Quantification of Tissue Oxygen Saturation in the Vastus Lateralis Muscle of Chronic Stroke Survivors during a Graded Exercise Test

Purpose

This study examined tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscles of chronic stroke survivors during a graded exercise test (GXT). We hypothesized the reduction in StO2 will be blunted in the paretic vs. non-paretic VL during a maximum-effort GXT.

Methods

Chronic stroke survivors performed a GXT and StO2 of the VL in each leg was measured using near infrared spectroscopy. Twenty-six stroke survivors performed a GXT.

Results

At rest, there was no difference in StO2 between the paretic and non-paretic VL (65±9% vs. 68±7%, respectively, p=0.32). The maximum change in StO2 from rest during the GXT was greater in the non-paretic vs. the paretic VL (-16±14% vs. -9±10%, respectively, p<0.001). The magnitude of the oxygen resaturation response was also greater in the non-paretic vs. the paretic VL (29±23% vs. 18±15%, respectively, p<0.001). VO2 Peak was associated with the magnitude of the VL StO2 change during (r2=0.54, p<0.0001) and after (r2=0.56, p<0.001) the GXT.

Conclusions

During a GXT there is a blunted oxygen desaturation response in the paretic vs. the non-paretic VL of chronic stroke survivors. In the paretic VL there was a positive correlation between the oxygen desaturation response during the GXT and VO2 Peak.

[Research impact and participatory health research: an international debate]

Seit einigen Jahren beschäftigt sich die akademische Welt verstärkt damit, welcher gesellschaftliche Nutzen von Forschung ausgeht und wie er erhoben und dargestellt werden kann. Zu der Wirkung von Forschung, dem sogenannten Forschungsimpact, werden verschiedene Diskussionen geführt – kontrovers besonders in Ländern, in denen Impact mittlerweile ein Faktor bei der Verteilung von Fördergeldern geworden ist. Partizipative Gesundheitsforschung ist ein Forschungsansatz, der diejenige in die Forschung einbindet, deren Arbeit oder Leben im Forschungsinteresse stehen. Mit diesem Ansatz soll auch außerhalb der akademischen Welt Wirkung erzielt werden, um Veränderungen zum gesundheitlichen Wohlergehen anzustoßen und die gesundheitliche Chancengleichheit in der Gesellschaft zu erhöhen.

Der Beitrag geht den Fragen nach, wie Forschungsimpact verstanden und erhoben werden kann und welchen Beitrag die Wirkungen der partizipativen Gesundheitsforschung zu gesundheitlicher Chancengleichheit leisten können. Er geht exemplarisch auf Aspekte von Impactdiskussionen im Vereinigten Königreich und in Deutschland ein und bildet dann den aktuellen Stand der fachlichen Auseinandersetzung mit dem Themenbereich ab. Schließlich beschreibt er die Wirkfaktoren der partizipativen Gesundheitsforschung, die zu einer Stärkung gesundheitlicher Chancengleichheit führen können.

Nicht nur im Bereich der partizipativen Gesundheitsforschung ermöglicht es die Diskussion über Forschungsimpact, die Nachhaltigkeit und den Wert von Forschung zu bewerten und zu stärken. Da die vielseitigen Wirkungen der partizipativen Gesundheitsforschung jedoch das Potenzial haben, gesundheitliche Ungleichheiten zu verringern, sollten sie entsprechend wahrgenommen und anerkannt werden.

[Participatory health research: origins and current trends]

Partizipative Gesundheitsforschung (PGF) wird international – und seit einigen Jahren auch in Deutschland – zunehmend als Möglichkeit wahrgenommen, wissenschaftliche Erkenntnisse zu erzeugen, die unmittelbar zur Verbesserung von Gesundheitschancen für sozial benachteiligte Bevölkerungsgruppen beitragen. Zentrales Merkmal der PGF ist die direkte Beteiligung der Menschen am Forschungsprozess, deren Arbeits- oder Lebensverhältnisse Gegenstand der Forschung sind. Dieser Beitrag gibt einen Überblick über Ursprünge, Grundlagen und aktuelle Entwicklungen der PGF. Wissenschaftliche Literatur aus der internationalen Diskussion um die PGF wird im Sinne eines narrativen Reviews rezipiert, der Schwerpunkt liegt auf Überblicksarbeiten und Publikationen der International Collaboration for Participatory Health Research.

