Manual For Use Research Articles

Developing video content for New Zealand’s online iSupport

AbstractBackgroundThe Empowering Dementia Carers in an iSupport Virtual Assistant (e‐DIVA) project aims to develop a website based on the World Health Organisation’s iSupport to support carers in Aotearoa New Zealand (NZ), Australia, Indonesia, and Vietnam. The website will be supplemented with culturally‐appropriate videos showing different scenarios in caring. As NZ had limited funding for the adaptation process, we decided to utilise the videos already developed by the Australian team and modify them to be locally‐relevant to NZ culture. There are some similarities in the culture and ethnic populations of the two countries, but also considerable differences. Here we aim to understand the need of cultural adaptation and describe the process of developing locally‐relevant videos for self‐paced dementia training to support carers in NZ.MethodWe worked with carers and social and health care practitioners to adapt the iSupport manual for use in NZ. We conducted separate focus groups with carers and care practitioners to agree on adapted videos for use in different modules in iSupport website. We reviewed the scripts and visuals and discussed how to ensure the content (scenario, dialogue) and delivery (music, visuals) were acceptable and relatable for NZ carers from different backgrounds.To adapt for Māori carers, we took the manual and videos that had been adapted for non‐Māori, and conducted focus groups with Māori carers and care practitioners to produce content that was culturally‐appropriate and Māori‐friendly.ResultUsing co‐design and consultation with carers and care professionals from specific cultures, we made changes to the backgrounds and visual representation of the characters to better reflect NZ culture, and ensuring inclusion and representation of Māori and Pasifika in the videos. We will present the adapted videos in AAIC 2023 next to the poster.ConclusionAdapting existing videos can be a low‐cost approach to provide supporting media for an online training tool such as iSupport.

The Role of Speech-Language Pathologists in Expanding Delivery of Teen Online Problem Solving for Adolescents With Acquired Brain Injury: A Quality Improvement Project.

Teen Online Problem Solving (TOPS) is an evidence-based teletherapy program designed to promote neurocognitive, behavioral, and psychosocial recovery following brain injury through family-centered training. To date, TOPS has been primarily administered by neuropsychologists and clinical psychologists. This clinical focus article discusses a quality improvement project to adapt the TOPS training and manual for use by speech-language pathologists (SLPs) and reports feedback from SLPs following TOPS training and after delivering the program with adolescents who experienced neurological insults. SLPs were invited to participate in TOPS training. Trainees were asked to complete posttraining surveys, active therapist questionnaires, and follow-up surveys directed to SLPs who had completed the intervention with at least one patient. To date, a total of 38 SLPs completed TOPS training, 13 have implemented TOPS with at least one adolescent. Eight SLPs and 16 psychologists/trainees responded to follow-up surveys to share their perspectives on the program. Perceptions of clinicians delivering the program did not differ significantly in most respects. SLPs rated the ease of understanding nonverbal communication higher than psychologists. Seven SLPs responded to an SLP-specific survey about their experiences administering TOPS, noting a range of advantages and some limitations in their open-ended responses. Training SLPs to deliver TOPS has the potential to increase service provision to adolescents with acquired brain injury who have cognitive communication difficulties and their families. https://doi.org/10.23641/asha.22357327.

Relações comunitárias vivenciadas numa pesquisa-intervenção no semiárido baiano

In this article, we report experiences and reflections about community relations experienced through a research intervention entitled Public policies and medicinal community garden: building a manual for use in associative projects, of the Graduate Program in Territorial Planning - PLANTERR (professional master's degree) from Universidade Estadual de Feira de Santana - Bahia. The research was conducted in the Community of Bastião in Retirolândia, Bahia with the participation of 12 women members from the Bastianense association. By applying the intervention research method, we aimed to investigate the relationship between the community and medicinal plants, as well as stimulate bonds between those involved, strengthening these bonds from the daily experience of the participants, their ways of life, their expectations and the relationships they maintain with the association and the local community. The result of this research-intervention was the implementation of a community garden of medicinal plants and the production of a socio-educational manual for the implementation of this type of vegetable garden.

