Significant Difference In Mean Rate Research Articles

Visual Field Outcomes in the Primary Tube Versus Trabeculectomy Study

PurposeTo describe visual field outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. DesignCohort analysis of a prospective multicenter randomized clinical trial. SubjectsA total of 155 eyes from 155 subjects randomly assigned to treatment with tube shunt surgery (n=84) or trabeculectomy with mitomycin C (n=71). MethodsThe PTVT Study was a multicenter randomized clinical trial comparing the safety and efficacy of trabeculectomy and tube shunt surgery in eyes without prior intraocular surgery. Subjects underwent standard automated perimetry (SAP) at baseline and annually for five years. SAP tests were deemed reliable if the false positive rate was ≤15%. Tests were excluded if visual acuity was ≤20/400 or loss of ≥2 Snellen lines from baseline were attributed to a non-glaucomatous etiology. Linear mixed-effects models were used to compare rates of change in SAP mean deviation (MD) between the two treatment groups. Intraocular pressure (IOP) control was assessed by percentage of visits with IOP <18 mmHg and mean IOP. Outcome MeasuresRate of change in SAP MD during follow-up. ResultsA total of 730 SAP tests were evaluated, with an average of 4.7 tests per eye. The average SAP MD at baseline was -12.8±8.3 dB in the tube group and -12.0±8.4 dB in the trabeculectomy group (p=0.57). The mean rate of change in SAP MD was -0.32±0.39 dB/year in the trabeculectomy group and -0.47±0.43 dB/year in the tube group (p=0.23). Eyes with mean IOP 14-17.5 mmHg had significantly faster rates of SAP MD loss compared to eyes with mean IOP <14 mmHg (-0.59±0.13 vs. -0.27±0.08 dB/year, p=0.012) and eyes with only 50-75% of visits with IOP <18 mmHg had faster rates than those with 100% of visits with IOP <18 mmHg (-0.90±0.16 vs. -0.29±0.08 dB/year, p<0.001). Multivariable analysis identified older age and worse IOP control as risk factors for faster progression in both treatment groups. ConclusionsNo statistically significant difference in mean rates of visual field change was observed between trabeculectomy and tube shunt surgery in the PTVT Study. Worse IOP control was significantly associated with faster rates of SAP MD loss during follow-up. Older patients were also at risk for faster progression.

0934 An Analysis of 5,212 Sleep Medicine Providers’ Online Patient Reviews

Abstract Introduction Online provider rating websites are an increasingly popular medium for patients to provide reviews &amp; feedback and obtain information about varying healthcare providers. There have yet to be studies on what factors significantly impact sleep medicine provider ratings. Healthgrades is a popular healthcare provider rating database with over 11 million patient reviews. This study analyzes various dimensions to determine what factors correlate with average sleep medicine provider ratings to improve patient satisfaction. Methods Data were collected on 5,212 sleep medicine providers’ online profiles using web data extraction software. Factors such as medical degree, gender, age, and ethnicity were compared to online ratings using Pearson correlation and ANOVA analysis via statistics software. Results Variables with positive correlation in provider rating include the presence of a headshot (pc=0.106, p&amp;lt; 0.01), designation of trustworthiness (pc=0.152, p&amp;lt; 0.01), and presence of care philosophy statement (pc=0.105, p&amp;lt; 0.01). The only variable with a negative correlation in provider rating was increasing age (p=-0.109, p&amp;lt; 0.01). A one-way ANOVA revealed that there was a statistically significant difference in mean rating between different healthcare degrees (F(122.271, 5062.570)=[17.955], p=&amp;lt;.001). Tukey’s HSD Test for multiple comparisons found that the mean value of ratings was significantly different between allopathic physicians and sleep medicine dentists (p=0.000, 95% C.I.=[-0.943,0.070]), physician assistants (p=0.000, 95% C.I.=[-1.268,-0.239]), and nurse practitioners (p=0.000, 95% C.I.=[-0.941,-0.188]). There was no statistically significant difference in mean online rating between allopathic physicians and osteopathic physicians (p=0.505), sleep psychologists (p=0.344), or foreign medical graduates (p=0.998), respectively. Conclusion This study suggests patients perceive sleep medicine providers’ online profiles with headshots, care philosophy statements, and designation of trustworthiness as contributing factors when rating. Additionally, degree type and age matter when rating online. Patients do not value factors such as ethnicity or gender strongly when rating their sleep medicine provider. Further study is needed to determine factors influencing non-physician providers’ higher ratings when compared to U.S. medical graduates. This study demonstrates the importance of building an online presence for sleep medicine practices and identifying characteristics patients value. The expectation is that this information can be used to improve the quality of care delivered in the field of sleep medicine. Support (if any)

