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Sample records for single qualitative case

  1. A qualitative single case study of parallel processes

    DEFF Research Database (Denmark)

    Jacobsen, Claus Haugaard

    2007-01-01

    Parallel process in psychotherapy and supervision is a phenomenon manifest in relationships and interactions, that originates in one setting and is reflected in another. This article presents an explorative single case study of parallel processes based on qualitative analyses of two successive...... randomly chosen psychotherapy sessions with a schizophrenic patient and the supervision session given in between. The author's analysis is verified by an independent examiner's analysis. Parallel processes are identified and described. Reflections on the dynamics of parallel processes and supervisory...

  2. Single-Case Designs and Qualitative Methods: Applying a Mixed Methods Research Perspective

    Science.gov (United States)

    Hitchcock, John H.; Nastasi, Bonnie K.; Summerville, Meredith

    2010-01-01

    The purpose of this conceptual paper is to describe a design that mixes single-case (sometimes referred to as single-subject) and qualitative methods, hereafter referred to as a single-case mixed methods design (SCD-MM). Minimal attention has been given to the topic of applying qualitative methods to SCD work in the literature. These two…

  3. Qualitative methodology in a psychoanalytic single case study

    DEFF Research Database (Denmark)

    Grünbaum, Liselotte

    features and breaks in psychotherapy investigated. One aim of the study was to contribute to the development of a transparent and systematic methodology for the psychoanalytic case study by application of rigorous qualitative research methodology. To this end, inductive-deductive principles in line...

  4. [Music therapy single case research--a qualitative approach].

    Science.gov (United States)

    Langenberg, M; Frommer, J; Tress, W

    1995-12-01

    A qualitative approach for describing music psychotherapy treatment is developed. For this purpose we employ the methodological principle of triangulation of perspectives (patient, therapist, independent observers, composers). Our approach is based on the concept of the resonator function describing the perceptive capacity of all participants for effective and relationship-referred significance of the work produced during the treatment. The qualitative method importing and extending the knowledge of the inner context of the case is illustrated by two musical improvisations from the treatment of a female patient suffering from chronic migraine.

  5. Qualitative Case Study Guidelines

    Science.gov (United States)

    2013-11-01

    Introduction to Sociological Methods. 2nd ed. New York, McGraw-Hill 14. Denzin , N. K. and Lincoln , Y. S. (2011) The SAGE Handbook of Qualitative...The Art of Science. In: Denzin , N. K. and Lincoln , Y. S. (eds.) Handbook of Qualitative Research. Thousand Oaks, Sage 19. GAO (1990) Case Study...Rinehart & Winston 39. Stake, R. E. (1994) Case Studies. In: Denzin , N. K. and Lincoln , Y. S. (eds.) Handbook of Qualitative Research. Thousand Oaks, Sage

  6. Toward Understanding the Role of Web 2.0 Technology in Self-Directed Learning and Job Performance in a Single Organizational Setting: A Qualitative Case Study

    Science.gov (United States)

    Caruso, Shirley J.

    2016-01-01

    This single instrumental qualitative case study explores and thickly describes job performance outcomes based upon the manner in which self-directed learning activities of a purposefully selected sample of 3 construction managers are conducted, mediated by the use of Web 2.0 technology. The data collected revealed that construction managers are…

  7. Qualitative Case Study Research as Empirical Inquiry

    Science.gov (United States)

    Ellinger, Andrea D.; McWhorter, Rochell

    2016-01-01

    This article introduces the concept of qualitative case study research as empirical inquiry. It defines and distinguishes what a case study is, the purposes, intentions, and types of case studies. It then describes how to determine if a qualitative case study is the preferred approach for conducting research. It overviews the essential steps in…

  8. Qualitative Secondary Analysis: A Case Exemplar.

    Science.gov (United States)

    Tate, Judith Ann; Happ, Mary Beth

    Qualitative secondary analysis (QSA) is the use of qualitative data that was collected by someone else or was collected to answer a different research question. Secondary analysis of qualitative data provides an opportunity to maximize data utility, particularly with difficult-to-reach patient populations. However, qualitative secondary analysis methods require careful consideration and explicit description to best understand, contextualize, and evaluate the research results. In this article, we describe methodologic considerations using a case exemplar to illustrate challenges specific to qualitative secondary analysis and strategies to overcome them. Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  9. Innovative Interpretive Qualitative Case Study Research Method ...

    African Journals Online (AJOL)

    lc2o

    The combined use of case study and systems theory is rarely discussed in the ... Scott, 2002), the main benefit of doing qualitative research is the patience ..... Teaching ICT to teacher candidates ... English Language Teachers. London: Arnold.

  10. Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study.

    Science.gov (United States)

    Leonhardt, Bethany L; Kukla, Marina; Belanger, Elizabeth; Chaudoin-Patzoldt, Kelly A; Buck, Kelly D; Minor, Kyle S; Vohs, Jenifer L; Hamm, Jay A; Lysaker, Paul H

    2018-03-01

    Emerging integrative metacognitive therapies for schizophrenia seek to promote subjective aspects of recovery. Beyond symptom remission, they are concerned with shared meaning-making and intersubjective processes. It is unclear, however, how such therapies should understand and respond to psychotic content that threatens meaning-making in therapeutic contexts. Accordingly, we sought to understand what factors precede and potentially trigger psychotic content within psychotherapy and what aids in resolution and return to meaning-making. Forty-eight transcripts from a single psychotherapy case were analyzed with thematic analysis. Passages of delusional or disorganized content were identified and themes present prior to the emergence and resolution of such material were identified and coded. Themes that preceded the emergence of psychotic content varied across early, middle, and late phases of therapy. Material related to the patient's experience of inadequacy and potential vulnerability, therapist setting boundaries within the therapeutic relationship and making challenges appeared to trigger psychotic content, especially early in treatment. Psychotic content may emerge in session following identifiable antecedents which change over phases of therapy. Attending to psychotic content by assuming a non-hierarchical stance and not dismissing psychotic content may aid in maintaining intersubjectivity and support patient's movements toward recovery in integrative metacognitive therapies.

  11. Linking Flexible-Dynamic Team Structures through Distributed Leadership: A Qualitative Evaluation with Single Design Case Approach and Application of Roster Method

    Directory of Open Access Journals (Sweden)

    Aykut BERBER

    2012-09-01

    Full Text Available Fierce competition in every sector has forced companies to re-design their structures towards being more customer-focused, faster and more responsive. In this vein, there is rising dominance of flexible-dynamic team structures in organizations and these teams are, most of the times, self-managed. Among these team structures, leadership characteristics are not only observed in official team leaders but such characteristics are distributed among team members. The concept of "leading without leaders" has gained scholarly interest and in this paper, aim is to evaluate and combine constructs of distributed leadership and flexible-dynamic team structures within a single design case approach. Local division of a multinational company that operates in luxury cosmetics sector is selected. In-depth interviews were conducted at the company site, and flexible-dynamic team structures were examined in detail. As a second tool, Roster method is applied to see existence and strength of distributed leadership among different departments. Findings supported that organizational structure of this company has become more flexible-dynamic with distributed leadership characteristics seen across all departments. These findings were significant because our selected company entered into Turkey market twice and the second entry has been operationally successful. Arguments are offered regarding differences between two periods and further implications are suggested in relation to adoption of a new and more responsive company structure. Structural changes between two periods constituted the focal point of this research.

  12. Rethinking a Case Study Method in Educational Research: A Comparative Analysis Method in Qualitative Research

    Science.gov (United States)

    Murakami, Yusuke

    2013-01-01

    There are two types of qualitative research that analyze a small number of cases or a single case: idiographic differentiation and nomothetic/generalization. There are few case studies of generalization. This is because theoretical inclination is weak in the field of education, and the binary framework of quantitative versus qualitative research…

  13. Rigour in qualitative case-study research.

    Science.gov (United States)

    Houghton, Catherine; Casey, Dympna; Shaw, David; Murphy, Kathy

    2013-03-01

    To provide examples of a qualitative multiple case study to illustrate the specific strategies that can be used to ensure the credibility, dependability, confirmability and transferability of a study. There is increasing recognition of the valuable contribution qualitative research can make to nursing knowledge. However, it is important that the research is conducted in a rigorous manner and that this is demonstrated in the final research report. A multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Multiple sources of evidence were collected: semi-structured interviews (n=58), non-participant observations at five sites and documentary sources. Strategies to ensure the rigour of this research were prolonged engagement and persistent observation, triangulation, peer debriefing, member checking, audit trail, reflexivity, and thick descriptions. Practical examples of how these strategies can be implemented are provided to guide researchers interested in conducting rigorous case study research. While the flexible nature of qualitative research should be embraced, strategies to ensure rigour must be in place.

  14. Qualitative case study data analysis: an example from practice.

    Science.gov (United States)

    Houghton, Catherine; Murphy, Kathy; Shaw, David; Casey, Dympna

    2015-05-01

    To illustrate an approach to data analysis in qualitative case study methodology. There is often little detail in case study research about how data were analysed. However, it is important that comprehensive analysis procedures are used because there are often large sets of data from multiple sources of evidence. Furthermore, the ability to describe in detail how the analysis was conducted ensures rigour in reporting qualitative research. The research example used is a multiple case study that explored the role of the clinical skills laboratory in preparing students for the real world of practice. Data analysis was conducted using a framework guided by the four stages of analysis outlined by Morse ( 1994 ): comprehending, synthesising, theorising and recontextualising. The specific strategies for analysis in these stages centred on the work of Miles and Huberman ( 1994 ), which has been successfully used in case study research. The data were managed using NVivo software. Literature examining qualitative data analysis was reviewed and strategies illustrated by the case study example provided. Discussion Each stage of the analysis framework is described with illustration from the research example for the purpose of highlighting the benefits of a systematic approach to handling large data sets from multiple sources. By providing an example of how each stage of the analysis was conducted, it is hoped that researchers will be able to consider the benefits of such an approach to their own case study analysis. This paper illustrates specific strategies that can be employed when conducting data analysis in case study research and other qualitative research designs.

  15. Qualitative case study methodology in nursing research: an integrative review.

    Science.gov (United States)

    Anthony, Susan; Jack, Susan

    2009-06-01

    This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research. Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology. In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria. Whittemore and Knafl's integrative review method guided the analysis. Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research. Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.

  16. Modalities of Generalization Through Single Case Studies.

    Science.gov (United States)

    Zittoun, Tania

    2017-06-01

    The value of case studies for theory building is still doubted in psychology. The paper argues for the importance of case studies and the possibility of generalizing from these for a specific sociocultural understanding of human development. The paper first clarifies the notion of abduction within case studies, drawing on pragmatists James and Peirce and expanding it with the work of Lewin, and argues that it is the core mechanism that allows generalization from case studies. The second section presents the possibility of generalizing from individual single case studies, for which not only the subjective perspective, but also the dynamics by which the social and cultural environment guide and enable the person's development, have to be accounted for. The third section elaborates the question of institutional case studies, where the challenge is to account both for institutional dynamics, and for persons' trajectories within; this is exemplified with an ongoing study on the process of obtaining citizenship in Switzerland. The paper briefly concludes by highlighting two possible implications of the paper, one concerning the process of theoretical reasoning, the other, the fact that sociocultural psychology could itself be seen as an institution in-the-making.

  17. Space-Based Space Surveillance Logistics Case Study: A Qualitative Product Support Element Analysis

    Science.gov (United States)

    2017-12-01

    REPORT TYPE AND DATES COVERED Joint applied project 4. TITLE AND SUBTITLE SPACE-BASED SPACE SURVEILLANCE LOGISTICS CASE STUDY: A QUALITATIVE ...INTENTIONALLY LEFT BLANK v ABSTRACT This research provides a qualitative analysis of the logistics impacts, effects, and sustainment challenges...provides a qualitative product support element-by-element review for both research questions. Chapters IV and V present the findings, results

  18. Collaboration and patient safety at an emergency department - a qualitative case study.

    Science.gov (United States)

    Pedersen, Anna Helene Meldgaard; Rasmussen, Kurt; Grytnes, Regine; Nielsen, Kent Jacob

    2018-03-19

    Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.

  19. The Use of Qualitative Content Analysis in Case Study Research

    OpenAIRE

    Kohlbacher, Florian

    2006-01-01

    Dieser Beitrag hat zum Ziel, Möglichkeiten zu untersuchen und zu diskutieren, wie qualitative Inhaltsanalyse als (Text-) Interpretationsmethode in der Fallstudienforschung angewendet werden kann. Zunächst wird die Fallstudienforschung als eine Forschungsstrategie innerhalb der qualitativen Sozialforschung kurz dargestellt. Danach folgt eine Einführung in die (qualitative) Inhaltsanalyse als Interpretationsmethode für qualitative Interviews und anderes Datenmaterial. Abschließend wird der Eins...

  20. The Aircraft Electric Taxi System: A Qualitative Multi Case Study

    Science.gov (United States)

    Johnson, Thomas Frank

    The problem this research addresses is the airline industry, and the seemingly unwillingness attitude towards adopting ways to taxi aircraft without utilizing thrust from the main engines. The purpose of the study was to get a better understanding of the decision-making process of airline executives, in respect to investing in cost saving technology. A qualitative research method is used from personal interviews with 24 airline executives from two major U.S. airlines, related industry journal articles, and aircraft performance data. The following three research questions are addressed. RQ1. Does the cost of jet fuel influence airline executives' decision of adopting the aircraft electric taxi system technology? RQ2 Does the measurable payback period for a return on investment influence airline executives' decision of adopting ETS technology? RQ3. Does the amount of government assistance influence airline executives' decision of adopting ETS technology? A multi case research study design is used with a triangulation technique. The participant perceptions indicate the need to reduce operating costs, they have concerns about investment risk, and they are in favor of future government sponsored performance improvement projects. Based on the framework, findings and implications of this study, a future research paper could focus on the positive environmental effects of the ETS application. A study could be conducted on current airport area air quality and the effects that aircraft main engine thrust taxiing has on the surrounding air quality.

  1. Experiences of case management with chronic illnesses: a qualitative systematic review.

    Science.gov (United States)

    Joo, J Y; Liu, M F

    2018-03-01

    This qualitative systematic review aimed to identify and synthesize recent qualitative studies to improve understanding of the experiences and perceptions of case management interventions that individuals with chronic illnesses and their caregivers have. Case management has been shown to be effective at improving quality of care and lowering costs for individuals with chronic illnesses. However, no qualitative review has been synthesized with recent qualitative studies about case management experiences by individual with chronic illnesses. This qualitative systematic review uses a thematic synthesis method to review 10 qualitative studies published within the last 10 years, from 2007 to 2016, thereby identifying and discussing the understandings that individuals with chronic illnesses and their caregivers have about case management. From this synthesis, three themes were identified as facilitators of case management (access to healthcare resources, health status supports and emotional aid) and two themes were identified as barriers to it (low information about case management and time constraints). This is the first qualitative systematic review of the perceptions and experiences that individuals with chronic illnesses and their caregivers have about case management. The facilitators of case management can be employed to inform patients about the benefits of case management and to improve population health. The findings about barriers to case management can be used to reform case management for populations with chronic illnesses. These factors should be considered by nursing researchers and healthcare policymakers when implementing case management. © 2018 International Council of Nurses.

  2. Incorporating Translation in Qualitative Studies: Two Case Studies in Education

    Science.gov (United States)

    Sutrisno, Agustian; Nguyen, Nga Thanh; Tangen, Donna

    2014-01-01

    Cross-language qualitative research in education continues to increase. However, there has been inadequate discussion in the literature concerning the translation process that ensures research trustworthiness applicable for bilingual researchers. Informed by the literature on evaluation criteria for qualitative data translation, this paper…

  3. Single Finds. The case of Roman Egypt

    DEFF Research Database (Denmark)

    Christiansen, Erik

    2006-01-01

    Survery of single or stray finds from Roman Egypt and discussion of them as evidence for the circulation and use of coins......Survery of single or stray finds from Roman Egypt and discussion of them as evidence for the circulation and use of coins...

  4. Swiss Armed Forces Organizational Level Leader Development: A Qualitative Case Study

    Science.gov (United States)

    2017-06-09

    Merriam, defines a case study as “an in-depth description and analysis of a bounded system.”79 Among the six different qualitative types of research ...80 John W. Creswell, Research Design: Qualitative , Quantitative, and Mixed Methods Approaches (Los Angeles, CA: SAGE, 2014), 201. 81 Ibid...Publishing Group, 1996. Creswell, John W. Research Design: Qualitative , Quantitative, and Mixed Methods Approaches. Los Angeles, CA: SAGE, 2014. Curphy

  5. Cross-dressing as a meaningful occupation: a single case study

    OpenAIRE

    Curtis, Morag; Morris, Karen

    2015-01-01

    Introduction: The purpose of this qualitative study was to explore the lived experience of cross-dressing, to raise awareness of cross-dressing and investigate any possible implications for occupational therapy.\\ud \\ud Method: A single design case study utilizing an unstructured interview was used with a male cross-dresser known to the first author. Following transcription, flexible and ongoing analysis was undertaken following an interpretative phenomenological analysis approach and emergent...

  6. The stressors and vulnerabilities of young single childless women with breast cancer: a qualitative study.

    Science.gov (United States)

    Corney, Roslyn; Puthussery, Shuby; Swinglehurst, Jane

    2014-02-01

    Marital or partnership status is seldom investigated as a primary contributing factor to women's wellbeing after a diagnosis of breast cancer. It has been suggested, however, that single childless women with breast cancer may face unique stressors. This paper explores the stressors and vulnerabilities of young single childless women with a first episode of breast cancer. A qualitative descriptive method was used. As part of a larger study examining fertility concerns of young childless women with first episode of breast cancer, in-depth semi-structured interviews were conducted with 10 single women. Recorded interviews were analysed using the framework approach. Findings cover three main themes: partnership worries; fertility concerns; and views about emotional and practical support received. Partnership worries included concerns about having to undergo treatment without a partner to support them; the fear of rejection by potential partners; and feelings about the precious time lost in diagnosis and treatment. Fertility concerns included dilemmas about having children and feelings about the options of pursuing Assisted Reproductive Techniques. Views about the emotional and practical support received included the overall support received as well as perceptions about the attitudes of health professionals towards fertility issues. Findings indicate that single childless women with breast cancer face additional vulnerabilities and may benefit from tailored support from health care professionals and interventions specifically targeted at them. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Conflicting Discourses in Qualitative Research: The Search for Divergent Data within Cases

    Science.gov (United States)

    Antin, Tamar M. J.; Constantine, Norman A.; Hunt, Geoffrey

    2015-01-01

    The search for disconfirming evidence, or negative cases, is often considered a valuable strategy for assessing the credibility or validity of qualitative research claims. This article draws on a multimethod qualitative research project to illustrate how a search for disconfirming evidence evolved from a check on the validity of findings to a…

  8. General practitioners learning qualitative research: A case study of postgraduate education.

    Science.gov (United States)

    Hepworth, Julie; Kay, Margaret

    2015-10-01

    Qualitative research is increasingly being recognised as a vital aspect of primary healthcare research. Teaching and learning how to conduct qualitative research is especially important for general practitioners and other clinicians in the professional educational setting. This article examines a case study of postgraduate professional education in qualitative research for clinicians, for the purpose of enabling a robust discussion around teaching and learning in medicine and the health sciences. A series of three workshops was delivered for primary healthcare academics. The workshops were evaluated using a quantitative survey and qualitative free-text responses to enable descriptive analyses. Participants found qualitative philosophy and theory the most difficult areas to engage with, and learning qualitative coding and analysis was considered the easiest to learn. Key elements for successful teaching were identified, including the use of adult learning principles, the value of an experienced facilitator and an awareness of the impact of clinical subcultures on learning.

  9. Perspectives about family meals from single-headed and dual-headed households: a qualitative analysis.

    Science.gov (United States)

    Berge, Jerica M; Hoppmann, Caroline; Hanson, Carrie; Neumark-Sztainer, Dianne

    2013-12-01

    Cross-sectional and longitudinal research has shown that family meals are protective for adolescent healthful eating behaviors. However, little is known about what parents think of these findings and whether parents from single- vs dual-headed households have differing perspectives about the findings. In addition, parents' perspectives regarding barriers to applying the findings on family meals in their own homes and suggestions for more widespread adoption of the findings are unknown. The current study aimed to identify single- and dual-headed household parents' perspectives regarding the research findings on family meals, barriers to applying the findings in their own homes, and suggestions for helping families have more family meals. The current qualitative study included 59 parents who participated in substudy of two linked multilevel studies-EAT 2010 (Eating and Activity in Teens) and Families and Eating and Activity in Teens (F-EAT). Parents (91.5% female) were racially/ethnically and socioeconomically diverse. Data were analyzed using a grounded theory approach. Results from the current study suggest that parents from both single- and dual-headed households have similar perspectives regarding why family meals are protective for healthful eating habits for adolescents (eg, provides structure/routine, opportunities for communication, connection), but provide similar and different reasons for barriers to family meals (eg, single-headed=cost vs dual-headed=lack of creativity) and ideas and suggestions for how to increase the frequency of family meals (eg, single-headed=give fewer options vs dual-headed=include children in the meal preparation). Findings can help inform public health intervention researchers and providers who work with adolescents and their families to understand how to approach discussions regarding reasons for having family meals, barriers to carrying out family meals, and ways to increase family meals depending on family structure. Copyright

  10. Methodology or method? A critical review of qualitative case study reports

    Directory of Open Access Journals (Sweden)

    Nerida Hyett

    2014-05-01

    Full Text Available Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12, social sciences and anthropology (n=7, or methods (n=15 case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

  11. Methodology or method? A critical review of qualitative case study reports

    Science.gov (United States)

    Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

    2014-01-01

    Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners. PMID:24809980

  12. Critical challenges in ERP implementation: A qualitative case study in the Canadian oil and gas industry

    Science.gov (United States)

    Menon, Sreekumar A.

    This exploratory qualitative single-case study examines critical challenges encountered during ERP implementation based on individual perspectives in four project roles: senior leaders, project managers, project team members, and business users, all specifically in Canadian oil and gas industry. Data was collected by interviewing participants belonging to these categories, and by analyzing project documentation about ERP implementation. The organization for the case study was a leading multinational oil and gas company having a substantial presence in the energy sector in Canada. The study results were aligned with the six management questions regarding critical challenges in ERP: (a) circumstances to implement ERP, (b) benefits and process improvements achieved, (c) best practices implemented, (d) critical challenges encountered, (e) strategies and mitigating actions used, and (f) recommendations to improve future ERP implementations. The study results highlight six key findings. First, the study provided valid circumstances for implementing ERP systems. Second, the study underscored the importance of benefits and process improvements in ERP implementation. Third, the study highlighted that adoption of best practices is crucial for ERP Implementation. Fourth, the study found that critical challenges are encountered in ERP Implementation and are significant during ERP implementation. Fifth, the study found that strategies and mitigating actions can overcome challenges in ERP implementation. Finally, the study provided ten major recommendations on how to improve future ERP implementations.

  13. Cybersecurity Implications for Industry, Academia, and Parents: A Qualitative Case Study in NSF STEM Education

    Science.gov (United States)

    Stevenson, Gregory V.

    Rationale: Former President Barack Obama's 3.9 trillion for the 2015 fiscal year budget request included a 2.9 billion investment in Science, Technology, Engineering and Math (STEM) education. Research then showed that the national spending for cybersecurity has exceeded $10.7 billion in the 2015 fiscal year. Nonetheless, the number of cyberattacks has risen year after year since 2012, potentially due to the lack of education and training in cybersecurity. Methodology: A qualitative case study research was conducted to explore and investigate the lived professional experiences of experts from San Antonio Texas whose efforts were aligned to increase the number of qualified cybersecurity professionals. To qualify the organizational needs for cybersecurity professionals, the study gathered expert opinions by surveying human resource managers pertaining to the needs of cybersecurity education. To refine and further validate data collection efforts, the study involved researcher observations and a survey of a narrow cohort to perform analytic induction to eliminate bias and exhaust the exploratory research (Maxwell, 2005). Result: The findings of the case study will: 1) help augment the importance of cybersecurity education in pre-kindergarten through 12th grade, 2) be utilized as a single guide for school leaders in the process of developing cybersecurity education strategies, and 3) in the longer term, be used by the National Sciences Foundation (NSF) as an effective model to institute cybersecurity education practices nationwide and thereby reduce the existing trouble of the nation by criminal cyber actors.

  14. How Academic Department Chairs View the Influence of Corporate Ethics Scandals on Ethics Education in Arizona Business Schools: A Qualitative Case Study at the Postsecondary Level

    Science.gov (United States)

    Gillis, Robert James

    2017-01-01

    The purpose of this qualitative single case study was to explore how department chairs described the influence of recent corporate ethics scandals on content and availability of ethics education in postsecondary business schools in Arizona. The following research questions guided this study: RQ1: How do department chairs describe the influence of…

  15. How Customer Facing Professionals Adapt to Changing Customer Needs in a Digital Environment: A Single Case Study

    Science.gov (United States)

    Hendriks, Stefan

    2017-01-01

    This qualitative single case study explored how customer facing professionals (CFPs) adapt to changing customer needs in a digital environment. This study focuses on: (1) Changing customer needs; (2) Competencies needed in a digital environment; (3) How they learn; and (4) What factors help or hinder their success. The site is a global Human…

  16. Single case studies as a means for developing psychological theories.

    Science.gov (United States)

    Skvortsov, Anatoliy; Romashchuk, Alexander

    2015-12-01

    The Socratic function of single case studies (SCSs) is described in its relation to the problem of scientific theory development. Contrary to the traditional point of view, the single case study is not a demonstration or verification of theoretical concepts, but a method of their generation and opportunity for analysis of their interrelations. Considering the case study from the perspective of the Socratic function brings to light important conclusions about the ecological validity of theory development. The essential features of the Socratic function are illustrated using the example of the famous Romantic Essays of Alexandr Luria. © 2015 The Institute of Psychology, Chinese Academy of Sciences and Wiley Publishing Asia Pty Ltd.

  17. Comparing Case Study and Ethnography as Qualitative Research Approaches

    OpenAIRE

    Suryani, Anne

    2008-01-01

    Abstract: This article reviews several differences between case study and ethnography in terms of definitions, characteristics, strengths and limitations. It provides current information by comparing these approaches from various social researchers’ perspectives. Although each method has strong points, they both have differences in conducting observation and interview as data collection techniques; choosing the length of time of data gathering and reporting details of a particular reality....

  18. Comparing Case Study and Ethnography as Qualitative Research Approaches

    Directory of Open Access Journals (Sweden)

    Anne Suryani

    2013-12-01

    Full Text Available Abstract: This article reviews several differences between case study and ethnography in terms of definitions, characteristics, strengths and limitations. It provides current information by comparing these approaches from various social researchers’ perspectives. Although each method has strong points, they both have differences in conducting observation and interview as data collection techniques; choosing the length of time of data gathering and reporting details of a particular reality.

  19. Exploring Stakeholder Definitions within the Aerospace Industry: A Qualitative Case Study

    Science.gov (United States)

    Hebert, Jonathan R.

    A best practice in the discipline of project management is to identify all key project stakeholders prior to the execution of a project. When stakeholders are properly identified, they can be consulted to provide expert advice on project activities so that the project manager can ensure the project stays within the budget and schedule constraints. The problem addressed by this study is that managers fail to properly identify key project stakeholders when using stakeholder theory because there are multiple conflicting definitions for the term stakeholder. Poor stakeholder identification has been linked to multiple negative project outcomes such as budget and schedules overruns, and this problem is heightened in certain industries such as aerospace. The purpose of this qualitative study was to explore project managers' and project stakeholders' perceptions of how they define and use the term stakeholder within the aerospace industry. This qualitative exploratory single-case study had two embedded units of analysis: project managers and project stakeholders. Six aerospace project managers and five aerospace project stakeholders were purposively selected for this study. Data were collected through individual semi-structured interviews with both project managers and project stakeholders. All data were analyzed using Yin's (2011) five-phased cycle approach for qualitative research. The results indicated that the aerospace project managers and project stakeholder define the term stakeholder as "those who do the work of a company." The participants build upon this well-known concept by adding that, "a company should list specific job titles" that correspond to their company specific-stakeholder definition. Results also indicated that the definition of the term stakeholder is used when management is assigning human resources to a project to mitigate or control project risk. Results showed that project managers tended to include the customer in their stakeholder definitions

  20. SINGLE-CASE INVESTIGATION OF AN EMOTION-FOCUSED THERAPY GROUP FOR ANXIETY AND DEPRESSION

    Directory of Open Access Journals (Sweden)

    Adèle Lafrance Robinson

    2012-11-01

    Full Text Available Emotion-focused therapy (EFT is an evidence-based treatment for depression and trauma and has shown promise for other presentations including anxiety. Minimal research exists investigating the outcomes of emotion-focused therapy in a group setting. The current research presents a mixed-method single-case study of one client’s experiences and outcomes following a nine-week EFT group for depression and anxiety. Weekly measures of session-feelings evaluations were collected. Follow-up measures, including a qualitative interview, were administered one year post-treatment. Pre-, post-, and follow-up measures assessed depression, anxiety, and emotional regulation. Results showed clinically significant improvements in anxiety, depression, and emotional regulation over time. Indirect and direct evidence of client change were detected. Five super-ordinate themes with sub-themes emerged from the qualitative analysis.

  1. Analysis of single nucleotide polymorphisms in case-control studies.

    Science.gov (United States)

    Li, Yonghong; Shiffman, Dov; Oberbauer, Rainer

    2011-01-01

    Single nucleotide polymorphisms (SNPs) are the most common type of genetic variants in the human genome. SNPs are known to modify susceptibility to complex diseases. We describe and discuss methods used to identify SNPs associated with disease in case-control studies. An outline on study population selection, sample collection and genotyping platforms is presented, complemented by SNP selection, data preprocessing and analysis.

  2. Revisiting Single Case Studies in International Business Research

    DEFF Research Database (Denmark)

    Worm, Verner; Jakobsen, Michael

    strategies when navigating a multinational organization? To answer this question we employ a phenomenological approach as a way of exploring the relationship between organizational changes and employers’ response towards them. We argue that single case studies provides us with the capability of providing...

  3. Perceptions of ESL Program Management in Canadian Higher Education: A Qualitative Case Study

    Science.gov (United States)

    Eaton, Sarah Elaine

    2017-01-01

    ESL programs at post-secondary institutions must often generate revenue in addition to teaching students English. Institutions often impose explicit expectations on these programs to generate profit, creating unique challenges for those who administer them. This qualitative case study investigated challenges faced by ESL program directors at one…

  4. Drawing Children into Reading: A Qualitative Case Study of a Preschool Drawing Curriculum

    Science.gov (United States)

    DeFauw, Danielle L.

    2016-01-01

    This article details a qualitative case study of 24 preschool children engaged with step-by-step drawing instruction provided by five educators as they developed their fine motor skills and drew detailed objects using the Drawing Children Into Reading curriculum (Halperin, W. A. (2011a). "Project 50 preschool manual." South Haven, MI:…

  5. Examination of Student Outcomes in Play Therapy: A Qualitative Case Study Design

    Science.gov (United States)

    Dillman Taylor, Dalena L.; Blount, Ashley J.; Bloom, Zachary

    2017-01-01

    Outcome research examining the effectiveness of teaching methods in counselor education is sparse. The researchers conducted a qualitative investigation utilizing an instrumental case study to examine the influence of a constructivist-developmental format on a play therapy counseling course in a large CACREP accredited university in the…

  6. Obstacles to moral education in a private school: a qualitative case study in Brazil

    OpenAIRE

    Leal Terra Silva, F. (Fabiana)

    2014-01-01

    Abstract This research intends to investigate obstacles to moral education in a private school in Brazil, based on teachers’ views, which were gathered through interviews, questionnaires and discussions during workshops. It is a qualitative case study conducted in a country where neoliberal values increasingly influence education, and where high rates of socio economic inequalities are easily observed. Similarly to other em...