PROACT – A Journey of Integration& Collaboration of Health Services into Residential Aged Care

Introduction: Residential Aged Care Facilities (RACFs) play an important role in the care of a group of older Australians who are rapidly increasing in numbers. They are often frail, dependent and are of high acuity. Demand for clinical care of RACF residents has increased, and there has been a shift in the characteristics of staff who care for them. It is now common practice in High Care facilities that the majority of direct care is provided by Assistants in Nursing and/or Personal Carers, who have little formal training. Sydney Local Health District (SLHD) in Sydney Australia has 77 Residential Aged Care Facilities (RACFs), with 4,576 beds. Description: In 2008 a telephone triage service, Aged Care Triage (ACT), was introduced to assist RACF’s to provide care to residents in the most appropriate setting. The service is staffed by experienced registered nurses. During the period July 2009 - June 2010 this service saved 2427 emergency department presentations across the District. The Access Care Team aims to provide the best care for residents of RACFs in the most appropriate setting by offering clinical advice and arranging services to support resident's care within the RACFs. It offers a partnership between RACFs, GPs and services of SLHD, by linking medical specialists and expert hospital nurses with GPs, ACAT/MAC, Sydney District Nursing and Palliative Care, with GPs and RACF staff. The Access Care Team can arrange outreach or outpatient services for clinical issues such as ambulatory care appointments, behavioural issues, continence issues, IV antibiotic therapy, Palliative care, Wound care management. The Access Care Team also has the capacity to facilitate and coordinate transfers to the most appropriate health services, such as appropriate emergency department if required. In 2010, funding was sourced to commence an RACF Outreach service. This compliments the ACT service. The outreach model was developed to improve access to primary health care for older people residing in RACFs and for the provision of face-to-face clinical nursing services to residential aged care facilities (RACFs) during the business hours period. Three senior nurses with extensive aged health experience are employed to provide a rapid and mobile outreach service to RACFs within SLHD catchment. They attend RACFs during business hours to resolve problems and prevent transfers or facilitate transfers to the Emergency Department. Aim, Theory, Targeted Population & Stakeholders: Together with relevant stakeholders the service and promotes an outreach model into residential care that: Builds on the existing ACT Service which is a central point of contact, resource for all RACF within SLHD Utilises an existing care manual for use within facilities to support RACF staff with evidence based algorithms for clinical care Provides regular targeted and group education for RACF staff Provide clinical coaching to RACF staff with all consultations. Promote collaborative work between acute care staff, RACF staff, GPs, Allied Health staff, families and significant others across primary and secondary settings. Establish goals of care and management plan for residents seen by the RACF outreach which facilitated efficiency of review in ED Enable the management of complex residents within the RACF Promote early intervention for highly complex residents Impacts: During the period June 2016 – January 2017 the RACF outreach team provided 777 occasions of service seeing 193 residents. 166 interventions ranging from care planning, medication review, complex wound management, comprehensive geriatric assessment, behaviour management, tube management and end of life planning Facilitation of geriatrician review. These residents would otherwise been transferred to one of the Districts ED’s. This small team of nurses have been able to sustain the model over a number of years while imparting clinical education to RACF staff to empower them to provide high quality care to frail aged residents. The right care, in the right place at the right time.

Behavioral Activation Treatment for Smoking (BATS) in smokers with depressive symptomatology

Purpose Cigarette smoking remains the primary preventable cause of mortality and morbidity globally. The overarching goal of the paper is to disseminate the Behavioral Activation Treatment for Smoking (BATS), which integrates behavioral activation principles with standard treatment guidelines to assist individuals in achieving short- and long-term smoking cessation. Through a series of sequential steps, BATS guides individuals who wish to quit smoking to increase their engagement in healthy, pleasurable, and value-consistent activities. Design/methodology/approach The document provides the BATS rationale and contains an abridged manual for use by clinicians and/or researchers in the context of clinical trials. Findings: BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms. Findings BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms. Practical implications A description of key components, forms, and strategies to address common treatment barriers are included. Originality/value BATS’s strong roots in learning theories and its idiographic nature allow for the intervention to be implemented flexibly across a wide range of settings and smoking populations. The treatment may also be combined seamlessly with pharmacotherapies. BATS targets both cigarette smoking and depressive symptoms, which constitute a significant barrier to cessation, through a common pathway: increasing rewarding activities. The treatment offers a parsimonious complement to standard smoking cessation treatments.

Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool.

Motivational interviewing (MI) has demonstrated a significant impact as an intervention strategy for addiction management, change in lifestyle behaviors, and adherence to prescribed medication and other treatments. Key elements to studying MI include training in MI of professionals who will use it, assessment of skills acquisition in trainees, and the use of a validated skills assessment tool. The purpose of this research project was to develop a psychometrically valid and reliable tool that has been designed to assess MI skills competence in health care provider trainees. The goal was to develop an assessment tool that would evaluate the acquisition and use of specific MI skills and principles, as well as the quality of the patient-provider therapeutic alliance in brief health care encounters. To address this purpose, specific steps were followed, beginning with a literature review. This review contributed to the development of relevant conceptual and operational definitions, selecting a scaling technique and response format, and methods for analyzing validity and reliability. Internal consistency reliability was established on 88 video recorded interactions. The inter-rater and test-retest reliability were established using randomly selected 18 from the 88 interactions. The assessment tool Motivational Interviewing Skills for Health Care Encounters (MISHCE) and a manual for use of the tool were developed. Validity and reliability of MISHCE were examined. Face and content validity were supported with well-defined conceptual and operational definitions and feedback from an expert panel. Reliability was established through internal consistency, inter-rater reliability, and test-retest reliability. The overall internal consistency reliability (Cronbach's alpha) for all fifteen items was 0.75. MISHCE demonstrated good inter-rater reliability and good to excellent test-retest reliability. MISHCE assesses the health provider's level of knowledge and skills in brief disease management encounters. MISHCE also evaluates quality of the patient-provider therapeutic alliance, i.e., the "flow" of the interaction.

Industrial-Strength Documentation for ACL2

The ACL2 theorem prover is a complex system. Its libraries are vast. Industrial verification efforts may extend this base with hundreds of thousands of lines of additional modeling tools, specifications, and proof scripts. High quality documentation is vital for teams that are working together on projects of this scale. We have developed XDOC, a flexible, scalable documentation tool for ACL2 that can incorporate the documentation for ACL2 itself, the Community Books, and an organization's internal formal verification projects, and which has many features that help to keep the resulting manuals up to date. Using this tool, we have produced a comprehensive, publicly available ACL2+Books Manual that brings better documentation to all ACL2 users. We have also developed an extended manual for use within Centaur Technology that extends the public manual to cover Centaur's internal books. We expect that other organizations using ACL2 will wish to develop similarly extended manuals.

Board 193 - Program Innovations Abstract Implementation of a Perioperative Emergency Manual with In-Situ Simulation Training (Submission #438)

Introduction/Background Critical events in the operating room are stressful and demanding even for highly trained physicians and staff. Emergency manuals and other cognitive aids, such as checklists, can help deliver best practices to patients during critical events. The Stanford Emergency Manuala was developed by the Stanford Anesthesia Cognitive Aid Group (SACAG)b as a resource for perioperative critical events. Simulation-based studies have shown that accessibility of and familiarity with relevant cognitive aids are vital to their effective use.1,2 Additionally, roles such as "readers" (staff who elect to read sections of an emergency manual aloud) have been shown to improve team performance in simulated crisis situations.3 As part of a hospital quality improvement project, we implemented an in situ mannequin-based simulation training curriculum in our hospital operating rooms, along with embedding two Emergency Manuals in all operating rooms (ORs). We hypothesized that these training sessions would lead to a significant improvement in OR staff familiarity with and intended usage of Emergency Manuals. Methods Members of the OR staff were identified by a nurse educator to participate in a scheduled simulation session, grouped according to specialty group and OR shift. We ran a total of nine single-session training modules over five months. In total, 126 staff participated in the training curriculum, including 64 nurses (51%), 30 surgical technicians (24%), 15 operating room assistants (12%), 12 anesthesia technicians (9%), and 5 staff members from other operating room roles (4%). During each 50 minute session we introduced why and how to use the Emergency Manual, along with principles of Crisis Resource Management (CRM)4 in the context of in-situ simulations portraying intraoperative critical events. Scenarios were designed to represent rare, refractory and complex events. They consisted of two to three live actors playing supporting roles and a low fidelity manikin. We used equipment available in the OR as well as a simulated display of vital signs (Laerdal SimMan 2G) controlled by a simulation technician.c Active participants in the simulation scenarios were assigned predetermined roles while other trainees observed and took notes about Emergency Manual use and CRM behaviors. All participants subsequently actively contributed during the group debrief. Following each session, participants completed a standardized evaluation form and a retrospective post-intervention Likert scale-based self-assessment to evaluate awareness of, familiarity with and willingness to use the Emergency Manual during clinical situations. Following the training sessions, familiarity with the existence and format of the Emergency Manual increased significantly (p<0.001). Participants reported more willingness to use the Emergency Manual for pre-crisis educational review and as a resource for debriefing (p<0.001). Additionally, participants reported a significant increase in willingness to suggest the Emergency Manual for use during rare, refractory and complex events, including willingness to act as a "reader" (p<0.001). Participant satisfaction with the sessions was high, with many qualitative responses expressing desire for more trainings of this type. Results: Conclusion Successful clinical implementation of emergency manuals depends upon accurate content that is presented in a usable format, as well as accessibility, familiarity and clinical culture. We show that even brief in-situ simulation is an effective training model to promote OR staff familiarity with why and how to use a novel cognitive aid - in this case the Stanford Emergency Manual - and to increase planned behavior regarding its future use. Future goals will include further integration at the individual, team and systems levels, interdisciplinary in-situ trainings, as well as the assessment of real time usage of the Emergency Manual during critical events.

