Subsequent Occasions Research Articles

Creating possibilities for action in the presence of environmental barriers in the process of ‘ageing in place’

ABSTRACTThe need for an understanding of ‘ageing in place’ as a progressive process has emerged among researchers in the field of environmental gerontology. The aim of this study was to explore this process, in relation to home modification services. Four older adults who had applied for home modification services in one Swedish municipality were included. Data were collected by open interviews with the participants in their homes on subsequent occasions, from before the modification had been installed until recognised stability in the situation relating to the home modification. In the analysis, the concept of place integration was used as a tool to explore the active relations that connect people and context over time. The main findings show that the participants used creativity and initiative to direct future situations towards increased possibilities for action. This indicates that services aiming to support people ‘ageing in place’ should be directed towards increasing possibilities for action rather than only facilitating activity performance. Furthermore, it can be concluded that if the service-users' creativity and efforts are recognised as resources in design and provision of services, services that aim to support individuals who are ageing in place have the potential to be empowering.

An educational partnership to enhance evidence-based wound care

This article describes an educational initiative that aimed to raise the knowledge and practice of nurses at one hospital where staff had become deskilled in wound care. An audit questionnaire was used to determine nurses' knowledge before and 4 months after an educational workshop, part of which considered pain issues. Following the educational initiative, nurses within the Trust were knowledgeable about when to take a wound swab and could recognize the signs of wound infection, but there were still issues around the clinical practice of taking a wound swab. Conversely, their use of descriptors of tissue type to justify dressing choice was improved. Analgesia was commonly given to address previous uncomfortable dressing changes, but there was no mention of pain assessment. When a product had adhered to the wound bed, many nurses advocated soaking to aid removal. This has limited efficacy, but few nurses advocated using an alternative dressing on subsequent occasions. These results suggest that 4 months may be too short a time to fully evaluate whether a single educational workshop is sufficient to sustain change in an organization. An ongoing competency-based programme has been implemented.

Temporal spike pattern learning

Sensory systems pass information about an animal's environment to higher nervous system units through sequences of action potentials. When these action potentials have essentially equivalent wave forms, all information is contained in the interspike intervals (ISIs) of the spike sequence. How do neural circuits recognize and read these ISI sequences? We address this issue of temporal sequence learning by a neuronal system utilizing spike timing dependent plasticity (STDP). We present a general architecture of neural circuitry that can perform the task of ISI recognition. The essential ingredients of this neural circuit, which we refer to as "interspike interval recognition unit" (IRU) are (i) a spike selection unit, the function of which is to selectively distribute input spikes to downstream IRU circuitry; (ii) a time-delay unit that can be tuned by STDP; and (iii) a detection unit, which is the output of the IRU and a spike from which indicates successful ISI recognition by the IRU. We present two distinct configurations for the time-delay circuit within the IRU using excitatory and inhibitory synapses, respectively, to produce a delayed output spike at time t_{0}+tau(R) in response to the input spike received at time t_{0} . R is the tunable parameter of the time-delay circuit that controls the timing of the delayed output spike. We discuss the forms of STDP rules for excitatory and inhibitory synapses, respectively, that allow for modulation of R for the IRU to perform its task of ISI recognition. We then present two specific implementations for the IRU circuitry, derived from the general architecture that can both learn the ISIs of a training sequence and then recognize the same ISI sequence when it is presented on subsequent occasions.

Ruminative self-focus and negative affect: An experience sampling study.

The authors conducted an experience sampling study to investigate the relationship between momentary ruminative self-focus and negative affect. Ninety-three adults recorded these variables at quasi-random intervals 8 times daily for 1 week. Scores on questionnaire measures of dispositional rumination were associated with mean levels of momentary ruminative self-focus over the experience sampling week. Concurrently, momentary ruminative self-focus was positively associated with negative affect. Cross-lagged analyses revealed that whereas ruminative self-focus predicted negative affect at a subsequent occasion, negative affect also predicted ruminative self-focus at a subsequent occasion. Decomposition of the dispositional rumination measure suggested that brooding, but not reflective pondering, was associated with higher mean levels of negative affect. Though broadly consistent with Nolen-Hoeksema's (1991) response styles theory, these results suggest that a reciprocal relationship exists between ruminative self-focus and negative affect.