Das Review ergibt, dass eine wachsende Anzahl von Forschenden im Gesundheitsbereich partizipativ arbeitet. Es ist auch deutlich erkennbar, dass ein eigenständiger wissenschaftlicher Diskurs und diverse Vereinigungen partizipativ Forschender sich in vielen Ländern etabliert haben. Folgende aktuelle internationale Entwicklungen sind hervorzuheben: Konsolidierung und Vernetzung, Klärung der Frage, was Partizipation in der Forschung bedeutet, Evaluation der Auswirkungen und des Mehrwerts der PGF, Weiterentwicklung der PGF in spezifischen Anwendungsbereichen und die Klärung ethischer Fragen in der PGF.

Two weeks of remote ischemic conditioning improves brachial artery flow mediated dilation in chronic stroke survivors

Many stroke survivors have reduced cardiorespiratory fitness as a result of their stroke. Ischemic conditioning (IC) is a noninvasive, cost-effective, easy-to-administer intervention that can be performed at home and has been shown to improve both motor function in stroke survivors and vascular endothelial function in healthy individuals. In this study, we examined the effects of 2 wk of remote IC (RIC) on brachial artery flow mediated dilation (FMD) in chronic stroke survivors. We hypothesized that FMD would be improved following RIC compared with a sham RIC control group. This was a prospective, randomized, double-blinded, controlled study. Twenty-four chronic stroke survivors (>6 mo after stroke) were enrolled and randomized to receive either RIC or sham RIC on their affected thigh every other day for 2 wk. For the RIC group, a blood pressure cuff was inflated to 225 mmHg for 5 min, followed by 5 min of recovery, and repeated a total of five times per session. For the sham RIC group, the inflation pressure was 10 mmHg. Brachial artery FMD was assessed on the nonaffected arm at study enrollment and following the 2-wk intervention period. Nine men and fourteen women completed all study procedures. Brachial artery FMD increased from 5.4 ± 4.8 to 7.8 ± 4.4% (P = 0.030; n = 12) in the RIC group, while no significant change was observed in the sham RIC group (3.5 ± 3.9% pretreatment versus 2.4 ± 3.1% posttreatment; P = 0.281, n = 11). Two weeks of RIC increases brachial artery FMD in chronic stroke survivors.NEW & NOTEWORTHY In this study, we report that 2 wk of remote ischemic conditioning (RIC) improves brachial artery flow-mediated dilation in chronic stroke survivors. Because poor cardiovascular health puts stroke survivors at a heightened risk for recurrent stroke and other cardiovascular events, an intervention that is simple, cost-effective, and easy to perform like RIC holds promise as a means to improve cardiovascular health in this at-risk population.

Reflexivity in Health Promotion: A Typology for Training

Reflexivity has emerged as a key concept in the field of health promotion (HP). Yet it remains unclear how diverse forms of reflexivity are specifically relevant to HP concerns, and how these “reflexivities” are interconnected. We argue that frameworks are needed to support more systematic integration of reflexivity in HP training and practice. In this article, we propose a typology of reflexivity in HP to facilitate the understanding of reflexivity in professional training. Drawing from key theories and models of reflexivity, this typology proposes three reflexive positions (ideal-types) with specific purposes for HP: reflexivity in, on, and underlying action. This article illustrates our typology’s ideal-types with vignettes collected from HP actors working with reflexivity in North America and Europe. We suggest that our typology constitutes a conceptual device to organize and discuss a variety of experiences of engaging with reflexivity for HP. We propose the typology may support integrating reflexivity as a key feature in training a future cadre of health promoters and as a means for building a responsible HP practice.

Occurrence and Sources of Radium in Groundwater Associated with Oil Fields in the Southern San Joaquin Valley, California

Geochemical data from 40 water wells were used to examine the occurrence and sources of radium (Ra) in groundwater associated with three oil fields in California (Fruitvale, Lost Hills, South Belridge). ²²⁶Ra+²²⁸Ra activities (range = 0.010-0.51 Bq/L) exceeded the 0.185 Bq/L drinking-water standard in 18% of the wells (not drinking-water wells). Radium activities were correlated with TDS concentrations (p < 0.001, ρ = 0.90, range = 145-15,900 mg/L), Mn + Fe concentrations (p < 0.001, ρ = 0.82, range = <0.005-18.5 mg/L), and pH (p < 0.001, ρ = -0.67, range = 6.2-9.2), indicating Ra in groundwater was influenced by salinity, redox, and pH. Ra-rich groundwater was mixed with up to 45% oil-field water at some locations, primarily infiltrating through unlined disposal ponds, based on Cl, Li, noble-gas, and other data. Yet ²²⁸Ra/²²⁶Ra ratios in pond-impacted groundwater (median = 3.1) differed from those in oil-field water (median = 0.51). PHREEQC mixing calculations and spatial geochemical variations suggest that the Ra in the oil-field water was removed by coprecipitation with secondary barite and adsorption on Mn-Fe precipitates in the near-pond environment. The saline, organic-rich oil-field water subsequently mobilized Ra from downgradient aquifer sediments via Ra-desorption and Mn/Fe-reduction processes. This study demonstrates that infiltration of oil-field water may leach Ra into groundwater by changing salinity and redox conditions in the subsurface rather than by mixing with a high-Ra source.