  7. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

    Science.gov (United States)

    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  8. Recruiting Young Volunteers in an Area of Selective Education: A Qualitative Case Study

    Science.gov (United States)

    Dean, Jon

    2016-01-01

    This article presents findings from a small qualitative case study of a youth volunteering brokerage organisation in England, operating in an area of selective state education. Data show how brokerage workers felt grammar schools managed their students in a concerted way to improve students' chances of attending university. Conversely, workers…

  9. Human Trafficking and Education: A Qualitative Case Study of Two NGO Programs in Thailand

    Science.gov (United States)

    Spires, Robert Weber

    2012-01-01

    In this qualitative, ethnographic case study, I examine two Thai NGO shelters/schools working with human trafficking survivors and at-risk populations of children ages 5-18. The two NGOs had a residential component, meaning that children live at the shelter, and an educational component, meaning that children are taught academic and vocational…

  10. A Qualitative Multi-Site Case Study: Examining Principals' Leadership Styles and School Performance

    Science.gov (United States)

    Preyear, Loukisha

    2015-01-01

    The purpose of this qualitative multi-site case study was to explore the impact of principals' leadership styles on student academic achievement in a high-poverty low-performing school district in Louisiana. A total of 17 participants, principals and teachers, from this school district were used in this study. Data source triangulation of…

  11. Exploring the Causes of Underachievement of African American Boys: A Qualitative Descriptive Case Study

    Science.gov (United States)

    Ennis, Rosetta

    2017-01-01

    The qualitative descriptive case study explores the underachievement phenomenon of fourth-grade African American boys in New York City public elementary schools. Numerous studies have been conducted at the middle school through college levels. However, very little is known about the underachievement phenomenon of fourth-grade African American…

  12. The Use of Qualitative Case Studies as an Experiential Teaching Method in the Training of Pre-Service Teachers

    Science.gov (United States)

    Arseven, Ilhami

    2018-01-01

    This study presents the suitability of case studies, which is a qualitative research method and can be used as a teaching method in the training of pre-service teachers, for experiential learning theory. The basic view of experiential learning theory on learning and the qualitative case study paradigm are consistent with each other within the…

  13. Approaches to sampling and case selection in qualitative research: examples in the geography of health.

    Science.gov (United States)

    Curtis, S; Gesler, W; Smith, G; Washburn, S

    2000-04-01

    This paper focuses on the question of sampling (or selection of cases) in qualitative research. Although the literature includes some very useful discussions of qualitative sampling strategies, the question of sampling often seems to receive less attention in methodological discussion than questions of how data is collected or is analysed. Decisions about sampling are likely to be important in many qualitative studies (although it may not be an issue in some research). There are varying accounts of the principles applicable to sampling or case selection. Those who espouse 'theoretical sampling', based on a 'grounded theory' approach, are in some ways opposed to those who promote forms of 'purposive sampling' suitable for research informed by an existing body of social theory. Diversity also results from the many different methods for drawing purposive samples which are applicable to qualitative research. We explore the value of a framework suggested by Miles and Huberman [Miles, M., Huberman,, A., 1994. Qualitative Data Analysis, Sage, London.], to evaluate the sampling strategies employed in three examples of research by the authors. Our examples comprise three studies which respectively involve selection of: 'healing places'; rural places which incorporated national anti-malarial policies; young male interviewees, identified as either chronically ill or disabled. The examples are used to show how in these three studies the (sometimes conflicting) requirements of the different criteria were resolved, as well as the potential and constraints placed on the research by the selection decisions which were made. We also consider how far the criteria Miles and Huberman suggest seem helpful for planning 'sample' selection in qualitative research.

  14. Treatment of paranoid personality disorder with cognitive analytic therapy: a mixed methods single case experimental design.

    Science.gov (United States)

    Kellett, Stephen; Hardy, Gillian

    2014-01-01

    Paranoid personality disorder (PPD) presents as chronic and widespread interpersonal distrust, whereby the actions of others are interpreted as malevolent and malicious. This research details the assessment, formulation and treatment of a case of PPD within a 24-session contract of cognitive analytic therapy (CAT). The outcome methodology was an A/B with extended follow-up single case experimental design (SCED). The SCED was supplemented with qualitative patient interviewing via the Change Interview regarding their experience of CAT, whether change had taken place and detailing of any identified change mechanisms. Quantitative results show that five out of the six daily rated paranoia target complaint measures were extinguished during the treatment phase. Qualitatively, the patient attributed change to the therapy conducted. The results suggest that CAT was an effective intervention in this case of PPD and are discussed in terms of identified methodological shortcomings, treatment implications and the potential for generating a convincing evidence base for the psychotherapy of PPD. Narrative reformulation using a CAT model offers a key opportunity for the patient to achieve a new understanding of their paranoia. Psychotherapy for PPD requires a cognitive component, within a boundaried and relational therapy, that is able to reflect on paranoid enactments and ruptures within the therapeutic relationship.There is a large role for clinician-researchers in developing a PPD outcome evidence base. Copyright © 2013 John Wiley & Sons, Ltd.

  15. Capturing Crime: The Qualitative Analysis of Individual Cases for Advancing Criminological Knowledge.

    Science.gov (United States)

    Wright, Kevin A; Bouffard, Leana A

    2016-02-01

    The qualitative analysis of individual cases has a prominent place in the development of criminological theory, yet progression in the scientific study of crime has largely been viewed as a distinctly quantitative endeavor. In the process, much of the theoretical depth and precision supplied by earlier methods of criminological knowledge production have been sacrificed. The current work argues for a return to our criminological roots by supplementing quantitative analyses with the qualitative inspection of individual cases. We provide a specific example of a literature (i.e., criminal specialization/versatility) that has become increasingly quantitative and could benefit from the use of the proposed approach. We conclude by offering additional areas of research that might be advanced by our framework presented here. © The Author(s) 2014.

  16. Qualitative case study research. The case of a Ph.D. research project on organising and managing new product development systems

    NARCIS (Netherlands)

    de Weerd-Nederhof, Petronella C.

    2001-01-01

    Discusses methodological aspects of case study research and qualitative data collection and analysis. Discusses the choice of a research strategy and data collection and analysis methods according to theory as well as the arguments which lead to qualitative case research. Suggests steps in research

  17. An iterative approach to case study analysis: insights from qualitative analysis of quantitative inconsistencies

    Directory of Open Access Journals (Sweden)

    Allain J Barnett

    2016-09-01

    Full Text Available Large-N comparative studies have helped common pool resource scholars gain general insights into the factors that influence collective action and governance outcomes. However, these studies are often limited by missing data, and suffer from the methodological limitation that important information is lost when we reduce textual information to quantitative data. This study was motivated by nine case studies that appeared to be inconsistent with the expectation that the presence of Ostrom’s Design Principles increases the likelihood of successful common pool resource governance. These cases highlight the limitations of coding and analysing Large-N case studies. We examine two issues: 1 the challenge of missing data and 2 potential approaches that rely on context (which is often lost in the coding process to address inconsistencies between empirical observations theoretical predictions.  For the latter, we conduct a post-hoc qualitative analysis of a large-N comparative study to explore 2 types of inconsistencies: 1 cases where evidence for nearly all design principles was found, but available evidence led to the assessment that the CPR system was unsuccessful and 2 cases where the CPR system was deemed successful despite finding limited or no evidence for design principles.  We describe inherent challenges to large-N comparative analysis to coding complex and dynamically changing common pool resource systems for the presence or absence of design principles and the determination of “success”.  Finally, we illustrate how, in some cases, our qualitative analysis revealed that the identity of absent design principles explained inconsistencies hence de-facto reconciling such apparent inconsistencies with theoretical predictions.  This analysis demonstrates the value of combining quantitative and qualitative analysis, and using mixed-methods approaches iteratively to build comprehensive methodological and theoretical approaches to understanding

  18. Physical Activity Experiences and Beliefs among Single Mothers: A Qualitative Study

    Science.gov (United States)

    Dlugonski, Deirdre; Motl, Robert W.

    2016-01-01

    Purpose: Single motherhood has been associated with negative health consequences such as depression and cardiovascular disease. Physical activity might reduce these consequences, but little is known about physical activity experiences and beliefs that might inform interventions and programs for single mothers. The present study used…

  19. Variability of writing disorders in Wernicke's aphasia underperforming different writing tasks: A single-case study.

    Science.gov (United States)

    Kozintseva, Elena; Skvortsov, Anatoliy

    2016-03-01

    The aim of our study was to evolve views on writing disorders in Wernicke's agraphia by comparing group data and analysis of a single patient. We showed how a single-case study can be useful in obtaining essential results that can be hidden by averaging group data. Analysis of a single patient proved to be important for resolving contradictions of the "holistic" and "elementaristic" paradigms of psychology and for the development of theoretical knowledge with the example of a writing disorder. The implementation of a holistic approach was undertaken by presenting the tasks differing in functions in which writing had been performed since its appearance in human culture (communicative, mnestic, and regulatory). In spite of the identical composition of involved psychological components, these differences were identified when certain types of errors were analyzed in the single subject. The results are discussed in terms of used writing strategy, resulting in a way of operation of involved components that lead to qualitative and quantitative changes of writing errors within the syndrome of Wernicke's agraphia. © 2016 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

  20. Cognitive therapy for punishment paranoia: a single case experiment.

    Science.gov (United States)

    Chadwick, P; Trower, P

    1996-04-01

    There is growing agreement that at least certain kinds of delusions defend against negative self-evaluation, and in consequence that cognitive therapy for delusions needs to address issues of self-evaluation more explicitly. However, in practice it can be difficult to enable clients to see the connection between delusions and self-esteem. The present single-case study exemplifies the conceptual and practical application of cognitive therapy for individuals who are both paranoid and have strong negative self-evaluative beliefs. A multiple-baseline approach is used, whereby one man's negative self-evaluative belief and two paranoid delusions are challenged sequentially. Conviction in two of the three beliefs changes at the point of intervention; conviction in the third changes prior to intervention. We discuss the details of the case, as well as the wider implications for cognitive approaches to delusions.

  1. A Qualitative Case Study on the Implementation of a Priority Seating Program at an NCAA Division I School

    National Research Council Canada - National Science Library

    Delich, Joseph R

    2004-01-01

    ...) athletic department's priority seating program. A qualitative case study was the chosen methodology and the use of personal interviews and documents were the primary sources of evidence for data collection...

  2. Implementation of case studies in undergraduate didactic nursing courses: a qualitative study.

    Science.gov (United States)

    Dutra, Danette K

    2013-07-04

    The implementation of unfolding scenario-based case studies in the didactic classroom is associated with learner-centered education. The utilization of learner-centered pedagogies, such as case studies, removes the focus from the instructor and instead places it on the student. Learner-centered pedagogies are believed to improve students' levels of cognition. The purpose of this study was to examine how nurse educators are implementing the pedagogies of case studies in their undergraduate didactic courses. The goal was to examine, document, report, and, ultimately, implement the strategies. Purposeful sampling was utilized in this qualitative, multisite-designed study. For each of the four participants, three separate site visits were completed. Observations and post-observational interviews took place at each site visit. Transcribed data from interviews, observations, and course documents were imported into the computer program Nvivo8. Repetitive comparative analysis was utilized to complete the data coding process. The guiding research question of this study sought to investigate the implementation strategies of case studies in didactic nursing courses. The implementation of case studies by the participants reflected two primary patterns: Formal Implementation (FI) and Informal Implementation (II) of case studies. The FI of case studies was further divided into two subcategories: Formal Implementation of case studies used Inside the Classroom setting (FIIC) and Formal Implementation of cases studies used Outside of the Classroom (FIOC). Results of this investigation have led to an increased understanding of implementation strategies of unfolding scenario-based case studies in undergraduate nursing didactic courses. Data collected were rich in the description of specific methodologies for utilization of case studies and may serve as a resource for faculty in development of creative strategies to enhance the didactic classroom experience.

  3. Computing tools for implementing standards for single-case designs.

    Science.gov (United States)

    Chen, Li-Ting; Peng, Chao-Ying Joanne; Chen, Ming-E

    2015-11-01

    In the single-case design (SCD) literature, five sets of standards have been formulated and distinguished: design standards, assessment standards, analysis standards, reporting standards, and research synthesis standards. This article reviews computing tools that can assist researchers and practitioners in meeting the analysis standards recommended by the What Works Clearinghouse: Procedures and Standards Handbook-the WWC standards. These tools consist of specialized web-based calculators or downloadable software for SCD data, and algorithms or programs written in Excel, SAS procedures, SPSS commands/Macros, or the R programming language. We aligned these tools with the WWC standards and evaluated them for accuracy and treatment of missing data, using two published data sets. All tools were tested to be accurate. When missing data were present, most tools either gave an error message or conducted analysis based on the available data. Only one program used a single imputation method. This article concludes with suggestions for an inclusive computing tool or environment, additional research on the treatment of missing data, and reasonable and flexible interpretations of the WWC standards. © The Author(s) 2015.

  4. Nurses' ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study.

    Science.gov (United States)

    Goethals, Sabine; Dierckx de Casterlé, Bernadette; Gastmans, Chris

    2013-11-01

    In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses' decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses' reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009-April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses' decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly.

  5. Approaches for building community participation: A qualitative case study of Canadian food security programs.

    Science.gov (United States)

    Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

    2017-10-01

    There is increasing opportunity and support for occupational therapists to expand their scope of practice in community settings. However, evidence is needed to increase occupational therapists' knowledge, confidence, and capacity with building community participation and adopting community-centered practice roles. The purpose of this study is to improve occupational therapists' understanding of an approach to building community participation, through case study of a network of Canadian food security programs. Qualitative case study was utilized. Data were semistructured interviews, field observations, documents, and online social media. Thematic analysis was used to identify and describe four themes that relate to processes used to build community participation. The four themes were use of multiple methods, good leaders are fundamental, growing participation via social media, and leveraging outcomes. Occupational therapists can utilize an approach for building community participation that incorporates resource mobilization. Challenges of sustainability and social exclusion must be addressed.

  6. Single-case synthesis tools II: Comparing quantitative outcome measures.

    Science.gov (United States)

    Zimmerman, Kathleen N; Pustejovsky, James E; Ledford, Jennifer R; Barton, Erin E; Severini, Katherine E; Lloyd, Blair P

    2018-03-07

    Varying methods for evaluating the outcomes of single case research designs (SCD) are currently used in reviews and meta-analyses of interventions. Quantitative effect size measures are often presented alongside visual analysis conclusions. Six measures across two classes-overlap measures (percentage non-overlapping data, improvement rate difference, and Tau) and parametric within-case effect sizes (standardized mean difference and log response ratio [increasing and decreasing])-were compared to determine if choice of synthesis method within and across classes impacts conclusions regarding effectiveness. The effectiveness of sensory-based interventions (SBI), a commonly used class of treatments for young children, was evaluated. Separately from evaluations of rigor and quality, authors evaluated behavior change between baseline and SBI conditions. SBI were unlikely to result in positive behavior change across all measures except IRD. However, subgroup analyses resulted in variable conclusions, indicating that the choice of measures for SCD meta-analyses can impact conclusions. Suggestions for using the log response ratio in SCD meta-analyses and considerations for understanding variability in SCD meta-analysis conclusions are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Single mothering as experienced by Burundian refugees in Australia: a qualitative inquiry.

    Science.gov (United States)

    Tsai, Lily P; Barr, Jennieffer A; Welch, Anthony

    2017-01-01

    Refugee mothers have fled from their homeland to escape persecutions with their children only to find other threats to their well-being in the new country. Building on previous research, it is known that being a new immigrant is challenging and requires adaptation. The adaptation process, known as acculturation, may not be successful leading to psychological distress. It is also known that a generation gap can occur when children acculturate faster than their parents. What was lacking was understanding about the experiences of single refugee mothers. Interpretative phenomenological study was undertaken to explore the lived experiences of eight Burundian refugee single mothers in Australia. Data were collected by in-depth interviews. Each interviews were transcribed and analyzed using thematic analysis. Findings revealed three themes. First theme 'Traditional mothering practices of Burundian culture' illustrated mothering strategies as practiced prior to their arrival in Australia including mothering with sufficient social support, strong position of parents, and regular use of physical disciplining. Second theme 'Challenges identified after arrival to new country' revealed that mothers felt their children acculturated faster than themselves which led to intergenerational gap. This has also led participants to live in a continuous dilemma, experiencing inner conflicts and struggles associated with their mothering practices, especially when mothers had arrived with a lack of knowledge relating to acceptable mothering practices in a new culture. Final theme, 'Reforming family life in Australia' highlighted the decisions made by single refugee mothers which is to embrace both new and original cultures, leading to successful acculturation. However, lack of appropriate knowledge of acceptable mothering practices led to involvement of legal authorities who threatening to remove children from the mother's care. This has led mothers feeling change of power from 'mother to

  8. An Exploration Study of RimbaIlmu: A Qualitative Evaluation of Shared Single Display Groupware in Sarawak, Malaysia

    Directory of Open Access Journals (Sweden)

    Cheah Waishiang

    2015-02-01

    Full Text Available Shared single display groupware that enables collaboration among people from different cultures and social practices encourages peer learning and teaching, whilst strengthening communication skills. It has been successfully evaluated in remote schools in China and India. Due to this, the question arises whether it can be deployed in rural schools or semi-urban schools in Sarawak? What are the issues and challenges? What are the impact of this technology among the students and teachers? This paper investigates the deployment of shared single display groupware in rural and semi-urban schools in Sarawak (one of the Malaysian states. We introduce a shared single display application, RimbaIlmu, in one semi-urban school and one rural school and conduct qualitative analysis from the observations among the participants. Observational data has shown that RimbaIlmu is able to stimulate collaboration between different genders; an engaging technology among students; a tool for group and individual assessment; a tool to facilitate leadership skills; fun to play with; allows ease of lab management and control; enabling novices to learn computers; promoting membership in collaboration learning and finally provide environment for task accomplishment with minimum teacher intervention.

  9. Promoting Career Development in the Early Years of a Person's Life through Self- and Career Construction Counselling (Using an Integrated, Qualitative + Quantitative Approach): A Case Study

    Science.gov (United States)

    Maree, Jacobus G.

    2018-01-01

    This article reports on the value of career construction counselling (integrating qualitative and quantitative strategies and associated techniques) for a young person. The participant was purposefully selected from a number of people who had sought career counselling in a private practice context. An intrinsic, single-case study design was…

  10. Effects of Single and Combined Application of Organic and Biological Fertilizers on Quantitative and Qualitative Yield of Anisum (Pimpinella anisum

    Directory of Open Access Journals (Sweden)

    N Kamayestani

    2015-07-01

    Full Text Available In order to study the effects of single and combined applications of biofertilazer and organic fertilizers on quantitative and qualitative characteristics of anisum (Pimpinella anisum, an experiment was conducted based on a Randomized Complete Block Design with three replications and fifteen treatments at Research Station, Faculty of Agriculture, Ferdowsi University of Mashhad, Iran, in 2011 year. Treatments were: (1 mycorrhiza (Glomus intraradices, (2 mycorrhiza + cow manure, (3 mycorrhiza + vermicompost, (4 mycorrhiza+ compost, (5 mycorrhiza + chemical fertilizer, (6 biosulfur (Thiobacillus sp. + Bentonite, (7 biosulfur + chemical fertilizer, (8 biosulfur + cow manure, (9 biosulfur + vermicompost, (10 biosulfur+compost,11 (cow manure, (12 vermicompost, (13 chemical fertilizer (NPK, (14compost and (15 control. The results showed that application of fertilizer treatments had significant effect on most characteristics of anisum. The highest number of seed per umbelet (7.24, economic yield (1263.4kg/ha were obtained fram biosulfur treatment. The highest dry matter yield (4504.1 kg/ha resulted from combined application of biosulfur + chemical fertilizer and the highest harvest index (25.97% observed in biosulfur+cow manure. The combined application of mycorrhiza affected some qualification traits, as the highest number of umbel per plant (65.7, 1000 seed-weight (3.24 g and essential oil percentage (5.3% resulted from combined application of mycorrhiza+chemical fertilizer. In general, it can be concluded that application of organic and biological fertilizer particularly mycorrhiza and biosulfur had a significant effect on improving of quantitative and qualitative characteristics of anisum. Furthermore, the combined application of organic and biological fertilizer had higher positive effects than their single application.

  11. Qualitative simulation of bathymetric changes due to reservoir sedimentation: A Japanese case study.

    Directory of Open Access Journals (Sweden)

    Ahmed Bilal

    Full Text Available Sediment-dynamics modeling is a useful tool for estimating a dam's lifespan and its cost-benefit analysis. Collecting real data for sediment-dynamics analysis from conventional field survey methods is both tedious and expensive. Therefore, for most rivers, the historical record of data is either missing or not very detailed. Available data and existing tools have much potential and may be used for qualitative prediction of future bathymetric change trend. This study shows that proxy approaches may be used to increase the spatiotemporal resolution of flow data, and hypothesize the river cross-sections and sediment data. Sediment-dynamics analysis of the reach of the Tenryu River upstream of Sakuma Dam in Japan was performed to predict its future bathymetric changes using a 1D numerical model (HEC-RAS. In this case study, only annually-averaged flow data and the river's longitudinal bed profile at 5-year intervals were available. Therefore, the other required data, including river cross-section and geometry and sediment inflow grain sizes, had to be hypothesized or assimilated indirectly. The model yielded a good qualitative agreement, with an R2 (coefficient of determination of 0.8 for the observed and simulated bed profiles. A predictive simulation demonstrated that the useful life of the dam would end after the year 2035 (±5 years, which is in conformity with initial detailed estimates. The study indicates that a sediment-dynamic analysis can be performed even with a limited amount of data. However, such studies may only assess the qualitative trends of sediment dynamics.

  12. Qualitative simulation of bathymetric changes due to reservoir sedimentation: A Japanese case study.

    Science.gov (United States)

    Bilal, Ahmed; Dai, Wenhong; Larson, Magnus; Beebo, Qaid Naamo; Xie, Qiancheng

    2017-01-01

    Sediment-dynamics modeling is a useful tool for estimating a dam's lifespan and its cost-benefit analysis. Collecting real data for sediment-dynamics analysis from conventional field survey methods is both tedious and expensive. Therefore, for most rivers, the historical record of data is either missing or not very detailed. Available data and existing tools have much potential and may be used for qualitative prediction of future bathymetric change trend. This study shows that proxy approaches may be used to increase the spatiotemporal resolution of flow data, and hypothesize the river cross-sections and sediment data. Sediment-dynamics analysis of the reach of the Tenryu River upstream of Sakuma Dam in Japan was performed to predict its future bathymetric changes using a 1D numerical model (HEC-RAS). In this case study, only annually-averaged flow data and the river's longitudinal bed profile at 5-year intervals were available. Therefore, the other required data, including river cross-section and geometry and sediment inflow grain sizes, had to be hypothesized or assimilated indirectly. The model yielded a good qualitative agreement, with an R2 (coefficient of determination) of 0.8 for the observed and simulated bed profiles. A predictive simulation demonstrated that the useful life of the dam would end after the year 2035 (±5 years), which is in conformity with initial detailed estimates. The study indicates that a sediment-dynamic analysis can be performed even with a limited amount of data. However, such studies may only assess the qualitative trends of sediment dynamics.

  13. Battling illness with wellness: a qualitative case study of a young rapper's experiences with music therapy.

    Science.gov (United States)

    Solli, Hans Petter

    2015-07-03

    Mental health difficulties are connected with major interpersonal and social challenges. Recent qualitative research indicates that music therapy can facilitate many of the core elements found to promote social recovery and social inclusion, findings also reflected in results from a growing body of effect studies. The objective of this study was to explore how music therapy might afford possibilities for social recovery to one man with psychosis admitted to a psychiatric intensive care unit. This was achieved by means of a qualitative case study featuring a description of the music therapeutic process alongside first-hand accounts of the participant's subjective experiences. The data were analysed using interpretative phenomenological analysis (IPA). The findings are presented in a narrative form reflecting processes and activities considered particularly important for the process of social recovery. Theoretical perspectives from the recovery literature and current perspectives in music therapy are discussed with a view to the possible use of music therapy for strengthening agency, (re)building identity, developing positive relationships, and expanding social networks.

  14. Qualitative case studies of five cochlear implant recipients' experience with music.

    Science.gov (United States)

    Bartel, Lee R; Greenberg, Simon; Friesen, Lendra M; Ostroff, Jodi; Bodmer, Daniel; Shipp, David; Chen, Joseph M

    2011-02-01

    Cochlear implantation has revolutionized the management of those who suffer from severe-to-profound hearing loss because many patients now achieve excellent speech understanding with objective testing. Nevertheless, speech understanding in noisy conditions and music appreciation remain significant challenges to cochlear implant (CI) users. Music appreciation is an extremely complex experience that is difficult to quantify through a conventional outcome study. This paper aims at documenting the experience of five CI patients with regard to music appreciation using qualitative techniques. This information was obtained through a semi-structured interview process. The interviews were then transcribed and analysed using a constant comparative method of qualitative description. The results together with medical case records were used to identify emerging themes. The common themes that evolved were: musical background, the experience of receiving the implant, current experience with music, attention, musical prediction ability, internal hearing, hedonic vs. critical listening, determination, and timbre perception. By documenting their experiences in this manner, novel insights into the patient perspective are provided that are unique to the literature. These descriptions will aid clinicians and researchers who work in the area of cochlear implantation to better understand the needs of their patients.

  15. Qualitative Task Analysis to Enhance Sports Characterization: A Surfing Case Study

    Directory of Open Access Journals (Sweden)

    Moreira Miguel

    2014-10-01

    Full Text Available The aim of this study was to develop a Matrix of Analysis for Sports Tasks (MAST, regardless of the sports activity, based on practice classification and task analysis. Being this a qualitative research our main question was: in assessing sports’ structure is it possible to make the characterization of any discipline through context and individuals’ behaviours? The sample was within a surf discipline in a competition flowing having 5 of the top 16 Portuguese surfers training together. Based on a qualitative method, studying the surf as the main activity was an interpretative study case. The MAST was applied in four phases: taxonomy; tasks and context description; task analysis; teaching and performance strategies. Its application allowed the activities’ characterization through the observation, surfer’s opinions and bibliographical support. The triangulation of the data was used as an information data treatment. The elements were classified by the challenges proposed to the practitioners and the taxonomy was constituted by the sport activities, group, modality and discipline. Surf is a discipline of surfing which is a sliding sport modality, therefore, a nature sport. In the context description, we had the wave’s components and constraints and the surfboards’ qualities. Through task analysis we obtained a taxonomy of surf manoeuvres. The structural and functional analysis allowed finding solutions for learning of surf techniques with trampoline and skateboards because these fit in sliding sports. MAST makes possible the development of strategies that benefit teaching and performance intervention

  16. Qualitative Task Analysis to Enhance Sports Characterization: A Surfing Case Study

    Science.gov (United States)

    Moreira, Miguel; Peixoto, César

    2014-01-01

    The aim of this study was to develop a Matrix of Analysis for Sports Tasks (MAST), regardless of the sports activity, based on practice classification and task analysis. Being this a qualitative research our main question was: in assessing sports’ structure is it possible to make the characterization of any discipline through context and individuals’ behaviours? The sample was within a surf discipline in a competition flowing having 5 of the top 16 Portuguese surfers training together. Based on a qualitative method, studying the surf as the main activity was an interpretative study case. The MAST was applied in four phases: taxonomy; tasks and context description; task analysis; teaching and performance strategies. Its application allowed the activities’ characterization through the observation, surfer’s opinions and bibliographical support. The triangulation of the data was used as an information data treatment. The elements were classified by the challenges proposed to the practitioners and the taxonomy was constituted by the sport activities, group, modality and discipline. Surf is a discipline of surfing which is a sliding sport modality, therefore, a nature sport. In the context description, we had the wave’s components and constraints and the surfboards’ qualities. Through task analysis we obtained a taxonomy of surf manoeuvres. The structural and functional analysis allowed finding solutions for learning of surf techniques with trampoline and skateboards because these fit in sliding sports. MAST makes possible the development of strategies that benefit teaching and performance intervention. PMID:25414757

  17. Qualitative and quantitative assessment of single fingerprints in forensic DNA analysis.

    Science.gov (United States)

    Ostojic, Lana; Klempner, Stacey A; Patel, Rosni A; Mitchell, Adele A; Axler-DiPerte, Grace L; Wurmbach, Elisa

    2014-11-01

    Fingerprints and touched items are important sources of DNA for STR profiling, since this evidence can be recovered in a wide variety of criminal offenses. However, there are some fundamental difficulties in working with these samples, including variability in quantity and quality of extracted DNA. In this study, we collected and analyzed over 700 fingerprints. We compared a commercially available extraction protocol (Zygem) to two methods developed in our laboratory, a simple one-tube protocol and a high sensitivity protocol (HighSens) that includes additional steps to concentrate and purify the DNA. The amplification protocols tested were AmpFLSTR® Identifiler® using either 28 or 31 amplification cycles, and Identifiler® Plus using 32 amplification cycles. We found that the HighSens and Zygem extraction methods were significantly better in their DNA yields than the one-tube method. Identifiler® Plus increased the quality of the STR profiles for the one-tube extraction significantly. However, this effect could not be verified for the other extraction methods. Furthermore, microscopic analysis of single fingerprints revealed that some individuals tended to shed more material than others onto glass slides. However, a dense deposition of skin flakes did not strongly correlate with a high quality STR profile. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Understanding girls' enrollment at Louise's Farm School: A qualitative case study

    Science.gov (United States)

    Nowak, Ashley E. P.

    This thesis presents a qualitative case study of enrollment and retention considerations at Louise's Farm School (LFS) in Palmer, Alaska, with a focus on how gender is performed in this domain. Interviews with 25 students, 12 parents, and 14 instructors revealed the enrollment decision-making process, identifying constraints to and enablers of girls' participation. Findings included three primary factors as greatly influencing girls' enrollment: (1) mothers' backgrounds; (2) mothers' knowledge of and the misperceptions regarding outcomes of LFS programing; and (3) girls' interest in LFS curriculum. Findings also exposed differences in mothers' and instructors' expectations for the educative development of girls and boys, suggesting that there is greater pressure on girls to perform academically while boys are expected to need greater space for physical expression.

  19. Case studies of patient interactions, care provision and the impact of emotions: a qualitative study.

    Science.gov (United States)

    Banning, Maggi; Gumley, Virginia

    2013-12-01

    Caring is a complex phenomenon. Nurses aim to relieve patient suffering, acknowledge subjective experiences, display empathy but also manage emotions related to care provision. This study explored nurses' perceptions, experiences and emotions related to caring for cancer patients. This qualitative study used semi-structured interviews to explore the emotions management of 32 nurses working in a cancer hospital in Pakistan. Data saturation occurred after 20 interviews. Three themes emerged from the data related to caring, acknowledgement of patients' feelings, professional behaviour, patient involvement and emotional control. Some nurses repressed their emotions and feelings over patients who had difficulties sustaining hope. In such cases nurses require supportive networks to assist their emotions management and intra-personal skills. Educational support is needed to help nurses express their views in relation to emotional contagion, significance of repressed emotions and to identify supportive ways to assist nurses to communicate their experiences.