A mão, o cérebro, o coração. Prescrições para a leitura em manuais escolares para o Curso Normal (1940 1960/ Brasil-Portugal)

School manuals to be used by teachers and students were established in Portugal and Brazil in the late 19 th century and were consolidated throughout the 20 th century as instruments/ objects of school culture. This text examines a school manual for use at the Normal Schools produced in Brazil in 1955 – Licoes de Pedagogia, 1o ano, by Aquiles Archero Junior –, which, in the requirements for reading, interacted with a manual produced in Portugal in 1949 and used in Brazil – A arte da leitura, by Mario Goncalves Viana. This research focuses on the requirements for the teaching of reading at school and seeks to highlight how authors used knowledge that contributed to make reading a school knowledge.

Providing web-based mental health services to at-risk women.

BackgroundWe examined the feasibility of providing web-based mental health services, including synchronous internet video conferencing of an evidence-based support/education group, to at-risk women, specifically poor lone mothers. The objectives of this study were to: (i) adapt a face-to-face support/education group intervention to a web-based format for lone mothers, and (ii) evaluate lone mothers' response to web-based services, including an online video conferencing group intervention program.MethodsParticipating mothers were recruited through advertisements. To adapt the face-to-face intervention to a web-based format, we evaluated participant motivation through focus group/key informant interviews (n = 7), adapted the intervention training manual for a web-based environment and provided a computer training manual. To evaluate response to web-based services, we provided the intervention to two groups of lone mothers (n = 15). Pre-post quantitative evaluation of mood, self-esteem, social support and parenting was done. Post intervention follow up interviews explored responses to the group and to using technology to access a health service. Participants received $20 per occasion of data collection. Interviews were taped, transcribed and content analysis was used to code and interpret the data. Adherence to the intervention protocol was evaluated.ResultsMothers participating in this project experienced multiple difficulties, including financial and mood problems. We adapted the intervention training manual for use in a web-based group environment and ensured adherence to the intervention protocol based on viewing videoconferencing group sessions and discussion with the leaders. Participant responses to the group intervention included decreased isolation, and increased knowledge and confidence in themselves and their parenting; the responses closely matched those of mothers who obtained same service in face-to-face groups. Pre-and post-group quantitative evaluations did not show significant improvements on measures, although the study was not powered to detect these.ConclusionsWe demonstrated that an evidence-based group intervention program for lone mothers developed and evaluated in face-to-face context transferred well to an online video conferencing format both in terms of group process and outcomes.