Abstract 60: Ischemic Conditioning Improves Brachial Artery Flow Mediated Dilation in Chronic Stroke Survivors

Introduction: Brachial artery flow mediated dilation (FMD) is a well-established measure of vascular endothelial health and is pathologically low in chronic stroke survivors. Ischemic conditioning (IC) is a cardioprotective stimulus and has been shown to improve FMD and enhance motor function in healthy humans. We recently showed that IC can improve paretic muscle strength and increase self-selected walking speed in stroke survivors. These improvements could be, in part, mediated by improved peripheral vascular function and increased blood flow to the exercising muscle. The effects of IC on vascular endothelial function post-stroke have not been investigated.

Hypothesis: Two weeks of IC on the paretic leg of chronic stroke survivors will improve FMD in the non-paretic brachial artery.

Methods: This was a prospective, randomized, blinded and controlled pilot study. Twenty chronic stroke survivors (>1-year post-stroke) received either IC (cuff inflation on the paretic leg for five minutes to 225 mmHg) or Sham IC (cuff inflation to 10 mmHg) every other day for two weeks (five on-off cycles per session). Brachial artery FMD was assessed using ultrasonography within 48 hours of the beginning and end of the intervention period.

Results: Eight men and twelve women participated in this study. The mean age was 59 ± 16 years and the mean time post-stroke was 9 ± 9 years. Brachial artery FMD increased in the IC group from 6.2 ± 4.9% to 8.9 ± 3.9% (n=10; p=0.023, 2-way Repeated Measures ANOVA) while no change was observed in the Sham IC group (pre- vs. post = 3.8 ± 3.9% vs. 2.7 ± 3.1%, respectively; p=0.32, n=10). Expressed as the mean change in FMD, IC increased FMD by 2.8 ± 3.7% while no change was observed in the Sham IC group (delta FMD = -1.1 ± 3.4%; p=0.024 IC vs. IC Sham, unpaired t-test).

Conclusions: Two weeks of IC increases brachial artery FMD in chronic stroke survivors. Taken together with our previous work that shows IC increases paretic muscle strength and walking speed in chronic stroke survivors, IC has the potential to improve both motor and cardiovascular function post-stroke. Future larger studies are needed to evaluate the efficacy of IC to improve stroke recovery and to identify the pathways involved which confer benefit to both the nervous and cardiovascular systems.

Two weeks of ischemic conditioning improves walking speed and reduces neuromuscular fatigability in chronic stroke survivors

This pilot study examined whether ischemic conditioning (IC), a noninvasive, cost-effective, and easy-to-administer intervention, could improve gait speed and paretic leg muscle function in stroke survivors. We hypothesized that 2 wk of IC training would increase self-selected walking speed, increase paretic muscle strength, and reduce neuromuscular fatigability in chronic stroke survivors. Twenty-two chronic stroke survivors received either IC or IC Sham on their paretic leg every other day for 2 wk (7 total sessions). IC involved 5-min bouts of ischemia, repeated five times, using a cuff inflated to 225 mmHg on the paretic thigh. For IC Sham, the cuff inflation pressure was 10 mmHg. Self-selected walking speed was assessed using the 10-m walk test, and paretic leg knee extensor strength and fatigability were assessed using a Biodex dynamometer. Self-selected walking speed increased in the IC group (0.86 ± 0.21 m/s pretest vs. 1.04 ± 0.22 m/s posttest, means ± SD; P < 0.001) but not in the IC Sham group (0.92 ± 0.47 m/s pretest vs. 0.96 ± 0.46 m/s posttest; P = 0.25). Paretic leg maximum voluntary contractions were unchanged in both groups (103 ± 57 N·m pre-IC vs. 109 ± 65 N·m post-IC; 103 ± 59 N·m pre-IC Sham vs. 108 ± 67 N·m post-IC Sham; P = 0.81); however, participants in the IC group maintained a submaximal isometric contraction longer than participants in the IC Sham group (278 ± 163 s pre-IC vs. 496 ± 313 s post-IC, P = 0.004; 397 ± 203 s pre-IC Sham vs. 355 ± 195 s post-IC Sham; P = 0.46). The results from this pilot study thus indicate that IC training has the potential to improve walking speed and paretic muscle fatigue resistance poststroke. NEW & NOTEWORTHY This pilot study is the first to demonstrate that ischemic conditioning can improve self-selected walking speed and reduce paretic muscle fatigue in stroke survivors. Ischemic conditioning has been shown to be safe in numerous patient populations, can be accomplished at home or at the bedside in only 45 min, and requires no specialized training. Future larger studies are warranted to determine the efficacy of ischemic conditioning as a neurorehabilitation therapy poststroke.