Competencies and Values of Barangay Nutrition Scholars in Eastern Visayas: Basis for Program Development

The study determined the competencies and values of Barangay Nutrition Scholars (BNS) in Eastern Visayas and the relationship between the said variables along the socio demographic variables, which formed as bases in proposing for a capacity training development program for BNS in the local community. The study utilized the quantitative research design in determining the values and competencies of the BNS. Descriptive and inferential statistics were employed to measure and analyze the variables. It was affirmed that there were significant differences in mean ratings for competence in implementing, monitoring and evaluating, and documenting and record keeping, while there are no significant differences in mean ratings for competence in planning, coordinating, and mobilizing resource. In terms of the core values practiced, it was affirmed that the BNS “practiced” the values of integrity, transparency, excellence in work, respect for human rights, and accountability while they only “moderately practiced” values of efficiency and equity on the other hand, MNAOs indicates that the BNSs “practiced” values of integrity, transparency, respect for human rights, and accountability BNSs only “moderately practiced” values of efficiency, equity, and excellence in work. Further, there is significant difference between the BNS and MNAO mean ratings. As a recommendation, it was put forward that the selection criteria for BNS be reviewed and consider factors that could improve nutrition program management including gender mainstreaming criteria. It is imperative to formulate a simplified version and an extensive practical approach to nutrition education training needs to be looked into when designing and modifying the existing programs.

Adjunctive dietary intervention for bipolar disorder: a randomized, controlled, parallel-group, modified double-blinded trial of a high n-3 plus low n-6 diet.

To investigate the preliminary efficacy of a high n-3 plus low n-6 (H3-L6) dietary intervention in improving mood stability in Bipolar Disorder (BD) when compared to dietary intervention with usual U.S. levels of n-6 and n-3 polyunsaturated fatty acid (PUFA) intakes (control diet, CD). This 2-arm, parallel-group, randomized, modified double-blind, controlled 48-week study of 12-week intensive diet intervention in subjects with BD was conducted at a single suburban-rural site in the mid-Atlantic region. Participants with DSM-IV TR BD I or II with hypomanic or depressive symptoms were randomized, stratified on gender (N=82). The intervention included the provision of group-specific study foods and dietary counseling. Variability of mood symptoms was measured by a twice-daily, 12-week ecological momentary analysis (EMA) paradigm, and group differences were analyzed using multilevel models. Circulating n-3 and n-6 fatty acids were measured at baseline and after 4, 8, and 12weeks of diet exposure. All 82 randomized participants were included in biochemical analyses. Seventy participants completed at least 2 EMA surveys and were included in primary EMA analyses. Variability in mood, energy, irritability, and pain as measured using EMA was reduced in the H3-L6group compared to the CD group. No significant differences in mean ratings of mood symptoms, or any other symptom measures, were detected. The dietary intervention effect on target PUFAs significantly differed by the group over time. A dietary intervention adjunctive to usual care showed preliminary efficacy in improving variability in mood symptoms in participants with BD. ClinicalTrials.Gov NCT02272010.

Teacher efficacy and attributes on the implementation of tiered instructional frameworks

United States federal mandates and reforms to address the needs of at-risk students have resulted in many states being required to implement evidence-based practices (EBP) and tiered systems of support (TSS). We examined the relationships between successful implementation of EBP and tiered frameworks, specifically Positive Behavior Interventions and Support (PBIS) and the constructs of teacher self-efficacy, collective efficacy, and teacher attributions. Data were collected using the School-wide Evaluation Tool (SET), Teacher Self-Efficacy Scale (TSES), the Collective Efficacy Scale (CES), and Teachers’ Attributions for Student Behavior Measure (TASBM). Significant correlations were found between PBIS implementation level and 1) Instructional Strategies subscale of the TSES; 2) Collective Efficacy Scale and both of its subscales; and 3) TASBM and its Stable and Blame subscales. Significant differences in mean ratings were found between high implementing schools and low implementing schools on the Instructional Strategies subscale of the TSES, on the CES, and both of its subscale. Results showed a decrease in mean ratings on the Blame subscale of the TASBM in schools that had higher implementation scores on the SET.