Perpetrators of Sexual Assault Continuing to Have Sex With Their Victims Following the Initial Assault

Among a sample of college students, roughly 30% of the women and 12% of the men reported having been the victim of a sexual assault sometime in their lives. Of the assault victims, approximately 23% of both sexes stated that they had sexual intercourse with their assaulters on at least one subsequent occasion. Female victims of a completed sexual assault were significantly more likely to continue being sexually active with their assailants than were female victims who managed to block the assault, while no such difference was found for male victims. This would imply that some men are using assaultive tactics to secure sex partners beyond a single sexual episode, thereby enhancing their potential reproductive success in evolutionary terms. Also, men who committed sexual assault reported having had more lifetime sex partners than did sexually experienced men with no sexual assault history. Overall, the idea that sexual assault is part of an evolved reproductive strategy is consistent with findings from this study.

Effects of Environmental Changes in a Stair Climbing Intervention: Generalization to Stair Descent

Visual improvements have been shown to encourage stair use in worksites independently of written prompts. This study examined whether visual modifications alone can influence behavior in a shopping mall. Climbing one flight of stairs, however, will not confer health benefits. Therefore, this study also assessed whether exposure to the intervention encouraged subsequent stair use. Interrupted time-series design. Escalators flanked by a staircase on either side. Ascending and descending pedestrians (N = 81,948). Following baseline monitoring, a colorful design was introduced on the stair risers of one staircase (the target staircase). A health promotion message was superimposed later on top. The intervention was visible only to ascending pedestrians. Thus, any rise in descending stair use would indicate increased intention to use stairs, which endured after initial exposure to the intervention. Observers inconspicuously coded pedestrians' means of ascent/descent and demographic characteristics. The design alone had no meaningful impact. Addition of the message, however, increased stair climbing at the target and nontarget staircases by 190% and 52%, respectively. The message also produced a modest increase in stair descent at the target (25%) and nontarget (9%) staircases. In public venues, a message component is critical to the success of interventions. In addition, it appears that exposure to an intervention can encourage pedestrians to use stairs on a subsequent occasion.

Prevalence of Hypertension and Pre-Hypertension among Adolescents

To determine the prevalence of hypertension and pre-hypertension on the basis of the 2004 National High Blood Pressure Education Program Working Group guidelines in an adolescent school-screening population. Cross-sectional assessment of blood pressure (BP) in 6790 adolescents (11-17 years) in Houston schools was conducted from 2003 to 2005. Initial measurements included height, weight, and 4 oscillometric BP readings. Repeat measurements were obtained on 2 subsequent occasions in students with persistently elevated BP. Final prevalence was adjusted for loss to follow-up and logistic regression used to assess risk factors. BP distribution at initial screen was 81.1% normal, 9.5% pre-hypertension, and 9.4% hypertension (8.4% Stage 1; 1% Stage 2). Prevalence after 3 screenings was 81.1% normal, 15.7% pre-hypertension, and 3.2% hypertension (2.6% Stage 1; 0.6% Stage 2). Hypertension and pre-hypertension increased with increasing body mass index. Sex, race, and classification as either at-risk for overweight or overweight were independently associated with pre-hypertension. Only classification as overweight was associated with hypertension. Application of new classification guidelines for adolescents with elevated BP reveals approximately 20% are at risk for hypertension. Further research determining the significance of each BP category and refining definitions to account for BP variability is warranted.