A systematic mixed studies review on Organizational Participatory Research: towards operational guidance

BACKGROUND

Organizational Participatory Research (OPR) seeks organizational learning and/or practice improvement. Previous systematic literature reviews described some OPR processes and outcomes, but the link between these processes and outcomes is unknown. We sought to identify and sequence the key processes of OPR taking place with and within healthcare organizations and the main outcomes to which they contribute, and to define ideal-types of OPR.

METHODS

This article reports a participatory systematic mixed studies review with qualitative synthesis A specialized health librarian searched MEDLINE, CINAHL, Embase Classic + Embase, PsycINFO, the Cochrane Library, Social Work Abstracts and Business Source Complete, together with grey literature data bases were searched from inception to November 29, 2012. This search was updated using forward citation tracking up to June 2014. Reporting quality was appraised and unclear articles were excluded. Included studies clearly reported OPR where the main research related decisions were co-constructed among the academic and healthcare organization partners. Included studies were distilled into summaries of their OPR processes and outcomes, which were subsequently analysed using deductive and inductive thematic analysis. All summaries were analysed; that is, data analysis continued beyond saturation.

RESULTS

Eighty-three studies were included from the 8873 records retrieved. Eight key OPR processes were identified. Four follow the phases of research: 1) form a work group and hold meetings, 2) collectively determine research objectives, 3) collectively analyse data, and 4) collectively interpret results and decide how to use them. Four are present throughout OPR: 1) communication, 2) relationships; 3) commitment; 4) collective reflection. These processes contribute to extra benefits at the individual and organizational levels. Four ideal-types of OPR were defined. Basic OPR consists of OPR processes leading to achieving the study objectives. This ideal-type and may be combined with any of the following three ideal-types: OPR resulting in random additional benefits for the individuals or organization involved, OPR spreading to other sectors of the organization and beyond, or OPR leading to subsequent initiatives. These results are illustrated with a novel conceptual model.

CONCLUSION

The model provides operational guidance to help OPR stakeholders collaboratively address organizational issues and achieve desired outcomes and more.

REVIEW REGISTRATION

As per PROSPERO inclusion criteria, this review is not registered.

Abstract TP143: Evaluation of Knee Extensor Muscle Strength and Femoral Artery Blood Flow in Subacute Stroke Patients Admitted to Inpatient Rehabilitation - a Feasibility Study

Introduction: Weakness of the contralateral leg muscles commonly occurs following unilateral stroke. We and others have also shown that the femoral artery is atrophied in the paretic (P) limb of chronic stroke subjects (>6 months post-stroke) compared to the non-paretic (NP) limb, and that both resting and hyperemic blood flow to the exercising muscle are dramatically reduced. Further, the hyperemic response positively correlates with leg strength and clinical measures of leg function. It is unknown if these changes in femoral artery diameter and peripheral blood flow are present in the subacute phase of stroke (<30 days post-stroke).

Hypothesis: Femoral artery diameter is smaller, and resting and hyperemic blood flow to exercising muscle is reduced in the P limb in subjects in the subacute phase of stroke admitted to inpatient rehabilitation.

Methods: Stroke patients were tested within three days of admission to inpatient rehabilitation in a hospital setting. Isometric knee extensor maximal voluntary contractions (MVCs) were measured in both legs using a Biodex dynamometer. Superficial femoral artery diameter and blood flow were measured at rest and immediately following MVCs using Doppler ultrasound.