Sex-Specific Effect of BDNF Val66Met Genotypes on the Progression of Open-Angle Glaucoma.

To investigate whether the brain-derived neurotrophic factor (BDNF) Val66Met genotype is associated with the rate of progression of open-angle glaucoma (OAG). In this retrospective cohort study, 148 OAG patients (292 eyes) were enrolled with a median follow-up period of 5.3 (range, 1.1-8.6) years. All participants had undergone regular clinical examinations by using spectral-domain optical coherence tomography (SD-OCT) scans and Humphrey (SITA) visual field tests. BDNF Val66Met polymorphisms were genotyped in all participants. Longitudinal visual field and retinal nerve fiber layer (RNFL) changes were compared between Met carriers (n = 68, 135 eyes) and Val homozygotes (n = 80, 157 eyes) by using the generalized estimating equations (GEE) model and Kaplan-Meier survival analysis. There was no significant difference in mean rates of progression for the two genotypes. However, there was a significant association between the Val66Met genotypes and slower OAG progression, as suggested by a higher rate of global RNFL loss in Val/Val homozygotes (P = 0.008) in the long-term survival analysis. The effect demonstrated a degree of sex specificity, with the significant difference present only in females (P = 0.016) but not males. Similar sexual dimorphism was presented in superior (P = 0.005 in females, P = 0.38 in males) and inferior (P = 0.004 in females, P = 0.41 in males) RNFL loss. No significant difference was observed in visual field parameters. Our results suggested that carriage of Met allele reduces the rate of long-term OAG progression. However, the fact that this effect is observed only in females indicates BDNF Val66Met influences the progression rate of OAG in a sex-specific manner.

The impact of exhibit type on behaviour of caged and free-ranging tamarins

The lack of appropriate stimuli associated with captive environments has been documented to cause several behavioural and physiological issues in captive species, including loss of natural behaviours, psychopathologies and decreased reproductive success. Providing free-ranging, naturalistic exhibits that replicate elements of a species’ natural environment is advocated as a means of promoting and preserving the natural behavioural repertoire in captive species. Exhibition of natural behaviour is considered beneficial to conservation in terms of animal health and welfare, reintroduction success, education and research. This study assessed differences in behaviour of emperor and pied tamarins housed in free-ranging and caged exhibits at Durrell Wildlife Park to determine the impact of exhibit type. Free-ranging tamarins were expected to exhibit a repertoire of behaviours more similar to that of wild tamarins based on their access to a more naturalistic and complex environment. Data was collected on a variety of behaviours, including activity, substrate use and communication, using instantaneous and one-zero sampling at 30s intervals. Findings indicated that both free-ranging and caged tamarins exhibited natural behaviours; however, there were significant differences in mean rates of behaviours between conditions. Free-ranging tamarins exhibited significantly higher rates of locomotion (emperors: P<0.001; pieds: P<0.001), long calls (pieds: P=0.019) and alarm calls (emperors: P=0.012), and displayed competent use of the environment in terms of natural substrate use (emperors: P<0.001; pieds: P=0.007) and interspecific interactions. Caged tamarins exhibited significantly higher rates of affiliative (emperors: P=0.001; pieds: P=0.026) and agonistic (emperors: P=0.003) intraspecific interactions and time spent in contact (emperors: P=0.048; pieds: P=0.043), which was largely attributed to spatial restrictions imposed by caged exhibits. This study, consistent with existing literature, indicated that the free-ranging exhibit was conducive to the expression of a behavioural repertoire more similar to that of wild tamarins. This was probably a result of the increased behavioural opportunities available in the free-ranging exhibit, highlighting their importance in promoting wild-type behaviours. However, some mean rates of behaviour were still noticeably less than those documented in wild counterparts. Methods to further promote natural behaviours in both exhibits are recommended to facilitate ex situ and in situ conservation efforts.

The influence of first impressions on subsequent ratings within an OSCE station.