  20. Manual therapy treatment of lumbar radiculopathy: A single case report

    Directory of Open Access Journals (Sweden)

    J.A. Riley

    2011-01-01

    Full Text Available Patients  with  lumbar  radiculopathy  are  often  managed with  manual therapy.  The  aim  of  this  single  case  study  was  to  describe  the outcome of manual therapy treatment of a patient with lumbar radiculopathy.  A 47-year-old female presented with acute, severe left buttock and postero-lateral thigh pain.  Symptom provocation occurred during lumbar flexion, coughing, sneezing, driving and prolonged sitting. her left straight leg raise neurodynamic test was limited and reproduced her pain, as did trigger points in the left lumbar and gluteal muscles. clinical neuro-conduction testing revealed weakness of the big and other toe extensors, as well as eversion and plantar flexion of the left ankle, and a diminished left ankle reflex. This indicated possible involvement of both the l5 and S1 nerve roots.   A  manual  therapy  treatment  approach including  lumbar rotation mobilisations (Maitland approach, massage, trigger point pressure release  and  Transversus  Abdominus muscle activation  was  used.   The  patient  was  symptom  free,  had  full pain-free  range  of  all  lumbar  movements,  a full  pain-free  left  straight leg  raise  neurodynamic  test  and  normal  neurological  conduction  six weeks  after  onset, following seven manual therapy treatments.  Although the results of this case report cannot be generalised, it describes the successful outcome of a patient with severe radicular pain and neurological deficits, whose signs and symptoms  had completely resolved following manual therapy treatment.

  1. Adding to the Truth of the Matter: The Case for Qualitative Research.

    Science.gov (United States)

    Florczak, Kristine L

    2017-10-01

    The purpose of this column is to discuss the impact that qualitative research has on translational research, whose aim is to improve the health and well-being of individuals. To that end, rigorous qualitative research is examined; translational research is entertained and the manner in which qualitative research can be a co-equal partner with quantitative research is proposed.

  2. "Best Case/Worst Case": Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions.

    Science.gov (United States)

    Kruser, Jacqueline M; Nabozny, Michael J; Steffens, Nicole M; Brasel, Karen J; Campbell, Toby C; Gaines, Martha E; Schwarze, Margaret L

    2015-09-01

    To evaluate a communication tool called "Best Case/Worst Case" (BC/WC) based on an established conceptual model of shared decision-making. Focus group study. Older adults (four focus groups) and surgeons (two focus groups) using modified questions from the Decision Aid Acceptability Scale and the Decisional Conflict Scale to evaluate and revise the communication tool. Individuals aged 60 and older recruited from senior centers (n = 37) and surgeons from academic and private practices in Wisconsin (n = 17). Qualitative content analysis was used to explore themes and concepts that focus group respondents identified. Seniors and surgeons praised the tool for the unambiguous illustration of multiple treatment options and the clarity gained from presentation of an array of treatment outcomes. Participants noted that the tool provides an opportunity for in-the-moment, preference-based deliberation about options and a platform for further discussion with other clinicians and loved ones. Older adults worried that the format of the tool was not universally accessible for people with different educational backgrounds, and surgeons had concerns that the tool was vulnerable to physicians' subjective biases. The BC/WC tool is a novel decision support intervention that may help facilitate difficult decision-making for older adults and their physicians when considering invasive, acute medical treatments such as surgery. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  3. Back to basics: qualitative spectral analysis as an investigatory tool, using calcite as a case study

    International Nuclear Information System (INIS)

    Lyons, R.G.

    1996-01-01

    The Interlab Comparison Project reported at the last meeting of this symposium illustrated a major difficulty in using EPR for dating in archaeology and geology. Different laboratories obtained varying (in some case widely varying) accumulated environmental doses (D e ) for the same material. Given the range of factors which may affect D e , a simple quick means of identifying crucial factors affecting D e is essential in order to target research effectively. Qualitative visual analysis of the ESR spectrum provides such a tool. The complex ESR spectrum is considered in the first instance as the superposition of a number of independent peaks. The changing shape of the spectrum under different conditions can be described in terms of varying contributions of the contributing peaks. This paper outlines the necessary concepts and presents a straightforward procedure by which constituent peaks and their relevant properties may be identified with minimal effort. This enables appropriate methods to be selected which will enhance the dating peak relative to other interfering peaks, reducing systematic bias in the estimate of D e . Speleothem calcite is used as a case study to demonstrate the effectiveness of this pragmatic approach. The concepts and procedures should be equally valuable when examining the ESR dating potential of other materials. (author)

  4. Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

    Science.gov (United States)

    Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M; Clark, Sunday; Flomenbaum, Neal E; Breckman, Risa; Markarian, Arlene; Riffin, Catherine; Lachs, Mark S; Pillemer, Karl

    2016-08-01

    Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney's office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser's substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.

  5. Toward Eco Product Development with Qualitative and CAE Design Process - Case Study of Flame Guiding Module

    Science.gov (United States)

    Chen, W. L.; Chao, F. L.

    2018-04-01

    Sustainable products become increasingly important for company in addressing eco-performance to satisfy global environmental regulations. Case study of flame guiding module reviewed design process and concerns related to the torch design. For enhancing flame height, the torch was embedded with an airflow guidance structure. The design process and design methodologies were investigated as an eco-design case study. Combine qualitative and CAE simulation were proposed to fulfil its main and auxiliary functions including reduction of impact during use. The design guidelines help prevent mistake arrangements, CAE helps understand combustion phenomenon. The flow field simulation enables fine tune of geometric design. Functional test and measurement are carried out to confirm the product features. On Eco-performance, we choose 5 items for evaluation the status of previous and redesign module, namely function need, low impact material, few manufacturing steps, low energy consumption, and safety. The radar diagram indicates that eco-performance of redesign module is better. Life cycle assessment calculated the carbon footprint of the manufacturing and processing stage with Eco-it. By using recycled steel in the flame module, it reduces raw material stage carbon footprint significantly.

  6. Electroconvulsive therapy in single manic episodes: a case series ...

    African Journals Online (AJOL)

    Objective: To evaluate the effectiveness of electroconvulsive therapy in the treatment of Bipolar I Disorder patients with a single manic episode. Method: In a retrospective study, we reviewed medical records of inpatients who had been admitted to treat a single manic episode of Bipolar I Disorder at Noor University Hospital, ...

  7. Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study.

    Directory of Open Access Journals (Sweden)

    Heather Ames

    Full Text Available Understanding stakeholders' (parents', communities' and health workers' perspectives of communication about childhood vaccination, including their preferences for its format, delivery and content, is an important step towards designing better communication strategies and ensuring more informed parents. Our objectives were to explore stakeholders' views, experiences and preferences for childhood vaccination communication in Cameroon.In 2014, in the Central and North West Regions of Cameron, we gathered qualitative data for our case study using the following methods: semi structured interviews; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; document analysis of reports and mass media communications about vaccination; and a survey of parents. We conducted a thematic analysis of the qualitative data to identify themes relating to views, experiences and perceptions of vaccination information and its delivery. Survey data were analysed using simple descriptive statistics.All of the parents interviewed felt that vaccinating their child was important, and trusted the information provided by health workers. However, many parents wanted more information. Parents did not always feel that they could ask questions during vaccination appointments. All participants felt that health workers and vaccination clinics were important sources of information. Social mobilisation activities such as door-to-door visits and announcements during religious services were important and accepted ways of communicating information, especially during vaccination campaigns. Information communicated through mass media and text messages was also seen as important. In general, stakeholders believed that more consistent messaging about routine vaccination through community channels would be helpful to remind parents of the importance of routine vaccination during ongoing rounds of vaccination

  8. Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study

    Science.gov (United States)

    Njang, Diangha Mabel; Glenton, Claire; Fretheim, Atle; Kaufman, Jessica; Hill, Sophie; Oku, Afiong; Cliff, Julie; Cartier, Yuri; Bosch-Capblanch, Xavier; Rada, Gabriel; Muloliwa, Artur Manuel; Oyo-Ita, Angela; Kum, Awah Paschal; Lewin, Simon

    2017-01-01

    Background Understanding stakeholders’ (parents’, communities’ and health workers’) perspectives of communication about childhood vaccination, including their preferences for its format, delivery and content, is an important step towards designing better communication strategies and ensuring more informed parents. Our objectives were to explore stakeholders’ views, experiences and preferences for childhood vaccination communication in Cameroon. Methods In 2014, in the Central and North West Regions of Cameron, we gathered qualitative data for our case study using the following methods: semi structured interviews; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; document analysis of reports and mass media communications about vaccination; and a survey of parents. We conducted a thematic analysis of the qualitative data to identify themes relating to views, experiences and perceptions of vaccination information and its delivery. Survey data were analysed using simple descriptive statistics. Results All of the parents interviewed felt that vaccinating their child was important, and trusted the information provided by health workers. However, many parents wanted more information. Parents did not always feel that they could ask questions during vaccination appointments. All participants felt that health workers and vaccination clinics were important sources of information. Social mobilisation activities such as door-to-door visits and announcements during religious services were important and accepted ways of communicating information, especially during vaccination campaigns. Information communicated through mass media and text messages was also seen as important. In general, stakeholders believed that more consistent messaging about routine vaccination through community channels would be helpful to remind parents of the importance of routine vaccination during ongoing

  9. GP leadership in clinical commissioning groups: a qualitative multi-case study approach across England.

    Science.gov (United States)

    Marshall, Martin; Holti, Richard; Hartley, Jean; Matharu, Tatum; Storey, John

    2018-06-01

    Clinical commissioning groups (CCGs) were established in England in 2013 to encourage GPs to exert greater influence over the processes of service improvement and redesign in the NHS. Little is known about the extent and the ways in which GPs have assumed these leadership roles. To explore the nature of clinical leadership of GPs in CCGs, and to examine the enablers and barriers to implementing a policy of clinical leadership in the NHS. A qualitative multi-case study approach in six localities across England. The case studies were purposefully sampled to represent different geographical localities and population demographics, and for their commitment to redesigning specified clinical or service areas. Data were collected from the case study CCGs and their partner organisations using a review of relevant documents, semi-structured individual or group interviews, and observations of key meetings. The data were analysed thematically and informed by relevant theories. GPs prefer a collaborative style of leadership that may be unlikely to produce rapid or radical change. Leadership activities are required at all levels in the system from strategy to frontline delivery, and the leadership behaviours of GPs who are not titular leaders are as important as formal leadership roles. A new alliance is emerging between clinicians and managers that draws on their different skillsets and creates new common interests. The uncertain policy environment in the English NHS is impacting on the willingness and the focus of GP leaders. GPs are making an important contribution as leaders of health service improvement and redesign but there are significant professional and political barriers to them optimising a leadership role. © British Journal of General Practice 2018.

  10. Patients' experiences of a multidisciplinary team-led community case management programme: a qualitative study.

    Science.gov (United States)

    Gowing, Alice; Dickinson, Claire; Gorman, Tom; Robinson, Louise; Duncan, Rachel

    2016-09-09

    To explore the views and experiences of patients on the care they have received while enrolled on the Northumberland High Risk Patient Programme (NHRPP). This programme involved case finding of frail patients using a multidisciplinary team (MDT)-led community case management programme, and support of patients through care planning and regular reviews using primary, community, secondary and social care professionals. A qualitative study using semistructured interviews, which were digitally recorded, transcribed and subject to thematic analysis. Community patients receiving primary care in the county of Northumberland, England. 23 participants took part, of which 16 were patients enrolled on the NHRPP, and 7 carers. GP practices were selected purposively by size, deprivation and location, and patients identified and invited by General Practitioners to participate. 4 main themes emerged from the data: awareness and understanding of the NHRPP, confidence in the primary healthcare team, limitations of home care and the active role of being a patient. Despite having a low level of awareness of the details of the NHRPP, participants did think that its broad aim made sense. Participants discussed their high level of satisfaction with their care and access to team members. However, some limitations of alternatives to hospital care were identified, including the need to consider psychological as well as medical needs, the importance of overnight care and the needs of those without informal carers. Finally, participants discussed the active nature of being a patient under the NHRPP if they were to contribute fully to planning and managing their own care. This study has identified that a programme of MDT-led case management was generally very well received by patients and their families. However, a number of factors were identified that could improve the implementation of the programme and further research needs to be undertaken to address these. Published by the BMJ

  11. The Viewpoints of Sexually Active Single Women About Premarital Sexual Relationships: A Qualitative Study in the Iranian Context.

    Science.gov (United States)

    Rahmani, Azam; Merghati-Khoei, Effat; Moghaddam-Banaem, Lida; Hajizadeh, Ebrahim; Montazeri, Ali

    2016-03-01

    Premarital sexual relationships could harm youth's health in terms of sexually transmitted infections or increased risk of unprotected sexual behaviors. Sexual abstinence has been recommended to prevent young adolescents from adverse outcomes of premarital sexual relationships. The aim of this study was to explore the viewpoints of sexually active single women about premarital sexual relationships in the Iranian context. In this qualitative study, we recruited 41 young women aged 18 to 35 years. Data were collected using focus group discussions and individual interviews. We employed conventional content analysis to analyze the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the reliability of the findings. Eight themes emerged from the data analysis: 'acceptance of sexual contact in the context of opposite-sex relationships, 'sexual activity as a guarantee for keeping the boyfriend in the relationship', 'premarital sexual relationship as an undeniable personal right', 'having successful marriage in spite of premarital sexual relationships', 'virginity as an old fashioned phenomenon', 'love as a license for premarital sexual behaviors', 'goal-oriented relationship as a license for premarital sexual behaviors', and 'experiencing premarital sexual relationships in order to gain perfection'. Results of this study could be applied to designing interventions, such as promotion of preventive beliefs or educational programs regarding premarital sexual relationships in conservative societies. These interventions could start within families and continue at schools and universities.

  12. Primary mandibular first molar with single root and single canal: a case report of a rare morphology.

    Directory of Open Access Journals (Sweden)

    Zahra Bahrololoomi

    2014-06-01

    Full Text Available Single rooted primary mandibular first molar is a rare developmental anomaly. Literatures reveal that failure of invagination of Hertwig's epithelial root sheath leads to this unusual root form. Thorough knowledge of root canal morphology and anatomical variations of primary teeth can help a pediatric dentist in successful root canal treatment. Hereby, we describe two cases of primary mandibular first molars with an unusual morphology as a single root called pyramidal molar.

  13. A Qualitative Exploration of Multiple Case Studies of the Perception of School Social Workers Concerning Their Roles in Public Schools

    Science.gov (United States)

    Morrison, Alesha Nicole

    2016-01-01

    This qualitative exploration in the form of multiple case studies interviewed a group of seven social workers from the St. Louis Metropolitan area to gain their perception as school social workers concerning their roles in public schools. The literature on school social workers indicated that school social workers brought unique knowledge and…

  14. A Qualitative Evaluation of the Use of Multimedia Case Studies in an Introductory Engineering Course at Two Southeastern Universities

    Science.gov (United States)

    Huett, Kim C.; Kawulich, Barbara

    2015-01-01

    Collaborating at two universities to improve teaching and learning in undergraduate engineering, an interdisciplinary team of researchers, instructors, and evaluators planned and implemented the use of multimedia case studies with students enrolled in an introductory engineering course. This qualitative action evaluation study focuses on results…

  15. Implications of Student and Lecturer Qualitative Views on Reading Lists: A Case Study at Loughborough University, UK

    Science.gov (United States)

    Brewerton, Gary

    2014-01-01

    This case study explores student and lecturer views of reading lists at Loughborough University. Taking the qualitative data from two surveys previously undertaken at the institution, it uses the grounded theory approach to identify key issues regarding the purpose, importance, visibility, content, currency, and length of reading lists, as well as…

  16. The Educational Needs of and Barriers Faced by Syrian Refugee Students in Turkey: A Qualitative Case Study

    Science.gov (United States)

    Aydin, Hasan; Kaya, Yeliz

    2017-01-01

    The purpose of this study is to explore the educational status of Syrian refugees in Turkish schools, and the perspectives of teachers and school principals regarding the needs of Syrian refugee students in two inner-city elementary schools in Istanbul, Turkey. A qualitative interpretive case study method was employed. Eight participants (seven…

  17. Rationales Shaping International Linkages in Higher Education: A Qualitative Case Study of the ASU-ITESM Strategic Alliance

    Science.gov (United States)

    Camacho Lizarraga, Monica Irene

    2011-01-01

    This qualitative case study examines the rationales of the relationship between Arizona State University (ASU)--an American public research university--and Tecnologico de Monterrey (ITESM), a Mexican private not for profit research university. The focus of the study is to document the different meanings participants attached to the rationales of…

  18. Responses of Children in an Ethnically Diverse Elementary Classroom to the Use of Multicultural Cinderella Stories: A Qualitative Case Study

    Science.gov (United States)

    Stout-Swain, Carolyn R.

    2013-01-01

    John Dewey believed that the foundation of education is built on social responsibility and democracy, and specifically proposed social change and thought of teachers essentially as social workers as a conduit to that change. In this qualitative case study, different cultures were introduced via literature to a group of fourth grade students in an…

  19. A Qualitative Descriptive Case Study of the Requirements of the IT Industry for Entry-Level IT Positions

    Science.gov (United States)

    Feuerherm, Todd Michael

    2009-01-01

    This qualitative descriptive case study explored the requirements of the IT industry for education, IT certification, and work experience for entry-level IT professionals. Research has shown a growing problem where IT graduates were not able to meet the requirements for entry-level IT jobs. IT enrollment has decreased considerably over the past…

  20. Employee motivation of senior engineers in aerospace companies in southern California: A qualitative case study

    Science.gov (United States)

    Banh, My-Le

    The purpose of this qualitative exploratory case study was to explore the lack of motivation of engineers with more than 15 years of experience working in aerospace companies in southern California. The sample size for this study consisted of 18 senior engineers. These participants held either a bachelor's or master's degree in engineering fields. Participants were recruited through networking with colleagues and snowball sampling. The data was collected through face-to-face and phone interviews. Participants also had the opportunity to review their responses after the interview. The data analysis resulted in 12 themes regarding the participants' perception of motivation. The top six predominant themes were (1) challenging and new assignments, (2) commitment, (3) opportunity, (4) supporting from managers, (5) team spirit, and (6) open communication. The study resulted in an in-depth understanding of how important motivation is to senior engineers. Based on the findings, leaders should create opportunities for senior employees to work on challenging assignments, acquire autonomy, and obtain more responsibilities. Providing such opportunities may motivate employees to perform well and committee with the organizations.

  1. Structuring and coding in health care records: a qualitative analysis using diabetes as a case study

    Directory of Open Access Journals (Sweden)

    Ann R R Robertson

    2015-03-01

    Full Text Available Background   Globally, diabetes mellitus presents a substantial burden to individuals and healthcare systems. Structuring and/or coding of medical records underpin attempts to improve information sharing and searching, potentially bringing clinical and secondary uses benefits.Aims and objectives   We investigated if, how and why records for adults with diabetes were structured and/or coded, and explored stakeholders’ perceptions of current practice.Methods   We carried out a qualitative, theoretically-informed case study of documenting healthcare information for diabetes patients in family practice and hospital settings, using semi-structured interviews, observations, systems demonstrations and documentary data.Results   We conducted 22 interviews and four on-site observations, and reviewed 25 documents. For secondary uses – research, audit, public health and service planning – the benefits of highly structured and coded diabetes data were clearly articulated. Reported clinical benefits in terms of managing and monitoring diabetes, and perhaps encouraging patient self-management, were modest. We observed marked differences in levels of record structuring and/or coding between settings, and found little evidence that these data were being exploited to improve information sharing between them.Conclusions   Using high levels of data structuring and coding in medical records for diabetes patients has potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK.

  2. Management and Encouragement of Pupil Participation in Primary Education: A Qualitative Case Study

    Directory of Open Access Journals (Sweden)

    Daniel García-Pérez

    2014-06-01

    Full Text Available Our work focuses on the participation of students of primary education in decision-making. We carried out a qualitative case study of two public Primary schools with the aim of illustrating good models of student participation. On the one hand, our results highlight the opportunities resulting from the creation of specific structures of student participation, such as class and student councils, because they allow students to participate in collective rule-making, conflict management and the planning and evaluation of school and class activities. On the other hand, the results emphasize the contributions derived from the use of teaching methods that enhance student participation in decision making on academic issues by selecting contents, the inclusion of self-assessment processes and the self-organization of work time. Overall, the results obtained point out that it is feasible to organize the activity of a Primary Education center encouraging students to participate in decision making and they add evidence supported in the practice of two schools to progress in the study and promotion of school participation.

  3. Complex young lives: a collective qualitative case study analysis of young fatherhood and breastfeeding.

    Science.gov (United States)

    Ayton, Jennifer; Hansen, Emily

    2016-01-01

    Of all births in Australia, 10 % are to young fathers aged less than 24 years. How young fathers experience any breastfeeding and how this is shaped by their social context is poorly understood. Our aim is to increase understanding of the lived experience of young fathers (aged less than 24 years) and to explore the way they speak about breastfeeding in the context of their lives and parenting. This collective case study analysis uses qualitative data from interviews and focus groups with young fathers (aged less than 24 years) and community support staff. The research was undertaken in Tasmania, Australia, March to December 2013. Young fathers in our study had complex social and emotional circumstances that meant breastfeeding was not a high priority despite them valuing the health benefits of breastfeeding for their babies. If supported by peers and their community they appear to have a more positive parenting experience. Breastfeeding although understood by the young fathers in our study as healthy and desirable is not a priority in their lives. Learning to be a parent and support their partners to breastfeed may be more effectively gained through mentoring and father-to-father localized community based support services.

  4. Supportive Communication to Facilitate Chinese Patients' Adaptation to a Permanent Colostomy: A Qualitative Case Study Approach.

    Science.gov (United States)

    Tao, Hui; Songwathana, Praneed; Isaramalai, Sang-Arun; Wang, Qingxi

    2016-01-01

    This study, which is a part of action research, aims to explore how supportive communication can impact individuals' adaptation to a permanent colostomy in a Chinese cultural context. Two Chinese rectal cancer patients with complexity and difficulty in living with a permanent colostomy were selected using a qualitative case study approach. The researcher (H.T.) interacted with the participants along their journey from the preoperative period until the third postoperative month after discharge via face-to-face or telephone interviews. Content analysis was applied. Supportive communication was characterized by "communication as a supportive tool," which consisted of 4 elements: respect, description, empathy, and empowerment. The nursing strategies included (1) developing a collaborative relationship with patients and families; (2) understanding patients' concerns and problems; (3) discussing potential solutions; (4) encouraging patients to take action; (5) bringing out emotional expression; (6) normalizing negative emotions; and (7) protecting hope. The findings of this study informed that supportive communication is a valuable tool for nurses to provide informational and emotional support to Chinese patients in order to enhance their adaptation to living with a permanent colostomy. Developing an operational manual to enhance supportive communication for patients with colostomy is suggested.

  5. Not so ‘invisible’: A Qualitative Case Study Exploring Gender Relations and Farm Management Software

    Directory of Open Access Journals (Sweden)

    Dale Carolyn Mackrell

    2010-01-01

    Full Text Available This qualitative case study explored farm management practices by women cotton growers who used computer-based information systems, most particularly the agricultural farm management software, CottonLOGIC, within the Australian cotton industry. This study found that, although gender differences and inequalities persist in rural parts of the region, the agency of women cotton growers ensures not only a sustainable future for themselves and their families, but also for the broader cotton industry as a whole. The use of farm management software by women cotton farmers was informed by Connell’s theoretical framework of gender relations (2002. The findings suggested that, women’s active participation in family farm partnerships and their acquisition of technological skills through the use of farm management software like CottonLOGIC, meant that all cotton growers benefit through the feminizing of specific farm management practices in family farm enterprises. This, therefore, has significant implications for developing the cotton industry into a truly sustainable entity.

  6. Advocacy, communication and social mobilisation for tuberculosis control in Pakistan: a qualitative case study.

    Science.gov (United States)

    Haq, Z; Khan, W; Rizwan, S

    2013-03-01

    A national-level study in four districts, one each in all four provinces of Pakistan, a high tuberculosis (TB) burden country. To examine how advocacy, communication and social mobilisation (ACSM) campaigns by the National Tuberculosis Programme (NTP) in Pakistan engaged the populations of interest, to what extent they were successful in promoting services and desired behaviours, and how these campaigns could be improved. This was a qualitative case study comprising 13 focus groups and 36 individual interviews in four districts. All three levels of the ACSM programme, i.e., planners, implementers and beneficiaries, were included among the respondents. Improved political commitment, availability of funds, partnership with the private sector, visibility of the NTP and access to directly observed treatment (DOT) were achieved. Individual and social environmental issues of poor patients and marginalised communities were addressed to some extent, and could be improved in the future. Empathy and respect from physicians, and better service delivery of the DOTS-based programme were desired by the patients. The strategic advocacy ensured political and financial commitment; however, identification and targeting of vulnerable populations, and carrying out context-based social mobilisation and effective counselling are crucial to increase the use of DOT. Evaluations should be built-in from the beginning to increase the evidence on effectiveness of ACSM campaigns.

  7. A qualitative case study to identify possible barriers that limit effective elementary science education

    Science.gov (United States)

    Foster, Donald Carey

    The purpose of this case study was to identify barriers that limit the effectiveness of elementary teachers in the teaching of science. It is of the utmost urgency that barriers be first identified, so that possible solutions can be explored to bring about the improvement of elementary science education. This urgency has been imposed by the scheduled national testing of students in science by 2007, as mandated by the No Child Left Behind Act of 2001. Using qualitative case study methods, the researcher conducted interviews with 8 elementary teachers from two schools within one school district who taught 3rd, 4th, and 5th grade. These interviews were designed to gain insight into barriers these elementary teachers perceived as factors limiting their effectiveness in teaching science and preparing students for high-stakes testing. Barriers in the areas of teacher background, typical teaching day, curriculum, inservices, and legislative influences were explored. This study concluded that the barriers explored do have a substantial negative affect on the teaching and learning of science in the elementary grades. Specifically, the barriers revealed in this study include the limited science background of elementary teachers, inadequate class time devoted to science, non-comprehensive curriculum, ineffective or lack of inservice training, and pressures from legislated mandates. But it is also clear that these barriers are so intertwined that one cannot remove these barriers one at a time. It will take a collective effort from all involved, including legislators, administrators, teachers, parents, and students, to alleviate these barriers and discover effective solutions to improve elementary science education.

  8. Navigating the complexities of qualitative comparative analysis: case numbers, necessity relations, and model ambiguities.

    Science.gov (United States)

    Thiem, Alrik

    2014-12-01

    In recent years, the method of Qualitative Comparative Analysis (QCA) has been enjoying increasing levels of popularity in evaluation and directly neighboring fields. Its holistic approach to causal data analysis resonates with researchers whose theories posit complex conjunctions of conditions and events. However, due to QCA's relative immaturity, some of its technicalities and objectives have not yet been well understood. In this article, I seek to raise awareness of six pitfalls of employing QCA with regard to the following three central aspects: case numbers, necessity relations, and model ambiguities. Most importantly, I argue that case numbers are irrelevant to the methodological choice of QCA or any of its variants, that necessity is not as simple a concept as it has been suggested by many methodologists, and that doubt must be cast on the determinacy of virtually all results presented in past QCA research. By means of empirical examples from published articles, I explain the background of these pitfalls and introduce appropriate procedures, partly with reference to current software, that help avoid them. QCA carries great potential for scholars in evaluation and directly neighboring areas interested in the analysis of complex dependencies in configurational data. If users beware of the pitfalls introduced in this article, and if they avoid mechanistic adherence to doubtful "standards of good practice" at this stage of development, then research with QCA will gain in quality, as a result of which a more solid foundation for cumulative knowledge generation and well-informed policy decisions will also be created. © The Author(s) 2014.

  9. 78 FR 58546 - State System Development Initiative (SSDI) Grant Program; Single-Case Deviation From Competition...

    Science.gov (United States)

    2013-09-24

    ... Development Initiative (SSDI) Grant Program; Single- Case Deviation From Competition Requirements AGENCY...). ACTION: Notice of Single-Case Deviation from Competition Requirements for the Maternal and Child Health... and quality data that is timely. SUPPLEMENTARY INFORMATION: Intended Recipient of the Award...

  10. The Single-Case Reporting Guideline in BEhavioural Interventions (SCRIBE) 2016 Statement

    Science.gov (United States)

    Tate, Robyn L.; Perdices, Michael; Rosenkoetter, Ulrike; Shadish, William; Vohra, Sunita; Barlow, David H.; Horner, Robert; Kazdin, Alan; Kratochwill, Thomas; McDonald, Skye; Sampson, Margaret; Shamseer, Larissa; Togher, Leanne; Albin, Richard; Backman, Catherine; Douglas, Jacinta; Evans, Jonathan J.; Gast, David; Manolov, Rumen; Mitchell, Geoffrey; Nickels, Lyndsey; Nikles, Jane; Ownsworth, Tamara; Rose, Miranda; Schmid, Christopher H.; Wilson, Barbara

    2016-01-01

    We developed a reporting guideline to provide authors with guidance about what should be reported when writing a paper for publication in a scientific journal using a particular type of research design: the single-case experimental design. This report describes the methods used to develop the Single-Case Reporting guideline In BEhavioural…

  11. Learning Separately: The Case for Single-Sex Schools

    Science.gov (United States)

    Meyer, Peter

    2008-01-01

    While there are no reliable counts of single-gender schools in the first half of the 20th century, best estimates are that most were schools for white boys. Many of the girls' schools that did exist early on served as "finishing" schools rather than preparation for college. In the 1960s and 1970s, the civil rights and feminist movements…

  12. A Conversational Model for Qualitative Research: A Case Study of Clergy and Religious Knowledge

    Science.gov (United States)

    Roland, Daniel; Wicks, Don A.

    2009-01-01

    This paper describes the qualitative research interview as a conversation designed to gain understanding of the world of research informants. It illustrates the potential of the qualitative research interview when the researcher is able to enter into and maintain a conversation with the research informant as an insider in the latter's community.…

  13. Collecting and analyzing qualitative data: Hermeneutic principles, methods and case examples

    Science.gov (United States)

    Michael E. Patterson; Daniel R. Williams

    2002-01-01

    Over the past three decades, the use of qualitative research methods has become commonplace in social science as a whole and increasingly represented in tourism and recrearion research. In tourism, for example, Markwell and Basche (1998) recently noted the emergence of a pluralistic perspective on science and the growth of research employing qualitative frameworks....

  14. Using Generic Inductive Approach in Qualitative Educational Research: A Case Study Analysis

    Science.gov (United States)

    Liu, Lisha

    2016-01-01

    Qualitative research strategy has been widely adopted by educational researchers in order to improve the quality of their empirical studies. This paper aims to introduce a generic inductive approach, pragmatic and flexible in qualitative theoretical support, by describing its application in a study of non-English major undergraduates' English…

  15. VARIED MALIGNANT PRESENTATIONS IN A SINGLE CASE OF XERODERMA PIGMENTOS

    Directory of Open Access Journals (Sweden)

    Rahul Shetty

    2013-10-01

    Full Text Available Xeroderma pigmentosum is a autosomal recessive genetic disorder in which cutaneous malignancies are very common. We report a rare case where four different varieties of cutaneous malignancies were seen in the same patient..

  16. Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

    Science.gov (United States)

    Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

    2014-03-01

    Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

  17. Single-case research design in pediatric psychology: considerations regarding data analysis.

    Science.gov (United States)

    Cohen, Lindsey L; Feinstein, Amanda; Masuda, Akihiko; Vowles, Kevin E

    2014-03-01

    Single-case research allows for an examination of behavior and can demonstrate the functional relation between intervention and outcome in pediatric psychology. This review highlights key assumptions, methodological and design considerations, and options for data analysis. Single-case methodology and guidelines are reviewed with an in-depth focus on visual and statistical analyses. Guidelines allow for the careful evaluation of design quality and visual analysis. A number of statistical techniques have been introduced to supplement visual analysis, but to date, there is no consensus on their recommended use in single-case research design. Single-case methodology is invaluable for advancing pediatric psychology science and practice, and guidelines have been introduced to enhance the consistency, validity, and reliability of these studies. Experts generally agree that visual inspection is the optimal method of analysis in single-case design; however, statistical approaches are becoming increasingly evaluated and used to augment data interpretation.

