Should we feed back research results in the midst of a study?

ABSTRACT: BACKGROUND: This report is an introduction to a series of three research papers that describe the evolution of the approaches taken by the Translating Research in Elder Care (TREC) research team during its first four years to feed back the research findings to study participants. TREC is an observational multi-method health services research project underway in 36 nursing homes in the prairie provinces of Canada. TREC has actively involved decision makers from the sector in all stages from initial planning, through data collection to dissemination activities. However, it was not planned as a fully integrated knowledge translation project. These three papers describe our progress towards fully integrated knowledge translation--with respect to timely and requested feedback processes. The first paper reports on the process and outcomes of creating and evaluating the feedback of research findings to healthcare aides (unregulated health professionals). These aides provide over 80% of the direct care in our sample and actively requested the feedback as a condition of their continued cooperation in the data acquisition process. The second paper describes feedback from nursing home administrators on preliminary research findings (a facility annual report) and evaluation of the reports' utility. The third paper discusses an approach to providing a more in-depth form of feedback (expanded feedback report) at one of the TREC nursing homes. FINDINGS: Survey and interview feedback from healthcare aides is presented in the first paper. Overall, healthcare aides' opinions about presentation of the feedback report and the understand ability, usability, and usefulness of the content were positive. The second paper describes the use of telephone interviews with facility administrators and indicates that the majority of contextual areas (e.g., staff job satisfaction) addressed in facility annual report to be useful, meaningful, and understandable. More than one-half of the administrators would have liked to have received information on additional areas. The third paper explores how a case study that examined how involvement with the TREC study influenced management and staff at one of the TREC nursing homes. The importance of understanding organizational routines and the impact of corporate restructuring were key themes emerging from the case study. In addition, the Director of Care suggested changes to the structure and format of the feedback report that would have improved its usefulness. CONCLUSIONS: We believe that these findings will inform others undertaking integrated knowledge translation activities and will encourage others to become more engaged in feedback processes.     

Insights into the impact and use of research results in a residential long-term care facility: a case study

ABSTRACT: BACKGROUND: Engaging end users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at 'Restwood' (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. METHODS: We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. RESULTS: We observed the importance of understanding organizational routines and the impact of key events in the facility's environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides)--what they did and said mattered, and TREC provided a means of having one's voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. CONCLUSIONS: Four themes emerged regarding staff engagement with the research process: sharing feedback reports from the TREC study; the meaning of TREC to staff; understanding organizational context; and using the study feedback for improvement at Restwood. This study has lessons for researchers on how to share research results with study participants, including management.     

Metrics for Success: Strategies for Enabling Core Facility Performance and Assessing Outcomes

Core Facilities are key elements in the research portfolio of academic and private research institutions. Administrators overseeing core facilities (core administrators) require assessment tools for evaluating the need and effectiveness of these facilities at their institutions. This article discusses ways to promote best practices in core facilities as well as ways to evaluate their performance across 8 of the following categories: general management, research and technical staff, financial management, customer base and satisfaction, resource management, communications, institutional impact, and strategic planning. For each category, we provide lessons learned that we believe contribute to the effective and efficient overall management of core facilities. If done well, we believe that encouraging best practices and evaluating performance in core facilities will demonstrate and reinforce the importance of core facilities in the research and educational mission of institutions. It will also increase job satisfaction of those working in core facilities and improve the likelihood of sustainability of both facilities and personnel.     

Feedback reporting of survey data to healthcare aides

ABSTRACT: BACKGROUND: This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides' (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed. METHODS: A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews. RESULTS: One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs' opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating. CONCLUSIONS: This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.     

Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention

ABSTRACT: BACKGROUND: Careful hand hygiene (HH) is the single most important factor in preventing the transmission of infections to patients, but compliance is difficult to achieve and maintain. A lack of understanding of the processes involved in changing staff behaviour may contribute to the failure to achieve success. The purpose of this study was to identify nurses' and administrators' perceived barriers and facilitators to current HH practices and the implementation of a new electronic monitoring technology for HH. METHODS: Ten key informant interviews (three administrators and seven nurses) were conducted to explore barriers and facilitators related to HH and the impact of the new technology on outcomes. The semi structured interviews were based on the Theoretical Domains Framework by Michie et al. and conducted prior to intervention implementation. Data were explored using an inductive qualitative analysis approach. Data between administrators and nurses were compared. RESULTS: In 9 of the 12 domains, nurses and administrators differed in their responses. Administrators believed that nurses have insufficient knowledge and skills to perform HH, whereas the nurses were confident they had the required knowledge and skills. Nurses focused on immediate consequences, whereas administrators highlighted long-term outcomes of the system. Nurses concentrated foremost on their personal safety and their families' safety as a source of motivation to perform HH, whereas administrators identified professional commitment, incentives, and goal setting. Administrators stated that the staff do not have the decision processes in place to judge whether HH is necessary or not. They also highlighted the positive aspects of teams as a social influence, whereas nurses were not interested in group conformity or being compared to others. Nurses described the importance of individual feedback and self-monitoring in order to increase their performance, whereas administrators reported different views. CONCLUSIONS: This study highlights the benefits of using a structured approach based on psychological theory to inform an implementation plan for a behavior change intervention. This work is an essential step towards systematically identifying factors affecting nurses' behaviour associated with HH.     

Biochemical characterization of a chloroplast localized fatty acid reductase from Arabidopsis thaliana

Primary long-chain fatty alcohols are present in a variety of phyla. In eukaryotes, the production of fatty alcohols is catalyzed by fatty acyl-CoA reductase (FAR) enzymes that convert fatty acyl-CoAs or acyl-ACPs into fatty alcohols. Here, we report on the biochemical properties of a purified plant FAR, Arabidopsis FAR6 (AtFAR6). In vitro assays show that the enzyme preferentially uses 16 carbon acyl-chains as substrates and produces predominantly fatty alcohols. Free fatty acids and fatty aldehyde intermediates can be released from the enzyme, in particular with suboptimal chain lengths and concentrations of the substrates. Both acyl-CoA and acyl-ACP could serve as substrates. Transient expression experiments in Nicotiana tabacum showed that AtFAR6 is a chloroplast localized FAR. In addition, expression of full length AtFAR6 in Nicotiana benthamiana leaves resulted in the production of C16:0-alcohol within this organelle. Finally, a GUS reporter gene fusion with the AtFAR6 promoter showed that the AtFAR6 gene is expressed in various tissues of the plant with a distinct pattern compared to that of other Arabidopsis FARs, suggesting specialized functions in planta.     

Biochemical characterization of a chloroplast localized fatty acid reductase from Arabidopsis thaliana

Primary long-chain fatty alcohols are present in a variety of phyla. In eukaryotes, the production of fatty alcohols is catalyzed by fatty acyl-CoA reductase (FAR) enzymes that convert fatty acyl-CoAs or acyl-ACPs into fatty alcohols. Here, we report on the biochemical properties of a purified plant FAR, Arabidopsis FAR6 (AtFAR6). In vitro assays show that the enzyme preferentially uses 16 carbon acyl-chains as substrates and produces predominantly fatty alcohols. Free fatty acids and fatty aldehyde intermediates can be released from the enzyme, in particular with suboptimal chain lengths and concentrations of the substrates. Both acyl-CoA and acyl-ACP could serve as substrates. Transient expression experiments in Nicotiana tabacum showed that AtFAR6 is a chloroplast localized FAR. In addition, expression of full length AtFAR6 in Nicotiana benthamiana leaves resulted in the production of C16:0-alcohol within this organelle. Finally, a GUS reporter gene fusion with the AtFAR6 promoter showed that the AtFAR6 gene is expressed in various tissues of the plant with a distinct pattern compared to that of other Arabidopsis FARs, suggesting specialized functions in planta.     

Quality of care in unlicensed homes for the aged in the Eastern Townships of Quebec

BACKGROUND: The recent proliferation of unlicensed homes for the aged in Quebec, coupled with the increased needs of the population they serve, has raised concerns about the quality of case these homes provide. The authors compared the quality of care in unlicensed homes with that in licensed long-term care facilities in a region of Quebec. METHODS: The study involved 301 impaired people aged 65 and over in 88 residential care facilities (52 unlicensed, 36 licensed) in the Eastern Townships of Quebec. Study participants were chosen according to a 2-stage sampling scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured using the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical management, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care. RESULTS: Overall, the quality of care was similar in the unlicensed and licensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse than the licensed facilities in 2 areas of care: physical care (mean score 1.80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical management (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-specific scores also revealed that both types of homes lacked appropriate attention to the psychosocial aspect of care. Overall, 25% of the facilities provided inadequate care to at least one resident. This situation was especially prevalent among homes with fewer than 40 residents, where up to 20% of the residents received inadequate care. INTERPRETATION: Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care.     