Competency-based assessment is placing increasing emphasis on the direct observation of learners. For this process to produce valid results, it is important that raters provide quality judgments that are accurate. Unfortunately, the quality of these judgments is variable and the roles of factors that influence the accuracy of those judgments are not clearly understood. One such factor is first impressions: that is, judgments about people we do not know, made quickly and based on very little information. This study explores the influence of first impressions in an OSCE. Specifically, the purpose is to begin to examine the accuracy of a first impression and its influence on subsequent ratings. We created six videotapes of history-taking performance. Each video was scripted from a real performance by six examinee residents within a single OSCE station. Each performance was re-enacted with six different actors playing the role of the examinees and one actor playing the role of the patient and videotaped. A total of 23 raters (i.e., physician examiners) reviewed each video and were asked to make a global judgment of the examinee's clinical abilities after 60s (First Impression GR) by providing a rating on a six-point global rating scale and then to rate their confidence in the accuracy of that judgment by providing a rating on a five-point rating scale (Confidence GR). After making these ratings, raters then watched the remainder of the examinee's performance and made another global rating of performance (Final GR) before moving on to the next video. First impression ratings of ability varied across examinees and were moderately correlated to expert ratings (r=.59, 95% CI [-.13, .90]). There were significant differences in mean ratings for three examinees. Correlations ranged from .05 to .56 but were only significant for three examinees. Rater confidence in their first impression was not related to the likelihood of a rater changing their rating between the first impression and a subsequent rating. The findings suggest that first impressions could play a role in explaining variability in judgments, but their importance was determined by the videotaped performance of the examinees. More work is needed to clarify conditions that support or discourage the use of first impressions.

Perceived teaching quality between near-peer and academic tutors in an osteopathic practical skills class

BackgroundNear-peer teaching (NPT) has been reported in a number of teaching programs across different health professions. The utilisation of near-peer teaching in a teaching program has been demonstrated as beneficial for the student, the near-peer tutor and the teaching institution. The literature reports that students evaluate near-peer teaching as comparable to faculty teaching. The use of near-peers with academic tutors in the same classroom and utilising near-peer teaching for an extended period is unreported in osteopathy and limited in the broader literature. ObjectiveThis study aimed to investigate the quality ratings of the academic tutors and near-peer tutors teaching in the same classroom, over a semester. DesignQuestionnaire-based study using the Practical Class Teaching Questionnaire (PCTQ). SettingOsteopathic practical skills laboratory. MethodsThe PCTQ is a 9-item teaching quality tool developed for this study. Students were asked to rate the academic tutors (ATs) and near-peer tutors with the PCTQ at week 5 and week 12 of a 12-week semester. Descriptive and inferential statistics were used to investigate differences between the tutor types and differences between administration times. ParticipantsStudents in the first year of the osteopathy program at Victoria University. ResultsStatistically significant differences in mean ratings (p < 0.05) between tutor types were noted at week 5. These differences had largely been ameliorated by week 12. There is a strong relationship between the total PCTQ and a global rating of teaching quality. ConclusionsTeaching quality of near-peer tutors and ATs is comparable at the end of a 12-week teaching period in a first year osteopathic practical skills subject. Although the mean near-peer tutors ratings were lower than the ATs at week 5, with increasing experience and confidence of the near-peer tutors these differences largely resolved by week 12. NPT should be considered for osteopathic practical skills subjects in the early years of the training program.

Emergency medicine resident well-being: stress and satisfaction

Emergency medicine (EM) residents are exposed to many work-related stressors, which affect them both physically and emotionally. It is unknown, however, how EM residents perceive the effect of these stressors on their well-being and how often they use unhealthy coping mechanisms to manage stress. To evaluate EM residents' perceptions of stressors related to their overall well-being and the prevalence of various coping mechanisms. An online survey instrument was developed to gauge resident stress, satisfaction with current lifestyle, stress coping mechanisms and demographics. A stratified random sample of EM residents from three postgraduate years (PGY-I, PGY-II and PGY-III) was obtained. Descriptive statistics and one-way analysis of variance were used to compare residents across PGY level. There were 120 potential participants in each of the three PGYs. The overall response rate was 30% (109) with mean age of 30 and 61% were male. On a 0-4 scale (0 = completely dissatisfied), respondents in PGY-I reported significantly less satisfaction with lifestyle than those in PGY-II and III (mean rating: 1.29, 1.66 and 1.70, respectively; P < 0.001). There were no significant differences in mean ratings between PGYs on each of the other stress categories: work relationships (1.37), work environment (1.10) and response to patients (1.08). Residents reported exercise (94%), hobbies (89%) and use of alcohol (71%) as coping methods. Residents reported low satisfaction with current lifestyle. This dissatisfaction was unrelated to perceived work-related stress. Some undesirable coping methods were prevalent, suggesting that training programs could focus on promotion of healthy group activities.