Managing programmed instruction and collaborative peer tutoring in the classroom: Applications in teaching Java™

To fulfill part of the course requirements, 34 undergraduate students in two courses completed an online programmed instruction tutor as the first technical training exercise in a Java™ programming course designed for information systems majors. The tutor taught a simple JApplet program to display a text string within a browser window on the Web. Students in the first course next participated in a collaborative peer tutoring session, based on the JApplet program, followed by a lecture on the program and by successfully running the program on the Web. For the second course, the peer tutoring session was scheduled after the lecture and after successfully running the program. Students in both courses completed tests of far transfer (“meaningful learning”) and software self-efficacy before using the tutor and on several subsequent occasions following that initial learning. Students in the second course also completed a 4-item scale to assess the development of classification and functionality knowledge regarding elements of the program. Students in both courses showed progressive improvement in all performance measures across the several assessment occasions. Students’ positive ratings of the effectiveness of both the tutor and the collaborative peer tutoring supported the value of these learning experiences in a technical knowledge domain. The results of this study, based on student performance observed within the context of the classroom, show the importance of providing a range of synergistic learning experiences that culminate in a level of skill and confidence that prepares and motivates all students for advanced instruction in Java. They also show how to manage the instructional techniques in the classroom to accomplish that educational outcome.

Nicotine intake and dose response when smoking reduced–nicotine content cigarettes

The progressive reduction of the nicotine content of cigarettes has been suggested as a way to wean smokers from nicotine and tobacco. As a first step in evaluating this strategy, we studied smokers smoking cigarettes containing tobacco with differing nicotine content. Twelve healthy smokers participated in a semiblinded, within-subject, crossover study. Subjects were asked to smoke 1 of their usual brand of cigarette and then on 5 subsequent occasions to smoke a research cigarette, each with differing nicotine content. The research cigarettes contained 0.6 to 10.1 mg nicotine per cigarette. Plasma nicotine and blood carboxyhemoglobin levels, as well as subjective and cardiovascular responses, were measured after smoking. Systemic nicotine intake per cigarette was estimated by use of plasma nicotine concentrations over time and clearance data from the general population. Systemic nicotine intake (0.26-1.47 mg per cigarette) varied with nicotine content of the cigarette (r = 0.82, P < .001). Compensation when smoking single low-nicotine content cigarettes ranged from -1% (95% confidence interval, -23% to 21%) to 34% (95% confidence interval, -39% to 107%) for 1-mg to 8-mg research cigarettes. Carbon monoxide intake and estimated tar exposure were similar across cigarettes. Low-nicotine content cigarettes were rated as being of lower quality and less satisfying than the 12-mg research cigarette or the usual brand (P < .05 for both comparisons). Cigarette smoking increased heart rate and decreased skin temperature, but the nicotine dose-response curve flattened at higher doses, with a maximal response being observed in cigarettes at a nicotine content level of about 8 mg. Our study suggests that reduced-nicotine content cigarettes are reasonable candidates for trying to reduce the level of nicotine addiction in smokers. The flat nicotine dose-cardiovascular response curve is consistent with other studies demonstrating tolerance to the cardiovascular effects of nicotine.

Bridging the Gap between the Sacred and the Secular in the History of American Foreign Relations

With the eruption of global hostilities between two universalistic, mutually exclusive ideologies, the president of the United States sought to rally Americans, and people around the world, to the cause of spreading freedom and democracy. What was most striking about his rhetoric was its explicit grounding in religious dogma and imagery. “The defense of mankind against these attacks,” the president told an audience at the onset of the crisis, “lies in the faith we profess—the brotherhood of man and the Fatherhood of God.”“Democracy,” he proclaimed three years later in the midst of an increasingly unpopular, stalemated war, “is first and foremost a spiritual force.” At a subsequent occasion, he warned against complacency because “we are under tremendous attacks” and stressed that Americans must remain vigilant and “establish the fervor, the strength of our convictions, because fundamentally Democracy is nothing in the world but a spiritual conviction, a conviction that each of us is enormously valuable because of a certain standing before our own God.” Finally, later still, when it was clear that the global struggle would last years, if not decades, the president informed the American people that although he had “sworn before you and Almighty God the same oath our forebears prescribed” in the eighteenth century, “the same revolutionary beliefs for which our forebears fought are still at issue around the globe—the belief that the rights of man come not from the generosity of the state but from the hand of God.”