  18. The Viewpoints of Sexually Active Single Women About Premarital Sexual Relationships: A Qualitative Study in the Iranian Context

    Science.gov (United States)

    Rahmani, Azam; Merghati-Khoei, Effat; Moghaddam-Banaem, Lida; Hajizadeh, Ebrahim; Montazeri, Ali

    2016-01-01

    Background: Premarital sexual relationships could harm youth’s health in terms of sexually transmitted infections or increased risk of unprotected sexual behaviors. Sexual abstinence has been recommended to prevent young adolescents from adverse outcomes of premarital sexual relationships. Objectives: The aim of this study was to explore the viewpoints of sexually active single women about premarital sexual relationships in the Iranian context. Patients and Methods: In this qualitative study, we recruited 41 young women aged 18 to 35 years. Data were collected using focus group discussions and individual interviews. We employed conventional content analysis to analyze the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the reliability of the findings. Results: Eight themes emerged from the data analysis: ‘acceptance of sexual contact in the context of opposite-sex relationships, ‘sexual activity as a guarantee for keeping the boyfriend in the relationship’, ‘premarital sexual relationship as an undeniable personal right’, ‘having successful marriage in spite of premarital sexual relationships’, ‘virginity as an old fashioned phenomenon’, ‘love as a license for premarital sexual behaviors’, ‘goal-oriented relationship as a license for premarital sexual behaviors’, and ‘experiencing premarital sexual relationships in order to gain perfection’. Conclusions: Results of this study could be applied to designing interventions, such as promotion of preventive beliefs or educational programs regarding premarital sexual relationships in conservative societies. These interventions could start within families and continue at schools and universities. PMID:27162757

  19. Two against one - a case for single-sided films

    International Nuclear Information System (INIS)

    Dixon, L.

    1979-01-01

    The disadvantages of double-sided X-ray film include parallax between the double images where the film is angled to the central ray, and a cross-over effect where light from the front screen affects the back emulsion and vice versa. An investigation of the percentage of the total film density due to cross-over showed the effect varied from 28% to 47%, increasing with total density and faster screens. Kilovoltage had little influence on the effect. A single emulsion film with one screen gave an appreciable increase in radiographic sharpness and definition but required an increase by about 2.5 times in the exposure required. A very fast screen overcame this effect without comparable loss of detail. The use of single emulsion films should also reduce the thickness of cut and therefore improve sharpness in tomography. (UK)

  20. Single-port laparoscopic partial splenectomy: a case report.

    Science.gov (United States)

    Hong, Tae Ho; Lee, Sang Kuon; You, Young Kyoung; Kim, Jun Gi

    2010-10-01

    With the better understanding of the importance of the spleen as a primary organ of the human immune system, there has been an increased interest in performing the partial splenectomy for a number of indications such as nonparasitic cysts, benign tumors, staging of lymphomas, etc. Moreover, laparoscopic partial splenectomy has been gaining more interest as the recommended approach for benign splenic disorders to preserve the splenic function with very low recurrence rates. Meanwhile, many surgeons have attempted to reduce the number and size of the ports in laparoscopic surgery with the aim of inducing less parietal trauma and fewer scars. One of these efforts is single-port laparoscopic surgery, which is a rapidly evolving field all over the world. Here, we describe a feasible method of single-port laparoscopic partial splenectomy for treating a benign splenic cyst that was located in the upper medial aspect of the spleen.

  1. The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 statement: Énoncé concernant la Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016.

    Science.gov (United States)

    Tate, Robyn L; Perdices, Michael; Rosenkoetter, Ulrike; Shadish, William; Vohra, Sunita; Barlow, David H; Horner, Robert; Kazdin, Alan; Kratochwill, Thomas; McDonald, Skye; Sampson, Margaret; Shamseer, Larissa; Togher, Leanne; Albin, Richard; Backman, Catherine; Douglas, Jacinta; Evans, Jonathan J; Gast, David; Manolov, Rumen; Mitchell, Geoffrey; Nickels, Lyndsey; Nikles, Jane; Ownsworth, Tamara; Rose, Miranda; Schmid, Christopher H; Wilson, Barbara

    2016-06-01

    We developed a reporting guideline to provide authors with guidance about what should be reported when writing a paper for publication in a scientific journal using a particular type of research design: the single-case experimental design. This report describes the methods used to develop the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016. As a result of 2 online surveys and a 2-day meeting of experts, the SCRIBE 2016 checklist was developed, which is a set of 26 items that authors need to address when writing about single-case research. This article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016) that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated. We recommend that the SCRIBE 2016 is used by authors preparing manuscripts describing single-case research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.Reporting guidelines, such as the Consolidated Standards of Reporting Trials (CONSORT) Statement, improve the reporting of research in the medical literature (Turner et al., 2012). Many such guidelines exist and the CONSORT Extension to Nonpharmacological Trials (Boutron et al., 2008) provides suitable guidance for reporting between-groups intervention studies in the behavioral sciences. The CONSORT Extension for N-of-1 Trials (CENT 2015) was developed for multiple crossover trials with single individuals in the medical sciences (Shamseer et al., 2015; Vohra et al., 2015), but there is no reporting guideline in the CONSORT tradition for single-case research used in the behavioral sciences. We developed the Single-Case

  2. High-performance work systems in health care management, part 2: qualitative evidence from five case studies.

    Science.gov (United States)

    McAlearney, Ann Scheck; Garman, Andrew N; Song, Paula H; McHugh, Megan; Robbins, Julie; Harrison, Michael I

    2011-01-01

    : A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. : The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. : Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. : In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover). : These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify

  3. Structuring and coding in health care records: a qualitative analysis using diabetes as a case study.

    Science.gov (United States)

    Robertson, Ann R R; Fernando, Bernard; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

    2015-03-27

    Globally, diabetes mellitus presents a substantial and increasing burden to individuals, health care systems and society. Structuring and coding of information in the electronic health record underpin attempts to improve sharing and searching for information. Digital records for those with long-term conditions are expected to bring direct and secondary uses benefits, and potentially to support patient self-management. We sought to investigate if how and why records for adults with diabetes were structured and coded and to explore a range of UK stakeholders' perceptions of current practice in the National Health Service. We carried out a qualitative, theoretically informed case study of documenting health care information for diabetes in family practice and hospital settings in England, using semi-structured interviews, observations, systems demonstrations and documentary data. We conducted 22 interviews and four on-site observations. With respect to secondary uses - research, audit, public health and service planning - interviewees clearly articulated the benefits of highly structured and coded diabetes data and it was believed that benefits would expand through linkage to other datasets. Direct, more marginal, clinical benefits in terms of managing and monitoring diabetes and perhaps encouraging patient self-management were also reported. We observed marked differences in levels of record structuring and/or coding between family practices, where it was high, and the hospital. We found little evidence that structured and coded data were being exploited to improve information sharing between care settings. Using high levels of data structuring and coding in records for diabetes patients has the potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK. A first step would be for hospitals to attain levels of health information technology infrastructure and systems use commensurate with family practices.

  4. A qualitative case study of ehealth and digital literacy experiences of pharmacy staff.

    Science.gov (United States)

    MacLure, Katie; Stewart, Derek

    2018-06-01

    eHealth's many forms are benchmarked by the World Health Organization. Scotland is considered an advanced adopter of ehealth. The third global survey on ehealth includes pharmacy-related ehealth indicators. Advances in ehealth place an obligation on pharmacy staff to demonstrate proficiency, or digital literacy, in using ehealth technologies. The aim of this study was to provide an indepth exploration of the ehealth and digital literacy experiences of pharmacy staff in the North East of Scotland. A qualitative local case study approach was adopted for observational and interview activities in community and hospital pharmacies. Interview and observational data were collated and analysed using a framework approach. This study gained management approval from the local health board following ethical review by the sponsor university. Nineteen pharmacies and staff (n = 94) participated including two hospitals. Most participants were female (n = 82), aged 29 years and younger (n = 34) with less than 5 years pharmacy experience (n = 49). Participants identified their own digital literacy as basic. Most of the pharmacies had minimum levels of technology implemented (n = 15). Four themes (technology, training, usability, processes) were inducted from the data, coded and modelled with illustrative quotes. Scotland is aspirational in seeking to support the developing role of pharmacy practice with ehealth, however, evidence to date shows most pharmacy staff work with minimum levels of technology. The self-reported lack of digital literacy and often mentioned lack of confidence in using IT suggest pharmacy staff need support and training. Informal work based digital literacy development of the pharmacy team is self-limiting. Usability of ehealth technology could be a key element of its' acceptability. There is potential to better engage with ehealth process efficiencies in both hospital and community pharmacy. As Scotland increasingly invests in ehealth pharmacy

  5. Mothers’ experiences in the Nurse-Family Partnership program: a qualitative case study

    Directory of Open Access Journals (Sweden)

    Landy Christine

    2012-09-01

    Full Text Available Abstract Background Few studies have explored the experiences of low income mothers participating in nurse home visiting programs. Our study explores and describes mothers' experiences participating in the Nurse-Family Partnership (NFP Program, an intensive home visiting program with demonstrated effectiveness, from the time of program entry before 29 weeks gestation until their infant's first birthday. Methods A qualitative case study approach was implemented. A purposeful sample of 18 low income, young first time mothers participating in a pilot study of the NFP program in Hamilton, Ontario, Canada partook in one to two face to face in-depth interviews exploring their experiences in the program. All interviews were digitally recorded and transcribed verbatim. Conventional content analysis procedures were used to analyze all interviews. Data collection and initial analysis were implemented concurrently. Results The mothers participating in the NFP program were very positive about their experiences in the program. Three overarching themes emerged from the data: 1. Getting into the NFP program; 2. The NFP nurse is an expert, but also like a friend providing support; and 3. Participating in the NFP program is making me a better parent. Conclusions Our findings provide vital information to home visiting nurses and to planners of home visiting programs about mothers' perspectives on what is important to them in their relationships with their nurses, how nurses and women are able to develop positive therapeutic relationships, and how nurses respond to mothers' unique life situations while home visiting within the NFP Program. In addition our findings offer insights into why and under what circumstances low income mothers will engage in nurse home visiting and how they expect to benefit from their participation.

  6. A single centre case series of gallstone sigmoid ileus management

    Directory of Open Access Journals (Sweden)

    Nicholas Farkas

    2017-01-01

    Conclusions: This is the first case series highlighting the differing strategies and challenges faced by clinicians managing gallstone sigmoid ileus. Conservative measures (including manual evacuation, endoscopy, lithotripsy and surgery all play important roles in relieving large bowel obstruction. It is essential to tailor care to individual patients’ needs given the complexities of this potentially life threatening condition.

  7. Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study.

    Science.gov (United States)

    Adams, Ryan D F; Cole, Elaine; Brundage, Susan I; Morrison, Zoe; Jansen, Jan O

    2018-03-22

    An understanding of stakeholders' views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals. This is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system. We conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care. This study provides insight into rural professionals' perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty

  8. Handling Imprecision in Qualitative Data Warehouse: Urban Building Sites Annoyance Analysis Use Case

    Science.gov (United States)

    Amanzougarene, F.; Chachoua, M.; Zeitouni, K.

    2013-05-01

    Data warehouse means a decision support database allowing integration, organization, historisation, and management of data from heterogeneous sources, with the aim of exploiting them for decision-making. Data warehouses are essentially based on multidimensional model. This model organizes data into facts (subjects of analysis) and dimensions (axes of analysis). In classical data warehouses, facts are composed of numerical measures and dimensions which characterize it. Dimensions are organized into hierarchical levels of detail. Based on the navigation and aggregation mechanisms offered by OLAP (On-Line Analytical Processing) tools, facts can be analyzed according to the desired level of detail. In real world applications, facts are not always numerical, and can be of qualitative nature. In addition, sometimes a human expert or learned model such as a decision tree provides a qualitative evaluation of phenomenon based on its different parameters i.e. dimensions. Conventional data warehouses are thus not adapted to qualitative reasoning and have not the ability to deal with qualitative data. In previous work, we have proposed an original approach of qualitative data warehouse modeling, which permits integrating qualitative measures. Based on computing with words methodology, we have extended classical multidimensional data model to allow the aggregation and analysis of qualitative data in OLAP environment. We have implemented this model in a Spatial Decision Support System to help managers of public spaces to reduce annoyances and improve the quality of life of the citizens. In this paper, we will focus our study on the representation and management of imprecision in annoyance analysis process. The main objective of this process consists in determining the least harmful scenario of urban building sites, particularly in dense urban environments.

  9. Ericksonian hypnotherapy for selective mutism: A single-case study.

    Science.gov (United States)

    Cavarra, Mauro; Brizio, Adelina; Gava, Nicoletta

    2017-01-16

    Children affected by selective mutism don't speak in contexts that are unfamiliar to them or in which speaking is expected or required (e.g. school, kindergarten…). Such disorder interferes with the child's normal activities, may have invalidating consequences in the long run if left untreated, is associated to anxious conditions and is considered hard to treat. Contemporary research is still in need of methodologically rigorous outcome studies and the results described in the small number of published randomized controlled trials and retrospective studies indicate cognitive-behavioral interventions lasting 20-24 sessions as the best therapeutic option. This case study, involving a 7-year-old girl, aims at providing preliminary evidence on the effectiveness of Ericksonian hypnosis in the treatment of this condition. A brief review of current evidence is provided. The case was treated by a licensed hypnotherapist, specialized in family therapy, in 5 sessions during the course of 3 months. After 3 months the symptoms of the client were resolved and the diagnosis was no longer applicable. Other improvements regarded her mood, social skills and school performance.  Conclusions: Ericksonian Hypnotherapy lead to the remission of the disorder and to the improvement of the general well being of the client in 5 sessions, a much briefer time span compared to what is reported in current literature. This paper represents the first step in the elaboration of replicable and reliable intervention principles.

  10. Challenges and strategies for effectively teaching the nature of science: A qualitative case study

    Science.gov (United States)

    Koehler, Catherine M.

    This year long, qualitative, case study examines two, experienced, high school, biology teachers as they facilitated nature of science (NOS) understandings in their classrooms. This study explored three research questions: (1) In what ways do experienced teachers' conceptions of NOS evolve over one full year as a result of participating in a course that explicitly address NOS teaching and learning? (2) In what ways do experienced teachers' pedagogical practices evolve over one full year as a result of participating in a course that explicitly address NOS teaching and learning?, and (3) What are the challenges facing experienced teachers in their attempts to implement NOS understandings in their science, high school classrooms? This study was conducted in two parts. In Part I (fall 2004 semester), the participants were enrolled in a graduate course titled, Teaching the Nature of Science , where they were introduced to: (1) NOS, (2) a strategy, the Model for Teaching NOS (MTNOS), which helped them facilitate teaching NOS understandings through inquiry-based activities, and (3) participated in "real" science activities that reinforced their conceptions of NOS. In Part II (spring 2005 semester), classroom observations were made to uncover how these teachers implemented inquiry-based activities emphasizing NOS understanding in their classrooms. Their conceptions of NOS were measured using the Views of the Nature of Science questionnaire. Results demonstrated that each teacher's conceptions of NOS shifted slightly during course the study, but, for one, this was not a permanent shift. Over the year, one teacher's pedagogical practices changed to include inquiry-based lessons using MTNOS; the other, although very amenable to using prepared inquiry-based lessons, did not change her pedagogical practices. Both reported similar challenges while facilitating NOS understanding. The most significant challenges included: (1) time management; (2) the perception that NOS was a

  11. An Improved Rank Correlation Effect Size Statistic for Single-Case Designs: Baseline Corrected Tau.

    Science.gov (United States)

    Tarlow, Kevin R

    2017-07-01

    Measuring treatment effects when an individual's pretreatment performance is improving poses a challenge for single-case experimental designs. It may be difficult to determine whether improvement is due to the treatment or due to the preexisting baseline trend. Tau- U is a popular single-case effect size statistic that purports to control for baseline trend. However, despite its strengths, Tau- U has substantial limitations: Its values are inflated and not bound between -1 and +1, it cannot be visually graphed, and its relatively weak method of trend control leads to unacceptable levels of Type I error wherein ineffective treatments appear effective. An improved effect size statistic based on rank correlation and robust regression, Baseline Corrected Tau, is proposed and field-tested with both published and simulated single-case time series. A web-based calculator for Baseline Corrected Tau is also introduced for use by single-case investigators.

  12. Beyond Clinical Case Studies in Psychoanalysis: A Review of Psychoanalytic Empirical Single Case Studies Published in ISI-Ranked Journals

    Science.gov (United States)

    Meganck, Reitske; Inslegers, Ruth; Krivzov, Juri; Notaerts, Liza

    2017-01-01

    Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation. PMID:29046660

  13. Entry Points When Undergraduate Research Mentors Reflect on Their Role: A Qualitative Case Study

    Science.gov (United States)

    Wallin, Patric; Adawi, Tom

    2018-01-01

    Graduate students and postdoctoral researchers are increasingly taking on mentoring roles in undergraduate research (UR). There is, however, a paucity of research focusing on how they conceptualize their mentoring role. In this qualitative interview study, we identified three entry points that mentors reflect on to define their role: (1) What are…

  14. Ethics and the Promotion of Inclusiveness within Qualitative Research: Case Examples from Asia and the Pacific

    Science.gov (United States)

    Czymoniewicz-Klippel, Melina T.; Brijnath, Bianca; Crockett, Belinda

    2010-01-01

    Qualitative researchers are often confronted by ethical challenges when making research decisions because current guidelines and principles guiding research ethics do not wholly cover the concerns that can arise in complex social research situations. In this article, the authors explore this dilemma in relation to our experiences of conducting…

  15. Viewing University Leadership Transition through a Socialization Lens: A Qualitative Case Study

    Science.gov (United States)

    Miller, Pete

    2006-01-01

    The purpose of this study was to describe the organizational socialization process of a university football team that had a new coach. This qualitative examination, rooted in the socialization work of Van Maanen and Schein (1979), lends insight into the personal and organizational characteristics that universities must consider when hiring new…

  16. Using qualitative research methods in biomedical innovation: the case of cultured red blood cells for transfusion.

    Science.gov (United States)

    Lyall, Catherine; King, Emma

    2016-05-11

    Qualitative research has a key role to play in biomedical innovation projects. This article focuses on the appropriate use of robust social science methodologies (primarily focus group studies) for identifying the public's willingness and preference for emerging medical technologies. Our study was part of the BloodPharma project (now known as the Novosang project) to deliver industrially generated red blood cells for transfusion. Previous work on blood substitutes shows that the public prefers donated human blood. However, no research has been conducted concerning attitudes to stem cell derived red blood cells. Qualitative research methods including interviews and focus groups provide the methodological context for this paper. Focus groups were used to elicit views from sub-sections of the UK population about the potential use of such cultured red blood cells. We reflect on the appropriateness of that methodology in the context of the BloodPharma project. Findings are in the form of lessons transferable to other interdisciplinary, science-led teams about what a social science dimension can bring; why qualitative research should be included; and how it can be used effectively. Qualitative data collection offers the strength of exploring ambivalence and investigating the reasons for views, but not necessarily their prevalence in wider society. The inherent value of a qualitative method, such as focus groups, therefore lies in its ability to uncover new information. This contrasts with a quantitative approach to simply 'measuring' public opinion on a topic about which participants may have little prior knowledge. We discuss a number of challenges including: appropriate roles for embedded social scientists and the intricacies of doing upstream engagement as well as some of the design issues and limitations associated with the focus group method.

  17. An investigation of pimary music education in Victorian schools: a single case study

    OpenAIRE

    Cosaitis, Wei

    2017-01-01

    This phenomenological research has employed a qualitative case study approach and investigates what practices are required in successful music curriculum development and quality music teaching within and without the music classroom in state-supported (government) primary schools in Victoria, Australia. To contextualize the study, issues involving the history of music education in Victorian government primary schools, current national and state music curricula, particular music teaching approa...

  18. Alliance-focused therapy for anorexia nervosa: integrative relational and behavioral change treatments in a single-case experimental design.

    Science.gov (United States)

    Satir, Dana A; Goodman, David M; Shingleton, Rebecca M; Porcerelli, John H; Gorman, Bernard S; Pratt, Elizabeth M; Barlow, David H; Thompson-Brenner, Heather

    2011-12-01

    Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention and poor outcome. One explanation for drop-out is weak treatment alliances. A single-case experimental analysis accompanied by in-depth qualitative description is presented for Ms. O, who received a novel treatment for AN called Alliance Focused Treatment (AFT) that attends to ruptures in the alliance, interpersonal difficulties and emotional avoidance. At intake Ms. O met diagnostic criteria for AN, Major Depressive Disorder, and Social Phobia. She was characterized as having symptoms of Obsessive Compulsive, Avoidant, and Depressive personality disorders. Treatment began with a Baseline followed by the experimental (AFT) and comparison treatments (Behavioral Change Treatment [BCT]) using a replicated experimental single-case phase change design. Graphs of slopes of kilocalorie and alliance change facilitated observation of treatment effects. Ms. O participated in 16 sessions of AFT and 8 sessions of BCT with specific benefits. Ratings of the treatment alliance were consistently high and she evidenced significant changes in weight, quality of life, and personality pathology. Associations between rupture/repair episodes and kilocalorie increases were observed. The utility of the treatment relationship in facilitating emotional expression was evident. At posttreatment, Ms. O endorsed cognitive AN symptoms, although these were not explicitly treated. This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. Further research on emotion regulation in AN and its effect on the treatment relationship are needed.

  19. Clinical Perspective A case of effective single-session treatment for ...

    African Journals Online (AJOL)

    This article reports a systematic clinical case study of the psychological assessment and treatment of Daniel (9), a coloured South African boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) (inattentive type). The case is of scientific interest because: (1) there was only a single treatment session, in which ...

  20. CONSUMPTION AND COMMUNICATION OF LUXURY BRANDS ONLINE – ILLUSTRATING A QUALITATIVE ONLINE CASE STUDY

    Directory of Open Access Journals (Sweden)

    Anita Radón

    2013-06-01

    Full Text Available Internet research has grown tremendously over the last decade and we see new and elaborate ways to use the Internet for data generation with increased technological abilities as well as increased Internet usage among companies and consumers. This paper illustrates a qualitative online study within the field of marketing with focus on the consumption and communication of brands. The specific interest is in showing how a particular phenomenon is studied using different Internet research methods and how this has resulted in more thick qualitative descriptions of consumption and communication in an online environment. The paper shows how the aim and context of a study leads to an Internet research approach and how the online study was conducted, the methods that were used, the results it gave and thus also sketches the possibilities and future of Internet research.

  1. Reinvestigations of six unusual paternity cases by typing of autosomal single-nucleotide polymorphisms

    DEFF Research Database (Denmark)

    Børsting, Claus; Morling, Niels

    2012-01-01

    and published as case work examples in forensic journals. Here, the cases were reinvestigated by typing the samples for 49 autosomal single-nucleotide polymorphisms (SNPs) using the SNPforID multiplex assay. RESULTS: Three cases were solved by the SNP investigation without the need for any additional testing....... In two cases, the SNP results supported the conclusions based on STRs. In the last case, the SNP results spoke in favor of paternity, and the combined paternity index based on autosomal STRs and SNPs was 12.3 billion. Nevertheless, the alleged father was excluded by X-chromosome typing. CONCLUSION...

  2. Regions and media from quantitative and qualitative perspectives: the case of Czech Republic

    Directory of Open Access Journals (Sweden)

    Jan Sucháček

    2013-01-01

    Full Text Available Media become increasingly important in co-creating the image of spatial units at various scales. The situation is even more intriguing in transition/post-transitions countries, which were exposed to modernization trends in rather short, almost compressed periods. The article aims at showing how media shape the image of NUTS III regions in the Czech Republic. Comparisons show TV coverage embodies media agenda in a satisfactory manner as it has one of the highest impacts on the public on the one hand and is representative enough on the other. That is why TV coverage at the national level with contributions related to individual NUTS III in the Czech Republic was chosen as a point of departure. Thus, the objective of the paper is to analyze and interpret TV news related to NUTS III regions in the Czech Republic. This will be accomplished from both quantitative and qualitative perspectives. Quantitative analysis is focusing on the number of contributions related to the size of the region in question. Nonetheless, self-governing regions in the Czech Republic will be evaluated also from qualitative perspective when the composition of TV news will be accentuated. Although it is stated only seldom media analysis is of utmost importance in relation to regional development. In order to quantify and evaluate afore mentioned dependencies the methods of regression and correlation analysis will be utilized. Moreover, correspondence analysis and analysis of contingency tables will be used in the qualitative part of our research.

  3. A single qualitative study can show same findings as years of quantitative research: Obstructive sleep apnoea as an example

    Directory of Open Access Journals (Sweden)

    Howard Tandeter

    2016-06-01

    Full Text Available Background Many years of quantitative research led to our present knowledge of the symptoms and associated features (S&AF of the obstructive sleep apnoea (OSA syndrome. Aims 1. To prove that a qualitative research approach may identify symptoms and associated features of OSA in less time/effort than that used in a quantitative approach; 2. To describe the experience of patients with OSA and the effects of the syndrome on their quality of life and that of their spouses and families (issues that quantitative methods fail to recognize. Methods We used a narrative inquiry methodology (qualitative research. The sample was selected using the “snowball sampling technique". The sample included 10 patients with moderate to severe OSA who had good adherence to CPAP and significant clinical improvement after treatment, and 3 of the patient’s spouses. Results The following issues were identified: A long pre-diagnosis phase of OSA (20 years in one of the patients; Characteristic S&AF of the syndrome as experienced by patients and their spouses; The need for increased awareness of both the public and the medical establishment in regards to this disorder; Premature ejaculation (not reported previously and nightmares (non-conclusive in the literature were identified and improved with CPAP therapy. Conclusion With the use of quantitative research methods it took decades to discover things that we found in one simple qualitative study. We therefore urge scientists to use more often these qualitative methods when looking for S&AF of diseases and syndromes.

  4. TA Treatment of Depression - A Hermeneutic Single-Case Efficacy Design Study - ‘Linda’ - a mixed outcome case

    Directory of Open Access Journals (Sweden)

    Mark Widdowson

    2013-07-01

    Full Text Available Hermeneutic Single-Case EfficacyDesign (HSCED is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study is the fourth article of a case series which has investigated the process and outcome of transactional analysis psychotherapy using Hermeneutic Single-Case Efficacy Design (Elliott 2002. The client, Linda, was a 45 yearold white British woman with mild depression who attended nine sessions of therapy. The conclusion of the judges was that this was a mixed-outcome case:whilst the client improved over the course of therapy and was positive about her experience of therapy, her changes did not last when she experienced considerable stressful events during follow-up. Linda provided a detailed and idiosyncratic description of the aspects of the therapy which were most helpful for her. A cross-case comparison with other cases in this series suggests several interesting features which are worthy of further investigation. Specifically, the use of a shared theoretical framework and an egalitarian therapeutic relationship were helpful. As with other cases in this series, the client experienced positive changes in her interpersonal relationships suggesting that this outcome of TA therapy warrants further investigation

  5. Change and Continuity in Vaping and Smoking by Young People: A Qualitative Case Study of A Friendship Group

    Directory of Open Access Journals (Sweden)

    Neil McKeganey

    2018-05-01

    Full Text Available This paper reports a qualitative case study of a small friendship group (n = 8 in Glasgow, Scotland. Interviewed twice at six months apart, these 16 to 17 year olds reported a substantial change in their use of and attitudes towards e-cigarettes and tobacco. At time 1, vaping generated much excitement and interest, with six out of eight individuals having their own vape device. At time 2, only two young people still vaped, with the others no longer professing any interest in continued vaping. The two regular smokers, who had been smoking before they first vaped, now only vaped privately and to reduce their tobacco intake. This small case study illustrates plasticity in the use of these devices; just as young people can move into their use, so too can they move away from them. This small study underscores the importance of differentiating between long-term, frequent, consistent use and more episodic, experimental and infrequent use by young people and for undertaking a measurement of actual e-cigarette use at multiple time points in both quantitative and qualitative studies. In addition, the case study illustrates the powerful impact which peers can have on teenagers use of e-cigarettes.

  6. Change and Continuity in Vaping and Smoking by Young People: A Qualitative Case Study of A Friendship Group.

    Science.gov (United States)

    McKeganey, Neil; Barnard, Marina

    2018-05-17

    This paper reports a qualitative case study of a small friendship group ( n = 8) in Glasgow, Scotland. Interviewed twice at six months apart, these 16 to 17 year olds reported a substantial change in their use of and attitudes towards e-cigarettes and tobacco. At time 1, vaping generated much excitement and interest, with six out of eight individuals having their own vape device. At time 2, only two young people still vaped, with the others no longer professing any interest in continued vaping. The two regular smokers, who had been smoking before they first vaped, now only vaped privately and to reduce their tobacco intake. This small case study illustrates plasticity in the use of these devices; just as young people can move into their use, so too can they move away from them. This small study underscores the importance of differentiating between long-term, frequent, consistent use and more episodic, experimental and infrequent use by young people and for undertaking a measurement of actual e-cigarette use at multiple time points in both quantitative and qualitative studies. In addition, the case study illustrates the powerful impact which peers can have on teenagers use of e-cigarettes.

  7. Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

    Science.gov (United States)

    Goethals, S; Dierckx de Casterlé, B; Gastmans, C

    2013-05-01

    The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Neoliberalism, welfare policy and health: a qualitative meta-synthesis of single parents' experience of the transition from welfare to work.

    Science.gov (United States)

    Cook, Kay

    2012-09-01

    Following the United States' lead, the emergence of neoliberal welfare policy across the western world has resulted in employment programmes for single parents, who are predominantly single mothers. While some governments claim that employment will improve single parents' incomes and well-being, researchers dispute that single parents can unproblematically move into the workforce, with net positive effects. While researchers have quantified the socio-economic effect of these programmes, in particular on participant health, no study has yet synthesized participants' experiences of welfare-to-work. Here, I present a meta-synthesis of eight qualitative health-related studies of single parents' (and exclusively single mothers') welfare-to-work transition. I report that single mothers faced a combination of health and economic issues which made their transition from welfare to work difficult, including degrees of poor physical and mental health. For participants in the United States, these health issues were often compounded by a loss of health benefits on moving into low-wage employment. In countries where a return to employment was required before children reached school age, a lack of affordable and appropriate child care, especially for children with health problems, exacerbated these difficulties. As a result of scarce resources, single mothers in receipt of welfare benefits often relied on food banks or went without food. A return to the workforce did not alleviate this problem as additional child care and reduced government subsidies depleted the funds available for food. I conclude that welfare-to-work policies are underpinned by the neoliberal assumption that the market more efficiently distributes resources than the State. However, for the women in the studies examined here, labour market participation often depleted access to essential resources. Interventions to address the 'problem' of welfare dependency must recognize the complex interplay between work

  9. Treatment of obsessive morbid jealousy with cognitive analytic therapy: An adjudicated hermeneutic single-case efficacy design evaluation.

    Science.gov (United States)

    Curling, Louise; Kellett, Stephen; Totterdell, Peter; Parry, Glenys; Hardy, Gillian; Berry, Katherine

    2018-03-01

    The evidence base for the treatment of morbid jealousy with integrative therapies is thin. This study explored the efficacy of cognitive analytic therapy (CAT). An adjudicated hermeneutic single-case efficacy design evaluated the cognitive analytic treatment of a patient meeting diagnostic criteria for obsessive morbid jealousy. A rich case record was developed using a matrix of nomothetic and ideographic quantitative and qualitative outcomes. This record was then debated by sceptic and affirmative research teams. Experienced psychotherapy researchers acted as judges, assessed the original case record, and heard the affirmative-versus-sceptic debate. Judges pronounced an opinion regarding the efficacy of the therapy. The efficacy of CAT was supported by all three judges. Each ruled that change had occurred due to the action of the therapy, beyond any level of reasonable doubt. This research demonstrates the potential usefulness of CAT in treating morbid jealousy and suggests that CAT is conceptually well suited. Suggestions for future clinical and research directions are provided. The relational approach of CAT makes it a suitable therapy for morbid jealousy. The narrative reformulation component of CAT appears to facilitate early change in chronic jealousy patterns. It is helpful for therapists during sessions to use CAT theory to diagrammatically spell out the patterns maintaining jealousy. © 2017 The British Psychological Society.