Students’ Attitudinal Constraints towards Workplace Diversity – Managing Innovation in International Business Education

A key challenge in managing innovation in international business education is the existence of attitudinal constraints towards workplace diversity. A favorable attitude towards diversity is critical in preparing students to participate in global workplace communities. In an earlier study, Divinagracia and Divinagracia (2011) identified diversity attitudinal differences on a sample of undergraduate Business School students in East Java, Indonesia. Using a diversity word-association instrument, students who were enrolled in the international management study program tend to rate workplace-diversity-associated words higher relative to others. Significant differences in mean ratings were found in 21 out of 35 words. Factor analysis revealed that words associated with attitudinal constraints were associated with behavioral reactions. This present study further revealed that attitudinal differences exist between groups of students who resided in Surabaya, Indonesia's second biggest city, compared to those who were raised in the suburbs and other islands. The results suggest that students, who grew up and were educated in a mega city where trade and international exchanges abound, were more supportive towards workplace diversity. It is a reflection that areas beyond the mega cities tend to provide lesser forms of inter-group contact to its residents. As a result, attitudinal constraints towards workplace diversity were manifested. Subsequent factor analysis further revealed that the students’ top-rated diversity-inhibiting words were linked to behavioral reactions and judgments. International business education providers must therefore identify ways of improving the diversity attitudes of students using innovative learning types and tools.

Abstract 88: Simple Stepstool Adjuncts Improve Depth and Duration of AHA Guideline-Compliant Chest Compressions

Introduction AHA guideline-compliant chest compressions (CCs) during cardiac arrest improve survival. Few studies assess optimal use of stepstools (adjuncts) to improve compliance of these guidelines. Hypothesis Stepstool use will increase the depth and duration of AHA guideline-compliant CC delivery in a pediatric cardiac arrest manikin model. Methods IRB-approved prospective, randomized trial conducted on healthcare providers who routinely deliver CCs at work. Volunteers performed 2 sessions of continuous CCs on a pediatric manikin, in random order on separate days. CCs were performed with vs. without use of a 13cm stepstool on a standard-height hospital stretcher (70cm) until maximal fatigue or 10 min. Quality parameters (CC depth, rate, % CCs with residual leaning force &gt;2.5kg) were recorded using a CPR-sensing automated feedback-enabled defibrillator. Data were analyzed in 30-second epochs. “AHA guideline-compliant” CCs were defined by achieving all 3 criteria: average depth ≥38mm, rate 90-120 CC/min, and residual leaning force in &lt;20% of CCs. “Time to failure” was defined as the first epoch where AHA guideline-compliant CC criteria were not met. Analysis included descriptive summaries, Student's t-test, Poisson regression, and Cox regression to produce a failure-time analysis. Results All 21 providers completed both sessions: 62.5% male; median age 34 years, range 28-60; median height 173cm, range 163-190cm. With stepstool adjunct, subjects attained goal mean CC depth ≥38mm in over twice as many epochs (RR 2.26; CI: 1.24, 4.12; p=0.008), without significant difference in mean rate or % CCs with leaning force &gt;2.5kg. Median time to failure (duration) to perform AHA guideline-compliant CCs was significantly longer with stepstools (3.5min) than without stepstools (6.0min) (HR 1.53; CI: 1.06, 2.21; p=0.023). Conclusions Stepstool adjunct increased the frequency of attaining goal depth, and time to failure (duration) of AHA guideline-compliant CCs, without increasing residual leaning force in this pediatric cardiac arrest manikin model. With stepstools, AHA guideline-compliant CCs were delivered for close to twice as long. Assessment in the clinical setting is warranted to evaluate the utility of these findings.

Character-Marked Red Alder Lumber from Southeastern Alaska: Profiled Panel Product Preferences by Residential Consumers

Red alder (Alnus rubra Bong.) lumber is widely used to produce furniture and other secondary wood products. Tongue and groove (T&G) paneling is a product with potential niche applications and requires relatively small investments in processing equipment. As such, it represents potential business opportunities for smaller wood products manufacturers in Alaska. This study considered red alder paneling with various levels of character marks, ranging from clear wood to high levels of character. Residential consumers evaluated four panels in Anchorage and Fairbanks, Alaska, and selected their overall favorite panels for potential use in their homes. Character marks, grain consistency, and color also were evaluated for all panels. Statistically significant differences were found between male and female respondents in their attribute ratings for three of the four panels and in color attribute ratings between Anchorage and Fairbanks respondents for the panels with high levels of character. For all four panels, highly significant differences in mean ratings were found among the three attributes (character marks, grain consistency, and color). Market location was generally more significant than gender in influencing attribute ratings. These results suggest that even though strong preferences may exist for clear wood in T&G panels, consumers are able to perceive and rate character mark features differently.