Factors Influencing Owner Satisfaction With Companion-Dog-Training Facilities

The aim of this study was to survey people currently attending companion-dog-training facilities about their reasons for attending training, their expectations prior to training, their training experiences, and the factors contributing to their satisfaction with these experiences. The 178 participants indicated that they experienced few canine behavioral difficulties prior to attending training, with factors other than dog behavior influencing their decision to attend a particular facility. Features identified as important were characteristics of the instructors and the facility itself, opportunities for the dog caretaker (owner) to develop dog-training skills and knowledge, and specific canine behavior outcomes. Satisfaction was a multidimensional concept: satisfaction with the instructors and facility being dissociable from satisfaction with progress made by the dog and handler. Each of these represented different aspects of the training experience. Training facilities may need to address a wide range of issues to engage additional dog owners in training activities. Identification of these issues is an important first step in this process.     

Factors influencing owner satisfaction with companion-dog-training facilities

The aim of this study was to survey people currently attending companion-dog-training facilities about their reasons for attending training, their expectations prior to training, their training experiences, and the factors contributing to their satisfaction with these experiences. The 178 participants indicated that they experienced few canine behavioral difficulties prior to attending training, with factors other than dog behavior influencing their decision to attend a particular facility. Features identified as important were characteristics of the instructors and the facility itself, opportunities for the dog caretaker (owner) to develop dog-training skills and knowledge, and specific canine behavior outcomes. Satisfaction was a multidimensional concept: satisfaction with the instructors and facility being dissociable from satisfaction with progress made by the dog and handler. Each of these represented different aspects of the training experience. Training facilities may need to address a wide range of issues to engage additional dog owners in training activities. Identification of these issues is an important first step in this process.     

白蜡虫far3基因cDNA全长克隆、原核表达和酶活分析

脂酰辅酶A还原酶(FAR)可将脂酰辅酶A还原为相应的脂肪醇,在白蜡生物合成中起至关重要的作用。本研究通过cDNA末端快速扩增技术获得白蜡虫Ericerus pela far3基因cDNA全长,其开放阅读框(ORF)1 566 bp。对白蜡虫FAR3编码蛋白进行系统发育分析,发现FAR3与人类Homo sapiens、小鼠Mus musculus、黑腹果蝇Drosophila melanogaster等物种的FAR聚为一支;成功构建pET-30a eGFP/EpelFAR3原核表达质粒,转入大肠杆菌Escherichia coli BL21感受态细胞,在浓度为0.05 mmol·L^-1的异丙基硫代半乳糖苷诱导6 h后有较高的蛋白表达量;经Western blot验证,表达蛋白分子量与预估蛋白分子量符合;质谱分析蛋白质分值为3 900,肽段覆盖度74%,所得肽段与理论序列相符;利用底物C24脂酰辅酶A、C26脂酰辅酶A、C28脂酰辅酶A和C30脂酰辅酶A对原核表达蛋白进行活性分析,利用气相色谱进行蛋白活性验证,没有理论产物相应脂肪醇的生成。本研究中白蜡虫far3 cDNA ORF的获得及原核表达的实现,为进一步的功能和组织表达定位研究奠定了基础。     

Parasitic nematode fatty acid- and retinol-binding proteins compromise host immunity by interfering with host lipid signaling pathways

Parasitic nematodes cause significant morbidity and mortality globally. Excretory/secretory products (ESPs) such as fatty acid- and retinol- binding proteins (FARs) are hypothesized to suppress host immunity during nematode infection, yet little is known about their interactions with host tissues. Leveraging the insect parasitic nematode, Steinernema carpocapsae, we describe here the first in vivo study demonstrating that FARs modulate animal immunity, causing an increase in susceptibility to bacterial co-infection. Moreover, we show that FARs dampen key components of the fly immune response including the phenoloxidase cascade and antimicrobial peptide (AMP) production. Our data also reveal that FARs deplete lipid signaling precursors in vivo as well as bind to these fatty acids in vitro, suggesting that FARs elicit their immunomodulatory effects by altering the availability of lipid signaling molecules necessary for an efficient immune response. Collectively, these data support a complex role for FARs in immunosuppression in animals and provide detailed mechanistic insight into parasitism in phylum Nematoda.     