  10. The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE 2016 Statement

    Directory of Open Access Journals (Sweden)

    Robyn L. Tate

    2016-04-01

    Full Text Available We developed a reporting guideline to provide authors with guidance about what should be reported when writing a paper for publication in a scientific journal using a particular type of research design: the single-case experimental design. This report describes the methods used to develop the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE 2016. As a result of 2 online surveys and a 2-day meeting of experts, the SCRIBE 2016 checklist was developed, which is a set of 26 items that authors need to address when writing about single-case research. This article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016 that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated. We recommend that the SCRIBE 2016 is used by authors preparing manuscripts describing single-case research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.

  11. Enhancing the hermeneutic single-case efficacy design: Bridging the research-practice gap.

    Science.gov (United States)

    Wall, Jessie M; Kwee, Janelle L; Hu, Monica; McDonald, Marvin J

    2017-09-01

    Systematic case study designs are emerging as alternative paradigm strategies for psychotherapy and social science research. Through enhanced sensitivity to context, these designs examine idiographic profiles of causal processes. We specifically advocate the use of the hermeneutic single-case efficacy design (HSCED). HSCED has recently been used to investigate the efficacy of an existing therapy with a new population (Observed and Experiential Integration for athlete performance barriers) and an emerging therapy (Lifespan Integration Therapy). We describe innovations in HSCED that were implemented for these studies. These developments include (a) integrating psychotherapists as case developers, (b) incorporating multiple cases in one investigation, and (c) tailoring the repertoire of assessment tools. These extensions strategically incorporated principles of contextual paradigms in HSCED, thus complementing single-case designs that neglect idiographic contexts. We discuss recommendations for using HSCED in practice-based research, highlighting its potential as a bridge to address the research-practice gap.

  12. The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 Statement †

    Science.gov (United States)

    Tate, Robyn L.; Perdices, Michael; Rosenkoetter, Ulrike; Shadish, William; Vohra, Sunita; Barlow, David H.; Horner, Robert; Kazdin, Alan; Kratochwill, Thomas; McDonald, Skye; Sampson, Margaret; Shamseer, Larissa; Togher, Leanne; Albin, Richard; Backman, Catherine; Douglas, Jacinta; Evans, Jonathan J.; Gast, David; Manolov, Rumen; Mitchell, Geoffrey; Nickels, Lyndsey; Nikles, Jane; Ownsworth, Tamara; Rose, Miranda; Schmid, Christopher H.; Wilson, Barbara

    2017-01-01

    ABSTRACT We developed a reporting guideline to provide authors with guidance about what should be reported when writing a paper for publication in a scientific journal using a particular type of research design: the single-case experimental design. This report describes the methods used to develop the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016. As a result of 2 online surveys and a 2-day meeting of experts, the SCRIBE 2016 checklist was developed, which is a set of 26 items that authors need to address when writing about single-case research. This article complements the more detailed SCRIBE 2016 Explanation and Elaboration article (Tate et al., 2016) that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single-case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated. We recommend that the SCRIBE 2016 is used by authors preparing manuscripts describing single-case research for publication, as well as journal reviewers and editors who are evaluating such manuscripts. SCIENTIFIC ABSTRACT Reporting guidelines, such as the Consolidated Standards of Reporting Trials (CONSORT) Statement, improve the reporting of research in the medical literature (Turner et al., 2012). Many such guidelines exist and the CONSORT Extension to Nonpharmacological Trials (Boutron et al., 2008) provides suitable guidance for reporting between-groups intervention studies in the behavioural sciences. The CONSORT Extension for N-of-1 Trials (CENT 2015) was developed for multiple crossover trials with single individuals in the medical sciences (Shamseer et al., 2015; Vohra et al., 2015), but there is no reporting guideline in the CONSORT tradition for single-case research used in the behavioural sciences. We

  13. Shared written case formulations and weight change in outpatient therapy for anorexia nervosa: a naturalistic single case series.

    Science.gov (United States)

    Gladwin, Alice M; Evangeli, Michael

    2013-01-01

    The therapeutic effects of written shared case formulations are underexplored and have not been examined in anorexia nervosa. This study explored the relationship between (a) the delivery (b) the quality of a shared written case formulation and weight in outpatient psychological therapy for anorexia nervosa. A naturalistic single case series approach was used to examine the case notes of women who had attended a specialist eating disorders service over a 2-year period. The case notes of 15 adult women who had undergone outpatient psychological therapy for anorexia nervosa with a shared written case formulation component were reviewed. The impact of the quality of the case formulation on weekly weight was examined for 14 of the clients where the case formulation was available. The nature of the relationship between the delivery of the written shared case formulation and weight was examined for all 15 clients. There was some evidence to support an association between delivery of the shared written case formulation and weight changes (both weight gain [five out of 15 clients] and weight loss [three out of 15 clients]) in individual cases. Higher case formulation quality was related to cases where weight change did not occur. The delivery of case formulations can be associated with important therapeutic change (both beneficial and potentially harmful) in anorexia nervosa. Future research into the causal mechanisms associated with sharing formulations will face the challenge of adopting strategies that allow for an in-depth exploration of complex therapy variables whilst overcoming methodological challenges. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Using Interpretive Qualitative Case Studies for Exploratory Research in Doctoral Studies: A Case of Information Systems Research in Small and Medium Enterprises

    Directory of Open Access Journals (Sweden)

    Shana R. Ponelis

    2015-12-01

    Full Text Available The use of the case study method has gained mainstream acceptance in both entrepreneurship and information systems research to develop conceptual and theoretical models that are novel, yet grounded in the literature. In spite of many texts on the case study method and the growing acceptance and use of thereof, there are relatively few examples that discuss how to apply the case study method. The purpose of this paper is to provide such an example by drawing upon the author’s research for her doctoral dissertation in the discipline of information systems and entrepreneurship research. First, the use of qualitative case studies as research method is motivated, then the importance of the research paradigm is discussed and the interpretivist research paradigm justified followed by a detailed discussion of the research design. The paper concludes with a discussion of lessons learned and recommendations based on the author’s experience with using the case study method. The practical yet theoretically founded approach of this paper may be useful to doctoral students who are considering or using the case study method. Equally, supervisors and others involved in research training may find this paper useful as an illustrative example of the case study method for their students.

  15. Connections Between Qualitative and Quantitative Thinking About Proportion: The Case of Paulina

    Science.gov (United States)

    Ruiz Ledesma, Elena Fabiola; Valdemoros Alvarez, Marta Elena

    2004-01-01

    The case study presented in this report was part of assessing a teaching proposal on ratio and proportion. A group of sixth-grade students of elementary education in Mexico participated in the implementation of the proposal. The girl of the case study was representative of those students in the group who had a lot of recourse to handling…

  16. Event-specific qualitative and quantitative detection of five genetically modified rice events using a single standard reference molecule.

    Science.gov (United States)

    Kim, Jae-Hwan; Park, Saet-Byul; Roh, Hyo-Jeong; Shin, Min-Ki; Moon, Gui-Im; Hong, Jin-Hwan; Kim, Hae-Yeong

    2017-07-01

    One novel standard reference plasmid, namely pUC-RICE5, was constructed as a positive control and calibrator for event-specific qualitative and quantitative detection of genetically modified (GM) rice (Bt63, Kemingdao1, Kefeng6, Kefeng8, and LLRice62). pUC-RICE5 contained fragments of a rice-specific endogenous reference gene (sucrose phosphate synthase) as well as the five GM rice events. An existing qualitative PCR assay approach was modified using pUC-RICE5 to create a quantitative method with limits of detection correlating to approximately 1-10 copies of rice haploid genomes. In this quantitative PCR assay, the square regression coefficients ranged from 0.993 to 1.000. The standard deviation and relative standard deviation values for repeatability ranged from 0.02 to 0.22 and 0.10% to 0.67%, respectively. The Ministry of Food and Drug Safety (Korea) validated the method and the results suggest it could be used routinely to identify five GM rice events. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Public health implications of 4 decades of neoliberal policy: a qualitative case study from post-industrial west central Scotland.

    Science.gov (United States)

    Garnham, L M

    2017-12-01

    The UK has long had a strong commitment to neoliberal policy, the risks of which for population health are well researched. Within Europe, Scotland demonstrates especially poor health outcomes, much of which is driven by high levels of deprivation, wide inequalities and the persistent impacts of deindustrialisation. The processes through which neoliberalism has contributed to this poor health record are the subject of significant research interest. Qualitative case study of a post-industrial town in west central Scotland. Primary data were collected using photovoice (11) and oral history (9) interviews, supplemented by qualitative and quantitative secondary source data. For those who fared poorly after the initial introduction of neoliberal policy in the 1970s, subsequent policy decisions have served to deepen and entrench negative impacts on the determinants of health. Neoliberalism has constituted a suite of rapidly and concurrently implemented policies, cross-cutting a variety of domains, which have reached into every part of people's lives. In formerly industrial parts of west central Scotland, policy developments since the 1970s have generated multiple and sustained forms of deprivation. This case study suggests that a turn away from neoliberal policy is required to improve quality of life and health. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  18. Coherent control of the single-photon multichannel scattering in the dissipation case

    Science.gov (United States)

    Shi, Yun-Xia; Wang, Hang-Yu; Ma, Jin-Lou; Li, Qing; Tan, Lei

    2018-03-01

    Based on the quasi-boson approach, a model of a Λ-type three-level atom coupled to a X-shaped coupled cavity arrays (CCAs) is used to study the transport properties of a single-photon in the dissipative case, and a classical field is introduced to motivate the one transition of the Λ-type three-level atom (ΛTLA). The analytical expressions of transmission and transfer rate are obtained. Our results show that the cavity dissipation will obviously weaken the single-photon transfer rate where the incident energy of the single photon is resonant with the excited energy of the atom. Whether the cavity dissipation exists or not, the single photon can be almost confined in the incident channel at large detuning, and we can regulate the intensity of the classical field to control the total transmission of the single-photon.

  19. A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient-Clinician Interactions.

    Science.gov (United States)

    Ng, Stella L; Phelan, Shanon; Leonard, MaryAnn; Galster, Jason

    2017-06-01

    Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients' needs, and attentive to society's influence. The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. "Connected" refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. The clinician case highlighted clinicians' heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed

  20. A qualitative analysis of student-written law and ethics cases: A snapshot of PY2 student experience.

    Science.gov (United States)

    Karwaki, Tanya E; Hazlet, Thomas K

    2017-05-01

    This study was designed to better understand pharmacy students' experiences and recognition of legal and ethical tensions existing in pharmacy practice as demonstrated in student-written law and ethics cases. A qualitative analysis of 132 student-written cases representing the team efforts of 1053 students over a 12-year time period was conducted. Student-written cases were coded and analyzed thematically. Our results demonstrate the types of ethical and legal issues our students have experienced in pharmacy practice during the first five quarters of their professional education. Our data highlight three themes: 1) ethical dilemmas presented when the law is misapplied; 2) ethical dilemmas presented when an institutional policy or law was viewed as insufficient; and 3) ethical dilemmas presented as provider distress. The third theme was further subdivided into five subthemes. The themes that emerged from this study represent some of the ethical dilemmas that second professional year students have encountered and how these dilemmas may intersect with legal boundaries. Educators can use cases demonstrating these themes to reinforce law and ethics education in the curriculum, thus helping prepare students for pharmacy practice. This article recommends how and when to use case examples. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Qualitative Event-Based Diagnosis: Case Study on the Second International Diagnostic Competition

    Science.gov (United States)

    Daigle, Matthew; Roychoudhury, Indranil

    2010-01-01

    We describe a diagnosis algorithm entered into the Second International Diagnostic Competition. We focus on the first diagnostic problem of the industrial track of the competition in which a diagnosis algorithm must detect, isolate, and identify faults in an electrical power distribution testbed and provide corresponding recovery recommendations. The diagnosis algorithm embodies a model-based approach, centered around qualitative event-based fault isolation. Faults produce deviations in measured values from model-predicted values. The sequence of these deviations is matched to those predicted by the model in order to isolate faults. We augment this approach with model-based fault identification, which determines fault parameters and helps to further isolate faults. We describe the diagnosis approach, provide diagnosis results from running the algorithm on provided example scenarios, and discuss the issues faced, and lessons learned, from implementing the approach

  2. A methodological review of qualitative case study methodology in midwifery research.

    Science.gov (United States)

    Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

    2016-10-01

    To explore the use and application of case study research in midwifery. Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis. An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting. © 2016 John Wiley & Sons Ltd.

  3. The role of qualitative risk assessment in environmental management: A Kazakhstani case study

    Energy Technology Data Exchange (ETDEWEB)

    Kajenthira, Arani, E-mail: arani.kajenthira@gmail.com [Belfer Center for Science and International Affairs, Harvard Kennedy School (United States); Department of Engineering Science, University of Oxford (United Kingdom); Holmes, John, E-mail: johnho@earth.ox.ac.uk [Department of Earth Sciences, University of Oxford (United Kingdom); McDonnell, Rachael, E-mail: rachael.mcdonnell@ouce.ox.ac.uk [School of Geography and the Environment, University of Oxford (United Kingdom)

    2012-03-15

    Successful environmental management is partly contingent on the effective recognition and communication of environmental health risks to the public. Yet risk perceptions are known to differ between experts and laypeople; laypeople often exhibit higher perceptions of risk in comparison to experts, particularly when these risks are associated with radiation, nuclear power, or nuclear waste. This paper consequently explores stakeholder risk perceptions associated with a mercury-contaminated chloralkali production facility in Kazakhstan. Using field observations and in-depth interviews conducted in the vicinity of the Pavlodar Chemical Plant, this work assesses the relevance of the substantial on-site mercury contamination to the health and livelihoods of the local population with the goal of informing remediation activity through a combination of quantitative and qualitative risk assessments. The findings of this research study cannot be broadly generalized to all the primary stakeholders of the site due to the small sample size; however, the indifference of the local population towards both the possibility of mercury-related health risks and the need for mitigation activity could pose a substantial barrier to successful site remediation and also suggests that a qualitative understanding of stakeholder risk perceptions could play an important role in striving towards sustainable, long-term environmental risk management. - Highlights: Black-Right-Pointing-Pointer A mercury spill in Kazakhstan created environmental and health risks. Black-Right-Pointing-Pointer We evaluated the role of risk communication/perception in environmental management. Black-Right-Pointing-Pointer Long-term risk mitigation was impeded by lack of engagement of site stakeholders. Black-Right-Pointing-Pointer Prioritizing engagement of the local population is critical for remediation success.

  4. The role of qualitative risk assessment in environmental management: A Kazakhstani case study

    International Nuclear Information System (INIS)

    Kajenthira, Arani; Holmes, John; McDonnell, Rachael

    2012-01-01

    Successful environmental management is partly contingent on the effective recognition and communication of environmental health risks to the public. Yet risk perceptions are known to differ between experts and laypeople; laypeople often exhibit higher perceptions of risk in comparison to experts, particularly when these risks are associated with radiation, nuclear power, or nuclear waste. This paper consequently explores stakeholder risk perceptions associated with a mercury-contaminated chloralkali production facility in Kazakhstan. Using field observations and in-depth interviews conducted in the vicinity of the Pavlodar Chemical Plant, this work assesses the relevance of the substantial on-site mercury contamination to the health and livelihoods of the local population with the goal of informing remediation activity through a combination of quantitative and qualitative risk assessments. The findings of this research study cannot be broadly generalized to all the primary stakeholders of the site due to the small sample size; however, the indifference of the local population towards both the possibility of mercury-related health risks and the need for mitigation activity could pose a substantial barrier to successful site remediation and also suggests that a qualitative understanding of stakeholder risk perceptions could play an important role in striving towards sustainable, long-term environmental risk management. - Highlights: ► A mercury spill in Kazakhstan created environmental and health risks. ► We evaluated the role of risk communication/perception in environmental management. ► Long-term risk mitigation was impeded by lack of engagement of site stakeholders. ► Prioritizing engagement of the local population is critical for remediation success.

  5. Successful angioplasty of tripolar renal arteries in a single setting: a case report.

    Science.gov (United States)

    Sharma, Gyarsi Lal; Morice, Marie-Claude; Catineau, Patrick

    2002-08-01

    Renal artery stenosis (RAS) is one of the important causes of correctable hypertension. There are various modes of therapy for RAS, including percutaneous transluminal renal angioplasty (PTRA) and surgery. PTRA has emerged as the treatment of choice in cases of renal artery stenosis. PTRA combined with stenting is associated with good immediate and long-term results. This case report describes successful angioplasty of bilateral multiple renal arteries in a single setting with good immediate and follow-up results.

  6. Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model: A qualitative case study.

    Science.gov (United States)

    Chowthi-Williams, Annette; Curzio, Joan; Lerman, Stephen

    2016-01-01

    Curriculum changes are a regular feature of nurse education, yet little is known about how such changes are managed. Research in this arena is yet to emerge. Evaluation of how a curriculum change in nurse education was managed through the application of a business change management model. A qualitative case study: the single case was the new curriculum, the Primary Care Pathway. One executive, three senior managers, two academics and nineteen students participated in this study in one faculty of health and social care in a higher education institution. The findings suggest that leadership was pivotal to the inception of the programme and guiding teams managed the change and did not take on a leadership role. The vision for the change and efforts to communicate it did not reach the frontline. Whilst empowerment was high amongst stakeholders and students, academics felt dis-empowered. Short-term wins were not significant in keeping up the momentum of change. The credibility of the change was under challenge and the concept of the new programme was not yet embedded in academia. Differences between the strategic and operational part of the organisation surfaced with many challenges occurring at the implementation stage. The business change model used was valuable, but was found to not be applicable during curriculum changes in nurse education. A new change model emerged, and a tool was developed alongside to aid future curriculum changes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Virtual peer-delivered memory intervention: a single-case experimental design in an adolescent with chronic memory impairment.

    Science.gov (United States)

    Cooper, Janine M; Lockett, Stephen; McIlroy, Alissandra; Gonzalez, Linda

    2018-01-01

    Children and adolescents with chronic memory impairment may develop coping strategies that enable functioning, yet these often remain undetectable using traditional psychometric measures. Personalized intervention studies that promote the use of such strategies designed specifically for use by this young cohort are scarce. To investigate the effect of a novel virtual reality peer-delivered memory intervention on the everyday functioning and well-being of SE, a 17-year-old female with a history of chronic verbal memory issues, impaired autobiographical event recall and elevated mood symptoms. A single-case ABA experimental design study was used to assess change. Following initial baseline assessment using objective neuropsychological and subjective functional questionnaires and intervention training, case SE used the intervention daily for 3 weeks before repeating key outcome measures. Using non-overlap of all pairs and qualitative feedback analysis, the results revealed a significant increase in event recall and self-reported positive changes to levels of everyday functioning. Supporting autobiographical event recall and prospective memory via a virtual peer-delivered intervention may lead to reduction in cognitive load, and benefit overall well-being and everyday functioning.

  8. Public Health Economic Burden Associated with Two Single Measles Case Investigations - Colorado, 2016-2017.

    Science.gov (United States)

    Marx, Grace E; Chase, Jennifer; Jasperse, Joseph; Stinson, Kaylan; McDonald, Carol E; Runfola, Janine K; Jaskunas, Jillian; Hite, Donna; Barnes, Meghan; Askenazi, Michele; Albanese, Bernadette

    2017-11-24

    During July 2016-January 2017, two unrelated measles cases were identified in the Denver, Colorado area after patients traveled to countries with endemic measles transmission. Each case resulted in multiple exposures at health care facilities and public venues, and activated an immediate and complex response by local and state public health agencies, with activities led by the Tri-County Health Department (TCHD), which serves Adams, Arapahoe, and Douglas counties. To track the economic burden associated with investigating and responding to single measles cases, personnel hours and supply costs incurred during each investigation were tracked prospectively. No secondary cases of measles were identified in either investigation. Postexposure prophylaxis (PEP) was administered to 31 contacts involving the first case; no contacts of the second case were eligible for PEP because of a delay in diagnosing measles disease. Public health costs of disease investigation in the first and second case were estimated at $49,769 and $18,423, respectively. Single measles cases prompted coordinated public health action and were costly and resource-intensive for local public health agencies.

  9. Forecasting demand for single-period products : A case study in the apparel industry

    NARCIS (Netherlands)

    Mostard, Julien; Teunter, Ruud; de Koster, Rene

    2011-01-01

    The problem considered is that of forecasting demand for single-period products before the period starts. We study this problem for the case of a mail order apparel company that needs to order its products pre-season. The lack of historical demand data implies that other sources of data are needed.

  10. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

    Science.gov (United States)

    Stapleton, Drue; Hawkins, Andrew

    2015-01-01

    Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

  11. The Iterative Use of Single Case Research Designs to Advance the Science of EI/ECSE

    Science.gov (United States)

    Barton, Erin E.; Ledford, Jennifer R.; Lane, Justin D.; Decker, Jessica; Germansky, Sara E.; Hemmeter, Mary Louise; Kaiser, Ann

    2016-01-01

    Research in early intervention/early childhood special education (EI/ECSE) is focused on identifying effective practices related to positive outcomes for young children with disabilities and their families. Individual responses to evidence-based practices are often variable, and non-responders are common. Single case research (SCR) might be…

  12. Applying Quality Indicators to Single-Case Research Designs Used in Special Education: A Systematic Review

    Science.gov (United States)

    Moeller, Jeremy D.; Dattilo, John; Rusch, Frank

    2015-01-01

    This study examined how specific guidelines and heuristics have been used to identify methodological rigor associated with single-case research designs based on quality indicators developed by Horner et al. Specifically, this article describes how literature reviews have applied Horner et al.'s quality indicators and evidence-based criteria.…

  13. Publishing Single-Case Research Design Studies That Do Not Demonstrate Experimental Control

    Science.gov (United States)

    Tincani, Matt; Travers, Jason

    2018-01-01

    Demonstration of experimental control is considered a hallmark of high-quality single-case research design (SCRD). Studies that fail to demonstrate experimental control may not be published because researchers are unwilling to submit these papers for publication and journals are unlikely to publish negative results (i.e., the file drawer effect).…

  14. Single-Case Design and Evaluation in R: An Introduction and Tutorial for School Psychologists

    Science.gov (United States)

    McGill, Ryan J.

    2017-01-01

    For the appraisal of single-case intervention data, school psychologists have been encouraged to focus most, if not all, of their interpretive weight on the visual inspection of graphed data. However, existing software programs provide practitioners with limited features for systematic visual inspection. R (R Development Core Team, 2014) is a…

  15. The Causes of Churn in the Telecommunication Industry: A Single, Exploratory Case Study on Kenyan Carriers

    Science.gov (United States)

    Halim, Joseph

    2015-01-01

    This single explorative case study investigated the causes of churn in the telecommunication industry in Kenya, narrowed down to include only the capital city of Nairobi. The question of this dissertation was split into three sub-questions. The first sub-question investigated the behavioral patterns of customers causing churn. The second…

  16. ADHD Symptom Reduction in Elementary Students: A Single-Case Effectiveness Design

    Science.gov (United States)

    Schottelkorb, April A.; Ray, Dee C.

    2009-01-01

    The authors used a single-case design to examine the effectiveness of child-centered play therapy (CCPT) and person-centered teacher consultation (PCTC) for four elementary students identified with attention deficit hyperactivity disorder (ADHD) symptoms. Two students participated in CCPT and their teachers participated in PCTC. Two students…

  17. Randomization and Data-Analysis Items in Quality Standards for Single-Case Experimental Studies

    Science.gov (United States)

    Heyvaert, Mieke; Wendt, Oliver; Van den Noortgate, Wim; Onghena, Patrick

    2015-01-01

    Reporting standards and critical appraisal tools serve as beacons for researchers, reviewers, and research consumers. Parallel to existing guidelines for researchers to report and evaluate group-comparison studies, single-case experimental (SCE) researchers are in need of guidelines for reporting and evaluating SCE studies. A systematic search was…

  18. Using Data Collection Apps and Single-Case Designs to Research Transformative Learning in Adults

    Science.gov (United States)

    Roessger, Kevin M.; Greenleaf, Arie; Hoggan, Chad

    2017-01-01

    To overcome situational hurdles when researching transformative learning in adults, we outline a research approach using single-case research designs and smartphone data collection apps. This approach allows researchers to better understand learners' current lived experiences and determine the effects of transformative learning interventions on…

  19. No Randomization? No Problem: Experimental Control and Random Assignment in Single Case Research

    Science.gov (United States)

    Ledford, Jennifer R.

    2018-01-01

    Randomization of large number of participants to different treatment groups is often not a feasible or preferable way to answer questions of immediate interest to professional practice. Single case designs (SCDs) are a class of research designs that are experimental in nature but require only a few participants, all of whom receive the…

  20. Therapist-Aided Exposure for Women with Lifelong Vaginismus: A Replicated Single-Case Design

    Science.gov (United States)

    ter Kuile, Moniek M.; Bulte, Isis; Weijenborg, Philomeen T. M.; Beekman, Aart; Melles, Reinhilde; Onghena, Patrick

    2009-01-01

    Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period…

  1. Impact of Single-Case Pupil Descriptions on Student Teacher Attitudes towards Inclusive Education

    Science.gov (United States)

    Röhm, Alexander; Schnöring, Annika; Hastall, Matthias R.

    2018-01-01

    Institutional and individual stigmatization are still major barriers for children with disabilities to access education. Teacher attitudes towards inclusive education play a crucial role in this regard, and are shaped by single-case descriptions from mass media or other sources. Building on exemplification theory and priming, two experiments with…

  2. Robotic right colectomy using the Da Vinci Single-Site® platform: case report.

    Science.gov (United States)

    Morelli, Luca; Guadagni, Simone; Caprili, Giovanni; Di Candio, Giulio; Boggi, Ugo; Mosca, Franco

    2013-09-01

    While single-port laparoscopy for abdominal surgery is technically challenging, the Da Vinci Single-Site® robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present a case of single-incision, robotic right colectomy using this device. A 74-year-old female with malignant polyp of caecum was operated on with a single-site approach using the Da Vinci Single-Site® robotic surgery device. Resection and anastomosis were performed extra-corporeally after undocking the robot. The procedure was successfully completed in 200 min. No surgical complications occurred during the intervention and the post-operative stay and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of right colectomy using the Da Vinci Single-Site® robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are restoration of triangulation and reduced instrument clashes. Copyright © 2013 John Wiley & Sons, Ltd.

  3. 8. Therapeutic and Educational Potential of Combining Cognitive Behavioural Therapy and Art – Qualitative Analysis of a Case Study

    Directory of Open Access Journals (Sweden)

    Růžička Michal

    2016-03-01

    Full Text Available Cognitive behavioural psychotherapy is, just like other psychotherapeutic systems, of an eclectic nature. Should a therapist be successful across a wide range of issues, he/she needs to be adaptable, flexible and eclectic in terms of the techniques applied. Eclectically oriented therapists use a wide range of interventions; however, they adhere to individual theoretical structures. The aim of the paper is to point out the application of a combination of artistic activities within the system of the Cognitive behavioural therapy. For this purpose the paper presents a qualitative analysis of two case studies. We formulated the following research questions. Can the methods of combining the cognitive behavioural therapy and art accelerate the course of therapy? Can the methods of combining the cognitive behavioural therapy and art be perceived by the client as effective? The phenomenon investigated in the case study is a functional analysis of a client’s case and subsequent application of therapeutic and educational techniques of the Cognitive behavioural therapy and art. In both case studies it was demonstrated that the involvement of therapeutic elements accelerated the course of therapy. The clients in the research sample assessed the therapy as beneficial.

  4. A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance.

    Science.gov (United States)

    Hung, Susanna Lok Lam; Fu, Sau Nga; Lau, Po Shan; Wong, Samuel Yeung Shan

    2015-01-31

    This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting. We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed. Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance. Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education

  5. A Qualitative Inquiry into the formation of Generational Cohorts: a Case of an Emerging Market

    Directory of Open Access Journals (Sweden)

    Hiram Ting

    2015-01-01

    Full Text Available This study use sociological theories of generations to identify generational cohorts for market segmentation. These theories are predominantly used in the West, hence little is known about their relevance in emerging markets, such as Malaysia. Past studies have mostly borrowed cohort labels from that of the U.S. sources, and assumed that their characteristics can be construed in the Malaysian context. Given the exploratory nature of the study, a qualitative approach by means of personal interview was conducted to identify the actual cohorts in Sarawak, a state in Malaysia. Specifically, major societal and historical events that Sarawakians could overtly recall due to their attachment to them during formative years were elicited. Accordingly forty-eight interviews were recorded, transcribed and content-analysed. Five cohorts were identified, and they were different from that of the U.S. sources. They were subsequently labelled as Neoteric-inheritors, Prospective-pursuers, Social-strivers, Idealistic-strugglers and Battling-lifers based on their collective experience of the events. The results show the relevance of theories of generations for market segmentation in emerging market.

  6. The Experience of Being a Guide Dog Puppy Raiser Volunteer: A Longitudinal Qualitative Collective Case Study

    Directory of Open Access Journals (Sweden)

    Anna Chur-Hansen

    2014-12-01

    Full Text Available There are no published studies that consider the experiences of guide dog puppy raisers. As these people are volunteers, their continued willingness to participate in the training of dogs for assisting the vision impaired and blind is essential for the viability of guide dog schools around the world. Using a qualitative, longitudinal methodology, data were collected from nine guide dog puppy raisers at four time points: before receiving the puppy, one week, then three months after the puppy arrived, and 13 months after the puppy arrived (at which time all puppies had left the raisers. Participants reported more challenges than benefits in raising the puppies. Volunteering to be a guide dog puppy raiser may not be the pleasant experience that is anticipated when community members first offer their services. Understanding what it is like to be a puppy raiser and working towards ways in which to address problems is essential, given that, without volunteers to train and care for puppies, vision impaired and blind people would not have access to guide dogs.

  7. Treatment of visuospatial neglect with biparietal tDCS and cognitive training: a single-case study

    Directory of Open Access Journals (Sweden)

    Anna-Katharine eBrem

    2014-09-01

    Full Text Available Symptoms of visuospatial neglect occur frequently after unilateral brain damage. Neglect hampers rehabilitation progress and is associated with reduced quality of life. However, existing treatment methods show limited efficacy. Transcranial direct current stimulation (tDCS is a neuromodulatory technique, which can be used to increase or decrease brain excitability. Its combination with conventional neglect therapy may enhance treatment efficacy.A 72-year-old male with a subacute ischaemic stroke of the right posterior cerebral artery suffering from visuospatial neglect, hemianopia, and hemiparesis was treated with biparietal tDCS and cognitive neglect therapy in a double-blind, sham-controlled single-case study. Four weeks of daily treatment sessions (5 days per week, 30 min were started 26 days post-stroke. During week 1 and 4 the patient received conventional neglect therapy, during week 2, conventional neglect therapy was combined once with sham and once with real biparietal tDCS. Week 3 consisted of daily sessions of real biparietal tDCS (1 mA, 20 min combined with neglect therapy. Outcome measures were assessed before, immediately after, as well as 1 week and 3 months after the end of treatment. They included subtests of the Test for Attentional Performance (TAP: covert attention (main outcome, alertness, visual field; the Neglect-Test (NET: line bisection, cancellation, copying; and activities of daily living (ADL. After real stimulation, covert attention allocation towards left-sided invalid stimuli was significantly improved, and line bisection and copying improved qualitatively as compared to sham stimulation. ADL were only improved at the 3-month follow-up. This single-case study demonstrates for the first time that combined application of tDCS and cognitive training may enhance training-induced improvements in measures of visuospatial neglect and is applicable in a clinical context.