Linear free energy relationship based estimates for the congener specific relative reductive defluorination rates of perfluorinated alkyl compounds

Linear free energy relationships (LFERs) were developed to estimate the congener specific relative rates of reductive defluorination for a suite of perfluorinated compound (PFC) classes. The LFERs were based on the semiempirically calculated lowest unoccupied molecular orbital energy (ELUMO) using gas and aqueous phase computations with the PM6 and RM1 methods. PFC classes in the modeling effort included the C1 through C8 perfluoroalkyl sulfonates (PFSAs), carboxylates (PFCAs), sulfonyl fluorides (PFSFs), sulfonamides and their derivatives (SAs), and the perfluorotelomer alcohols (PFTAls), olefins (PFTOls), and acids (PFTAcs). Gas and aqueous phase calculations using the PM6 method predict that branched PFSA, PFCA, and PFSF congeners will have more rapid reductive defluorination kinetics than their linear counterparts. The RM1 method predicts that only PFSFs will display intra-homologue dependent branching effects. For the PFSAs and PFSFs, both the PM6 and RM1 methods predict no significant difference in mean rates of reductive defluorination between the homologue groups. For the PFCAs, the PM6 method suggests no significant difference in inter-homologue mean rates of reductive defluorination, whereas the RM1 method predicts a significant increase with a lengthening perfluoroalkyl chain. All approaches used suggest that the intrahomologue variability in reduction rates increases with increasing chain length for PFSAs, PFCAs, and PFSFs, implying that the larger homologue groups in these classes will see a more rapid linearization of the congener profiles under reducing conditions than their lower homologue counterparts. Chain length has a negligible effect on the estimated rates of SA reductive defluorination, but a significant role for the fluorotelomer derivatives. Ratios of rates between the C8:C1 straight chain telomeric congeners are expected to range up to 200-fold depending on the computational combination. The kinetics for reductively defluorinating PFC starting materials will likely be 2 to 3 orders of magnitude more rapid than for most of the partially defluorinated degradation products. Significant quantities of partially defluorinated PFCs are thus expected to be observed under steady state conditions during reductive treatment processes, leading to a potentially significant reservoir of these compounds residing in reducing environmental and biological systems.

Indices of Choking under Pressure among Athletes during Competition

This study provides information on choking under pressure among university athletes during competition. 300 athletes were sampled and rated on a questionnaire on external and internal perceived sources of choking (alpha = .69 and .72). Analysis indicates a significant difference in mean rating on the two choking indices for men and women athletes. The women's means were higher than the men's but the difference was less than 1.00. Means for four sport groups were similar for the Internal subscale but significantly different on the External subscale.

Evaluation of bath grab bar placement for older adults

The patterns of use, perceived usefulness and perceived safety of five different configurations of bathtub grab bars were evaluated by 103 community-living seniors in Canada. Current bathing activities, fall history, sociodemographic characteristics, balance measures as well as details about the home bathing environment were recorded. Participants were then videotaped as they got into, sat down, got up and exited a bath tub using each of the five configurations. The videotapes were used to determine the pattern of grab bar use for each and participants ranked each for perceived function and safety. The five configurations corresponded to standards published by the Canadian Standards Association, the US Uniform Accessibility Standards, a modification of the Ontario Building code (OBC, a Canadian provincial code), a common configuration and a composite configuration. Although most respondents did not have bathtub grab bars installed in their home, those with home bars reported that they used the bars on a regular basis. Significant differences in mean ratings of safety, comfort, ease of use, helpfulness, likelihood of use, and total composite score were detected between configurations with the modified OBC consistently ranked least favourable. There were no statistically significant relationships between the respondents' profiles, their preferred configurations or their patterns of bar use. A series of recommendations and suggestions for future research are made.