The Use of a Self-removal Prolene Suture After Daycase Laparoscopic Surgery

The use of nonabsorbable skin sutures after daycase laparoscopic surgery is said to give better cosmetic results but the need for the patient to return for subsequent removal negates some of the advantages of daycase surgery. We therefore devised a skin stitch tied like half a shoelace, which could be removed at home by the patients themselves, but we needed to assess whether patients were willing and capable of removing their own sutures. Between May 2003 and August 2004 a qualitative study using in-depth interviews investigated 89 women undergoing elective laparoscopic daycase surgery and using our "slip knot" suture. Patients were initially anxious about removing their own sutures but very few practical problems were encountered with most welcoming the use of the same stitch on a subsequent occasion. A strong finding was the positive feeling that patients had about participating in their own care. The slip knot stitch is a simple, effective form of skin closure, improving time management for both staff and patients and empowering patients with decisions about their own care. It is popular with patients.

Changing Their Minds With Time: A Comparison of Hypothetical and Actual Reproductive Behaviors in Parents of Children With Cystic Fibrosis

Newborn screening for cystic fibrosis, with appropriate counseling, enables carrier parents to be informed early about future reproductive choices. Previous studies have assessed attitudes toward reproductive decisions in a hypothetical pregnancy or have measured reproductive behaviors. We aimed to measure parent attitudes to reproductive technologies and to compare prospectively these attitudes with later reproductive behaviors. Parents of children who had cystic fibrosis and were aged 2 to 7 years were surveyed at baseline using a written questionnaire that explored attitudes to prenatal testing and termination of pregnancy in a hypothetical pregnancy. Parent knowledge and access to genetic counseling services also were assessed. Five years later, we compared attitudes with actual reproductive behaviors. Fifty-six mothers participated at baseline, and 43 were resurveyed 5 years later. Parent knowledge of cystic fibrosis and genetics was very good. A total of 93% had met a genetic counselor at the time of diagnosis, and more than half had on at least 1 subsequent occasion. At baseline, 82% reported that they would be likely to have prenatal diagnosis in a subsequent pregnancy, and 56% reported that they would be likely to terminate an affected pregnancy. Twenty-seven mothers since had been pregnant, with prenatal diagnosis used in 33 of the 55 pregnancies. In 67%, the hypothetically reported behavior regarding use of prenatal testing was the same as their actual behavior. Five of the 33 tested pregnancies were affected; all ended in termination. Reproductive choices in relationship to the number of children wanted, together with attitudes toward prenatal diagnosis and termination of pregnancy, were dynamic over time, with decisions having changed in both directions. This cohort of parents has actively used reproductive technologies since the birth of a child who has cystic fibrosis that was diagnosed by newborn screening. The dynamic aspect of reproductive choices highlights the importance of ongoing access to genetic counseling beyond the initial period of diagnosis and education, regardless of whether parents report that they expect to use reproductive technologies.

Bioavailability of slowly cycling soil phosphorus: major restructuring of soil P fractions over four decades in an aggrading forest

Although low solubility and slow cycling control P circulation in a wide range of ecosystems, most studies that evaluate bioavailability of soil P use only indices of short-term supply. The objective here is to quantify changes in P fractions in an Ultisol during the growth of an old-field pine forest from 1957 to 2005, specifically changes with organic P (Po) and with inorganic P (Pi) associated with Fe and Al oxides as well as Ca compounds. Changes in soil P were estimated from archived mineral soil samples collected in 1962 shortly after pine seedlings were planted, and on six subsequent occasions (1968, 1977, 1982, 1990, 1997, and 2005) from eight permanent plots and four mineral soil layers (0-7.5, 7.5-15, 15-35, and 35-60 cm). Despite the net transfer of 82.5 kg ha(-1) of P from mineral soil into tree biomass and O horizons, labile soil P was not diminished, as indexed by anion exchange resins, and NaHCO(3) and Mehlich III extractants. An absence of depletion in most labile P fractions masks major restructuring of soil P chemistry driven by ecosystem development. During 28 years of forest growth, decreases were significant and substantial in slowly cycling Po and Pi associated with Fe and Al oxides and Ca compounds, and these accounted for most of the P supplied to biomass and O horizons, and for buffering labile soil fractions as well. Changes in soil P are attributed to the P sink strength of the aggrading forest (at 2.9 kg ha(-1) year(-1) over 28 years); legacies of fertilization, which enriched slowly cycling fractions of Po and Pi; and the changing biogeochemistry of the soil itself.

