, support, network, and provide resources to stroke survivors post discharge. The SS2S program provides at least 2 monthly calls from trained SS2S stroke volunteers to participants and/or caregivers. The volunteers educate on treatment and appointment adherence, offer community resources, information on support groups, access to Podcasts, and a connection to survivors and/or caregivers with other survivors.
Purpose:
An evaluation of SS2S was conducted to inform program effectiveness, as well as identify opportunities for program improvement for replication and scalability.
Methods:
The evaluation study was a one-group, post-only design. Adults who experienced a stroke and received treatment at the study hospital were eligible to participate. Participants who met the inclusion criteria were invited to participate in the SS2S program evaluation. A third party conducted the interviews using a semi-structured interview guide approved by the IRB. Interviews were transcribed and coded for themes using an inductive and deductive thematic approach and analyzed using NVivo 12.
Results:
Interviews were conducted for four months. 32 participants were contacted, 6 agreed to a full interview and 2 agreed to provide limited feedback. The majority were male and had at least 2 calls with a SS2S volunteer. The majority indicated they had a positive experience. Both participants and coordinators agreed that stroke survivors with residual stroke complications, limited resources and limited social support would benefit from the program the most. The majority of participants agreed that they enjoyed receiving a follow up phone call and were encouraged by them.
Conclusions:
Although the study sample size was small, the results support the SS2S program aims. The program works best when it connects patients with relevant and timely resources as well as offers the survivors the emotional support to talk freely and feel heard.
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Affiliation(s)
- Amy Barnard
- Northwestern Lake Forest Hosp, Lake Forest, IL
| | | | - Kylie Picou
- The American Heart Association- Cen, dallas, TX
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4
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Holl JL, Khorzad R, Zobel R, Barnard A, Hillman M, Vargas A, Richards C, Mendelson S, Prabhakaran S. Risk Assessment of the Door-In-Door-Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers. J Am Heart Assoc 2021; 10:e021803. [PMID: 34533049 PMCID: PMC8649509 DOI: 10.1161/jaha.121.021803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Patients with acute stroke at non- or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive, systematic, risk assessment of the door-in-door-out process and its application to solution design. Methods and Results A learning collaborative (clinicians, patients, and caregivers) at 2 PSCs and 3 comprehensive stroke centers in Chicago, Illinois participated in a failure modes, effects, and criticality analysis to identify steps in the process; failures of each step, underlying causes; and to characterize each failure's frequency, impact, and safeguards using standardized scores to calculate risk priority and criticality numbers for ranking. Targets for solution design were selected among the highest-ranked failures. The failure modes, effects, and criticality analysis process map and risk table were completed during in-person and virtual sessions. Failure to detect severe stroke/large-vessel occlusion on arrival at the PSC is the highest-ranked failure and can lead to a 45-minute door-in-door-out delay caused by failure to obtain a head computed tomography and computed tomography angiogram together. Lower risk failures include communication problems and delays within the PSC team and across the PSC comprehensive stroke center and paramedic teams. Seven solution prototypes were iteratively designed and address 4 of the 10 highest-ranked failures. Conclusions The failure modes, effects, and criticality analysis identified and characterized previously unrecognized failures of the door-in-door-out process. Use of a risk-informed approach for solution design is novel for stroke and should mitigate or eliminate the failures.
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Affiliation(s)
- Jane L Holl
- Department of Neurology Biological Sciences Division University of Chicago Chicago IL
| | | | | | - Amy Barnard
- Northwestern Medicine Lake Forest Hospital Lake Forest IL
| | | | | | - Christopher Richards
- Department of Emergency Medicine University of Cincinnati College of Medicine Cincinnati OH
| | - Scott Mendelson
- Department of Neurology Biological Sciences Division University of Chicago Chicago IL
| | - Shyam Prabhakaran
- Department of Neurology Biological Sciences Division University of Chicago Chicago IL
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5
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Bolt M, Shelley C, Hollingdale R, Chadwick S, Barnard A, Leverton A, Stewart A, Adams E, South C. PO-1574 Evaluation of automated plan quality for cervical cancer using the Ethos TPS. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Dunnell L, Chu K, Barnard A, Walker G. 467 FRAILTY IN SITU SIMULATION. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty.
Method
Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected.
Results
30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team.
Conclusion
In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.
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Affiliation(s)
- L Dunnell
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
| | - K Chu
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
| | - A Barnard
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
| | - G Walker
- Older Persons' Unit, Guy's and St Thomas' NHS Foundation Trust
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7
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Van de Poël A, Toledo-Sherman L, Breccia P, Cachope R, Bate JR, Angulo-Herrera I, Wishart G, Matthews KL, Martin SL, Peacock M, Barnard A, Cox HC, Jones G, McAllister G, Vater H, Esmieu W, Clissold C, Lamers M, Leonard P, Jarvis RE, Blackaby W, Eznarriaga M, Lazari O, Yates D, Rose M, Jang SW, Muñoz-Sanjuan I, Dominguez C. Structure-Based Exploration of Selectivity for ATM Inhibitors in Huntington's Disease. J Med Chem 2021; 64:5018-5036. [PMID: 33783225 DOI: 10.1021/acs.jmedchem.1c00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our group has recently shown that brain-penetrant ataxia telangiectasia-mutated (ATM) kinase inhibitors may have potential as novel therapeutics for the treatment of Huntington's disease (HD). However, the previously described pyranone-thioxanthenes (e.g., 4) failed to afford selectivity over a vacuolar protein sorting 34 (Vps34) kinase, an important kinase involved with autophagy. Given that impaired autophagy has been proposed as a pathogenic mechanism of neurodegenerative diseases such as HD, achieving selectivity over Vps34 became an important objective for our program. Here, we report the successful selectivity optimization of ATM over Vps34 by using X-ray crystal structures of a Vps34-ATM protein chimera where the Vps34 ATP-binding site was mutated to approximate that of an ATM kinase. The morpholino-pyridone and morpholino-pyrimidinone series that resulted as a consequence of this selectivity optimization process have high ATM potency and good oral bioavailability and have lower molecular weight, reduced lipophilicity, higher aqueous solubility, and greater synthetic tractability compared to the pyranone-thioxanthenes.