  8. Embodying Authentic Leadership through Popular Education at Highlander Research and Education Center: A Qualitative Case Study

    Science.gov (United States)

    Glowacki-Dudka, Michelle; Griswold, Wendy

    2016-01-01

    In 2013 and 2014, workshops were held at Highlander Research and Education Center that explored the topics of authentic leadership and popular education. The participants shared their experiences through reflective writing upon completion of the workshops and approximately a year following. These reflections were developed into a case study. This…

  9. University ERP Implementation in Germany: Qualitative Exploratory Case Study of Administrative Staff Experiences

    Science.gov (United States)

    Thelen, Anja

    2015-01-01

    Enterprise Resource Planning (ERP) implementations are expensive, time-consuming, and often do not lead to the expected outcome of integrated IT systems. Many German universities are implementing ERP systems as Campus Management Systems (CMS) and a solution to any problem, need, or requirement the organization has. This exploratory case study…

  10. Young Registered Nurses' Intention to Leave the Profession and Professional Turnover in Early Career: A Qualitative Case Study

    Science.gov (United States)

    Salanterä, Sanna

    2013-01-01

    In a time of global nursing shortages an alarming number of young registered nurses have expressed a willingness to leave the profession. In this qualitative case study we investigate in depth why young nurses leave nursing profession and reeducate themselves for a new career. The study is based on longitudinal interviews of three young registered nurses in Finland. These nurses were first interviewed between December 2006 and May 2007, when they were 29–32 years old and having an intention to leave the profession. The second interview took place four years later, from January 2011 to March 2011 when all of them had made the transition to a new career. Data were analyzed in two stages. In the first stage, comprehensive career story narratives were formed on the basis of the interviews. In the second stage, emerging themes in these stories were compared, contrasted, and interpreted in the context of the overall career histories. Nursing as a second career choice and demanding work content as well as poor practice environment and the inability to identify with the stereotypical images of nurses were main themes that emerged from these career stories. The results of this interpretative qualitative study reflect a shift toward insights into understanding professional turnover as a complex and long-lasting process. PMID:24027640

  11. Young registered nurses' intention to leave the profession and professional turnover in early career: a qualitative case study.

    Science.gov (United States)

    Flinkman, Mervi; Isopahkala-Bouret, Ulpukka; Salanterä, Sanna

    2013-01-01

    In a time of global nursing shortages an alarming number of young registered nurses have expressed a willingness to leave the profession. In this qualitative case study we investigate in depth why young nurses leave nursing profession and reeducate themselves for a new career. The study is based on longitudinal interviews of three young registered nurses in Finland. These nurses were first interviewed between December 2006 and May 2007, when they were 29-32 years old and having an intention to leave the profession. The second interview took place four years later, from January 2011 to March 2011 when all of them had made the transition to a new career. Data were analyzed in two stages. In the first stage, comprehensive career story narratives were formed on the basis of the interviews. In the second stage, emerging themes in these stories were compared, contrasted, and interpreted in the context of the overall career histories. Nursing as a second career choice and demanding work content as well as poor practice environment and the inability to identify with the stereotypical images of nurses were main themes that emerged from these career stories. The results of this interpretative qualitative study reflect a shift toward insights into understanding professional turnover as a complex and long-lasting process.

  12. Qualitative and Quantitative Assessment of Wastewater of Pistachio Processing Terminals (Case Study: Kerman city

    Directory of Open Access Journals (Sweden)

    F Khademi

    2016-03-01

    Full Text Available Introduction: Wastewaters resulting from seasonal processing such as pistachio processing industry are one of the most important factors of environmental pollution. High concentration of pollutants are the qualitative characteristics of wastewaters that due high consumption of water and energy resources as well as high levels production of waste have a good potential to realization of projects to reduce the environmental impacts and optimizing the consumption of energy resources.The aim of this study was to determine the wastewater̛ s quality and quantity of pistachio processing terminals. Methods: this study is cross-sectional study that has been implemented from mid –September until late October (pistachio harvest season in each of the years 2012-2013-2014 in Kerman.Firstely according to field study, the characteristics and location of 20 pistachio processing terminals were determined by a GPS device. Then 8 pistachio processing terminals were selected in around of wastewater collection system. Composite sampling method with total of 72 samples was done in each year during pistachio operation. Samples were conducted from pistachio processing wastewater screen filter outlet. In each of samples BOD5, COD, TSS, pH and Total phenolic were determined. Sampling and tests were done according to water and wastewater standard methods book (20th edition. Concentration of Phenolic compounds was measured by folin ciocaltive method. The Data was analyzed by SPSS software. Results: the average of total produced wastewater in pistachio processing terminals in this study was 85.9m3/d. The average BOD5, COD, TSS, Total phenolic and PH were 6106, 21570, 682, 4154 (mg/L and 5.5 respectively. Conclusion: The obtained results from raw wastewater of pistachio processing terminals showed they have high BOD and COD. This is caused by presentation of priority pollutants (phenolic compounds which have high potential in pollution and toxicity for discharging any

  13. Literacy learning in secondary school science classrooms: A cross-case analysis of three qualitative studies

    Science.gov (United States)

    Dillon, Deborah R.; O'Brien, David G.; Moje, Elizabeth B.; Stewart, Roger A.

    The purpose of this cross-case analysis is to illustrate how and why literacy was incorporated into science teaching and learning in three secondary classrooms. Research questions guiding the analysis include: (a) How were literacy events shaped by the teachers' philosophies about teaching science content and teaching students? and (b) How was literacy (reading, writing, and oral language) structured by the teachers and manifested in science lessons? The methodology of ethnography and the theoretical framework of symbolic interactionism were employed in the three studies on which the cross-case analysis was based. The researchers assumed the role of participant observers, collecting data over the period of 1 year in each of the three classrooms. Data, in the form of fieldnotes, interviews, and artifacts, were collected. In each study, data were analyzed using the constant comparative method (Glaser & Strauss, 1967) to determine patterns in the teachers' beliefs about learning and how these influenced their choice of literacy activities. The cross-case analysis was conducted to determine patterns across the three teachers and their classrooms. The findings from this analysis are used to compare how the teachers' philosophies of teaching science and their beliefs about how students learn influenced their use of literacy practices during lessons. Specifically, each teacher's use of literacy activities varied based on his or her beliefs about teaching science concepts. Furthermore, reading, writing, and oral language were important vehicles to learning science concepts within daily classroom activities in the three classrooms.Received: 1 April 1993; Revised: 30 August 1993;

  14. A qualitative model for strategic analysis of organizations. Application and alternative proposal on a study case

    Directory of Open Access Journals (Sweden)

    Santiago Ferro Moreno

    2015-12-01

    Full Text Available The strategic analysis of organizations is based on the internal and external environments, in order to identify positive and negative variables and factors. The interrelation and timing of these strategic forces are essential to create alternative solutions that tend to achieve the organizational objectives.The normative prospective has theorical and methodological foundations to create a desired future and from it, be able to identify impelling and restraining forces that have influence on the particular problematic situation (go from the current situation to a better one in a certain time.The aim of this article is to analyze on a strategic way a real case with a normative-prospective model that considers the temporal dynamics of the factors impact and variables in time allowing to suggest alternative solutions.Semi-structured interviews were performed with all the employees of this case and structured observations and workshops with the commercial and general management.In consequence, with the results, the desired, current and improved situations were built. Additionally, forces were identified classified and appreciated and lastly solutions were suggested. With the proposed prospective method, alternative solutions could be constructed in order to settle temporary organizational objectives. No constraints were found to use the current method in other cases.Keywords: Strategic forces, Normative prospective, Problematic situations, Strategies

  15. Can you see me? Experiences of nurses working night shift in Australian regional hospitals: a qualitative case study.

    Science.gov (United States)

    Powell, Idona

    2013-10-01

    To report a study that explored the experiences of night-shift nurses, focusing on employee interrelationships and work satisfaction. Night-shift nurses are a critical component in hospital care making it essential to understand the experiences that give meaning to their work and understand how these nurses and the organization can benefit from their contribution to hospital care. A literature review revealed minimal research in this area. Qualitative case study. A qualitative case study using semi-structured interviews and self-completed diaries was conducted in 2010 in regional public hospitals in Australia. Participants were 14 nurses working nights half or more of their shifts in medical or surgical wards. Thematic analysis identified four major areas of concern: work relationships, work environment, work practices and lifestyle impact. Notably, work relationships were most meaningful for nurses on the same shift; night-shift nurses experienced working conditions inferior to their daytime counterparts including a perception of minimal leadership. Despite limited education opportunities, night shift provided opportunity for professional growth for some nurses with a slippage in skills for others; night shift provided flexibility for family and social activities, yet impeded these same activities, primarily due to pervasive fatigue. Night-shift nurses considered their role critical, yet believed that they were poorly regarded. The strong interpersonal relationships developed between night-shift workers need to be capitalized on whilst developing a more effective leadership model, improved work environment, more equitable professional development, and genuine recognition of the critical role of night nurses. © 2013 Blackwell Publishing Ltd.

  16. A qualitative case study of the legislative process of the hygienist-therapist bill in a large Midwestern state.

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    Dollins, Haley E; Bray, Kimberly Krust; Gadbury-Amyot, Cynthia C

    2013-10-01

    Inequitable access to dental care contributes to oral health disparities. Midlevel dental provider models are utilized across the globe as a way to bridge the gap between preventive and restorative dental professionals and increase access to dental care. The purpose of this study was threefold: to examine lessons learned from the state legislative process related to creation of the hygienist-therapist in a Midwestern state, to improve understanding of the relationship between alternative oral health delivery models and public policy and to inform the development and passage of future policies aimed at addressing the unmet dental needs of the public. This research investigation utilized a qualitative research methodology to examine the process of legislation relating to an alternative oral health delivery model (hygienist-therapist) through the eyes of key stakeholders. Interview data was analyzed and then triangulated with 3 data sources: interviews with key stakeholders, documents and researcher participant field notes. Data analysis resulted in consensus on 3 emergent themes with accompanying categories. The themes that emerged included social justice, partnerships and coalitions, and the legislative process. This qualitative case study suggests that the creation of a new oral health workforce model was a long and arduous process involving multiple stakeholders and negotiation between the parties involved. The creation of this new workforce model was recognized as a necessary step to increasing access to dental care at the state and national level. The research in this case study may serve to inform advocates of access to oral health care as other states pursue their own workforce models.

  17. Optimal visualization of focal nodular hyperplasia: quantitative and qualitative evaluation of single and multiphasic arterial phase acquisition at 1.5 T MR imaging.

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    Rousseau, Caroline; Ronot, Maxime; Vilgrain, Valérie; Zins, Marc

    2016-05-01

    To evaluate the qualitative and quantitative benefit of multiple arterial phase acquisitions for the depiction of hypervascularity in FNH explored MR imaging using an extracellular contrast agent. Between 2007 and 2014, all patients who underwent MR imaging for the exploration of FNH were included. The protocol included a single or a triple arterial phase ("single" and "triple" group, respectively). Arterial phases were visually divided into four types: (1) angiographic, (2) early, (3) late, and (4) portal. Signal intensity on arterial phase images was visually recorded as intense, moderate, or low for each lesion. Lesion-to-liver contrast (LLC) and relative lesion enhancement (RE) were calculated and compared between the two groups using the Mann-Whitney test. Thirty-five women were included (mean 45-year old, range 20-66), with 50 FNH (mean size 30 mm). Single and triple groups included 20 patients (30 FNH) and 15 patients (20 FNH), respectively. Signal intensity was intense in all lesions in the triple group and in 22/30 (73%) in the single group (p = 0.041). Intense signals were more frequently found in the early arterial phase (p < 0.001). RE was not significantly different (1.78 ± 0.84 vs. 1.98 ± 1.81 p = 0.430, in the single and triple groups, respectively) but LLC was significantly higher in the triple group (0.32 ± 0.10 vs. 0.22 ± 0.10, p = 0.005). LLC was significantly higher in the first two arterial phases in the triple group (p < 0.001). Acquisition of three arterial phases improves the visualization of hypervascularity of FNH, as lesions show high visual signal intensity and contrast. Optimal visualization is obtained in the early arterial phase.

  18. Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study.

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    Orban, Kristina; Ekelin, Maria; Edgren, Gudrun; Sandgren, Olof; Hovbrandt, Pia; Persson, Eva K

    2017-09-11

    Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

  19. Making the case for a fracture liaison service: a qualitative study of the experiences of clinicians and service managers.

    Science.gov (United States)

    Drew, Sarah; Gooberman-Hill, Rachael; Farmer, Andrew; Graham, Laura; Javaid, M Kassim; Cooper, Cyrus; Judge, Andrew

    2015-10-01

    To develop services, healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies. Patients with hip fracture are at high risk of subsequent fracture. To prevent this, guidance recommends structuring fracture prevention services around coordinator based models. These are known as Fracture Liaison Services (FLS). 33 semi-structured qualitative interviews were conducted with healthcare professionals with experience of making business cases for FLS. Data was analysed thematically. Challenges in the development of business cases included collecting all the relevant data and negotiating compartmentalised budgets that impeded service development. Participants described communication and cooperation between providers and commissioners as variable. They felt financial considerations were the most important factor in funding decisions, while improved quality of care was less influential. Other factors included national guidelines and political priorities. The personalities of clinicians championing services, and the clinical interests of commissioners were seen to influence the decision-making process, suggesting that participants felt that decisions were not always made on the basis of evidence-based care. Effective strategies included ways of providing support, demonstrating potential cost effectiveness and improved quality of care. Using a range of sources including audit data collected on the successful Glasgow FLS, and improving cooperation between stakeholders was advocated. Participants felt that the work of commissioners and providers should be better integrated and suggested strategies for doing this. This study provides information to healthcare professionals about how best to develop business cases for FLS. We conclude with recommendations on how to develop effective cases. These include using guidance such as toolkits, aligning the aims of FLS with national priorities and benchmarking

  20. Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study.

    Science.gov (United States)

    Ament, Stephanie M C; Gillissen, Freek; Moser, Albine; Maessen, José M C; Dirksen, Carmen D; von Meyenfeldt, Maarten F; van der Weijden, Trudy

    2017-12-01

    Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success. An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed. A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts. The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological

  1. The quantitative and qualitative contributions of faith-based organizations to healthcare: The Kenya case

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    Alfredo L. Fort

    2017-01-01

    Full Text Available Although faith based organizations (FBOs have had a long presence teaching health personnel and delivering health services to many rural and remote populations in the developing world, their poor visibility for this work can be due to several factors. FBOs may keep a low profile, be confused with non-religious non-governmental organizations (NGOs, or be excluded from surveys because respondents may not know the affiliation of the healthcare facility from which they last received services. It has been argued that their large networks, logistics agreements with governments, and mission-driven stance bring them closer to the communities they serve and that their services have been a higher quality than average.Kenya has had a long history of established FBOs but there has also been substantial recent health investment by the government. We aimed to find the quantitative and qualitative contributions of FBOs by analyzing two recent data sources: the live web-based nationwide Master Health Facility List and the 2010 nationwide Service Provision Assessment (SPA survey. Using this information, we found that FBOs contribute to 11% of all health facilities’ presence in the country, doubling to 23% of all available beds, indicating their relative strength in owning mid-level hospitals around the country.We also constructed an index of “readiness” as a weighted average from services offered, good management practices, and availability of medicines and commodities for 17 items assessed during the SPA survey. We found that FBOs topped the list of managing authorities, with 69 percent of their health facilities achieving such readiness, followed closely by the government at 68 percent, NGOs at 60 percent and lastly a distant private for-profit sector at 51 percent.These results seem to confirm that FBOs continue to contribute to an important proportion of health care coverage in Kenya and do so with a relatively high quality of care among all actors

  2. Williams-Beuren syndrome associated with single kidney and nephrocalcinosis: a case report.

    Science.gov (United States)

    Abidi, Kamel; Jellouli, Manel; Ben Rabeh, Rania; Hammi, Yousra; Gargah, Tahar

    2015-01-01

    Williams-Beuren syndrome is a rare neurodevelopmental disorder, characterized by congenital heart defects, abnormal facial features, mental retardation with specific cognitive and behavioral profile, growth hormone deficiency, renal and skeletal anomalies, inguinal hernia, infantile hypercalcaemia. We report a case with Williams-Beuren syndrome associated with a single kidney and nephrocalcinosis complicated by hypercalcaemia. A male infant, aged 20 months presented growth retardation associated with a psychomotor impairment, dysmorphic features and nephrocalcinosis. He had also hypercalciuria and hypercalcemia. Echocardiography was normal. DMSA renal scintigraphy showed a single functioning kidney. The FISH generated one ELN signal in 20 metaphases read and found the presence of ELN deletion, with compatible Williams-Beuren syndrome.

  3. Population-based worksite obesity management interventions: a qualitative case study.

    Science.gov (United States)

    Romney, Martha C; Thomson, Erin; Kash, Kathryn

    2011-06-01

    Due to the increased prevalence of obesity and associated direct and indirect costs to employers, weight management programs have become an integral component of employer and insurer benefits plans. The programs vary in foci, scope, breadth, and implementation. The aim of this study was to explore promising employer-sponsored population-based obesity management programs. A case study that utilized a telephonic semi-structured questionnaire was conducted with small and large organizations located in different regions of the United States that had been recruited to participate. Eight employers and 1 health care advocacy coalition who met the inclusion criteria were interviewed about features of their weight management programs. The case study revealed a number of themes consistent with reports in the literature and reflecting cited best practices. Key findings include confirmation that weight management is a significant component of the wellness strategy in all participating organizations because employers are invested in population health programs and cost savings. Based upon their experience and knowledge, occupational health specialists are responsible for designing, implementing, managing, and evaluating employee health programs. Almost all employers utilize electronic media as a prominent component of wellness and disease management initiatives. Experience has shown that incentives-both financial and nonmonetary-are effective motivators for employee engagement and outcomes. However, while employers report success, favorable outcomes have been difficult to quantify.

  4. Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study.

    Science.gov (United States)

    Vannieuwenborg, Frederic; Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

    2016-10-31

    In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for

  5. Student Response to Remote-Online Case-Based Learning: A Qualitative Study.

    Science.gov (United States)

    Nicklen, Peter; Keating, Jennifer L; Maloney, Stephen

    2016-03-22

    Case-based learning (CBL) typically involves face-to-face interaction in small collaborative groups with a focus on self-directed study. To our knowledge, no published studies report an evaluation of Web conferencing in CBL. The primary aim of this study was to explore student perceptions and attitudes in response to a remote-online case-based learning (RO-CBL) experience. This study took place over a 2-week period in 2013 at Monash University, Victoria, Australia. A third year cohort (n=73) of physiotherapy students was invited to participate. Students were required to participate in 2 training sessions, followed by RO-CBL across 2 sessions. The primary outcome of interest was the student feedback on the quality of the learning experience during RO-CBL participation. This was explored with a focus group and a survey. Most students (68/73) completed the postintervention survey (nonparticipation rate 8%). RO-CBL was generally well received by participants, with 59% (40/68) of participates stating that they'd like RO-CBL to be used in the future and 78% (53/68) of participants believing they could meet the CBL's learning objectives via RO-CBL. The 4 key themes relevant to student response to RO-CBL that emerged from the focus groups and open-ended questions on the postintervention survey were how RO-CBL compared to expectations, key benefits of RO-CBL including flexibility and time and cost savings, communication challenges in the online environment compared to face-to-face, and implications of moving to an online platform. Web conferencing may be a suitable medium for students to participate in CBL. Participants were satisfied with the learning activity and felt they could meet the CBL's learning objectives. Further study should evaluate Web conferencing CBL across an entire semester in regard to student satisfaction, perceived depth of learning, and learning outcomes.

  6. How novice, skilled and advanced clinical researchers include variables in a case report form for clinical research: a qualitative study.

    Science.gov (United States)

    Chu, Hongling; Zeng, Lin; Fetters, Micheal D; Li, Nan; Tao, Liyuan; Shi, Yanyan; Zhang, Hua; Wang, Xiaoxiao; Li, Fengwei; Zhao, Yiming

    2017-09-18

    Despite varying degrees in research training, most academic clinicians are expected to conduct clinical research. The objective of this research was to understand how clinical researchers of different skill levels include variables in a case report form for their clinical research. The setting for this research was a major academic institution in Beijing, China. The target population was clinical researchers with three levels of experience, namely, limited clinical research experience, clinicians with rich clinical research experience and clinical research experts. Using a qualitative approach, we conducted 13 individual interviews (face to face) and one group interview (n=4) with clinical researchers from June to September 2016. Based on maximum variation sampling to identify researchers with three levels of research experience: eight clinicians with limited clinical research experience, five clinicians with rich clinical research experience and four clinical research experts. These 17 researchers had diverse hospital-based medical specialties and or specialisation in clinical research. Our analysis yields a typology of three processes developing a case report form that varies according to research experience level. Novice clinician researchers often have an incomplete protocol or none at all, and conduct data collection and publication based on a general framework. Experienced clinician researchers include variables in the case report form based on previous experience with attention to including domains or items at risk for omission and by eliminating unnecessary variables. Expert researchers consider comprehensively in advance data collection and implementation needs and plan accordingly. These results illustrate increasing levels of sophistication in research planning that increase sophistication in selection for variables in the case report form. These findings suggest that novice and intermediate-level researchers could benefit by emulating the comprehensive

  7. Evaluating fidelity in home-visiting programs a qualitative analysis of 1058 home visit case notes from 105 families.

    Directory of Open Access Journals (Sweden)

    Thomas Saïas

    Full Text Available Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011.To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses.During the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother's adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers' self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother's education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child's language development.In this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families' urgent needs

  8. Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

    Science.gov (United States)

    Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

    2018-02-05

    Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by

  9. Identifying socio-environmental factors that facilitate resilience among Canadian palliative family caregivers: a qualitative case study.

    Science.gov (United States)

    Giesbrecht, Melissa; Wolse, Faye; Crooks, Valorie A; Stajduhar, Kelli

    2015-06-01

    In Canada, friends and family members are becoming increasingly responsible for providing palliative care in the home. This is resulting in some caregivers experiencing high levels of stress and burden that may ultimately surpass their ability to cope. Recent palliative care research has demonstrated the potential for caregiver resilience within such contexts. This research, however, is primarily focused on exploring individual-level factors that contribute to resilience, minimizing the inherent complexity of this concept, and how it is simultaneously influenced by one's social context. Therefore, our study aims to identify socio-environmental factors that contribute to palliative family caregiver resilience in the Canadian homecare context. Drawing on ethnographic fieldnotes and semistructured interviews with family caregivers, care recipients, and homecare nurses, this secondary analysis employs an intersectionality lens and qualitative case study approach to identify socio-environmental factors that facilitate family caregivers' capacity for resilience. Following a case study methodology, two cases are purposely selected for analysis. Findings demonstrate that family caregiver resilience is influenced not only by individual-level factors but also by the social environment, which sets the lived context from which caregiving roles are experienced. Thematic findings of the two case studies revealed six socio-environmental factors that play a role in shaping resilience: access to social networks, education/knowledge/awareness, employment status, housing status, geographic location, and life-course stage. Findings contribute to existing research on caregiver resilience by empirically demonstrating the role of socio-environmental factors in caregiving experiences. Furthermore, utilizing an intersectional approach, these findings build on existing notions that resilience is a multidimensional and complex process influenced by numerous related variables that intersect

  10. Psychological therapy for psychogenic amnesia: Successful treatment in a single case study.

    Science.gov (United States)

    Cassel, Anneli; Humphreys, Kate

    2016-01-01

    Psychogenic amnesia is widely understood to be a memory impairment of psychological origin that occurs as a response to severe stress. However, there is a paucity of evidence regarding the effectiveness of psychological therapy approaches in the treatment of this disorder. The current article describes a single case, "Ben", who was treated with formulation-driven psychological therapy using techniques drawn from cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) for psychogenic amnesia. Before treatment, Ben exhibited isolated retrograde and anterograde memory impairments. He received 12 therapy sessions that targeted experiential avoidance followed by two review sessions, six weeks and five months later. Ben's retrograde and anterograde memory impairments improved following therapy to return to within the "average" to "superior" ranges, which were maintained at follow-up. Further experimental single case study designs and larger group studies are required to advance the understanding of the effectiveness and efficacy of psychological therapy for psychogenic amnesia.

  11. The wavefield of acoustic logging in a cased-hole with a single casing - Part I: a monopole tool

    Science.gov (United States)

    Wang, Hua; Fehler, Michael

    2018-01-01

    The bonding quality of the seal formed by the cement or collapse material between casing and formation rock is critical for the hydraulic isolation of reservoir layers with shallow aquifers, production and environmental safety, and plug and abandonment issues. Acoustic logging is a very good tool for evaluating the condition of the bond between different interfaces. The understanding of the acoustic logging wavefields in wells with single casing is still incomplete. We use a 3-D finite difference method to simulate wireline monopole wavefields in a single cased borehole with different bonding conditions at two locations: (1) between the cement and casing and (2) between the cement and formation. Pressure snapshots and waveforms for different models are shown, which allow us to better understand the wave propagation. Modal dispersion curves and data processing methods such as velocity-time semblance and dispersion analysis facilitate the identification of propagation modes in the different models. We find that the P wave is submerged in the casing modes and the S wave has poor coherency when the cement is replaced with fluid. The casing modes are strong when cement next to the casing is partially or fully replaced with fluid. The amplitude of these casing modes can be used to determine the bonding condition of the interface between casing and cement. However, the limited variation of the amplitude with fluid thickness means that amplitude measurements may lead to an ambiguous interpretation. When the cement next to the formation is partially replaced with fluid, the modes propagate in the combination of steel casing and cement and the velocities are highly dependent on the cement thickness. However, if the cement thickness is large (more than 2/3 of the annulus between casing and rock), the arrival time of the first arrival approximates that of the formation compressional wave when cement is good. It would highly likely that an analyst could misjudge cement quality

  12. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis.

    Science.gov (United States)

    Ma, Fuchang; Lv, Fan; Xu, Peng; Zhang, Dapeng; Meng, Sining; Ju, Lahong; Jiang, Huihui; Ma, Liping; Sun, Jiangping; Wu, Zunyou

    2015-07-02

    The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China. A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors' views on shifting the HIV/AIDS case management services to CHSCs. It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs' wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA's fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services. Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be

  13. Bilateral involvement of a single cranial nerve: analysis of 578 cases.

    Science.gov (United States)

    Keane, James R

    2005-09-27

    The author reviewed 34 years of personal experience with inpatients in a large municipal hospital to analyze the seats and causes of involvement of single pairs of cranial nerves. Among 578 cases, the sixth (n = 234) and second (211) nerves predominated, followed by the fourth (48), seventh (30), third (27), and eighth (18) cranial nerves. Trauma (99), infection (94), tumor (92), increased intracranial pressure (85), vascular disease (74), and demyelination (66) were common causes.

  14. Single-session treatment of a major complication of dens invaginatus: a case report.

    Science.gov (United States)

    Caldari, Mauro; Monaco, Carlo; Ciocca, Leonardo; Scotti, Roberto

    2006-05-01

    Dens invaginatus is a dental malformation that may give rise to several complications. Caries of the invagination can severely weaken the whole tooth, making it susceptible to fracture. Subgingival fractures are major complications threatening tooth survival and usually require periodontal/orthodontic/prosthetic treatment if long-term viability is to be ensured. This article describes a case of single-session restoration of a fractured invaginated tooth by means of endodontic treatment followed by fragment reattachment.

  15. Stories from early-career women physicians who have left academic medicine: a qualitative study at a single institution.

    Science.gov (United States)

    Levine, Rachel B; Lin, Fenny; Kern, David E; Wright, Scott M; Carrese, Joseph

    2011-06-01

    The number of women in academic medicine has steadily increased, although gender parity still does not exist and women leave academics at somewhat higher rates than men. The authors investigated the reasons why women leave careers in academic medicine. Semistructured, one-on-one interviews were conducted in 2007-2008 with 20 women physicians who had left a single academic institution to explore their reasons for opting out of academic careers. Data analysis was iterative, and an editing analysis style was used to derive themes. A lack of role models for combining career and family responsibilities, frustrations with research (funding difficulties, poor mentorship, competition), work-life balance, and the institutional environment (described as noncollaborative and biased in favor of male faculty) emerged as key factors associated with a decision to leave academic medicine for respondents. Faced with these challenges, respondents reevaluated their priorities and concluded that a discrepancy existed between their own and institutional priorities. Many respondents expressed divergent views with the institutional norms on how to measure success and, as a consequence, felt that they were undervalued at work. Participants report a disconnection between their own priorities and those of the dominant culture in academic medicine. Efforts to retain women faculty in academic medicine may include exploring the aspects of an academic career that they value most and providing support and recognition accordingly.

  16. Detection of Botulinum Toxin Muscle Effect in Humans Using Magnetic Resonance Imaging: A Qualitative Case Series.

    Science.gov (United States)

    O'Dell, Michael W; Villanueva, Mark; Creelman, Carly; Telhan, Gaurav; Nestor, Jaclyn; Hentel, Keith D; Ballon, Douglas; Dyke, Jonathan P

    2017-12-01

    Although important for dosing and dilution, there are few data describing botulinum toxin (BT) movement in human muscle. To better understand BT movement within human muscle. Proof-of-concept study with descriptive case series. Outpatient academic practice. Five subjects with stroke who were BT naive with a mean age of 60.4 ± 14 years and time poststroke of 4.6 ± 3.7 years. Three standardized injections were given to the lateral gastrocnemius muscle (LGM): 2 contained 25 units (U) of onabotulinumtoxinA (Botox) in 0.25 mL of saline solution and the third 0.25 mL of saline solution only. The tibialis anterior muscle (TAM) was not injected in any subject. A leg magnetic resonance image was obtained at baseline, 2 months, and 3 months later with a 3.0 Tesla Siemens scanner. Three muscles, the LGM, lateral soleus muscle (LSM), and TAM, were manually outlined on the T2 mapping sequence at each time point. A histogram of T2 relaxation times (T2-RT) for all voxels at baseline was used to calculate a mean and standard deviation (SD) T2-RT for each muscle. Botulinum toxin muscle effect (BTME) at 2 months and 3 months was defined as a subject- and muscle-specific T2-RT voxel threshold ≥3 SD above the baseline mean at or near BT injection sites. BTME volume for each leg magnetic resonance imaging slice at 3 time points and 3 muscles for all subjects. One subject missed the 3-month scan, leaving 18 potential observations of BTME. Little to no BTME effect was seen in the noninjected TAM. A BTME was detected in the LGM in 13 of 18 possible observations, and no effect was detected in 5 observations. Possible BTME effect was seen in the LSM in 3 subjects due to either diffusion through fascia or needle misplacement. Volume of BTME, as defined here, appeared to be substantially greater than the 0.25-mL injection volume. This descriptive case series is among the first attempts to quantify BTME within human muscle. Our findings are preliminary and are limited by a few

  17. QuantifyMe: An Open-Source Automated Single-Case Experimental Design Platform †

    Science.gov (United States)

    Sano, Akane; Ferguson, Craig; Mohan, Akshay; Picard, Rosalind W.