Response to: Ethics, data and the pharmaceutical physician

To the Editor: The very recent publications (1, 2) are presented as guides to the ethical concerns specifically raised for physicians in the development of new medicines and to the standards expected in their solution. It should be welcomed as a valuable attempt to provide standards and direction for the physician in this specific area. It is important that the reports from the Faculty of Pharmaceutical Medicine should cover all aspects of a physician's responsibilities in developing a new medicine, including the types of information and assessments necessary to support the risk–benefit judgement needed before a drug is studied in humans on the first or any subsequent occasion. I sought and failed to find a clear statement that the pharmaceutical physician must have access to all the pharmaceutical and non-clinical information about a drug needed to make that evaluation and so that safety can be judged. The pharmaceutical physician must either analyse the information or ensure that a formal assessment is provided by someone qualified to do so before responsibility can properly be accepted for approving or undertaking any clinical investigation. What I believe the Faculty should state is a mandatory requirement for full access to pharmaceutical, pharmacological and toxicological investigations to ensure that the properties of the drug have been appropriately investigated in relation to its intended use, the nature of the subjects to be treated and the form of the intended clinical study. Without such information, an adequate risk–benefit assessment cannot be made and the pharmaceutical physician would not be able to provide an ethical or otherwise adequate decision about the acceptability of the planned clinical investigation. This is the only way to avoid unscrupulous or forgetful attempts to overlook harmful data or necessary investigations not done.

Methylene Blue Treatment for Methemoglobinemia and Subsequent Dramatic Bispectral Index Reduction

Methylene Blue Treatment for Methemoglobinemia and Subsequent Dramatic Bispectral Index Reduction

Are cholinergic enhancers beneficial for memory in schizophrenia? An event-related potentials (ERPs) study of rivastigmine add-on therapy in a crossover trial

Studies have reported beneficial effects of cholinergic enhancers, e.g., rivastigmine, on memory in schizophrenia but others have not. Possibly, these discrepancies are related to the lack of specificity of the tests used. This study investigated the effect of rivastigmine on memory in schizophrenia using event-related potentials (ERPs). Eighteen patients treated with atypical antipsychotic received rivastigmine adjuvant therapy in a randomized, crossover design. They were assessed at baseline (T1) and on two subsequent occasions (T2 and T3), where one half of the subjects were taken rivastigmine and the other half not. ERPs were recorded during a recognition memory task on each session. Behavioral and ERP data were analyzed using mixed ANOVA models first at T1 to detect potential group differences and for the trial (T1–T2) to determine the influence of rivastigmine, i.e., session×group interactions. The results showed no group difference at T1 except a trend for one group to be less efficient than the other on RT measures. When controlling for this difference the results on the trial data showed a trend for a benefit of rivastigmine on the RT memory effect. ERP analysis revealed that rivastigmine affects the amplitudes of two components elicited within 150–300 ms over posterior (reduced N2b) and frontal sites (enhanced P2a). It also enhances the magnitude of the memory (old/new) effect on two later components over posterior (N400) and frontal sites (F-N400). These results suggest that rivastigmine improves selective attention by enhancing interference inhibition processes (P2a) and lowering the reactivity to incoming stimulus (N2b). It also improves the integration of information with knowledge (N400) and with its context (F-N400). Generally, this study showed that the beneficial effect of rivastigmine on memory is not unitary but rather comes from its action at different time points within information processing cascade.

Modeling late-life adaptation in affective well-being under a severe chronic health condition: The case of age-related macular degeneration.

Age-related macular degeneration (AMD) was used as a case model to longitudinally study adaptation in affective well-being under a prevalent chronic health condition. Measures of positive and negative affect, obtained at 5 subsequent measurement occasions with 3-month intervals in between, were analyzed in 90 older adults diagnosed with AMD. The authors proposed a pattern of adaptation that shows initial decline in affective well-being after disease outbreak, followed by a turnaround into a restorative phase of increase, implying nonlinear intraindividual trajectories, with changes substantially related to disease duration. Analysis was conducted by means of a nonlinear mixed models approach. Results confirmed the hypothesized adaptation pattern for positive affect but not for negative affect, which was found more stable across measurement occasions.