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Affiliation(s)
| | - Leticia Toledo-Sherman
- CHDI Management/CHDI Foundation, 6080 Center Drive, Los Angeles, California 90045, United States
| | - Perla Breccia
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Roger Cachope
- CHDI Management/CHDI Foundation, 6080 Center Drive, Los Angeles, California 90045, United States
| | - Jennifer R Bate
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | | | - Grant Wishart
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Kim L Matthews
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Sarah L Martin
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Marcus Peacock
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Amy Barnard
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Helen C Cox
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Graham Jones
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - George McAllister
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Huw Vater
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - William Esmieu
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Cole Clissold
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Marieke Lamers
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Philip Leonard
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Rebecca E Jarvis
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Wesley Blackaby
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Maria Eznarriaga
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Ovadia Lazari
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Dawn Yates
- Charles River, Chesterford Research Park, Saffron Walden CB10 1XL, U.K
| | - Mark Rose
- CHDI Management/CHDI Foundation, 6080 Center Drive, Los Angeles, California 90045, United States
| | - Sung-Wook Jang
- CHDI Management/CHDI Foundation, 6080 Center Drive, Los Angeles, California 90045, United States
| | - Ignacio Muñoz-Sanjuan
- CHDI Management/CHDI Foundation, 6080 Center Drive, Los Angeles, California 90045, United States
| | - Celia Dominguez
- CHDI Management/CHDI Foundation, 6080 Center Drive, Los Angeles, California 90045, United States
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8
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Abughoush K, Parnianpour Z, Holl J, Ankenman B, Khorzad R, Perry O, Barnard A, Brenna J, Zobel RJ, Bader E, Hillmann ML, Vargas A, Lynch D, Mayampurath A, Lee J, Richards CT, Peacock N, Meurer WJ, Prabhakaran S. Abstract P270: Simulating the Effects of Door-In-Door-Out Interventions. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Acute stroke (AS) is a highly time sensitive treatment condition affecting approximately 800,000 people/year in the US. Most AS patients receive care at a primary stroke center (PSC), but some require more advanced treatments, and rely on a timely transfer to a comprehensive stroke center (CSC) where such treatments can be given. Stroke teams at 2 Chicago area PSCs and 4 CSCs, collectively, developed solutions (Graph) targeting both reported and perceived failures/delays/weakness in the current PSC door-in-door-out (DIDO) process for transferring patients to a CSC. The study simulates the potential impact of the solutions on DIDO.
Methods:
Current state (baseline) times were calculated from time stamps in the electronic health record (EHR) (e.g., door to CT), estimated by the stroke teams (e.g., hand-off time) or retrieved (e.g., DIDO, door to stroke activation) from a prospectively maintained REDCap data registry (2/2018-1/2020). Proportions (e.g., % with ischemic stroke, % transferred) were estimated from hospital data. Changes in times after implementation of a solution were obtained from peer reviewed literature, when available, or by consensus expert opinion. Simio (version 11.197.19514) was used to simulate the current and future states with implementation of the solutions, with 500 replications, to estimate changes in DIDO.
Results:
Implementation of all solutions would achieve a decrease in DIDO of 33 minutes (19%) from current state. The largest driver of this change was direct to CT/CTA protocol implementation (21 minutes) followed by using a handoff tool for paramedics prior to transfer (13 minutes).
Conclusion:
The proposed solutions can achieve nearly a 20% reduction in DIDO times. The “Direct to CT/CTA Protocol” solution is the major driver of the improvement. Data simulation is helpful by assessing the potential impact of many solutions and the relative impact of each solution to inform implementation decisions.
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Affiliation(s)
| | | | - Jane Holl
- Neurology, Univ of Chicago, Chicago, IL
| | | | | | | | - Amy Barnard
- Northwestern Lake Forest Hosp, Lake Forest, IL
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9
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Vandenborne K, Kim S, Willcocks R, Morales J, Lingineni K, Barnard A, Schmidt S, Daniels M, Triplett W, Larkindale J, Walter G, Rooney W, Steering Committe DMR. MUSCLE IMAGING – MRI. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Prabhakaran S, Khorzad R, Parnianpour Z, Richards CT, Meurer W, Barnard A, Bader E, Hillman M, Zobel R, Lee J, Mendelson SJ, Holl JL. Abstract TMP63: Door-In-Door-Out Process Times at 5 Primary Stroke Centers in Chicago. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tmp63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Many patients with acute stroke require inter-facility transfer from primary stroke centers (PSC) to comprehensive stroke centers. Given the time-sensitive benefits of endovascular treatments, door-in-door-out (DIDO) time at the PSC is a target for quality improvement.
Methods:
As part of a funded ongoing study of redesigning the acute stroke DIDO process, we collected data on consecutive patients with acute stroke between February 2018 and February 2019 who required inter-facility transfer from 5 PSCs to one of 3 CSCs in the Chicago region. The stroke coordinators at each site abstracted data on mode of transport (critical care vs. advanced life support [ALS]), medical events and treatments (intubation, intravenous medications including tPA), times from arrival to: triage, telestroke activation and start, CT and CTA start, initial transfer center contact, ambulance request, and ambulance arrival and departure times. We evaluated predictors of DIDO time using linear regression.
Results:
Among 107 patients who met study criteria, 67.6% arrived by EMS, 83.2% had telestroke evaluation, 34.6% had tPA treatment, and 43.9% underwent CTA at the PSC. The median DIDO time was 146 (IQR 99-220) minutes. The largest contributors to DIDO time (Figure) were CT to CTA time (45 [18-86] minutes), ambulance scene time (26 [21-35] minutes), and telestroke to transfer center contact (median 23 [0-61] minutes). Independent predictors of DIDO time were obtaining CTA (+64.1 [29.4-98.5] minutes), use of ALS ambulance (+52.5 minutes [17.5-87.5] minutes), and use of intravenous medications besides tPA (+59.9 [15.7-104.1] minutes).