185 Q-Care Profiles: Development of a New Instrument to Stimulate Communication with Adolescents with Chronic Disorders During Consultations

Background: A previous Q-methodological study revealed four distinct preference profiles for health care delivery and self-management: ‘Conscious & Compliant’; ‘Backseat Patient’; ‘Self-confident & Autonomous’; and ‘Worried & Insecure’.Aim: 1) To examine the prevalence of Q-care profiles (QCP); 2) To explore the associations with adolescent characteristics and 3) Develop an attractive tool for communication during consultations. Methods: Web-survey among all chronic patients (12-19 yrs) of a paediatric hospital and their parents. Adolescents' fit to the Abbreviated QCP descriptions was scored on a five-point Likert-scale.Results: 990 adolescents and 778 parents responded. Adolescents recognize themselves twice as often in the ‘Conscious & Compliant’ profile than in the other profiles. Fit to any of the profiles is associated with age, gender, quality of life, impact of disease, self-efficacy, independent behaviour and readiness for transition. While the ‘Backseat Patient’ and the ‘Worried & Insecure’ type feel less self-efficacious, the ‘Self-confident & Autonomous’ type is at risk for non-adherence. Parents & children's assessments correspond fairly well, but there are significant differences.Conclusions: The Q-care profiles are recognizable to adolescents and parents, and they discriminate fairly well. The QCP seem potentially suitable to stimulate communication with adolescents. A practical manual for use of QCP during consultations was developed, including tips for interventions to be used by healthcare providers to address typical problems associated with each profile. Further research into the applicability of this new tool and the possibility to use the Q-care profiles as a screening instrument for self-management failure is now underway.

Rituais para entrar ou sair da moda

Contra a ideia hegemônica de que a chamada indústria da moda “dita” modos de ser e de se vestir, queremos afirmar que os sujeitos podem ser criadores a contrapelo das “imposições” midiáticas, porque esse mesmo repertório, tornado público, pode ser apropriado “selvagemente”, uma vez que permanece a possibilidade de combinações dos mesmos objetos estéticos da moda que escapam aos manuais de uso. Este texto pretende explorar procedimentos de ruptura consciente das “regras da moda”, reinventando para si um modo singular de ser e de se vestir por meio das histórias e composições corporais de Beth e Davi.

Educational Practice for Inhaled Treatments in French Cystic Fibrosis Care Centers

Inhaled treatments are very common in cystic fibrosis (CF) patients. We sent a questionnaire to the 49 French Cystic Fibrosis Care Centers (CFCCs) to see how the inhalation technique of CF patients was initiated and monitored (composition and formation of a potential educational team, use of a manual for use, amount of devices available for demonstration, education to disinfection procedure, realization and frequency of the inhalation technique monitoring, use of the patient's own device, and frequency of checking when a pediatric patient transfers to an adult CFCC). Results were expressed in percent and compared with the test of the difference between two correlated proportions. Education for aerosol therapy was not performed in about 20% of the CFCCs. A specific educational member was present in 33 CFCCs (68%). CFCCs owned statistically less nebulizers for demonstration than other devices. Disinfection advices were always given for nebulizers, but less frequently for spacers (80%) and dry powder inhalers (50%). The inhalation technique was monitored less than once a year or never in 22% of the cases, and rarely with the patient's own material. This monitoring was device dependent (56% with nebulizers vs. 76% with the other devices, p < 0.05). For nebulizers, monitoring depended on the presence of an educational member (p < 0.01) and of a manual for use (p = 0.03). When transferring to an adult CFCC, the inhalation technique was checked in less than a third of the patients. The inhalation technique is poorly and insufficiently initiated and monitored in CF patients. Educational teams and programs are urgently required.

Baker, F. &amp; Tamplin, J. (2006). Music Therapy Methods in Neuro-Rehabilitation: A Clinician's Manual. Philadelphia: Jessica Kingsley Publishers. 256 pages. ISBN 1 84310 4121. $55.00