Listening to classical music can (slightly) improve stereo-acuity in normal observers

Aims: To test for improvements in stereo-acuity, relative to pre-test measurements, after listening to pieces of classical music and whether any stereo-­acuity improvement tended to be found following enjoyable stimuli. Methods: In a double-masked repeated measures study 15 participants with normal vision had their stereo-acuity measured to threshold using the Frisby stereo-test on five occasions: prior to exposure to the test stimuli, and then on four subsequent occasions each time after listening to a particular stimulus for 10 minutes. Participants also rated their enjoyment of each stimulus. Results: After listening to each of the musical stimuli stereo-acuity was improved significantly when com­pared with the pre-test level, but listening to the control white noise stimulus produced no significant improvement in stereo-acuity. There was no signifi­cant difference between any of the musical pieces in cither their effect on stereo-acuity or enjoyment rating. The white noise stimulus was found to be significantly less enjoyable than any of the musical pieces. This suggested that the effect of the music was possibly due to a change in participants’ mood. Conclusion: Our findings for stereo-acuity are con­sistent with previous studies that have shown that listening to classical music can improve performance in spatial tasks.

Concentrations and emissions of gasoline and other vapors from residential vehicle garages

High concentrations of airborne volatile organic compounds (VOCs) may be present in residential garages due to emissions from vehicles, lawnmowers, storage containers, and many other items stored in the garage. VOC emissions will ultimately be transported into ambient air and, if the garage is attached to a residence or other building, into living spaces. This study reports on VOC concentrations and emissions at 15 residential garages in Michigan that varied in type, size, use and other characteristics. VOCs were measured in garages and in outside air using 4-day passive sampling, thermal desorption, and GC-MS analysis. Effective air exchange rates (AERs) were determined using a perfluorocarbon tracer gas and the constant injection method. A modeling analysis shows the effect of time-varying ventilation. To estimate temporal and spatial variability, concentrations were measured on 7 subsequent occasions at multiple locations in one garage. This garage was well-mixed, and the temporal variation in AERs and concentrations was modest. Across the 15 garages, 36 different VOCs in garage air, and 20 in ambient air, were quantified. Source groups identified and attributed to garage emissions included evaporated gasoline, solvents, paints, oils, and cleaners. Concentrations of gasoline-related VOCs in most garages were high, e.g., benzene levels reached 159 μg m −3 in one garage. TVOC emissions per garage averaged 3.0±4.1 g day −1, and AERs averaged 0.77±0.51 h −1. VOC concentrations and AERs were not strongly correlated to observed house, garage or meteorological factors, but appeared largely dependent on occupant activities (opening of the garage door) and VOC sources present. This study quantifies the importance of attached garages as VOC sources, and the results are significant for understanding and mitigating indoor exposures, and for estimating emissions for source inventory purposes.

Experience-dependent choices ensure species-specific fragrance accumulation in male orchid bees

Male neotropical orchid bees (Euglossini) collect volatile chemicals from orchid flowers and other sources and store them in hind leg cavities. The accumulated fragrance bouquets are later emitted at mating sites. Although most other insects synthesize pheromone blends de novo, specific euglossine perfumes are derived from active choices in a changing fragrance market. Male bees of three species of Euglossa possessed distinctive fragrance phenotypes showing little variation by locality and habitat in mainland Central America. In cage experiments, fragrance choice by male Euglossa imperialis was influenced markedly by a bee's collection history. Collection of a given chemical strongly reduced its attractiveness on subsequent occasions, an effect that was retained over days. Experimentally adding the chemicals directly to bee hind legs produced no effect. We conclude that bees learn and remember chemicals they collect. Innate odor preferences, memory and the avoidance of overcollecting by negative feedback may be the primary mechanisms that ensure unique blends of pheromone analogs in these tropical forest bees.