Conclusions:
We identified major opportunities for reducing DIDO times for inter-facility acute stroke transfers. Reducing the need for or time to CTA, earlier, streamlined transfer center contact, and using critical care ambulances are likely important strategies to decrease DIDO times.
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Affiliation(s)
| | | | | | | | | | - Amy Barnard
- Northwestern Lake Forest Hosp, Lake Forest, IL
| | | | | | | | - Jungwha Lee
- Preventive Medicine, Northwestern Univ, Chicago, IL
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11
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Parnianpour Z, Khorzad R, Richards C, Meurer W, Barnard A, Bader E, Hillmann M, Zobel R, Hamilton T, Knight L, Holl J, Prabhakaran S. Abstract WP365: Reducing Door-in-Door-out Times by Applying Failure Modes Effects and Criticality Analysis. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Given the time-critical nature of acute stroke, reducing door-in-door-out (DIDO) times at primary stroke centers (PSC) prior to transfer to comprehensive stroke centers (CSC) is a priority. We applied Failure Modes Effects and Criticality Analysis (FMECA) to the DIDO process at a PSC, an engineering methodology widely used in other industries, to understand the most critical areas negatively impacting DIDO time.
Methods:
We collected data during 2 in-person and 5 virtual Learning Collaborative (LC) meetings, enhanced by electronic surveys. The LC team consisted of 18 clinicians affiliated with 6 different healthcare systems including 3 PSCs and 3 CSCs, 2 participants from EMS agencies, and 5 patients and caregivers. The LC team created a DIDO process map with individual steps. For each step, we asked LC members to identify ways in which the process could be performed incorrectly, incompletely, skipped or delayed (failures) along with the clinical impact, their causes, frequency and existing safeguards. Each clinical impact, frequency and safeguard was scored from 1-10 (lowest to highest). Frequency, severity, and safeguards scores were multiplied to calculate a criticality score to rank the top DIDO process failures.
Results:
Among 61 DIDO process steps, the top 12 steps with the highest criticality score represented 40.4% of the sum of criticalities (Figure). Among these, the highest criticality scores were for: 1) Delay in the decision to obtain CTA; 2) Delay in stroke recognition by the EMS team; 3) Delay in stroke identification at triage.
Conclusion:
We identified opportunities to re-design the DIDO process for acute stroke. Existing safeguards for the identified “high” criticality failures rely on human factors (e.g., multiple visual inspections, provider’s experience). There is a need to develop better stroke identification tools and automatic triggers within the DIDO process to increase timely stroke transfers from PSC to CSCs.
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Affiliation(s)
| | | | | | | | - Amy Barnard
- Northwestern Medicine Lake Forest Hosp, Lake Forest, IL
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12
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Hepburn AC, Steele RE, Veeratterapillay R, Wilson L, Kounatidou EE, Barnard A, Berry P, Cassidy JR, Moad M, El-Sherif A, Gaughan L, Mills IG, Robson CN, Heer R. The induction of core pluripotency master regulators in cancers defines poor clinical outcomes and treatment resistance. Oncogene 2019; 38:4412-4424. [PMID: 30742096 PMCID: PMC6546609 DOI: 10.1038/s41388-019-0712-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/31/2022]
Abstract
Stem cell characteristics have been associated with treatment resistance and poor prognosis across many cancer types. The ability to induce and regulate the pathways that sustain these characteristic hallmarks of lethal cancers in a novel in vitro model would greatly enhance our understanding of cancer progression and treatment resistance. In this work, we present such a model, based simply on applying standard pluripotency/embryonic stem cell media alone. Core pluripotency stem cell master regulators (OCT4, SOX2 and NANOG) along with epithelial–mesenchymal transition (EMT) markers (Snail, Slug, vimentin and N-cadherin) were induced in human prostate, breast, lung, bladder, colorectal, and renal cancer cells. RNA sequencing revealed pathways activated by pluripotency inducing culture that were shared across all cancers examined. These pathways highlight a potential core mechanism of treatment resistance. With a focus on prostate cancer, the culture-based induction of core pluripotent stem cell regulators was shown to promote survival in castrate conditions—mimicking first line treatment resistance with hormonal therapies. This acquired phenotype was shown to be mediated through the upregulation of iodothyronine deiodinase DIO2, a critical modulator of the thyroid hormone signalling pathway. Subsequent inhibition of DIO2 was shown to supress expression of prostate specific antigen, the cardinal clinical biomarker of prostate cancer progression and highlighted a novel target for clinical translation in this otherwise fatal disease. This study identifies a new and widely accessible simple preclinical model to recreate and explore underpinning pathways of lethal disease and treatment resistance.
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Affiliation(s)
- A C Hepburn
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - R E Steele
- Prostate Cancer UK/Movember Centre of Excellence for Prostate Cancer, Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, BT9 7AE, UK
| | - R Veeratterapillay
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - L Wilson
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - E E Kounatidou
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - A Barnard
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - P Berry
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - J R Cassidy
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - M Moad
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - A El-Sherif
- Department of Pathology, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - L Gaughan
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - I G Mills
- Prostate Cancer UK/Movember Centre of Excellence for Prostate Cancer, Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, BT9 7AE, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, UK
| | - C N Robson
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - R Heer
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK.