Results: A pilot group of four subjects (1 male, 3 female) aged 68 ± 4 years (range 56-75 years) completed all study procedures on average 13 ± 5 days post ischemic stroke (range 7-24 days). All subjects had infarcts of the middle cerebral artery (3 right, 1 left). P leg knee extensor MVCs were lower compared to the NP leg (93.8 ± 25.5 Nm vs. 160.4 ± 33.2 Nm, respectively; p<0.05). Superficial femoral artery diameter was smaller in the P leg compared to the NP leg (5.7 ± 0.4 mm vs. 6.0 ± 0.5 mm, respectively; p=0.06), and resting blood flow was reduced (172 ± 46 ml/min vs. 206 ± 54 ml/min, respectively; p<0.05). Hyperemic blood flow in response to knee extensor MVCs was also lower in the P limb compared to the NP limb (239 ± 62 ml/min vs. 435 ± 67 ml/min, respectively; p<0.05).

Conclusions: We show feasibility of testing knee extensor muscle strength and peripheral blood flow in subacute stroke inpatients. Our preliminary data indicates that femoral artery atrophy has occurred in the P leg and that both resting and hyperemic blood flow to the P muscle are reduced.

Organizational participatory research: a systematic mixed studies review exposing its extra benefits and the key factors associated with them

BACKGROUND

In health, organizational participatory research (OPR) refers to health organization members participating in research decisions, with university researchers, throughout a study. This non-academic partner contribution to the research may take the form of consultation or co-construction. A drawback of OPR is that it requires more time from all those involved, compared to non-participatory research approaches; thus, understanding the added value of OPR, if any, is important. Thus, we sought to assess whether the OPR approach leads to benefits beyond what could be achieved through traditional research.

METHODS

We identified, selected, and appraised OPR health literature, and at each stage, two team members independently reviewed and coded the literature. We used quantitative content analysis to transform textual data into reliable numerical codes and conducted a logistic regression to test the hypothesis that a co-construction type OPR study yields extra benefits with a greater likelihood than consultation-type OPR studies.

RESULTS

From 8873 abstracts and 992 full text papers, we distilled a sample of 107 OPR studies. We found no difference between the type of organization members' participation and the likelihood of exhibiting an extra benefit. However, the likelihood of an OPR study exhibiting at least one extra benefit is quadrupled when the impetus for the study comes from the organization, rather than the university researcher(s), or the organization and the university researcher(s) together (OR = 4.11, CI = 1.12-14.01). We also defined five types of extra benefits.

CONCLUSIONS

This review describes the types of extra benefits OPR can yield and suggests these benefits may occur if the organization initiates the OPR. Further, this review exposes a need for OPR authors to more clearly describe the type of non-academic partner participation in key research decisions throughout the study. Detailed descriptions will benefit others conducting OPR and allow for a re-examination of the relationship between participation and extra benefits in future reviews.

Participatory epidemiology: the contribution of participatory research to epidemiology

Background

Epidemiology has contributed in many ways to identifying various risk factors for disease and to promoting population health. However, there is a continuing debate about the ability of epidemiology not only to describe, but also to provide results which can be better translated into public health practice. It has been proposed that participatory research approaches be applied to epidemiology as a way to bridge this gap between description and action. A systematic account of what constitutes participatory epidemiology practice has, however, been lacking.

Methods

A scoping review was carried out focused on the question of what constitutes participatory approaches to epidemiology for the purpose of demonstrating their potential for advancing epidemiologic research. Relevant databases were searched, including both the published and non-published (grey) literature. The 102 identified sources were analyzed in terms of comparing common epidemiologic approaches to participatory counterparts regarding central aspects of the research process. Exemplary studies applying participatory approaches were examined more closely.

Results

A highly diverse, interdisciplinary body of literature was synthesized, resulting in a framework comprised of seven aspects of the research process: research goal, research question, population, context, data synthesis, research management, and dissemination of findings. The framework specifies how participatory approaches not only differ from, but also how they can enhance common approaches in epidemiology. Finally, recommendations for the further development of participatory approaches are given. These include: enhancing data collection, data analysis, and data validation; advancing capacity building for research at the local level; and developing data synthesis.

Conclusion

The proposed framework provides a basis for systematically developing the emergent science of participatory epidemiology.