Laboratory Design for Microbiological Safety

Of the large amount of funds spent each year in this country on construction and remodeling of biomedical research facilities, a significant portion is directed to laboratories handling infectious microorganisms. This paper is intended for the scientific administrators, architects, and engineers concerned with the design of new microbiological facilities. It develops and explains the concept of primary and secondary barriers for the containment of microorganisms. The basic objectives of a microbiological research laboratory, (i) protection of the experimenter and staff, (ii) protection of the surrounding community, and (iii) maintenance of experimental validity, are defined. In the design of a new infectious-disease research laboratory, early identification should be made of the five functional zones of the facility and their relation to each other. The following five zones and design criteria applicable to each are discussed: clean and transition, research area, animal holding and research area, laboratory support, engineering support. The magnitude of equipment and design criteria which are necessary to integrate these five zones into an efficient and safe facility are delineated.     

Role of the general practitioner in the delivery of surgical and anesthesia services in rural western Canada.

OBJECTIVE: To determine the present role of general practitioners (GPs) in the delivery of surgical and anesthesia services in rural western Canada. DESIGN: Survey by mailed questionnaire in November 1993, with telephone follow-up of nonresponders. SETTING: Rural British Columbia, Alberta, the Yukon Territory and the Northwest Territories. PARTICIPANTS: Administrators of 148 rural hospitals; of the 121 who completed it 101 represented hospitals that met the inclusion criteria (fewer than 51 beds and serving a population of 15,000 or less). OUTCOME MEASURES: Hospital characteristics, type of practitioners providing surgical and anesthesia services, length and location of GPs'', surgical and anesthesia training, types of surgical procedures performed by GPs and opinions of administrators regarding the delivery of surgical services in their community. RESULTS: Surgical services were provided by 56 (55%) of the 101 hospitals; at 45 (80%) they were provided by GPs, and at 33 (59%) they were provided by GPs with limited additional surgical training. Fifteen (27%) of the 56 hospitals were said to rely solely on GPs with limited surgical training for surgical services. At 45 (80%) of the 56 hospitals anesthesia services were provided by GPs, all of whom had limited additional training in anesthesia; 36 (64%) were said to rely solely on GPs for anesthesia services. Just over three quarters (76% [74/98]) of the administrators felt that their community''s surgical needs were well met. CONCLUSION: GPs with limited specialty training continue to play a role in providing surgical and anesthesia services in rural western Canada. This has implications for postgraduate training programs in Canada.     

主要利益相关方在履行《名古屋议定书》中的关系与义务

生物遗传资源及其相关传统知识的获取与惠益分享(Access and Benefit Sharing,ABS)涉及三个主要利益相关方,即提供方、使用方和监管方.在我国履行《名古屋议定书》的过程中,需深刻理解《名古屋议定书》中对于提供方、使用方和监管方的相关规定,分析三方关系内涵及各自义务,对有效履行《名古屋议定书》具有重...     

‘This Is Real Misery’: Experiences of Women Denied Legal Abortion in Tunisia

Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff.     

The function and organization of lateral prefrontal cortex: a test of competing hypotheses

The present experiment tested three hypotheses regarding the function and organization of lateral prefrontal cortex (PFC). The first account (the information cascade hypothesis) suggests that the anterior-posterior organization of lateral PFC is based on the timing with which cue stimuli reduce uncertainty in the action selection process. The second account (the levels-of-abstraction hypothesis) suggests that the anterior-posterior organization of lateral PFC is based on the degree of abstraction of the task goals. The current study began by investigating these two hypotheses, and identified several areas of lateral PFC that were predicted to be active by both the information cascade and levels-of-abstraction accounts. However, the pattern of activation across experimental conditions was inconsistent with both theoretical accounts. Specifically, an anterior area of mid-dorsolateral PFC exhibited sensitivity to experimental conditions that, according to both accounts, should have selectively engaged only posterior areas of PFC. We therefore investigated a third possible account (the adaptive context maintenance hypothesis) that postulates that both posterior and anterior regions of PFC are reliably engaged in task conditions requiring active maintenance of contextual information, with the temporal dynamics of activity in these regions flexibly tracking the duration of maintenance demands. Activity patterns in lateral PFC were consistent with this third hypothesis: regions across lateral PFC exhibited transient activation when contextual information had to be updated and maintained in a trial-by-trial manner, but sustained activation when contextual information had to be maintained over a series of trials. These findings prompt a reconceptualization of current views regarding the anterior-posterior organization of lateral PFC, but do support other findings regarding the active maintenance role of lateral PFC in sequential working memory paradigms.