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Bates D, Mitchell B, Barnard A. Prolotherapy in the treatment of pelvic instability. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Willcocks R, Forbes S, Lott D, Senesac C, Arora H, Barnard A, Harrington A, Daniels M, Finanger E, Tennekoon G, Finkel R, Wang D, Rooney W, Walter G, Sweeney H, Vandenborne K. Magnetic resonance biomarkers in the proximal and distal upper extremity in a large cohort of boys with Duchenne muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Mitchell B, Verrills P, Vivian D, Barnard A. Sacral nerve stimulation for the treatment of chronic low back, pelvic girdle and leg pain – A prospective study. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mitchell B, Bates D, Verrills P, Vivian D, Barnard A. Biological cell therapies for discogenic low back pain. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freitag J, Boyd R, Bates D, Huguenin L, Shah K, Barnard A. To evaluate the effect of autologous adipose derived mesenchymal stem cell therapy in the treatment of osteoarthritis – A case series analysis. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nozicka N, Barnard A, Meller LA. Abstract TP386: Clinical Nurse Specialist Influence on the Implementation of Telestroke in a Community Hospital. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
In 2013, a telestroke program was initiated within our hospital system. The Clinical Nurse Specialist (CNS) led the interprofessional team to implement the telestroke program at the spoke facility. Prior to implementation the hospital never successfully gave tPA in less than 60 minutes.
Purpose:
Implement telestroke into existing processes to ensure early access to neurological consultation and improve D2N time for eligible patients.
Methods
The CNS used the National Association of Clinical Nurse Specialist’s core competencies to help guide the implementation of telestroke. Collaboration: established shared vision and goals between the hub and spoke to identify and optimize outcomes. Collegiality: identified and engaged key stakeholders. System leadership: managed interdisciplinary workflow, empowered others to influence clinical practice. Evaluation of clinical practice: defined key goals and metrics, monitored data, provided feedback to clinicians and disseminated performance metrics. Consultation: local expert on existing processes, provided data analysis and quality monitoring to assess effectiveness of the program. Research: identified best practices, used evidence to drive process changes. Ethical decision making: provided clinician education to ensure competence with new equipment and processes while maintaining a patient centered approach. Coaching/direct patient care: provided bedside assistance to clinicians.
Results
Visibility of CNS influence on the redesign of the stroke patient care delivery process is evident in the following outcomes: time to activation of neurology consult reduced by 20 minutes, since implementation tPA given in < 60 min 68% of the time.
Conclusions
The CNS utilized core competencies to successfully implement telestroke. The redesign of this care delivery process required the CNS to influence the care for complex stroke patients, empower clinical staff to change practice and create a system wide approach to care of stroke patients. As a result, patient outcomes improved, demonstrating CNS impact on the safety, efficiency, reliability and quality of care for these complex patients.
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Affiliation(s)
- Nancy Nozicka
- Northwestern Medicine Lake Forest Hosp, Lake Forest, IL
| | - Amy Barnard
- Northwestern Medicine Lake Forest Hosp, Lake Forest, IL
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DuToit N, Mitchell B, Joseph J, Barnard A. Movement and muscle activation patterns following medial branch blocks for facet joint pain, and sacroiliac injection for sacroiliac joint pain. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Barnard A, Romero de Mello Sa S, Willcocks R, Senesac C, Finkel R, Forbes S, Sweeney H, Tennekoon G, Triplett W, Lott D, Wang D, Byrne B, Hammers D, Pham J, Rooney W, Finanger E, Walter G, Vandenborne K, Russman B. Genetic polymorphisms modify intramuscular fat infiltration in Duchenne muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jumelle C, Mauclair C, Houzet J, Barnard A, He Z, Piselli S, Perrache C, Gain P, Thuret G. Transfer of molecules into the endothelial cells of whole human corneas using carbon nanoparticles activated by femtosecond laser. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Jumelle
- Corneal Graft Biology- Engineering and Imaging Laboratory- EA2521- Federative Institute of Research in Sciences and Health Engineering- Faculty of Medicine; University Jean Monnet; Saint-Etienne France
| | - C. Mauclair
- Laboratory Hubert Curien- UMR-CNRS 5516; University Jean Monnet; Saint-Etienne France
| | - J. Houzet
- Laboratory Hubert Curien- UMR-CNRS 5516; University Jean Monnet; Saint-Etienne France
| | - A. Barnard
- Corneal Graft Biology- Engineering and Imaging Laboratory- EA2521- Federative Institute of Research in Sciences and Health Engineering- Faculty of Medicine; University Jean Monnet; Saint-Etienne France
| | - Z. He
- Ophthalmology; University Hospital; Saint-Etienne France
| | - S. Piselli
- Corneal Graft Biology- Engineering and Imaging Laboratory- EA2521- Federative Institute of Research in Sciences and Health Engineering- Faculty of Medicine; University Jean Monnet; Saint-Etienne France
| | - C. Perrache
- Corneal Graft Biology- Engineering and Imaging Laboratory- EA2521- Federative Institute of Research in Sciences and Health Engineering- Faculty of Medicine; University Jean Monnet; Saint-Etienne France
| | - P. Gain
- Corneal Graft Biology- Engineering and Imaging Laboratory- EA2521- Federative Institute of Research in Sciences and Health Engineering- Faculty of Medicine; University Jean Monnet; Saint-Etienne France
| | - G. Thuret
- Corneal Graft Biology- Engineering and Imaging Laboratory- EA2521- Federative Institute of Research in Sciences and Health Engineering- Faculty of Medicine and Institut Universitaire de France- Bd St Michel- Paris; University Jean Monnet; Saint-Etienne France
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Mitchell B, Verrills P, Vivian D, Barnard A. Peripheral nerve field stimulation therapy for patients with thoracic pain: A prospective study. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mitchell B, Barnard A. Is intradiscal methylene blue injection an effective treatment alternative for discogenic low back pain? J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Mitchell B, Verrills P, Vivian D, Barnard A. Sacral nerve stimulation for the treatment of chronic intractable pelvic pain—A prospective study. J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clark EL, Hadjimichael C, Temperley R, Barnard A, Fuller-Pace FV, Robson CN. p68/DdX5 supports β-catenin & RNAP II during androgen receptor mediated transcription in prostate cancer. PLoS One 2013; 8:e54150. [PMID: 23349811 PMCID: PMC3547877 DOI: 10.1371/journal.pone.0054150] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 12/07/2012] [Indexed: 11/18/2022] Open