Can reflexivity be learned? An experience with tobacco control practitioners in Canada

Summary

To explore an example of a reflexive intervention with health professionals working in tobacco control (TC). This study reports the perceived intervention effects regarding: (i) participants' understanding of reflexivity and personal learning and (ii) conditions needed in order to integrate reflexivity into professional and organizational practices. This is a qualitative study using an interpretative evaluation framework to assess the perceived effects of a reflexive intervention in Montréal, Québec. Semi-structured qualitative interviews (n = 8) gathered data. Data analysis began deductively, guided by the broad categories found in research questions. Sub-categories to populate these broad categories captured the inhibitors and facilitators through an inductive thematic analysis. Our study reveals that, following the intervention, most participants had a generally good understanding of reflexivity and described concrete learning in association with the intervention. Main facilitators and inhibitors to conducting a reflexive workshop pertained to the organizational context as well as to the professional and individual characteristics of the participants. Some participants implemented sustainable changes as a result of the intervention, such as creating a tool, reviewing work plans and developing new mechanisms to integrate the voice of their clientele in the planning process. The need and interest for dialogue among health professionals about how TC intervention activities may inadvertently contribute to social inequalities in smoking is apparent. While there appears to be potential for reflexive practice, the integration of reflexivity into practice is reliant upon the organizational context (financial and time constraints, culture, support, and climate) and the reflexivity concept itself (intangibility, complexity and fuzziness).

[Participatory Quality Development: Engaging Community Members in All Phases of Project Planning and Implementation]

Community participation, recognised as a central feature of successful health promotion and prevention, is often difficult to implement. In this research project internationally recognised methods of participatory health research were applied to demonstrate ways in which community members can be engaged. Participatory health research is characterised by a close collaboration between academic researchers, practitioners and community members in order to generate common knowledge. It is not a question of translating knowledge from research into practice, but rather a question of promoting a collective learning process on the part of all participants for the purpose of developing solutions which address the interests and needs of local people. The result of the project is a new approach for strengthening the quality of prevention and health promotion interventions: participatory quality development (PQD).

[Practice-based evidence in prevention and health promotion among socially disadvantaged communities]

In recent years numerous health promotion and prevention efforts have been created for socially disadvantaged communities. There is a broad consensus that such measures should be scientifically sound; however, the criteria for evidence-based medicine (EBM) have been shown to have limited applicability in this area. It is widely debated which scientific approaches are most appropriate. Several authors have called for the production of "practice-based evidence"(PBE) as an alternative, focusing on ways to produce evidence based directly on practical experience. Implied is a variety of methodological and epistemological approaches for generating knowledge about the effectiveness of interventions. In contrast to the usual means of generating evidence, PBE suggests that practitioners instead of researchers take on the leading role in the generation and interpretation of intervention data. To date, PBE is an idea in need of further definition, both in terms of theory and practice. On the basis of recent research the authors present a definition for PBE and a model for how it could be generated. The authors propose an "Evidence Cycle" which would synthesize the findings from local evaluations for the purpose of generating practice guidelines (Good Practice Criteria) which can be developed in an ongoing way as new data becomes available. In this way local theories of disease causation and development and local evidence for intervention effectiveness could be drawn together to produce empirically-based, generalizable statements about effective health promotion and prevention for disadvantaged communities.

Factors controlling the regional distribution of vanadium in groundwater

Although the ingestion of vanadium (V) in drinking water may have possible adverse health effects, there have been relatively few studies of V in groundwater. Given the importance of groundwater as a source of drinking water in many areas of the world, this study examines the potential sources and geochemical processes that control the distribution of V in groundwater on a regional scale. Potential sources of V to groundwater include dissolution of V rich rocks, and waste streams from industrial processes. Geochemical processes such as adsorption/desorption, precipitation/dissolution, and chemical transformations control V concentrations in groundwater. Based on thermodynamic data and laboratory studies, V concentrations are expected to be highest in samples collected from oxic and alkaline groundwater. However, the extent to which thermodynamic data and laboratory results apply to the actual distribution of V in groundwater is not well understood. More than 8400 groundwater samples collected in California were used in this study. Of these samples, high (> or =50 microg/L) and moderate (25 to 49 microg/L) V concentrations were most frequently detected in regions where both source rock and favorable geochemical conditions occurred. The distribution of V concentrations in groundwater samples suggests that significant sources of V are mafic and andesitic rock. Anthropogenic activities do not appear to be a significant contributor of V to groundwater in this study. High V concentrations in groundwater samples analyzed in this study were almost always associated with oxic and alkaline groundwater conditions, which is consistent with predictions based on thermodynamic data.

Building an international collaboration on participatory health research

THE PROBLEM

Participatory health research (PHR) is receiving increased international attention as an approach for addressing various health issues. However, PHR has not yet achieved the status of other forms of research in terms of having an impact on health policy decisions.