Effect of hyperbaric oxygenation on intracranial pressure elevation rate in rats during the early phase of severe traumatic brain injury

Intracranial pressure (ICP) was monitored to evaluate the therapeutic effect of hyperbaric oxygen (HBO 2) treatment following traumatic brain injury (TBI). This subject is controversial. The aim of our study was to determine whether HBO 2 treatment has a therapeutic effect on ICP dynamics and survival following severe fluid percussion brain injury (FPBI) in rats. Changes in ICP level were analyzed every 30 min during an 8-h monitoring period following trauma and at the end of experiment (20 h). The control (A) and experimental (B) groups consisted of 7 and 4 rats, respectively. Group B was subjected to 1.5 atmospheres absolute (ATA) 100% oxygen for 60 min beginning 2 h after FPBI. No significant differences in ICP were noted between groups A and B before and after HBO 2 treatment until 3.5 h after trauma. At 4 h, for the first time, the difference became significant ( P = 0.025; n = 11) and remained significant ( P < 0.05) for all measurement points until end of monitoring, when mean ICP values reached 37.17 ± 14.25 and 20.25 ± 2.63 mm Hg in groups A and B, respectively. Linear approximation models showed different trends (b1 = 3.80 ± 0.23; r 2 = 0.65, P < 0.001 and b1 = 1.56 ± 0.25; r 2 = 0.77, P < 0.001) for groups A and B, respectively. Covariance analysis confirmed significant differences between slopes for groups A and B ( F = 148.04, P < 0.001; df = 2,177), i.e., a significant difference in mean rate of ICP elevation. By the end of the experiment, 3 out of 7 rats from group A had died, but none from group B. We conclude that the application of HBO 2 during the early phase of severe FPBI significantly diminished ICP elevation rate and decreased mortality level.

Unscheduled care for people with asthma in a multi-ethnic area is reduced following educational outreach programme by specialist nurses

Question Do asthma specialist nurses reduce health service use and improve outcomes across different ethnic groups? Study design Cluster randomised controlled trial. Main results Specialist nurse intervention reduced the percentage of participants attending unscheduled care in the subsequent year compared with usual care (adjusted odds ratio with clustering 0.61, 95% CI 0.38 to 0.99). First attendance for unscheduled asthma care in the same time period was delayed by specialist nurse intervention (hazard ratio [HR] 0.73, 95% CI 0.54 to 1.00). The effect of specialist nurse intervention on time to attendance was greater in white people (HR 0.57, 95% CI 0.38 to 0.85) compared with South Asian people (HR 0.72, 95% CI 0.48 to 1.09) or other ethnicities (HR 1.29, 95% CI 0.51 to 3.22). There were no significant difference in mean rates of hospital admission between groups. Authors’ conclusions Unscheduled care for people with asthma was reduced in practices where asthma specialist nurses provided an educational outreach and clinical support programme to staff. Improved outcomes were not equally distributed among ethnic groups.

Stressful Life Events: A Revision and Update of the Social Readjustment Rating Scale

The widely used and cited Social Readjustment Rating Scale developed by Holmes and Rahe (1967) was comprehensively revised and updated. The new instrument, containing 51 major life events, was administered to a national sample of 5000. Respondents were asked to rate the stressfulness of each life event on a 1–100 scale. Completed surveys were returned by 3122 individuals (62.4%). Responses were analyzed using repeated measures MANOVA and profile analysis. Major results included: (a) statistically and practically significant differences in mean ratings for the 51 life events; (b) five overlapping themes in the top 20 rated life events—death and dying, healthcare, crime and the criminal justice system, financial/economic issues, and family-related issues; and (c) an amazing level of agreement concerning perceived life event stressfulness, regardless of gender, age, or income level.

The learning needs of first-year surgical residents in the intensive care unit

Residents are more likely to learn from educational experiences when properly prepared from the start of instruction and expectations are clear and consistent. The purpose of this study was to examine what first year residents need to know and be able to perform before starting their rotation in the intensive care unit (ICU). The sample included surgical faculty, first through fifth year general surgery residents, and ICU nurses. A survey was developed that listed 110 knowledge and skill items felt to be possible prerequisite learning objectives. Respondents were asked to evaluate the required level of knowledge or skill on a 5-point Likert-type scale. Items were divided into knowledge or skill categories and then ranked in descending order by their mean ratings. Four knowledge and 10 skill items were ranked highly by all 3 groups of respondents. Kruskall-Wallis analyses found 58 items with statistically significant differences in mean ratings between groups of respondents. With this information a self assessment tool was developed to determine the level of performance on these identified learning objectives. A course of instruction can now be developed to assist residents in meeting these objectives before they assume patient care responsibilities in the ICU.