Baker, F. & Tamplin, ). (2006). Music Therapy Methods in Neuro-Rehabilitation: A Clinician's Manual. Philadelphia: Jessica Kingsley Publishers. 256 pages. ISBN 1 84310 4121. $55.00. The authors mention in their introduction that one of the motivating factors in writing this manual was to develop a useful resource that includes descriptions and detailed protocols of interventions (p. 16). What resulted is a wonderful compendium for newly qualified clinicians and students entering into neuro-rehabilitation. Plus, it is a useful resource for managers, supervisors, and educators supporting those already working in this field. Two experienced Australian clinicians from the field of neuro-rehabilitation have authored this concise manual, published in paperback. The information in the manual involves work with adults. However, there is also a chapter about pediatrie rehabilitation written by Jeanette Kennedy, another experienced Australian clinician and supervisor. Professor Barbara Wheeler provides a foreword for the manual, wherein she warmly welcomes the manual for use within the field, highlighting that it will complement already available texts. The focus of the information in the manual is the practical application of music therapy with a range of impairments and populations, but primarily those individuals with acquired brain injury. The manual also discusses the areas of physical rehabilitation, cognition and behavior, communication, emotional adjustment, and, as already mentioned, pediatrie rehabilitation. The approach most advocated by the authors, as highlighted in the introduction of the manual and then subsequently throughout, is an impairment-based one that is functional in orientation. This approach is supported by an overview of the brain and the information-processing mechanisms outlined in chapter 1. Accordingly, examples of tangible work (emergent from practice) that can be communicated concretely to members of the treating team are highlighted. The material shared in chapter 1 is presented logically, and the authors have collated varied and diverse information useful to music therapists, an approach that helps readers avoid the need to consult varied texts published across the field. The emphasis on the functional approach is timely, considering the pressure on clinicians and managers to demonstrate evidence-based practice in this field. Chapter 1 is followed by an informative and wide-reaching chapter regarding music therapy with patients in altered stages of consciousness (or commonly referred to as low-awareness states)-more specifically vegetative, minimally conscious, and the related post-amnesic state. The authors skillfully integrate allied literature, of which there is a broad range available to clinicians in journals, to introduce some of the controversies about the use of music and sensory stimulation with this patient group. The authors clearly define the differences between arousal and awareness as related to the field while also highlighting the controversies regarding the use of sensory stimulation versus regulation. As this population is a sub-population within the field of neuro-rehabilitation and one that requires advanced competency-based skills, this chapter is recommended to educators and those assisting newly qualified therapists based in hospitals who may work with just a few of these patients. The easy-to-understand protocols are useful examples of how clinicians can approach work with these patients. Also, a number of commonly used scales are referenced in the chapter, and these will assist in orientating new clinicians to this area. In chapter 2, additional information that could have been included is material relating to discharge criteria. Even though the title of the chapter may suggest that low-awareness states are stages of consciousness through which one proceeds, some patients never emerge from these states. Hence, clinicians who work with these patients toward functional gains may need to regularly consider discharging such patients. …

Development of an Interviewer Training Manual for a Cervical Health Project on the Apsáalooke Reservation

This article describes strategies used to develop a survey interview training manual for use on the Apsáalooke (Crow Indian) Reservation and delineates how this process and product differed from those discussed in the extant literature on survey interview training. Working to ensure cultural appropriateness is especially important due to past research improprieties with Native American populations. This manual was developed as a part of a cervical health intervention program, Messengers for Health. Areas covered include goals of survey research, recruitment and enrollment, manner of the interviewer, nonverbal behavior, beginning the interview, and language use. Limitations of this work and suggestions for conducting survey research with Native American populations are also included.

Investigation of a Pseudomonas aeruginosa Outbreak Related to Upper Endoscopy Procedures