Abstract
The DEAD box RNA helicase p68 (Ddx5) is an important androgen receptor (AR) transcriptional co-activator in prostate cancer (PCa) and is over-expressed in late stage disease. β-Catenin is a multifunctional protein with important structural and signalling functions which is up-regulated in PCa and similar to p68, interacts with the AR to co-activate expression of AR target genes. Importantly, p68 forms complexes with nuclear β-Catenin and promotes gene transcription in colon cancer indicating a functional interplay between these two proteins in cancer progression. In this study, we explore the relationship of p68 and β-Catenin in PCa to assess their potential co-operation in AR-dependent gene expression, which may be of importance in the development of castrate resistant prostate cancer (CRPCa). We use immunoprecipitation to demonstrate a novel interaction between p68 and β-Catenin in the nucleus of PCa cells, which is androgen dependent in LNCaP cells but androgen independent in a hormone refractory derivative of the same cell line (representative of the CRPCa disease type). Enhanced AR activity is seen in androgen-dependent luciferase reporter assays upon transient co-transfection of p68 and β-Catenin as an additive effect, and p68-depleted Chromatin-Immunoprecipitation (ChIP) showed a decrease in the recruitment of the AR and β-Catenin to androgen responsive promoter regions. In addition, we found p68 immunoprecipitated with the processive and non-processive form of RNA polymerase II (RNAP II) and show p68 recruited to elongating regions of the AR mediated PSA gene, suggesting a role for p68 in facilitating RNAP II transcription of AR mediated genes. These results suggest p68 is important in facilitating β-Catenin and AR transcriptional activity in PCa cells.
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Affiliation(s)
- Emma L. Clark
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Richard Temperley
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amy Barnard
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Frances V. Fuller-Pace
- Division of Cancer Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Craig N. Robson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Illsley M, Barnard A, Landau D. 152 Variation in maximal oesophageal dose with respiration during radical radiotherapy for NSCLC. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Freitag J, Barnard A. The next step in osteoarthritis management–Photoactivated Platelet Rich Plasma injections: A case study. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sauer MJ, Roesler CS, Werdell PJ, Barnard A. Under the hood of satellite empirical chlorophyll a algorithms: revealing the dependencies of maximum band ratio algorithms on inherent optical properties. Opt Express 2012; 20:20920-20933. [PMID: 23037216 DOI: 10.1364/oe.20.020920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Empirically-based satellite estimates of chlorophyll a [Chl] (e.g. OC3) are an important indicator of phytoplankton biomass. To correctly interpret [Chl] variability, estimates must be accurate and sources of algorithm errors known. While the underlying assumptions of band ratio algorithms such as OC3 have been tacitly hypothesized (i.e. CDOM and phytoplankton absorption covary), the influence of component absorption and scattering on the shape of the algorithm and estimated [Chl] error has yet to be explicitly revealed. We utilized the NOMAD bio-optical data set to examine variations between satellite estimated [Chl] and in situ values. We partitioned the variability into (a) signal contamination and (b) natural phytoplankton variability (variability in chlorophyll-specific phytoplankton absorption). Not surprisingly, the OC3 best-fit curve resulted from a balance between these two different sources of variation confirming the bias by detrital absorption on global scale. Unlike previous descriptions of empirical [Chl] algorithms, our study (a) quantified the mean detrital:phytoplankton absorption as ~1:1in the global NOMAD data set, and (b) removed detrital (CDOM + non-algal particle) absorption in radiative transfer models directly showing that the scale of the remaining variability in the band ratio algorithm was dominated by phytoplankton absorption cross section.
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Affiliation(s)
- Michael J Sauer
- US Geological Survey, 6000 J Street, Placer Hall, Sacramento, California 95819, USA.
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30
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Mitchell B, Rose R, Barnard A. Prolotherapy for sacro-iliac joint pain: Reduction in pain and increases in strength. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Mitchell B, Verrills P, Vivian D, Sinclair C, Barnard A. Radiofrequency neurotomy for sacroilliac joint pain—Prospective study. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Lesbians are a marginalized group of women living in a heteronormative society. This study describes lesbians' subjective experiences of depression, and identifies the ways that dominant and alternative discourses shaped their understandings of depression and sexuality. Twelve self-identified lesbians participated in up to three in-depth interviews conducted over a 9-month period. Thematic analysis led to themes that explicated their physical and emotional descriptions of depression; identified troubled interpersonal relationships as a primary source of depression; and discussed the means implemented to cope with depression, including taking medication, engaging in therapy, developing social support networks, and discovering their own spirituality. Depression and sexuality were understood within the framework of the dominant discourses of (1) medical model, (2) dysfunctional family, and (3) organized religion; and the alternative discourses of (1) lesbian identity, (2) alternative families, and (3) spirituality. Nurses in clinical practice can assist depressed lesbian clients by bolstering explorations of spirituality and the development of strong support networks within the lesbian and gay communities. Politically, institutionalized heteronormativity must be attacked at every level.
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Affiliation(s)
- Amy Barnard
- COPE Community Services, Tucson, Arizona 85712, USA.