    2018-01-01

    Smartphones and wearable sensors have enabled unprecedented data collection, with many products now providing feedback to users about recommended step counts or sleep durations. However, these recommendations do not provide personalized insights that have been shown to be best suited for a specific individual. A scientific way to find individualized recommendations and causal links is to conduct experiments using single-case experimental design; however, properly designed single-case experiments are not easy to conduct on oneself. We designed, developed, and evaluated a novel platform, QuantifyMe, for novice self-experimenters to conduct proper-methodology single-case self-experiments in an automated and scientific manner using their smartphones. We provide software for the platform that we used (available for free on GitHub), which provides the methodological elements to run many kinds of customized studies. In this work, we evaluate its use with four different kinds of personalized investigations, examining how variables such as sleep duration and regularity, activity, and leisure time affect personal happiness, stress, productivity, and sleep efficiency. We conducted a six-week pilot study (N = 13) to evaluate QuantifyMe. We describe the lessons learned developing the platform and recommendations for its improvement, as well as its potential for enabling personalized insights to be scientifically evaluated in many individuals, reducing the high administrative cost for advancing human health and wellbeing. PMID:29621133

  18. QuantifyMe: An Open-Source Automated Single-Case Experimental Design Platform

    Directory of Open Access Journals (Sweden)

    Sara Taylor

    2018-04-01

    Full Text Available Smartphones and wearable sensors have enabled unprecedented data collection, with many products now providing feedback to users about recommended step counts or sleep durations. However, these recommendations do not provide personalized insights that have been shown to be best suited for a specific individual. A scientific way to find individualized recommendations and causal links is to conduct experiments using single-case experimental design; however, properly designed single-case experiments are not easy to conduct on oneself. We designed, developed, and evaluated a novel platform, QuantifyMe, for novice self-experimenters to conduct proper-methodology single-case self-experiments in an automated and scientific manner using their smartphones. We provide software for the platform that we used (available for free on GitHub, which provides the methodological elements to run many kinds of customized studies. In this work, we evaluate its use with four different kinds of personalized investigations, examining how variables such as sleep duration and regularity, activity, and leisure time affect personal happiness, stress, productivity, and sleep efficiency. We conducted a six-week pilot study (N = 13 to evaluate QuantifyMe. We describe the lessons learned developing the platform and recommendations for its improvement, as well as its potential for enabling personalized insights to be scientifically evaluated in many individuals, reducing the high administrative cost for advancing human health and wellbeing.

  19. QuantifyMe: An Open-Source Automated Single-Case Experimental Design Platform.

    Science.gov (United States)

    Taylor, Sara; Sano, Akane; Ferguson, Craig; Mohan, Akshay; Picard, Rosalind W

    2018-04-05

    Smartphones and wearable sensors have enabled unprecedented data collection, with many products now providing feedback to users about recommended step counts or sleep durations. However, these recommendations do not provide personalized insights that have been shown to be best suited for a specific individual. A scientific way to find individualized recommendations and causal links is to conduct experiments using single-case experimental design; however, properly designed single-case experiments are not easy to conduct on oneself. We designed, developed, and evaluated a novel platform, QuantifyMe, for novice self-experimenters to conduct proper-methodology single-case self-experiments in an automated and scientific manner using their smartphones. We provide software for the platform that we used (available for free on GitHub), which provides the methodological elements to run many kinds of customized studies. In this work, we evaluate its use with four different kinds of personalized investigations, examining how variables such as sleep duration and regularity, activity, and leisure time affect personal happiness, stress, productivity, and sleep efficiency. We conducted a six-week pilot study ( N = 13) to evaluate QuantifyMe. We describe the lessons learned developing the platform and recommendations for its improvement, as well as its potential for enabling personalized insights to be scientifically evaluated in many individuals, reducing the high administrative cost for advancing human health and wellbeing.

  20. THE EFFECTS OF CULTURE ON KNOWLEDGE MANAGEMENT PRACTICE: A QUALITATIVE CASE STUDY OF MSC STATUS COMPANIES

    Directory of Open Access Journals (Sweden)

    Charmaine Ryan

    2006-01-01

    Full Text Available Knowledge is recognised as being an important asset in organisations these days. Despite this, many organisations are not doing enough to effectively manage this important asset for its competitive advantage. In response to this, knowledge management which is defined as a process that effectively creates, captures, shares and uses organisation-wide knowledge to improve the organisation’s performance was conceived and has since gained widespread acceptance the world over. Despite its widespread acceptance, little is known about the current levels of knowledge management within the Malaysian context, in particular amongst the Multimedia Super Corridor (MSC status companies in Malaysia. Furthermore, the extent to which cultural factors impact upon knowledge management practice in these companies is not known. This study investigated the various cultural factors (collaboration, mutual trust, leadership and incentives/rewards using a multiple case study approach operating within a critical realism research paradigm and found that these factors have impact on the level of knowledge management practice. The study also established that cultural factors do play an important role in facilitating knowledge management practice in these MSC status companies in Malaysia. It was found that collaboration, mutual trust, leadership, kiasu-ism and incentives/rewards have significant impact on the level of knowledge management practice. In view of the findings of this study, it is suggested that the relevant authorities pay adequate attention on these cultural factors to ensure that the knowledge management initiatives undertaken by Malaysian companies are effectively deployed.

  1. 78 FR 41070 - Notice of Single-Case Deviation from Competition Requirements: Transfer of Grantee Request for...

    Science.gov (United States)

    2013-07-09

    ... Single-Case Deviation from Competition Requirements: Transfer of Grantee Request for the Detroit Healthy... Health and Human Services (HHS). ACTION: Notice of Single-Case Deviation from Competition Requirements... pregnancy and interconceptional phases for women and infants residing in the proposed project area. In order...

  2. Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

    Science.gov (United States)

    Byun, Tara McAllister; Hitchcock, Elaine R.; Ferron, John

    2017-01-01

    Purpose: Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of…

  3. Comparing Single Case Design Overlap-Based Effect Size Metrics from Studies Examining Speech Generating Device Interventions

    Science.gov (United States)

    Chen, Mo; Hyppa-Martin, Jolene K.; Reichle, Joe E.; Symons, Frank J.

    2016-01-01

    Meaningfully synthesizing single case experimental data from intervention studies comprised of individuals with low incidence conditions and generating effect size estimates remains challenging. Seven effect size metrics were compared for single case design (SCD) data focused on teaching speech generating device use to individuals with…

  4. Operationally Comparable Effect Sizes for Quantifying Changes in Behavior, with Application to Meta-Analysis of Single-Case Studies

    Science.gov (United States)

    Pustejovsky, James E.

    2013-01-01

    Single-case designs (SCDs) are a class of research methods for evaluating intervention effects by taking repeated measurements of an outcome over time on a single case, both before and after the deliberate introduction of a treatment. SCDs are used heavily in fields such as special education, school psychology, social work, and applied behavior…

  5. The case of Iranian immigrants in the greater Toronto area: a qualitative study

    Directory of Open Access Journals (Sweden)

    Dastjerdi Mahdieh

    2012-02-01

    Full Text Available Abstract Introduction Iranians comprise an immigrant group that has a very different cultural background from that of the mainstream Canadian population and speaks a language other than English or French; in this case mainly Farsi (Persian. Although Iranian immigrants in Toronto receive a high proportion of care from Farsi-speaking family physicians and health care providers than physicians who cannot speak Farsi, they are still not satisfied with the provided services. The purpose of this study was to identify the obstacles and issues Iranian immigrants faced in accessing health care services as seen through the eyes of Iranian health care professionals/providers and social workers working in Greater Toronto Area, Canada. Methods Narrative inquiry was used to capture and understand the obstacles this immigrant population faces when accessing health care services, through the lens of fifty Iranian health care professionals/providers and social workers. Thirty three health care professionals and five social workers were interviewed. To capture the essence of issues, individual interviews were followed by three focus groups consisting of three health care professionals and one social worker in each group. Results Three major themes emerged from the study: language barrier and the lack of knowledge of Canadian health care services/systems; lack of trust in Canadian health care services due to financial limitations and fear of disclosure; and somatization and needs for psychological supports. Conclusion Iranians may not be satisfied with the Canadian health care services due to a lack of knowledge of the system, as well as cultural differences when seeking care, such as fear of disclosure, discrimination, and mistrust of primary care. To attain equitable, adequate, and effective access to health care services, immigrants need to be educated and informed about the Canadian health care system and services it provides. It would be of great benefit to

  6. Evaluation of how a real time pre-registration health care curricula was managed through the application of a newly designed Change Management Model: A qualitative case study.

    Science.gov (United States)

    Chowthi-Williams, Annette

    2018-02-01

    Curricula change in nurse education is of international importance. The pace of such change has been continuous and has triggered criticisms of inadequate preparation of practitioners. There are no change formulae for managing curricula change and despite a raft of change methods, globally change success remains low. A lack of a unified voice, undue focus on cognition, and arguably no existing models for academia and a literature gap contribute to change challenge. A new Change Management Model designed from research with emotion as its underpinning philosophy is evaluated. Evaluation of a newly designed Change Management Model through a real time pre-registration health care curricula change. A qualitative case study was adopted. The single case study was the new pre-registration health care curricula. This study took place in a Faculty of Health and Social care in one HEI in the UK. Four senior academics and fifteen academics across professions and specialisms involved in the curricula change took part in the study. The findings suggested that leadership operated differently throughout the organisation. Distributive and collective leadership created a critical mass of people to help deliver the new curricula but academics felt excluded at the strategic level. Emotion at the strategic level inhibited innovation but boosted engagement, emotional relationships and creativity at the operational level. Face to face communication was favoured for its emotional connection. A top down approach created an emotional disconnect and impacted inclusiveness, engagement, empowerment, vision and readiness for change. Testing the new model widely not only in organisations, practice and team changes but personal change in improving health and wellbeing could be beneficial. The continuing gap in knowledge on the link between emotion and curricula change, practice and organisational change and therapeutic value of the model also warrants further research. Crown Copyright © 2017

  7. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases.

    Science.gov (United States)

    Mamelak, Adam N; Carmichael, John; Bonert, Vivien H; Cooper, Odelia; Melmed, Shlomo

    2013-09-01

    The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke's cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke's cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92% concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73%) for GH-secreting, 12/12 (100%) for ACTH-secreting, and 8/17 (47%) for prolactin-secreting tumors. Post-operative complications included transient (11%) and permanent (1.4%) diabetes insipidus, hyponatremia (13%), and new anterior pituitary hormonal deficits (1.4%). CSF leak occurred in 42 cases (15%), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10% of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes

  8. Treatment of chronic spontaneous urticaria with a single dose of omalizumab: A study of four cases

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    Radhakrishnan Subramaniyan

    2016-01-01

    Full Text Available Background: Chronic spontaneous urticaria (CSU has a detrimental effect on patients′ emotional and physical quality of life. Omalizumab, an anti-immunoglobulin E humanized monoclonal antibody, has been shown to be very effective in the treatment of refractory chronic urticaria patients but may not be an economically viable option for all CSU patients. However, we present a case series where a single dose of omalizumab gave sustained relief of symptoms in patients with CSU, which may be an economical option. Aims: The aim of this study is to assess the efficacy of a single dose of omalizumab in the treatment of CSU. Materials and Methods: Four patients of CSU whose disease was not controlled with four times the licensed dose of tablet fexofenadine 180 mg were exhibited one subcutaneous injection of omalizumab and were followed up at 4 weekly intervals for 24 weeks for Weekly Urticaria Activity Score 7 (UAS7 and Dermatology Life Quality Index (DLQI. Results: A sharp decline in UAS7 and DLQI was documented in 7-10 days. The decline was maintained up to 16 weeks in one case and 20 weeks in the other three cases. Both the scores at the end of the follow-up period of 24 weeks were better than the pre-omalizumab scores. Conclusion: The results of this case series indicate the efficacy of a single-dose omalizumab in treating moderate to severe refractory CSU. Further studies are required to identify the minimum frequency of administering omalizumab to effectively control CSU. This would greatly reduce the cost of this novel therapy.

  9. Why Do Adults With ADHD Choose Strength-Based Coaching Over Public Mental Health Care? A Qualitative Case Study From the Netherlands

    NARCIS (Netherlands)

    Schrevel, Samuel J C; Dedding, Christine; Broerse, Jacqueline E W

    2016-01-01

    For this qualitative case study, 23 semistructured interviews were conducted with clients of a private coaching center in the Netherlands. We explored why adults with attention deficit/hyperactivity disorder (ADHD) prefer coaching, which is financed out-of-pocket, over public mental health care and

  10. A Qualitative Multi-Case Study of the Influence of Personal and Professional Ethics on the Leadership of Public School Superintendents

    Science.gov (United States)

    McDermott, Brian J.

    2010-01-01

    The purpose of this study is to examine the influence of personal and professional ethics on the leadership of public school superintendents. A multi-case, qualitative research design was used to gather data from four practicing public school superintendents. Transformational leadership theory and the three pillars of ethics of leadership…

  11. Bridge flap technique as a single-step solution to mucogingival problems: A case series

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    Vivek Gupta

    2011-01-01

    Full Text Available Shallow vestibule, gingival recession, inadequate width of attached gingiva (AG and aberrant frenum pull are an array of mucogingival problems for which several independent and effective surgical solutions are reported in the literature. This case series reports the effectiveness of the bridge flap technique as a single-step surgical entity for increasing the depth of the vestibule, root coverage, increasing the width of the AG and solving the problem of abnormal frenum pull. Eight patients with 18 teeth altogether having Millers class I, II or III recession along with problems of shallow vestibule, inadequate width of AG and with or without frenum pull underwent this surgical procedure and were followed-up till 9 months post-operatively. The mean root coverage obtained was 55% and the mean average gain in width of the AG was 3.5 mm. The mean percentage gain in clinical attachment level was 41%. The bridge flap technique can be an effective single-step solution for the aforementioned mucogingival problems if present simultaneously in any case, and offers considerable advantages over other mucogingival surgical techniques in terms of simplicity, limited chair-time for the patient and the operator, single surgical intervention for manifold mucogingival problems and low morbidity because of the absence of palatal donor tissue.

  12. Combining p-values in replicated single-case experiments with multivariate outcome.

    Science.gov (United States)

    Solmi, Francesca; Onghena, Patrick

    2014-01-01

    Interest in combining probabilities has a long history in the global statistical community. The first steps in this direction were taken by Ronald Fisher, who introduced the idea of combining p-values of independent tests to provide a global decision rule when multiple aspects of a given problem were of interest. An interesting approach to this idea of combining p-values is the one based on permutation theory. The methods belonging to this particular approach exploit the permutation distributions of the tests to be combined, and use a simple function to combine probabilities. Combining p-values finds a very interesting application in the analysis of replicated single-case experiments. In this field the focus, while comparing different treatments effects, is more articulated than when just looking at the means of the different populations. Moreover, it is often of interest to combine the results obtained on the single patients in order to get more global information about the phenomenon under study. This paper gives an overview of how the concept of combining p-values was conceived, and how it can be easily handled via permutation techniques. Finally, the method of combining p-values is applied to a simulated replicated single-case experiment, and a numerical illustration is presented.

  13. How might schools influence young people's drug use? Development of theory from qualitative case-study research.

    Science.gov (United States)

    Fletcher, Adam; Bonell, Chris; Sorhaindo, Annik; Strange, Vicki

    2009-08-01

    To explore young people's experiences of school and drug use, generate hypotheses regarding the pathways through which schools may influence students' drug use, and examine how these may vary according to students' sociodemographic characteristics. Qualitative data were collected through semistructured interviews with 30 students (aged 14-15) and 10 teachers in two case-study schools. Students were purposively sampled to encompass variations in socioeconomic status, gender, ethnicity, and school engagement. Techniques associated with thematic content analysis and grounded theory were used to analyze the data and generate hypotheses. Three potential pathways via which school effects on drug use may occur were identified: (1) peer-group sorting and drug use as a source of identity and bonding among students who are disconnected from the main institutional markers of status; (2) students' desire to "fit in" at schools perceived to be unsafe and drug use facilitating this; and/or (3) drug use as a strategy to manage anxieties about school work and escape unhappiness at schools lacking effective social support systems. Various pathways may plausibly underlie school effects on drug use. These support the idea of "whole-school" interventions to reduce drug use through: recognizing students' varied achievements and promoting a sense of belonging, reducing bullying and aggression, and providing additional social support for students. Such interventions should be piloted and evaluated in a range of settings to examine effects on students' drug use. Broader policies relating to secondary school targets, curricula, assessment, and streaming may also influence rates of adolescent drug use.

  14. Credibility and (disuse of feedback to inform teaching : a qualitative case study of physician-faculty perspectives

    Directory of Open Access Journals (Sweden)

    Carr TF

    2015-06-01

    Full Text Available Evaluation plays a central role in teaching in that physician-faculty theoretically use evaluations from clinical learners to inform their teaching. Knowledge about how physician-faculty access and internalize feedback from learners is sparse and concerning given its importance in medical training. This study aims to broaden our understanding. Using multiple data sources, this cross-sectional qualitative case study conducted in Spring of 2014 explored the internalization of learner feedback among physician-faculty teaching medical students, residents and fellows at a southwest academic medical center. Twelve one-on-one interviews were triangulated with observation notes and a national survey. Thematic and document analysis was conducted. Results revealed that the majority accessed and reviewed evaluations about their teaching. Most admitted not using learner feedback to inform teaching while a quarter did use them. Factors influencing participants use or disuse of learner feedback were the a reporting metrics and mechanisms, and b physician-faculty perception of learner credibility. Physician-faculty did not regard learners’ ability to assess and recognize effective teaching skills highly. To refine feedback for one-on-one teaching in the clinical setting, recommendations by study participants include: a redesigning of evaluation reporting metrics and narrative sections, and b feedback rubric training for learners.

  15. Qualitative case studies of professional-level workers with traumatic brain injuries: A contextual approach to job accommodation and retention.

    Science.gov (United States)

    Roessler, Richard T; Rumrill, Phillip D; Rumrill, Stuart P; Minton, Deborah L; Hendricks, Deborah J; Sampson, Elaine; Stauffer, Callista; Scherer, Marcia J; Nardone, Amanda; Leopold, Anne; Jacobs, Karen; Elias, Eileen

    2017-09-14

    Traumatic brain injury (TBI) is a multi-systemic disability that causes a wide range of difficulties with personal and social functioning. Four individuals with TBI participated in an evaluation of barriers to their continued employment following graduation from college. A trained interviewer completed the Work Experience Survey (WES) in teleconsultation sessions with each participant. Researchers applied a qualitative case study research design. Participants reported a wide range of difficulties in performing essential functions of their jobs (3 to 24) that have the potential to significantly affect their productivity. Career mastery problems reflected outcomes associated with TBI such as 'believing that others think I do a good job' and 'having the resources (e.g., knowledge, tools, supplies, and equipment) needed to do the job.' Indicative of their wish to continue their current employment, participants reported high levels of job satisfaction. The WES is a cost-effective needs assessment tool to aid health and rehabilitation professionals in providing on-the-job supports to workers with TBI.

  16. Conforming to partnership values: a qualitative case study of public–private mix for TB control in Ghana

    Directory of Open Access Journals (Sweden)

    Joshua Amo-Adjei

    2016-01-01

    Full Text Available Background: Public–private mix (PPM can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. Design: This is a qualitative case study of PPM in tuberculosis (TB control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI were conducted with respondents. Data emanating from the IDIs were analysed deductively. Results: Although the respondents’ perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers’ failure to follow-up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Conclusions: Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are ‘soft’ or standard contracts.

  17. Conforming to partnership values: a qualitative case study of public-private mix for TB control in Ghana.

    Science.gov (United States)

    Amo-Adjei, Joshua

    2016-01-01

    Public-private mix (PPM) can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. This is a qualitative case study of PPM in tuberculosis (TB) control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI) were conducted with respondents. Data emanating from the IDIs were analysed deductively. Although the respondents' perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers' failure to follow-up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are 'soft' or standard contracts.

  18. The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study.

    Science.gov (United States)

    Farre, Albert; Heath, Gemma; Shaw, Karen; Jordan, Teresa; Cummins, Carole

    2017-04-01

    Objectives To explore paediatric nurses' experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses' role in the medication process and the distributed nature of nurses' medication risk management practices. Nurses' contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

  19. Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

    Science.gov (United States)

    Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

    2016-08-01

    To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  20. Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit.

    Science.gov (United States)

    Backman, Chantal; Marck, Patricia B; Krogman, Naomi; Taylor, Geoff; Sales, Anne; Bonten, Marc J M; Gigengack-Baars, Ada C M

    2012-01-01

    The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data. In this qualitative case study analysis, a socio-ecological approach on health systems informed the research design and provided a framework to better understand the complexity of implementing effective IP&C. The study was conducted on a surgical unit at a Netherlands' hospital that reported successful reductions in the prevalence of targeted multidrug-resistant organisms. Research methods included unit observations (n=3), review of relevant policies and procedures, five practitioner-led photo walkabouts of the unit (n=7), three photo elicitation focus groups with practitioners (n=13) and the review of related IP&C data. The findings indicate some conditions and processes present that may influence the low prevalence of multidrug-resistant organisms, including the 'search and destroy' active surveillance strategy, low occupancy rates, a centralised bed cleaning system and the presence of an active grass roots Hygiene in Practice group, which engages practitioners in several ongoing activities to promote IP&C on the units. Further research on the benefits of practitioner-led community of practices on IP&C practices such as the Hygiene in Practice group is also recommended. Additional case studies to compare theses practices with other acute care hospital around the world would be a valuable way to better understand what IP&C programmes are most effective in which contexts and for what reasons. Further data are available by contacting the primary author directly.

  1. Creating advantages through franchising in healthcare: a qualitative, multiple embedded case study on the role of the business format.

    Science.gov (United States)

    Nijmeijer, Karlijn J; Huijsman, Robbert; Fabbricotti, Isabelle N

    2014-11-02

    Business format franchising is an organizational form that originates from the business sector. It is increasingly used in healthcare, being a promising organizational form for improving the competitiveness and efficiency of organizations, the quality of care, and the professional work environment. However, evidence is lacking concerning how these healthcare franchises should be designed to actually deliver the promised benefits. This study explores how the design of the central element in franchising, the business format (i.e., brand name, support systems, specification of the products and services), helps or hinders the achievement of positive results. A qualitative comparative embedded case study was conducted. The cases focused on three Dutch healthcare franchises providing mental healthcare, hospital care and care for the intellectually disabled. The data were collected through document analyses, observations, and 96 in-depth, semi-structured interviews with franchisors and unit actors (franchisees, unit managers, professionals). The interviews were recorded and transcribed verbatim. A conceptual model based on a systematic review of studies in other industries was used as an initial method for coding the data. New inductive codes were used to enrich and extend the analysis. The data were subjected to within-case and cross-case comparative thematic analyses. Different business format designs have different effects on results, as perceived by franchisors and unit actors. The analysis revealed how this variation in perceived effects can be explained by different dynamics with regard to system-wide adaptation, local adaptation, professionals' resistance to change, ease of knowledge sharing, bureaucracy, overhead, uniform brand presentation, accelerating effects and reliable performance levels. The analysis resulted in a new typology of four types of business formats, showing how combinations of business format elements facilitate or hinder the achievement of

  2. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

  3. Bone single photon emission computed tomography (SPECT in a patient with Pancoast tumor: a case report

    Directory of Open Access Journals (Sweden)

    Hamid Javadi

    Full Text Available CONTEXT: Non-small cell lung carcinomas (NSCLCs of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS for detecting the level of abnormality in cases of superior sulcus tumors. CASE REPORT: We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP bone single-photon emission-computed tomography (SPECT was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.

  4. The International intraval project. Phase 1 case 2. Radionuclide migration in single natural fractures in granite

    International Nuclear Information System (INIS)

    Skagius, K.

    1992-01-01

    The INTRAVAL study addresses validation of geosphere transport models for use in repository performance assessment by examining various test cases relevant to radioactive waste disposal. This report describes the results from INTRAVAL test case 2 which is based on a set of laboratory experiments studying migration of non-sorbing as well as sorbing tracers in a single fracture in granitic cores. Three project teams have investigated this test case. Models including advection, dispersion, sorption to the fracture surface, matrix diffusion and sorption within the rock matrix were calibrated against the experimental breakthrough curves. Obtained best-fit values of the parameters determining the interaction between tracer and rock were in fair agreement with independently measured data. Models neglecting matrix diffusion and sorption within the rock matrix gave poor fits to the experimental data. These results suggest the need to include matrix diffusion and matrix sorption in the model to represent data for this test case. Furthermore, it was not possible to distinguish between hydrodynamic dispersion and channelling dispersion since equally good fits were obtained with both models. Equally good fits were also obtained with models assuming constant fracture aperture and variable fracture aperture. In the context of performance assessment of repositories in fractured rock, the major outcome from this test case is additional support for the inclusion of matrix diffusion and matrix sorption in the transport models. 17 refs., 14 figs., 3 tabs

  5. Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

    Directory of Open Access Journals (Sweden)

    Yasuhiro Sumino

    2011-01-01

    Full Text Available Laparoendoscopic single-site surgery (LESS is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

  6. Effects of donepezil on behavioural manifestations of thalamic infarction: a single case observation

    Directory of Open Access Journals (Sweden)

    Rodrigo eRiveros

    2011-03-01

    Full Text Available Objective: To examine the effect of donepezil for the treatment of cognitive and behavioural disorders associated with thalamic lesions in a 45 years old male who suffered an infarct in the left thalamus. Background: Recent studies suggest that donepezil may improve executive functions impairments due to subcortical ischemic lesionsMethod: The crossover effects of donepezil were analyzed in a single case of thalamic infarction with cognitive and behavioural alterations. Results: Significant behavioural modifications related to improved performances in executive functions were observed with the treatment. Conclusions: The results suggest that donepezil may have significant effect on executive functions that can alter behavioural outcomes after thalamic infarctions

  7. Change in psychotherapy: a dialogical analysis single-case study of a patient with bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Alessandro eSalvini

    2012-12-01

    Full Text Available Starting from the critical review of various motivational frameworks of change that have been applied to the study of eating disorders, the present paper provides an alternative conceptualization of the change in psychotherapy presenting a single case study. We analysed six psychotherapeutic conversations with a bulimic patient and found out narratives for and against change. We read them in terms of tension between dominance and exchange in I-positions, as described by Hermans. These results indicate that the dialogical analysis of clinical discourse may be a useful method to investigate change from the beginning to the end of therapy.

  8. The measurement of the vertical component of hydraulic conductivity in single cased and uncased boreholes

    International Nuclear Information System (INIS)

    Black, J.H.; Noy, D.J.; Brightman, M.A.

    1986-11-01

    The project summarised in the paper aimed to assess the different existing methods of measuring vertical hydraulic conductivity in single boreholes by carrying out some actual field testing. The measurements are relevant to the disposal of radioactive waste into argillaceous rocks, where the primary geological barrier to potential leachate migration is the mudrock. Also the prime parameter of interest in the assessment of mudrocks is the vertical component of hydraulic conductivity. A description of the methods of test analysis and interpretation is given. The experimental programme for open borehole testing and cased borehole testing is described, along with the practical and theoretical considerations. (U.K.)

  9. A fixed partial appliance approach towards treatment of anterior single tooth crossbite: Report of two cases

    Directory of Open Access Journals (Sweden)

    M Gawthaman

    2017-01-01

    Full Text Available Crossbite can be treated using both removable and fixed appliances. This paper describes the report of two cases by a method of treating anterior single tooth in crossbite which is locked out of arch form with a simple fixed partial appliance. Orthodontic treatment was initiated by creating space for the locked out incisor using open coil spring and further corrected using MBT brackets and nitinol archwire for alignment. Treatment goals were achieved, and esthetics and occlusion were maintained postoperatively. Treatment objectives were obtained within a short duration using this technique, and there was an improvement in patients' smile.

  10. Discussions On Worst-Case Test Condition For Single Event Burnout

    Science.gov (United States)

    Liu, Sandra; Zafrani, Max; Sherman, Phillip

    2011-10-01

    This paper discusses the failure characteristics of single- event burnout (SEB) on power MOSFETs based on analyzing the quasi-stationary avalanche simulation curves. The analyses show the worst-case test condition for SEB would be using the ion that has the highest mass that would result in the highest transient current due to charge deposition and displacement damage. The analyses also show it is possible to build power MOSFETs that will not exhibit SEB even when tested with the heaviest ion, which have been verified by heavy ion test data on SEB sensitive and SEB immune devices.

  11. Single-port access laparoscopic abdominoperineal resection through the colostomy site: a case report

    DEFF Research Database (Denmark)

    Lauritsen, Morten; Bulut, O

    2012-01-01

    Single-port access (SPA) laparoscopic surgery is emerging as an alternative to conventional laparoscopic and open surgery, although its benefits still have to be determined. We present the case of a 87-year-old woman who underwent abdominoperineal resection (APR) with SPA. The abdominal part...... of the operation was performed with a SILS port inserted through the marked colostomy site, and the specimen was removed through the perineum after intersphincteric dissection. Operating time was 317 min. Bleeding was negligible. The specimen measured 26 cm in length. Thirteen lymph nodes were found, 2...

  12. Crossover learning of gestures in two ideomotor apraxia patients: A single case experimental design study.

    Science.gov (United States)

    Shimizu, Daisuke; Tanemura, Rumi

    2017-06-01

    Crossover learning may aid rehabilitation in patients with neurological disorders. Ideomotor apraxia (IMA) is a common sequela of left-brain damage that comprises a deficit in the ability to perform gestures to verbal commands or by imitation. This study elucidated whether crossover learning occurred in two post-stroke IMA patients without motor paralysis after gesture training approximately 2 months after stroke onset. We quantitatively analysed the therapeutic intervention history and investigated whether revised action occurred during gesture production. Treatment intervention was to examine how to influence improvement and generalisation of the ability to produce the gesture. This study used an alternating treatments single-subject design, and the intervention method was errorless learning. Results indicated crossover learning in both patients. Qualitative analysis indicated that revised action occurred during the gesture-production process in one patient and that there were two types of post-revised action gestures: correct and incorrect gestures. We also discovered that even when a comparably short time had elapsed since stroke onset, generalisation was difficult. Information transfer between the left and right hemispheres of the brain via commissural fibres is important in crossover learning. In conclusion, improvements in gesture-production skill should be made with reference to the left cerebral hemisphere disconnection hypothesis.

  13. Therapeutic Assessment of Complex Trauma: A Single-Case Time-Series Study.

    Science.gov (United States)

    Tarocchi, Anna; Aschieri, Filippo; Fantini, Francesca; Smith, Justin D

    2013-06-01

    The cumulative effect of repeated traumatic experiences in early childhood incrementally increases the risk of adjustment problems later in life. Surviving traumatic environments can lead to the development of an interrelated constellation of emotional and interpersonal symptoms termed complex posttraumatic stress disorder (CPTSD). Effective treatment of trauma begins with a multimethod psychological assessment and requires the use of several evidence-based therapeutic processes, including establishing a safe therapeutic environment, reprocessing the trauma, constructing a new narrative, and managing emotional dysregulation. Therapeutic Assessment (TA) is a semistructured, brief intervention that uses psychological testing to promote positive change. The case study of Kelly, a middle-aged woman with a history of repeated interpersonal trauma, illustrates delivery of the TA model for CPTSD. Results of this single-case time-series experiment indicate statistically significant symptom improvement as a result of participating in TA. We discuss the implications of these findings for assessing and treating trauma-related concerns, such as CPTSD.

  14. Quality Assessment of Kumu Injection, a Traditional Chinese Medicine Preparation, Using HPLC Combined with Chemometric Methods and Qualitative and Quantitative Analysis of Multiple Alkaloids by Single Marker.