BACKGROUND: In August 2003, a possible outbreak was reported to Infection Control by the endoscopy suite. Two patients had Pseudomonas aeruginosa isolates with identical sensitivity patterns. One case (P) had a chronic pancreatic pseudocyst that was drained by endoscopic ultrasound (EUS) on August 15, 2003. A bacterial culture done from the pseudocyst aspirate obtained during the procedure grew P. aeruginosa. A second case (M), had EUS done on August 21, 2003. On September 11, 2003, she had another EUS exam and fine needle aspiration (FNA) for further investigation of a mass with an additional bacterial culture that grew P. aeruginosa. METHOD: A formal outbreak investigation was initiated to determine the source of contamination and to limit the progress of the outbreak. Microbiologic sampling of implicated endoscope, the automated endoscope reprocessor, and tap water indicated the scope as the most likely source of contamination. All upper endoscopic cases done with the implicated scope during June–August 2003 were reviewed for P. aeruginosa. No other cases were identified. Survey of protocols identified compliance with AER manufacturer manual for use; current education on reprocessing; appropriate precleaning, cleaning, rinsing, and drying with documentation. All quality checks were done and documented appropriately. The implicated endoscope was sent to an independent device examination firm. The scope was found to have several defects. Ribotyping of six patient and linear scope P. aeruginosa isolates, plus two nosocomial isolates unrelated to the outbreak isolates, were submitted for genetic studies. RESULTS: Patients P and M were identified to have P. aeruginosa following EUS/FNA. The implicated endoscope was cultured and grew P. aeruginosa of identical genetic type to the ones recovered from both patients. This endoscope was also found to have several defects by an independent investigator and was taken out of service when clustering was initially detected. A replacement scope was obtained. CONCLUSIONS: Per agreement of GUH, CDC, and third-party endoscope expert, it was highly unlikely that washers could have caused this outbreak. The problem appeared limited to one endoscope during a brief period in August 2003. The implicated scope was in use since June 2001, and a recommendation was made to have scopes changed preventively every 12–18 months. Infection Control is initiating a competency program throughout the hospital that will provide education, training, and documentation for proper cleaning and high-level disinfection/sterilization of instruments.

Vozzo, J. A. (ed.) Tropical tree seed manual

Tropical tree seed manual, by its sheer volume, is a heavyweight when it comes to providing useful information about a variety of seed topics and descriptions for 196 tropical tree species. Despite the focus on tropical species, the information contained in the technical chapters is pertinent to researchers, professors and students working with seed of any species. Work on this book began in early 1996, following authorization from the North American Forestry Commission to compile a reference manual for use among its membership in Canada, the United States and Mexico. The USDA Forest Service supported the project by permitting employees to make contacts and compile the data, and overseeing the entire production process. The manual is organized into two parts. Part I contains nine technical chapters each authored or co‐authored by internationally renowned scientists in their field of expertise. Chapter 1, dealing with ‘Tropical tree seed biology’, is lavishly illustrated with colour diagrams, illustrations and pictures. The section on reproductive biology and seed biology are subdivided into angiosperms and gymnosperms. It also has sections on fruit and seed dispersal, seed germination and seedling development. This chapter is the longest at just over 100 pages. The next three chapters deal with ‘Collection’, ‘Storage’ and ‘Orthodox/recalcitrance’. These are quite straightforward and provide a good discussion of the topics. I feel the chapter on orthodox/recalcitrance should have preceded the chapter on storage because these classifications are applied to seeds based on their storage ability, and it seems to be out of place to discuss seed storage before discussing how seed is classified based on its storage behaviour, although both topics are intertwined. ‘Dormancy and germination’ in Chapter 5 is well covered, including the theory behind dormancy and the various treatments applied to release seed from dormancy. In addition, factors affecting germination and how germination tests are conducted are also presented. Chapter 6, dealing with ‘Pathology’, is divided into two parts; one focusing on principles and the other on practice. ‘Life Histories’ or life cycles of tropical trees are dealt with in Chapter 7, including impacts natural disturbances can cause. The next chapter deals with ‘Ethnobotany’ and discusses the many uses humans have found for trees and plants. Chapter 9 discusses ‘Tropical dendrology’, but the text applies to general nomenclature, classification and identification of trees. It also provides advice on collecting and storing specimens. Part II, ‘Species descriptions’, is the largest section of the manual, comprising almost 570 pages. This section provides useful information to collectors, handlers, seedsmen and nursery managers. Species are arranged in alphabetical order by genus. Information included for each species comprises: botanical nomenclature, occurrence, growth habits, geographic race and hybridization, use, flowering and fruiting, collection of fruits, cones and seeds, extraction and cleaning, storage, pre‐germination treatments, germination tests, nursery practices, seedling care, and additional information. Each species description is also accompanied by a black and white drawing of the leaf, reproductive structures, seed and germinant. The pages are alphabetically index tabbed, making it easy to locate a particular genus. As well, there is a ‘Supplemental species drawing’ section containing 19 species for which a comprehensive description was not available. The ‘References’ section is impressive, consisting of at least 2400 references. A ‘Glossary of terms’ is included in which the pages on which each term is found are referenced. Indices of common names and scientific names are provided, allowing one to easily locate a species. Last but not least there is a section providing a brief biography of 30 of the 63 authors who contributed to the manual. This manual is a must‐have and a valuable reference for anyone working with tree seed. The copy I reviewed was soft cover, which hopefully will withstand the test of time and use, and pages will not become unglued and fall out. The paper used is glossy and of high quality. In addition to the tremendous volume of information contained in this manual, and the publication quality, it is free of charge.