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Mitchell B, Verrills P, Vivian D, Sinclair C, Barnard A. Peripheral nerve stimulation: A novel treatment for chronic low back pain and failed back surgery syndrome. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Trevethick MA, Mantell SJ, Stuart EF, Barnard A, Wright KN, Yeadon M. Treating lung inflammation with agonists of the adenosine A2A receptor: promises, problems and potential solutions. Br J Pharmacol 2008; 155:463-74. [PMID: 18846036 PMCID: PMC2579671 DOI: 10.1038/bjp.2008.329] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/16/2008] [Accepted: 07/30/2008] [Indexed: 01/17/2023] Open
Abstract
Adenosine A(2A) receptor agonists may be important regulators of inflammation. Such conclusions have come from studies demonstrating that, (i) adenosine A(2A) agonists exhibit anti-inflammatory properties in vitro and in vivo, (ii) selective A(2A) antagonists enhance inflammation in vivo and, (iii) knock outs of this receptor aggravate inflammation in a wide variety of in vivo models. Inflammation is a hallmark of asthma and COPD and adenosine has long been suggested to be involved in disease pathology. Two recent publications, however, suggested that an inhaled adenosine A(2A) receptor agonist (GW328267X) did not affect either the early and late asthmatic response or symptoms associated with allergic rhinitis suggesting that the rationale for treating inflammation with an adenosine A(2A) receptor agonist may be incorrect. A barrier to fully investigating the role of adenosine A(2A) receptor agonists as anti-inflammatory agents in the lung is the side effect profile due to systemic exposure, even with inhalation. Unless strategies can be evolved to limit the systemic exposure of inhaled adenosine A(2A) receptor agonists, the promise of treating lung inflammation with such agents may never be fully explored. Using strategies similar to that devised to improve the therapeutic index of inhaled corticosteroids, UK371,104 was identified as a selective agonist of the adenosine A(2A) receptor that has a lung focus of pharmacological activity following delivery to the lung in a pre clinical in vivo model of lung function. Lung-focussed agents such as UK371,104 may be suitable for assessing the anti-inflammatory potential of inhaled adenosine A(2A) receptor agonists.
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Affiliation(s)
- M A Trevethick
- Allergy and Respiratory Biology, Pfizer Global R&D, Sandwich, Kent, UK.
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Affiliation(s)
- M. Craven
- Agricultural Research Council, Small Grain Institute, Private Bag X29, Bethlehem, 9700, South Africa
- Agricultural Research Council, Grain Crops Institute, Private Bag X1251, Potchefstroom, 2520, South Africa
- Corresponding author. Phone: (018) 299 6100 (Int: +2718) Fax: (018) 294 7146 (Int: +2718). E-mail:
| | - A. Barnard
- Agricultural Research Council, Small Grain Institute, Private Bag X29, Bethlehem, 9700, South Africa
| | - M. T. Labuschagne
- University of the Free State, Dept. Plant Sciences. Bloemfontein, 9300, South Africa
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Craven M, Barnard A, Otto W, Labuschagne MT. Classification of South African Bread Wheat Cultivars According to Hagberg Falling Number Reaction to Fertilizer Treatment. Cereal Chem 2007. [DOI: 10.1094/cchem-84-3-0214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M. Craven
- Agricultural Research Council-Small Grain Institute (ARC-SGI), Private Bag X1251, Potchefstroom, 2520, South Africa
- Corresponding author. Phone: (018) 299 6100 (Int: +27 18). Fax: (018) 294 7146 (Int: +27 18). E-mail:
| | - A. Barnard
- Agricultural Research Council-Small Grain Institute, Private Bag X29, Bethlehem, 9700, South Africa
| | - W. Otto
- Agricultural Research Council-Small Grain Institute, Private Bag X29, Bethlehem, 9700, South Africa
| | - M. T. Labuschagne
- University of the Free State, Department of Plant Sciences. Bloemfontein, 9300, South Africa
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Barnard A. Palliative care is on the move--masihambe! S Afr Med J 2006; 96:118, 120. [PMID: 16532079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
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Barnard A, Muller M. A strategy for the management of HIV/ AIDS in the health sector of the city of Johannesburg. Curationis 2005; 27:5-17. [PMID: 15712821 DOI: 10.4102/curationis.v27i4.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The HIV/AIDS pandemic is posing major challenges to all sectors in South Africa, including the health sector of the city of Johannesburg. The health sector of the city of Johannesburg, as a result of the pandemic, is faced with increasing demands on its scarce resources at a time of major reform at local government level including transformation of the health sector. The overall objective of the study is to explore and describe a strategy for the management of HIV/AIDS by the health sector of the city of Johannesburg. An exploratory, descriptive and quantitative research design was utilized and the UNAIDS "Guide to the strategic planning process for a national response to HIV/AIDS" (1998), was employed to formulate the strategy. The content validity of the strategy was determined according to the process originally described by Lynn (1986) and adopted by Muller (in Booyens, 1998:607-609). The research was conducted in two phases. The first phase, the developmental phase, involved the exploration and description of the theoretical framework and the response to the pandemic, and formulation of a draft strategy. The second phase, the quantification phase, involved the assertion of the content of the strategy by a group of experts and determination of the content validity index (CVI). The final strategy focused on the following: to lead and facilitate intersectoral collaboration; to strengthen primary health care services to provide comprehensive community-based care; prevention of new infections; community mobilization towards prevention, non discrimination and non stigmatization and empowerment of the health sector to deal with the AIDS.pandemic. The CVI results showed that the average content validity index determined during this study was adequate: full score (1.0) for acceptability and technical soundness, and 0.89 for feasibility and perceived affordability. The strategy formulated for the management of HIV/AIDS by the health sector of the city of Johannesburg is therefore acceptable, technically sound and feasible and perceived as affordable. It was finally recommended that the strategy be adopted for implementation within the health sector of the city of Johannesburg.
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Abstract
BACKGROUND A dearth of knowledge and information exist about the understanding of the experience of surviving a life-threatening illness such as Ebola Hemorrhagic Fever (Ebola). OBJECTIVES To understand the ways in which survivors of Ebola understood the experience of surviving a life-threatening illness. METHODS Eleven participants were asked to illustrate their understanding of the experience of surviving Ebola. (Only six of the drawings are published in this paper.) Using drawings and interviews as data, a phenomenographic approach was used to guide the research process and to analyse data. RESULTS Analysis revealed four ways of understanding the experience. These are described as categories of descriptions or conceptions, namely, escape in peaceful awareness, hope for a world outside of fear, persistence in defying death, and constant fear of dying. Importantly, the structure and referential aspects of the experiences are portrayed in the form of an outcome space, which is the understanding of the experience of living as survivors of Ebola, described as both "living in fear of the predatory spectre", while simultaneously "living in constant hopefulness". This experience is illustrated as paradoxically living in fear while concurrently hoping for life. DISCUSSION Understanding the experience of survivors of a life-threatening illness is significant to nursing and its practice. Critical to this significance is its influence on the practice of compassionate and competent nursing.