PURPOSE OF ARTICLE

This article reports on the current status of the new International Collaboration on Participatory Health Research (ICPHR).

KEY POINTS

By formulating common definitions and standards for PHR and synthesizing the results and methods of participatory research, the collaboration will seek to strengthen the role of PHR in academic and political institutions.

CONCLUSION

The collaboration is an important structure for advancing the practice, theory, and impact of PHR internationally.

[Participation in the cooperation between target group, project and sponsor]

The intrinsic connection between empowerment and participation is apparent in the Ottawa Charter on Health Promotion. In order for citizens to reach a higher degree of autonomy and control over health-related factors (empowerment) they need to have an active role in the decision-making processes affecting their lives and the environment in which they live (participation). This implies that many decisions are made affecting the health of citizens over which they have no influence. The question is: Who has the power to make such decisions and how can this power be shared more equitably? This question can be raised not only at the highest political level, but also locally in the context of the collaboration between various stake-holders. The local level plays a key role in deciding which health promotion measures are developed and funded, thus contributing in an important way to strengthening communities. In this article the method "Circles of Decision-Making" is presented as a tool for assisting those working at the local level in determining to what degree the active participation of the various stake-holders has been achieved and in what ways the participation of those "on the outside" of decision-making processes can be strengthened. This method is based on the concept of Participatory Quality Development (PQD) created by the authors and their community partners. PQD uses methods from community-based research to address issues of quality in community-level health promotion and prevention.

Setting up a peer review process for community-based organizations: conflicts and challenges

BACKGROUND

The authors are conducting a national demonstration project in Germany to develop quality assurance structures and methods for community-based HIV prevention.

OBJECTIVES

We sought to provide outside input to AIDS service organizations (ASOs) on their prevention work while improving the local discourse on the quality of HIV prevention.

METHODS

A voluntary peer review process with community workers, funders, community members, and researchers as reviewers.

LESSONS LEARNED

Although the idea of a peer review process is interesting for many ASOs, it has been difficult finding organizations to participate in the process. Issues of trust regarding the intentions of the reviewers and concerns about publicizing the results have prevented implementation.

CONCLUSIONS

Peer review is a promising idea for the further development of quality assurance in the HIV prevention of German ASOs. More time needs to be invested in implementing the process to build trust on all sides.

A flexible digit with tactile feedback for invasive clinical applications

This paper describes research on measurement of tactile sense using a flexible digit appropriate to endoscopy and minimal access surgery. It is envisaged that the sensing method will facilitate the navigation of flexible invasive devices, such as endoscopes, and also aid diagnosis using tactile perception as well as visual observation. The proposed master-slave digit system incorporates the application of the distributive sensing method applied to tactile sensing in order to discriminate different contact conditions of the flexible digit. The paper concentrates on the description of the application of this method and places this in the context of the user and the integrated system. The approach to sensing is able to discriminate the position, magnitude, distributed profile and width of the applied contacting load by using only four sensing points. Values to describe these parameters are evaluated to an accuracy greater than 93 per cent.

Homosexuality and HIV/AIDS prevention: the challenge of transferring lessons learned from Western Europe to Central and Eastern European Countries

In order to stem the rapidly growing HIV/AIDS epidemics in Eastern Europe a transfer of prevention know-how and experience from Western European countries is necessary. The success of such a transfer is contingent on addressing a number of challenging issues. Monolithic ideas of East/West difference need to give way to the growing empirical evidence which not only shows a tremendous diversity but also many similarities among the 51 countries within the WHO European region. These include similarities regarding sexual attitudes and HIV prevention needs. Western constructs such as a gay identity need to be de-emphasized however, when it comes to promoting human rights (and thus improving HIV prevention for men who have sex with men) in Central and Eastern Europe. In asking the question of what should be transferred from Western Europe to other countries, both the strengths and weaknesses of the last 20 years of prevention need to be considered. In terms of Western European research the strength lies in identifying the social structural causes of HIV transmission. In terms of practice, the successes of instituting country-level structures while also working within the gay community are to be emphasized. Short-comings are evident in terms of reaching men of lower socio-economic status, cultural minorities and sex workers. On such questions, the expertise of Europe as a whole is needed in order to find new answers.