Becoming a manual occupation? The construction of a therapy manual for use with language impaired children in mainstream primary schools.

The construction of therapy protocols for a large-scale randomized controlled trial comparing speech and language therapists and assistants, and group and individual therapy approaches for children aged 6-11 in mainstream schools is outlined. The aim was to outline the decision-making processes that led to the construction of the research therapy manual, and to give a preliminary report on compliance with the manual. A search of the research and professional literature and of published therapy materials was conducted to locate usable examples of effective language therapy for primary school children. Results were collated into a manual of therapy principles and activities to structure research intervention. The use of the manual with children (n=30) receiving individual or group direct therapy from a speech and language therapist in the first phase of intervention was audited. Very few high-level research studies were found, but the professional literature gave added information. Therapies for comprehension monitoring, vocabulary development, later grammar and narrative were adapted for the research intervention, and procedures compiled into a manual to guide research speech and language therapists and assistants. The audit of direct therapy suggested that the manual was useable, providing a suitable range of activities and materials for therapy intervention. Its use helped to record the therapy offered to research children, and formed a sound basis for discussion amongst speech and language therapists and between speech and language therapist/assistant pairs. The construction and use of a therapy manual allowed the provision of replicable therapy within the research project whilst maintaining flexibility.

Guide for Investigating and Remediating Distress in Flexible Pavements: California Department of Transportation's New Procedure

In 2001, the California Department of Transportation (Caltrans) initiated a 3-year, $7 million project with MACTEC, Inc. The project included on-call flexible pavement consulting services to Caltrans in the areas of new products, asphalt rubber, modified binders, moisture sensitivity, failure investigations, independent quality assurance, training, laboratory testing, pavement maintenance, pavement rehabilitation, and asphalt recycling. One of the key tasks of the project was to develop a comprehensive guide and a detailed procedure to investigate flexible pavement distresses and develop cost-effective remedies and repair strategies. The emphasis of the procedure is on addressing premature distress and certain problems that might arise during pavement construction. The guide contains two manuals: (a) an office manual that describes the types of flexible pavement distress, identifies the factors that affect distress and performance, and provides tools that can be used to characterize distress condition, determine likely causes, and generate a corrective solution and (b) a field manual for use in the field by experienced engineers familiar with the new tools and requiring little instruction on its application. The principles presented in the guide are based on modern pavement engineering technology and are applicable to the practices of many federal, state, and local agencies. The process presented in the guide is summarized, and several of the new tools that have applicability to other agencies are described.

A representative, highly informative ’genotyping set’ of barley SSRs

We have developed a ’genotyping set’ of 48 SSR-based genetic markers for application in genetical studies of barley. The SSRs are a subset of a collection of approximately 600 SSRs available to the barley research community. They have been specifically chosen according to the following criteria: (1) they are single locus; (2) their product quality is good under standard assay conditions; (3) they are distributed across the barley genome; and (4) they exhibit reasonably high polymorphic information content (PIC) values in the cultivated barley gene-pool. To maximise genotyping throughput, one of each SSR primer pair was 5´ end-labelled with either fam, hex or tet fluorochromes to allow automated data capture after running the samples on a DNA sequencer. SSR product sizes were assembled from a reference set of 24 barley genotypes which allowed the construction of ’graphical genotypes’ of each of the individual lines. The graphical genotypes provide a convenient tool for interrogating genetic similarity in the individuals surveyed. The product sizes were compared to those obtained from end-labelling one of the primers with 33P and separating the products by denaturing PAGE followed by autoradiography. Although inconsistencies in size were common, they could generally be easily resolved. A reference manual for use of the ’genotyping set’ has been produced and is available as a PDF download file at http://www.scri.sari.ac.uk/ssr/pdf. These well-characterised barley SSRs, for the first time, provide a common set of robust PCR-based tools which can be used to integrate and compare information collected from fundamental and/or applied genetic studies on barley in different laboratories across the world.