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Affiliation(s)
- R C Locsin
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431-0091, USA.
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Abstract
OBJECTIVE To describe a new disease-specific questionnaire with established measurement properties that addresses the dimensions of health-related quality of life considered important to women with endometriosis. METHODS The Endometriosis Health Profile-30 was developed in three stages. Stage 1 included open-ended exploratory interviews with 25 women to generate the items on the questionnaire. Stage 2 was an 87-item questionnaire administered in a postal survey to identify the most salient dimensions of health-related quality of life. In stage 3, the reliability and validity of the questionnaire were evaluated. RESULTS The final instrument contained a core questionnaire with 30 items and five scales: pain, control and powerlessness, emotional well-being, social support, and self-image. Six modular parts consisting of 23 questions were also developed and measured the areas of sexual intercourse, work, relationship with children, feelings about the medical profession, treatment, and infertility. All the scales achieved high internal reliability, with Cronbach's alpha coefficient ranging from 0.83 to 0.93 (core questionnaire) and 0.79 to 0.96 (modules). The intraclass correlation coefficients to evaluate the test-retest reliability were high (range 0.88-0.98, P <.001). Content validity was demonstrated as the questionnaire was developed from interviews of patients rather than existing literature and clinical scales. Construct validity was assessed by correlating the Endometriosis Health Profile-30 scales with the relevant Short Form-36 scales. High correlations for all comparisons were found (-0.41 to -0.73). CONCLUSION The Endometriosis Health Profile-30 is a reliable, valid, patient-generated instrument to measure the health-related quality of life of women with endometriosis. Its application in various health care settings will provide new and valuable information on the effect of endometriosis on health-related quality of life from the patients' perspective.
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Affiliation(s)
- G Jones
- Nuffield Department of Obstetrics and Gynaecology and Health Services Research Unit, Division of Public Health and Primary Health Care, University of Oxford, United Kingdom.
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Abstract
UNLABELLED AIM(S) OF THE PAPER: This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing. BACKGROUND/RATIONALE Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society. CONCLUSION The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re-examination of the relationship(s) between technology, humane care and nursing practice.
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Affiliation(s)
- A Barnard
- School of Nursing, Queensland University of Technology, Australia.
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Abstract
Classical radiative transfer programs are based on the plane-parallel assumption. We show that the Gershun equation is valid if the irradiance is averaged over a sufficiently large area. We show that the equation is invalid for horizontal areas of the order of tens of meters in which horizontal gradients of irradiance in the presence of waves are much larger than vertical gradients. We calculate the distribution of irradiance beneath modeled two-dimensional surface waves. We show that many of the features typically observed in irradiance profiles can be explained by use of such models. We derive a method for determination of the diffuse attenuation coefficient that is based on the upward integration of the irradiance field beneath waves, starting at a depth at which the irradiance profile is affected only weakly by waves.
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Affiliation(s)
- J R Zaneveld
- College of Oceanic and Atmospheric Sciences, Oregon State University, 104 Ocean Administration Building, Corvallis, Oregon 97331-0000, USA.
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44
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Abstract
This article describes the findings of a phenomenographic research approach used to understand the experiences of competence of new nurse graduates. The aim of phenomenography is to describe the qualitatively different ways in which people understand a phenomenon. Six new graduates, who had been employed in two paediatric metropolitan hospitals in Australia, participated in the research. The graduates were interviewed and asked to describe and draw their understanding of competence. The interviews were audio-taped and transcribed verbatim. Interview transcripts were analysed according to accepted phenomenographic methods of analysis. The graduates described eight conceptions of competence: competence as safe practice; competence as limited independence; competence as utilization of resources; competence as management of time and workload; competence as ethical practice; competence as performance of clinical skills; competence as knowledge; and competence as evolving. The final outcome of identification of conceptions led to the development of an outcome space (a diagrammatic representation of the logical relations between conceptions). The outcome space depicted a three-level hierarchical relationship between the eight conceptions of competence experienced within a global framework of safety. The findings contribute to nursing knowledge by describing the meaning of competence from the perspective of the new nurse graduate. The need for support and assistance by employers of new graduates is confirmed from the findings. New nurse graduate experiences of competence provide suggestions for improving undergraduate education programmes as well as clarification of entry-level competency standards.
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Affiliation(s)
- P L Ramritu
- Nursing Research Centre/Queensland Centre for Evidence Based Nursing and Midwifery, Mater Misericordiae Hospitals, South Brisbane, Australia.