Critical evaluation of the ability of sequential extraction procedures to quantify discrete forms of selenium in sediments and soils

Sequential extraction procedures (SEPs) have been widely used to characterize the mobility, bioavailibility, and potential toxicity of trace elements in soils and sediments. Although oft-criticized, these methods may perform best with redox-labile elements (As, Hg, Se) for which more discrete biogeochemical phases may arise from variations in oxidation number. We critically evaluated two published SEPs for Se for their specificity and precision by applying them to four discrete components in an inert silica matrix: soluble Se(VI) (selenate), Se(IV) (selenite) adsorbed onto goethite, elemental Se, and a metal selenide (FeSe; achavalite). These were extracted both individually and in a mixed model sediment. The more selective of the two procedures was modified to further improve its selectivity (SEP 2M). Both SEP 1 and SEP 2M quantitatively recovered soluble selenate but yielded incomplete recoveries of adsorbed selenite (64% and 81%, respectively). SEP 1 utilizes 0.1 M K2S2O8 to target "organically associated" Se, but this extractant also solubilized most of the elemental (64%) and iron selenide (91%) components of the model sediment. In SEP 2M, the Na2SO3 used in step III is effective in extracting elemental Se but also extracted 17% of the Se from the iron selenide, such that the elemental fraction would be overestimated should both forms coexist. Application of SEP 2M to eight wetland sediments further suggested that the Na2SO3 in step III extracts some organically associated Se, so a NaOH extraction was inserted beforehand to yield a further modification, SEP 2OH. Results using this five-step procedure suggested that the four-step SEP 2M could overestimate elemental Se by as much as 43% due to solubilization of organic Se. Although still imperfect in its selectivity, SEP 20H may be the most suitable procedure for routine, accurate fractionation of Se in soils and sediments. However, the strong oxidant (NaOCl) used in the final step cannot distinguish between refractory organic forms of Se and pyritic Se that might form under sulfur-reducing conditions.

The old problem of adherence: research on treatment adherence and its relevance for HIV/AIDS

The international published research on patient adherence was selectively reviewed with the goal of determining its relevance for the treatment of HIV/AIDS. Results show that not adhering to treatment regimes is so widespread that no combination of sociodemographic variables is reliably predictive of patients' not following doctors' orders. Achieving 100% adherence for any treatment or patient group does not appear to be realistic. Characteristics of the patient's situation, of the given therapy, and of the disease itself affect adherence. In addition, the patient-doctor relationship and the context of the treatment are important. Often overlooked are the existential dimensions of meaning, self-determination and quality of life which are particularly important for the chronically ill. Treatment needs to be negotiated individually with each patient on the basis of an open therapeutic relationship and with the help of multidimensional interventions. Lessons from the discourse on safer sex can steer adherence research and practice away from a behavioural and reductionist approach toward the context and meaning of treatment.

Endomorphin-like immunoreactivity in the rat dorsal horn and inhibition of substantia gelatinosa neurons in vitro

Endomorphin 1 and 2 are two tetrapeptides recently isolated from bovine as well as human brains and proposed to be the endogenous ligand for the mu-opiate receptor. Opioid compounds expressing mu-receptor preference are generally potent analgesics. The spinal cord dorsal horn is considered to be an important site for the processing of sensory information including pain. The discovery that endomorphins produced greater analgesia in mice upon intrathecal as compared to intracerebroventricular injections raises the possibility that dorsal horn neurons may represent the anatomic site upon which endomorphins exert their analgesic effects. We report here the detection of endomorphin 2-immunuoreactive fiber-like elements in superficial layers of the rat dorsal horn by immunohistochemical techniques. Whole-cell patch recordings from substantia gelatinosa neurons of cervical spinal cord slices revealed two conspicuous effects of exogenously applied endomorphin 1 and 2: (i) depression of excitatory postsynaptic potentials evoked by stimulation of dorsal root entry zone, and (ii) hyperpolarization of substantia gelatinosa neurons. These effects were reversed by the selective mu-opiate receptor antagonist beta-funaltrexamine. Collectively, the detection of endomorphin-like immunoreactivity in nerve fibers of the superficial layers and the inhibitory action of endomorphins on substantia gelatinosa neurons provide further support for a potential role of these two peptides in spinal nociception.

Defining the elements of a successful volunteer program in the provision of AIDS services

Volunteerism has been the cornerstone of HIV/AIDS services since the founding of the first AIDS service organizations (ASOs) in the early 1980s. The work of volunteers continues to be an integral part of care in the face of limited resources and the spreading epidemic. As existing ASOs seek to improve and expand services, and communities seek to establish new organizations to combat the disease, guidelines for practice are necessary to facilitate the implementation of effective, efficient, and successful volunteer programs. This article provides a synthesis of a diverse literature base on the subject and describes the current practical experience at three large American ASOs.