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45
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Cooke MS, Evans MD, Burd RM, Patel K, Barnard A, Lunec J, Hutchinson PE. Induction and excretion of ultraviolet-induced 8-oxo-2'-deoxyguanosine and thymine dimers in vivo: implications for PUVA. J Invest Dermatol 2001; 116:281-5. [PMID: 11180005 DOI: 10.1046/j.1523-1747.2001.01251.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Molecular epidemiology has linked ultraviolet-induced DNA damage with mutagenesis and skin carcinogenesis. Ultraviolet radiation may damage DNA in one of two ways: either directly, leading to lesions such as cyclobutane thymine dimers (T<>T), or indirectly, via photosensitizers that generate free radical species that may ultimately produce such oxidative lesions as 8-oxo-2'-deoxyguanosine. We report the results of a pilot, case control study in which seven, healthy, human volunteers (skin type II; aged 23-56 y; three male, four female) received a suberythemal dose of whole body irradiation from ultraviolet-A-emitting fluorescent tubes used in psoralen plus ultraviolet A therapy. First void, mid-stream urine samples were collected pre-exposure and daily postexposure, for up to 13 d. Analysis of urinary 8-oxo-2'-deoxyguanosine and cyclobutane thymine dimers was by competitive enzyme-linked immunosorbent assay (interassay coefficient of variation < or = 10%) and compared with a matched, control group of unirradiated individuals. A maximal increase in levels of urinary 8-oxo-2'-deoxyguanosine was seen 4 d post-ultraviolet exposure. A subsequent reduction was noted, before finally returning to baseline. Similarly, cyclobutane thymine dimer levels peaked 3 d postexposure, before returning to baseline. In contrast to the 8-oxo-2'-deoxyguanosine analysis, however, a second peak was noted at days 9-11, before again returning to baseline. This is the first report examining urinary 8-oxo-2'-deoxyguanosine and cyclobutane thymine dimers following ultraviolet exposure of healthy human subjects. This work illustrates the induction and time course for excretion of ultraviolet-induced lesions, perhaps alluding to repair and ultimately offering the potential to define psoralen plus ultraviolet A dosage regimes in terms of minimizing DNA damage and hence cancer risk.
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Affiliation(s)
- M S Cooke
- Oxidative Stress Group, Division of Chemical Pathology, University of Leicester, RKCSB, Leicester Royal Infirmary NHS Trust, PO Box 65, Leicester LE2 7LX, UK.
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46
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Barnard A. Alteration to will as an experience of technology and nursing. J Adv Nurs 2000; 31:1136-44. [PMID: 10840247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This paper presents one finding to arise from a recent qualitative research study that examined ways of understanding technology in surgical nursing, and examines its implications for nursing and health care practice. Although the research reported identified eight qualitatively different ways of understanding technology, this paper examines the specific experience that technology can alter will (volition). The experience described is a new area of knowledge and is in need of further examination and research. Nonetheless, it is significant to understanding technology, contemporary nursing practice and the provision of health care services. The paper concludes with some suggested approaches for curtailing the experience and a discussion related to challenges that arise from the finding that technology can alter the free will of nurses.
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Affiliation(s)
- A Barnard
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove Campus, Kelvin Grove, Queensland 4059, Australia
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47
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Abstract
This article identifies assumptions common to interpreting technological progress in contemporary nursing practice. Technology is described in terms of its characteristics and progress is identified as an ideological assumption influencing the way we think about, practice, and explain technology in contemporary nursing. Arguments associated with linear development, the elimination of scarcity, the technological imperative, the advancement of nursing, and technology as a neutral phenomenon are examined. It is argued that understanding progress assists us to develop insight into the relationship between technology and nursing.
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Affiliation(s)
- A Barnard
- School of Nursing, Queensland University of Technology, Red Hill, Australia.
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48
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Abstract
The purpose of this paper is to describe the result of phenomenographic research undertaken to identify the qualitatively different ways technology is understood and experienced by contemporary surgical nurses. Twenty surgical nurses were interviewed and conversations were recorded through the use of drawings and audiotape that were analysed using a series of seven analytical steps. There were two major outcomes of the research: eight categories of description were revealed and each one constitutes a conception of the experience and understanding of technology, and an outcome space portraying the logical relations between conceptions was identified. Conceptions revealed demonstrate the importance of technology to the theory, practice, research and education of nurses, and highlight the complexity and significance of technology in contemporary surgical nursing experience.
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Affiliation(s)
- A Barnard
- Queensland University of Technology, Queensland, Australia.
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49
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Abstract
Phenomenography is a little-known qualitative research approach that has potential for health care research, particularly when people's understanding of their experience is the goal. Phenomenography is explained as a qualitative, nondualistic research approach that identifies and retains the discourse of research participants. This article seeks to present the major assumptions associated with phenomenographic research. An example of the way in which research outcomes are presented is included to emphasize its distinctiveness. It is noted that phenomenography has potential in the area of qualitative health research and will benefit from ongoing development and application.
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Affiliation(s)
- A Barnard
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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50
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Darling D, Galea-Lauri J, Gäken J, Towner P, Kuiper M, Hollingsworth S, Hirst W, Barnard A, Buggins A, Mufti G, Farzaneh F. In vitro immune modulation by antibodies coupled to tumour cells. Gene Ther 1997; 4:1350-60. [PMID: 9472559 DOI: 10.1038/sj.gt.3300534] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modification of autologous tumour cells to express the immune costimulator B7.1 is a potential strategy for immunotherapy of cancer. Previously, this has involved introduction of genetic material into cells, in vitro culture, and confirmation of the protein product on the cell surface. This is possible only if sufficient tumour is obtainable and efficiently modified in a short time. Whilst progress has been made on ex vivo tumour cell culture and transfection/infection procedures there are still tumour types for which the present means of gene transfer are not efficient enough. We describe a highly efficient in vitro procedure for the modification of over 99% of the cells in a population, allowing the expression of cell surface proteins with potential immune modulatory activities. This procedure, which can be completed in as little as 24 h with no upper limit on cell number, utilizes succinimide esters to label cell surface proteins with biotin covalently. Biotinylated cell membrane proteins then anchor an avidin bridge for immobilizing protein G'-biotin. This can serve to bind immunoglobulin (Ig) molecules via their Fc region such that the variable region of the antibody is freely and functionally available. In the present study the binding of a stimulatory mouse anti-human CD28 monoclonal antibody to the surface of tumour cells is used to show that the modified cells are capable of co-stimulating T cells in vitro. The simplicity of the method, and the use of common reagents, represents a further step towards a realistic, truly 'off-the-shelf', nongene immunotherapy protocol.
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Affiliation(s)
- D Darling
- Department of Molecular Medicine, King's College School of Medicine and Dentistry, London, UK
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