    Science.gov (United States)

    Wang, Ning; Li, Zhi-Yong; Zheng, Xiao-Li; Li, Qiao; Yang, Xin; Xu, Hui

    2018-04-09

    Kumu injection (KMI) is a common-used traditional Chinese medicine (TCM) preparation made from Picrasma quassioides (D. Don) Benn. rich in alkaloids. An innovative technique for quality assessment of KMI was developed using high performance liquid chromatography (HPLC) combined with chemometric methods and qualitative and quantitative analysis of multi-components by single marker (QAMS). Nigakinone (PQ-6, 5-hydroxy-4-methoxycanthin-6-one), one of the most abundant alkaloids responsible for the major pharmacological activities of Kumu, was used as a reference substance. Six alkaloids in KMI were quantified, including 6-hydroxy- β -carboline-1-carboxylic acid (PQ-1), 4,5-dimethoxycanthin-6-one (PQ-2), β -carboline-1-carboxylic acid (PQ-3), β -carboline-1-propanoic acid (PQ-4), 3-methylcanthin-5,6-dione (PQ-5), and PQ-6. Based on the outcomes of twenty batches of KMI samples, the contents of six alkaloids were used for further chemometric analysis. By hierarchical cluster analysis (HCA), radar plots, and principal component analysis (PCA), all the KMI samples could be categorized into three groups, which were closely related to production date and indicated the crucial influence of herbal raw material on end products of KMI. QAMS combined with chemometric analysis could accurately measure and clearly distinguish the different quality samples of KMI. Hence, QAMS is a feasible and promising method for the quality control of KMI.

  15. The inference from a single case: moral versus scientific inferences in implementing new biotechnologies.

    Science.gov (United States)

    Hofmann, B

    2008-06-01

    Are there similarities between scientific and moral inference? This is the key question in this article. It takes as its point of departure an instance of one person's story in the media changing both Norwegian public opinion and a brand-new Norwegian law prohibiting the use of saviour siblings. The case appears to falsify existing norms and to establish new ones. The analysis of this case reveals similarities in the modes of inference in science and morals, inasmuch as (a) a single case functions as a counter-example to an existing rule; (b) there is a common presupposition of stability, similarity and order, which makes it possible to reason from a few cases to a general rule; and (c) this makes it possible to hold things together and retain order. In science, these modes of inference are referred to as falsification, induction and consistency. In morals, they have a variety of other names. Hence, even without abandoning the fact-value divide, there appear to be similarities between inference in science and inference in morals, which may encourage communication across the boundaries between "the two cultures" and which are relevant to medical humanities.

  16. Musicogenic epilepsy: review of the literature and case report with ictal single photon emission computed tomography.

    Science.gov (United States)

    Wieser, H G; Hungerbühler, H; Siegel, A M; Buck, A

    1997-02-01

    We report a case of musicogenic epilepsy with ictal single photon emission computed tomography (SPECT) study and discuss the findings of this patient in the context of 76 cases with musicogenic epilepsy described in the literature and seven other cases followed in Zurich. We analyzed the 83 patients according to the precipitating musical factors, type of epilepsy, presumed localization of seizure onset, and demographic data. Fourteen of 83 patients (17%) had seizures triggered exclusively by music. At time of examination, music was the only known precipitating stimulus in 65 of 83 patients (78%). Various characteristics of the musical stimulus were significant, e.g., musical category, familiarity, and instruments. Musicogenic epilepsy is a particular form of epilepsy with a strong correlation to the temporal lobe and a right-sided preponderance. A high musial standard might predispose for musicogenic epilepsy. Moreover, the majority of cases do not fall into the category of a strictly defined "reflex epilepsy," but appear to depend on the indermediary of a certain emotional reaction mediated through limbic mesial temporal lobe structures.

  17. Social validity in single-case research: A systematic literature review of prevalence and application.

    Science.gov (United States)

    Snodgrass, Melinda R; Chung, Moon Y; Meadan, Hedda; Halle, James W

    2018-03-01

    Single-case research (SCR) has been a valuable methodology in special education research. Montrose Wolf (1978), an early pioneer in single-case methodology, coined the term "social validity" to refer to the social importance of the goals selected, the acceptability of procedures employed, and the effectiveness of the outcomes produced in applied investigations. Since 1978, many contributors to SCR have included social validity as a feature of their articles and several authors have examined the prevalence and role of social validity in SCR. We systematically reviewed all SCR published in six highly-ranked special education journals from 2005 to 2016 to establish the prevalence of social validity assessments and to evaluate their scientific rigor. We found relatively low, but stable prevalence with only 28 publications addressing all three factors of the social validity construct (i.e., goals, procedures, outcomes). We conducted an in-depth analysis of the scientific rigor of these 28 publications. Social validity remains an understudied construct in SCR, and the scientific rigor of social validity assessments is often lacking. Implications and future directions are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. The impact of ordinate scaling on the visual analysis of single-case data.

    Science.gov (United States)

    Dart, Evan H; Radley, Keith C

    2017-08-01

    Visual analysis is the primary method for detecting the presence of treatment effects in graphically displayed single-case data and it is often referred to as the "gold standard." Although researchers have developed standards for the application of visual analysis (e.g., Horner et al., 2005), over- and underestimation of effect size magnitude is not uncommon among analysts. Several characteristics have been identified as potential contributors to these errors; however, researchers have largely focused on characteristics of the data itself (e.g., autocorrelation), paying less attention to characteristics of the graphic display which are largely in control of the analyst (e.g., ordinate scaling). The current study investigated the impact that differences in ordinate scaling, a graphic display characteristic, had on experts' accuracy in judgments regarding the magnitude of effect present in single-case percentage data. 32 participants were asked to evaluate eight ABAB data sets (2 each presenting null, small, moderate, and large effects) along with three iterations of each (32 graphs in total) in which only the ordinate scale was manipulated. Results suggest that raters are less accurate in their detection of treatment effects as the ordinate scale is constricted. Additionally, raters were more likely to overestimate the size of a treatment effect when the ordinate scale was constricted. Copyright © 2017 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  19. Single-case synthesis tools I: Comparing tools to evaluate SCD quality and rigor.

    Science.gov (United States)

    Zimmerman, Kathleen N; Ledford, Jennifer R; Severini, Katherine E; Pustejovsky, James E; Barton, Erin E; Lloyd, Blair P

    2018-03-03

    Tools for evaluating the quality and rigor of single case research designs (SCD) are often used when conducting SCD syntheses. Preferred components include evaluations of design features related to the internal validity of SCD to obtain quality and/or rigor ratings. Three tools for evaluating the quality and rigor of SCD (Council for Exceptional Children, What Works Clearinghouse, and Single-Case Analysis and Design Framework) were compared to determine if conclusions regarding the effectiveness of antecedent sensory-based interventions for young children changed based on choice of quality evaluation tool. Evaluation of SCD quality differed across tools, suggesting selection of quality evaluation tools impacts evaluation findings. Suggestions for selecting an appropriate quality and rigor assessment tool are provided and across-tool conclusions are drawn regarding the quality and rigor of studies. Finally, authors provide guidance for using quality evaluations in conjunction with outcome analyses when conducting syntheses of interventions evaluated in the context of SCD. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. [Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case].

    Science.gov (United States)

    Telich-Tarriba, José Eduardo; Parrao-Alcántara, Iris Jocelyn; Montes-Hernández, Jesús Manuel; Vega-Pérez, Jesús

    2015-01-01

    Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  1. Stakeholders' perceptions of integrated community case management by community health workers: a post-intervention qualitative study.

    Directory of Open Access Journals (Sweden)

    Denise L Buchner

    Full Text Available Integrated community case management (iCCM involves delivery of simple medicines to children with pneumonia, diarrhea and/or malaria by community health workers (CHWs. Between 2010 and 2012, an iCCM intervention trial was implemented by Healthy Child Uganda. This study used qualitative tools to assess whether project stakeholders perceived that iCCM improved access to care for children under five years of age.The intervention involved training and equipping 196 CHWs in 98 study villages in one sub-county in Uganda in iCCM. During the eight-month intervention, CHWs assessed sick children, provided antimalarials (coartem for fever, antibiotics (amoxicillin for cough and fast breathing, oral rehydration salts/zinc for diarrhea, and referred very sick children to health facilities. In order to examine community perceptions and acceptability of iCCM, post-intervention focus groups and key respondent interviews involving caregivers, health workers, CHWs and local leaders were carried out by experienced facilitators using semi-structured interview guides. Data were analyzed using thematic analysis techniques.Respondents reported increased access to health care for children as a result of iCCM. Access was reportedly closer to home, available more hours in a day, and the availability of CHWs was perceived as more reliable. CHW care was reported to be trustworthy and caring. Families reported saving money especially due to reduced transportation costs, and less time away from home. Respondents also perceived better health outcomes. Linkages between health facilities and communities were reportedly improved by the iCCM intervention due to the presence of trained CHWs in the community.iCCM delivered by CHWs may improve access to health care and is acceptable to families. Policymakers should continue to seek opportunities to implement and support iCCM, particularly in remote communities where there are health worker shortages.

  2. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone.

    Directory of Open Access Journals (Sweden)

    Anna J Dare

    2016-05-01

    Full Text Available Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs, yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs.We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable.National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political, technical, and financial

  3. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone.

    Science.gov (United States)

    Dare, Anna J; Lee, Katherine C; Bleicher, Josh; Elobu, Alex E; Kamara, Thaim B; Liko, Osborne; Luboga, Samuel; Danlop, Akule; Kune, Gabriel; Hagander, Lars; Leather, Andrew J M; Yamey, Gavin

    2016-05-01

    Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs. We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable. National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political, technical, and financial support from

  4. Can urban regeneration programmes assist coping and recovery for people with mental illness? Suggestions from a qualitative case study.

    Science.gov (United States)

    Whitley, Rob; Prince, Martin

    2006-03-01

    Researchers and policy-makers are increasingly recognizing that urban socio-environmental conditions can affect the development and course of numerous health problems. The aim of this paper is to investigate the impact an urban regeneration programme can have on everyday functioning, coping and recovery for people with a mental illness. We were also interested in discerning which component parts of the regeneration are the most important in positively affecting people with mental illness. These questions were explored through an in-depth qualitative case study of the Gospel Oak neighbourhood in London, which recently underwent an intensive urban regeneration programme. Interviews and focus groups were conducted with residents living with a mental illness (n = 16). Relevant participant observation was also conducted. Participants reported that interventions that improved community safety were by far the most important in affecting everyday coping and functioning. Interventions that improved the quantity and quality of shared community facilities had a positive, but milder effect on mental health. Component parts that appeared to have little effect included environmental landscaping and greater community involvement in decision-making processes. Most participants reported that their mental illness was a consequence of severe insults over the life-span, for example childhood neglect or family breakdown. Thus, the regeneration was seen as something that could assist coping, but not something that could significantly contribute to complete recovery. Our results thus suggest that urban regeneration can have a mild impact on people with mental illness, but this appears to be outweighed by life-span experience of severe individual-level risk factors. That said, some of our findings converge with other studies indicating that community safety and community facilities can play a role in positively affecting mental health. Further ethnographic and epidemiological research is

  5. Perspectives on enhancing international practical training of students in health and social care study programs - A qualitative descriptive case study.

    Science.gov (United States)

    Hvalič-Touzery, Simona; Hopia, Hanna; Sihvonen, Sanna; Diwan, Sadhna; Sen, Soma; Skela-Savič, Brigita

    2017-01-01

    Internationalization of practical training in health and social care study programs is an important aspect of higher education. However, field mentors' and classroom teachers' competence in guiding culturally diverse students varies widely in European countries, and the majority does not have enough training in guiding foreign students. This study aimed to examine which factors enhance the efficacy of international practical placement experiences in health and social care study programs. A qualitative descriptive case study design was used. The study was conducted at six higher education institutions-two in Finland and one in Croatia, Estonia, the Netherlands and Slovenia. A convenience sample of 14 mentors, 15 teachers and 14 students with international experiences from six higher education institutions which are part of the Bologna Process was recruited. The data were collected from six focus groups using a semi-structured questionnaire based on a literature review. Each higher education institution conducted one group interview that was tape-recorded, transcribed and analysed for themes. Participants made several recommendations for enhancing the practical placement experience of students, teachers, and mentors. Most recommendations dealt with practical supervision of students. Three major themes noted were: 'Attitudes towards internationalization of practical placements', 'Factors impacting the international placement experience', and 'Pedagogical methods used and structural support available for internationalization.' The study highlights the need for strengthening the multicultural knowledge and skills of mentors and teachers. The findings provide practical guidelines for improving the international placement experience across health and social care fields. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study.

    Science.gov (United States)

    Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

    2017-01-27

    Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone

    Science.gov (United States)

    Dare, Anna J.; Lee, Katherine C.; Bleicher, Josh; Elobu, Alex E.; Kamara, Thaim B.; Liko, Osborne; Luboga, Samuel; Danlop, Akule; Kune, Gabriel; Hagander, Lars; Leather, Andrew J. M.; Yamey, Gavin

    2016-01-01

    Background Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs. Methods and Findings We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable. Conclusions National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political

  8. The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus.

    Science.gov (United States)

    McDonald, Julie; Jayasuriya, Rohan; Harris, Mark Fort

    2012-03-13

    Ongoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences. A qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services) and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons. Three themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each other's roles and professional identity. The level of trust related to the acceptance of each other's roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and vulnerability associated with these changes has affected the level

  9. The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    McDonald Julie

    2012-03-01

    Full Text Available Abstract Background Ongoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences. Methods A qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons. Results Three themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each other's roles and professional identity. The level of trust related to the acceptance of each other's roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and

  10. Qualitative cosmology

    International Nuclear Information System (INIS)

    Khalatnikov, I.M.; Belinskij, V.A.

    1984-01-01

    Application of the qualitative theory of dynamic systems to analysis of homogeneous cosmological models is described. Together with the well-known cases, requiring ideal liquid, the properties of cosmological evolution of matter with dissipative processes due to viscosity are considered. New cosmological effects occur, when viscosity terms being one and the same order with the rest terms in the equations of gravitation or even exceeding them. In these cases the description of the dissipative process by means of only two viscosity coefficients (volume and shift) may become inapplicable because all the rest decomposition terms of dissipative addition to the energy-momentum in velocity gradient can be large application of equations with hydrodynamic viscosty should be considered as a model of dissipative effects in cosmology

  11. A Case Study of Single-Sex Middle School Mathematics Classes in a Mixed-Sex Public School

    Science.gov (United States)

    Kawasha, Fridah Singongi Silishebo

    2010-01-01

    The purpose of this case study was to (a) examine the main and interaction effects of gender, race and class-type on mathematics achievement, mathematics attitudes and sources of mathematics self-efficacy, (b) investigate teacher-student interactions in the single-sex mathematics classes and (c) investigate perspectives about single-sex…

  12. The mechanism distinguishability problem in biochemical kinetics: the single-enzyme, single-substrate reaction as a case study.

    Science.gov (United States)

    Schnell, Santiago; Chappell, Michael J; Evans, Neil D; Roussel, Marc R

    2006-01-01

    A theoretical analysis of the distinguishability problem of two rival models of the single enzyme-single substrate reaction, the Michaelis-Menten and Henri mechanisms, is presented. We also outline a general approach for analysing the structural indistinguishability between two mechanisms. The approach involves constructing, if possible, a smooth mapping between the two candidate models. Evans et al. [N.D. Evans, M.J. Chappell, M.J. Chapman, K.R. Godfrey, Structural indistinguishability between uncontrolled (autonomous) nonlinear analytic systems, Automatica 40 (2004) 1947-1953] have shown that if, in addition, either of the mechanisms satisfies a particular criterion then such a transformation always exists when the models are indistinguishable from their experimentally observable outputs. The approach is applied to the single enzyme-single substrate reaction mechanism. In principle, mechanisms can be distinguished using this analysis, but we show that our ability to distinguish mechanistic models depends both on the precise measurements made, and on our knowledge of the system prior to performing the kinetics experiments.

  13. Meta- and statistical analysis of single-case intervention research data: quantitative gifts and a wish list.

    Science.gov (United States)

    Kratochwill, Thomas R; Levin, Joel R

    2014-04-01

    In this commentary, we add to the spirit of the articles appearing in the special series devoted to meta- and statistical analysis of single-case intervention-design data. Following a brief discussion of historical factors leading to our initial involvement in statistical analysis of such data, we discuss: (a) the value added by including statistical-analysis recommendations in the What Works Clearinghouse Standards for single-case intervention designs; (b) the importance of visual analysis in single-case intervention research, along with the distinctive role that could be played by single-case effect-size measures; and (c) the elevated internal validity and statistical-conclusion validity afforded by the incorporation of various forms of randomization into basic single-case design structures. For the future, we envision more widespread application of quantitative analyses, as critical adjuncts to visual analysis, in both primary single-case intervention research studies and literature reviews in the behavioral, educational, and health sciences. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  14. Management of an Endodontic Infection with an Extra Oral Sinus Tract in a Single Visit: A Case Report

    OpenAIRE

    Satish Kumar, Krishnamurthy; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Prakash, Venkatachalam; Tamilselvi, Ramachandran

    2013-01-01

    Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in ...

  15. Mycetoma: experience of 482 cases in a single center in Mexico.

    Directory of Open Access Journals (Sweden)

    Alexandro Bonifaz

    2014-08-01

    Full Text Available Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013. A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11% were actinomycetomas and 38 cases (7.88% were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years. The main affected localization was lower and upper limbs (70.74% and 14.52% respectively. Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported. The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%. Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21% and Actinomadura madurae (8.7%; meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

  16. Coats' disease and congenital retinoschisis in a single eye: a case report and DNA analysis.

    Science.gov (United States)

    Berinstein, D M; Hiraoka, M; Trese, M T; Shastry, B S

    2001-01-01

    The clinical features of Coats' disease and congenital retinoschisis (RS) are distinctly different. Therefore, finding changes consistent with Coats' disease and congenital RS in a single eye is an unusual occurrence. The following report describes two cases with a Coats' telangiectatic lesion in one region of the retina separated by normal retina and the presence of central and peripheral congenital RS. Molecular genetic analysis of the Norrie disease and RS genes failed to identify disease-causing or polymorphic mutations in either of the genes, suggesting that the above condition is clinically and genetically a different disorder. Further studies are needed to identify the genes responsible for the above disorder and associated ocular manifestations. Copyright 2001 S. Karger AG, Basel.

  17. Single Party Cabinets and Presidential Democracies: insights from the Argentinean case

    Directory of Open Access Journals (Sweden)

    Marcelo CAMERLO

    2013-07-01

    Full Text Available The study of presidential cabinets has mainly focused on coalitional formations, distinguishing individual ministers in terms of their party affiliation particularly at cabinet instauration and termination. This article moves the focus to single-party cabinets to study minister appointment in situations where the legislative support is less relevant. A model of analysis that observes extra-partisan affiliations, individual technical skills and personal liaison with the president is proposed and exploratory applied to the Argentinean case. The results suggest that well positioned presidents tend to apply closer strategies of portfolio distribution, with levels of institutionalization that depends on the president’s party organization and the president’s style of leadership.

  18. The contribution of single case studies to the neuroscience of vision.

    Science.gov (United States)

    Zihl, Josef; Heywood, Charles A

    2016-03-01

    Visual neuroscience is concerned with the neurobiological foundations of visual perception, that is, the morphological, physiological, and functional organization of the visual brain and its co-operative partners. One important approach for understanding the functional organization of the visual brain is the study of visual perception from the pathological perspective. The study of patients with focal injury to the visual brain allows conclusions about the representation of visual perceptual functions in the framework of association and dissociation of functions. Selective disorders have been reported for more "elementary" visual capabilities, for example, color and movement vision, but also for visuo-cognitive capacities, such as visual agnosia or the visual field of attention. Because these visual disorders occur rather seldom as selective and specific dysfunctions, single cases have always played, and still play, a significant role in gaining insights into the functional organization of the visual brain. © 2016 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

  19. Historical Single Image-Based Modeling: The Case of Gobierna Tower, Zamora (Spain

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    Jesús Garcia-Gago

    2014-01-01

    Full Text Available Historical perspective images have been proved to be very useful to properly provide a dimensional analysis of buildings façades or even to generate a pseudo-3D reconstruction based on rectified images of the whole structure. In this paper, the case of Gobierna Tower (Zamora, Spain is analyzed from a historical single image-based modeling approach. In particular, a bottom-up approach, which takes advantage from the perspective of the image, the existence of the three vanishing points and the usual geometric constraints (i.e., planarity, orthogonality, and parallelism is applied for the dimensional analysis of a destroyed historical building. Results were compared with ground truth measurements existing in a historical topographical surveying obtaining deviations of about 1%.

  20. Single nucleotide polymorphisms and unacceptable late toxicity in breast cancer adjuvant radiotherapy: a case report

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    Lazzari G

    2017-05-01

    Full Text Available Grazia Lazzari,1 Maria Iole Natalicchio,2 Angela Terlizzi,3 Francesco Perri,4 Giovanni Silvano1 1Radiation Oncology Unit, San Giuseppe Moscati Hospital, Taranto, 2Molecular Biology Laboratory, Pathological Anatomy Department, Ospedali Riuniti, Foggia, 3Medical Physic Unit, San Giuseppe Moscati Hospital, 4Medical Oncology Unit, Presidio Ospedaliero Centrale - Santissima Annunziata, Taranto, Italy Background: There has recently been a strong interest in the inter-individual variation in normal tissue and tumor response to radiotherapy (RT, because tissue radiosensitivity seems to be under genetic control. Evidence is accumulating on the role of polymorphic genetic variants, such as single nucleotide polymorphisms (SNPs that could influence normal tissue response after radiation. The most studied SNPs include those in genes involved in DNA repair (single- and double-strand breaks, and base excision and those active in the response to oxidative stress.Case report: We present the case report of a 60-year-old woman with early breast cancer who underwent adjuvant hormone therapy and conventional radiotherapy, and subsequently developed unacceptable cosmetic toxicities of the irradiated breast requiring a genetic test of genes involved in DNA repair mechanisms. The patient was found to be heterozygous for G28152A (T/C and C18067T (A/G mutations in X-ray repair cross-complementing group 1 (XRCC1 and 3 (XRCC3, respectively, homozygous for A313G (G/G mutation in glutathione S transferase Pi 1 (GSTP1, and wild-type for A4541G (A/A in XRCC3 and G135C (G/G in RAD51 recombinase.Conclusion: The role of SNPs should be taken into account when a severe phenomenon appears in normal tissues after radiation treatment, because understanding the molecular basis of individual radiosensitivity may be useful for identifying moderately or extremely radiosensitive patients who may need tailored therapeutic strategies. Keywords: radiosensitivity, SNPs, fibrosis, DNA repair

  1. Diagnosing developmental dyscalculia on the basis of reliable single case FMRI methods: promises and limitations.

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    Philipp Johannes Dinkel

    Full Text Available FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number

  2. Diagnosing developmental dyscalculia on the basis of reliable single case FMRI methods: promises and limitations.

    Science.gov (United States)

    Dinkel, Philipp Johannes; Willmes, Klaus; Krinzinger, Helga; Konrad, Kerstin; Koten, Jan Willem

    2013-01-01

    FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number representation in

  3. Single Coronary Artery Anomaly: A Case Report and Review of Literature.

    Science.gov (United States)

    Elbadawi, Ayman; Baig, Basarat; Elgendy, Islam Y; Alotaki, Erfan; Mohamed, Ahmed H; Barssoum, Kirolos; Fries, David; Khan, Muhammad; Khouzam, Rami N

    2018-02-06

    Single coronary artery is a rare anomaly, which is usually associated with other cardiac congenital abnormalities. A 56-year-old female presented with unstable angina. The patient reported complaints of typical chest pain on exertion few months prior to presentation, which progressed to become at rest. The pain was associated palpitations and dizziness. Past medical history was significant for hypertension and hyperlipidemia. Vital signs were stable. Physical examination was non-remarkable. Electrocardiogram showed normal sinus rhythm, with intermittent episodes of sinus bradycardia, and non-specific T-wave changes. Trans-thoracic echocardiogram showed normal left ventricular function and no segmental wall-motion abnormalities. Selective coronary angiography showed a normal left main coronary artery arising from left coronary cusp. The left main branched to a normal left anterior descending artery and to the left circumflex artery; a large vessel which supplied also the territory of the right coronary artery (RCA) through its terminal extension. Aortography showed absence of RCA with no other vessels arising from the right or non-coronary cusps. The patient was managed conservatively and discharged home with resolution of symptoms. We report a rare case of isolated single coronary artery with absent RCA. The patient presented with unstable angina, and was managed conservatively. Cardiologists should be aware of this rare condition, which carries a potential risk of sudden cardiac death.

  4. Qualitative Research Methods in Visual Communication. Case Study: Visual Networks in the Promotional Videos of the European Year of Volunteering

    Directory of Open Access Journals (Sweden)

    Camelia Cmeciu

    2013-05-01

    Full Text Available European Years are a means of promoting European issues at a macro and micro-level. The objective of this paper is to provide the visual differences in the framing of the issue of volunteering at a European and national level. The approach focuses on a blending of two qualitative research methods in visual communication: ATLAS.ti (computer assisted/ aided qualitative data analysis software and social semiotics. The results of our analysis highlight two network views on volunteering promoted through videos, a salience of transactional processes in the implementation of volunteering at a European and national level, and a classification of various types of social practices specific to Romania. This study provides an insight into the way in which two different qualitative methods may be combined in order to provide a visual representation and interpretation to a European issue.

  5. Predictors of Default from Treatment for Tuberculosis: a Single Center Case-Control Study in Korea.

    Science.gov (United States)

    Park, Cheol-Kyu; Shin, Hong-Joon; Kim, Yu-Il; Lim, Sung-Chul; Yoon, Jeong-Sun; Kim, Young-Su; Kim, Jung-Chul; Kwon, Yong-Soo

    2016-02-01

    Default from tuberculosis (TB) treatment could exacerbate the disease and result in the emergence of drug resistance. This study identified the risk factors for default from TB treatment in Korea. This single-center case-control study analyzed 46 default cases and 100 controls. Default was defined as interrupting treatment for 2 or more consecutive months. The reasons for default were mainly incorrect perception or information about TB (41.3%) and experience of adverse events due to TB drugs (41.3%). In univariate analysis, low income (defaulter (15.2% vs. 2.0%, P = 0.005), and combined extrapulmonary TB (54.3% vs. 34.0%, P = 0.020) were significant risk factors for default. In multivariate analysis, the absence of TB stigma (adjusted odd ratio [aOR]: 46.299, 95% confidence interval [CI]: 8.078-265.365, P defaulters (aOR: 33.226, 95% CI: 2.658-415.309, P = 0.007), and low income (aOR: 5.246, 95% CI: 1.249-22.029, P = 0.024) were independent predictors of default from TB treatment. In conclusion, patients with absence of disease stigma, treated by a non-pulmonologist, who were former defaulters, and with low income should be carefully monitored during TB treatment in Korea to avoid treatment default.

  6. Hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm formation in a single family: case report

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    Paraskevaidis Stylianos

    2009-06-01

    Full Text Available Abstract Background Hypertrophic cardiomyopathy (HCM is an extremely heterogeneous disease. An under recognized and very often missed subgroup within this broad spectrum concerns patients with left ventricular (LV apical aneurysms in the absence of coronary artery disease. Case presentation We describe a case of HCM with midventricular obstruction and apical aneurysm formation in 3 patients coming from a single family. This HCM pattern was detected by 2D-echocardiography and confirmed by cardiac magnetic resonance imaging. A cardioverter defibrillator was implanted in one of the patients because of non-sustained ventricular tachycardia detected in 24-h Holter monitoring and an abrupt drop in systolic blood pressure during maximal exercise test. The defibrillator activated 8 months after implantation by suppression of a ventricular tachycardia providing anti-tachycardia pacing. The patient died due to refractory heart failure 2 years after initial evaluation. The rest of the patients are stable after a 2.5-y follow-up period. Conclusion The detection of apical aneurysm by echocardiography in HCM patients may be complicated. Ventricular tachycardia arising from the scarred aneurysm wall may often occur predisposing to sudden death.

  7. Exploring representations and experiences of case-management users: towards difficulties and solutions to leading qualitative interviews with older people with complex living conditions.

    Science.gov (United States)

    Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique

    2013-01-01

    By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.

  8. Rating the methodological quality of single-subject designs and n-of-1 trials: introducing the Single-Case Experimental Design (SCED) Scale.

    Science.gov (United States)

    Tate, Robyn L; McDonald, Skye; Perdices, Michael; Togher, Leanne; Schultz, Regina; Savage, Sharon

    2008-08-01

    Rating scales that assess methodological quality of clinical trials provide a means to critically appraise the literature. Scales are currently available to rate randomised and non-randomised controlled trials, but there are none that assess single-subject designs. The Single-Case Experimental Design (SCED) Scale was developed for this purpose and evaluated for reliability. Six clinical researchers who were trained and experienced in rating methodological quality of clinical trials developed the scale and participated in reliability studies. The SCED Scale is an 11-item rating scale for single-subject designs, of which 10 items are used to assess methodological quality and use of statistical analysis. The scale was developed and refined over a 3-year period. Content validity was addressed by identifying items to reduce the main sources of bias in single-case methodology as stipulated by authorities in the field, which were empirically tested against 85 published reports. Inter-rater reliability was assessed using a random sample of 20/312 single-subject reports archived in the Psychological Database of Brain Impairment Treatment Efficacy (PsycBITE). Inter-rater reliability for the total score was excellent, both for individual raters (overall ICC = 0.84; 95% confidence interval 0.73-0.92) and for consensus ratings between pairs of raters (overall ICC = 0.88; 95% confidence interval 0.78-0.95). Item reliability was fair to excellent for consensus ratings between pairs of raters (range k = 0.48 to 1.00). The results were replicated with two independent novice raters who were trained in the use of the scale (ICC = 0.88, 95% confidence interval 0.73-0.95). The SCED Scale thus provides a brief and valid evaluation of methodological quality of single-subject designs, with the total score demonstrating excellent inter-rater reliability using both individual and consensus ratings. Items from the scale can also be used as a checklist in the design, reporting and critical

  9. Understanding the Role of Identity and the Retention of Mexican American Students in Higher Education: A Qualitative Case Study

    Science.gov (United States)

    De Leon, Juan, Jr.

    2012-01-01

    This qualitative ethnographic narrative inquiry explored the role of identity and the retention of Mexican American students in higher education. Leadership identity, a dimension of identity, was explored using narratives provided by 13 Mexican American students, attending a university in the northwest United States. Interview data was compiled,…

  10. Genome wide single cell analysis of chemotherapy resistant metastatic cells in a case of gastroesophageal adenocarcinoma

    International Nuclear Information System (INIS)

    Hjortland, Geir Olav; Fodstad, Oystein; Smeland, Sigbjorn; Hovig, Eivind; Meza-Zepeda, Leonardo A; Beiske, Klaus; Ree, Anne H; Tveito, Siri; Hoifodt, Hanne; Bohler, Per J; Hole, Knut H; Myklebost, Ola

    2011-01-01

    Metastatic progression due to development or enrichment of therapy-resistant tumor cells is eventually lethal. Molecular characterization of such chemotherapy resistant tumor cell clones may identify markers responsible for malignant progression and potential targets for new treatment. Here, in a case of stage IV adenocarcinoma of the gastroesophageal junction, we report the successful genome wide analysis using array comparative genomic hybridization (CGH) of DNA from only fourteen tumor cells using a bead-based single cell selection method from a bone metastasis progressing during chemotherapy. In a case of metastatic adenocarcinoma of the gastroesophageal junction, the progression of bone metastasis was observed during a chemotherapy regimen of epirubicin, oxaliplatin and capecitabine, whereas lung-, liver and lymph node metastases as well as the primary tumor were regressing. A bone marrow aspirate sampled at the site of progressing metastasis in the right iliac bone was performed, and single cell molecular analysis using array-CGH of Epithelial Specific Antigen (ESA)-positive metastatic cells, and revealed two distinct regions of amplification, 12p12.1 and 17q12-q21.2 amplicons, containing the KRAS (12p) and ERBB2 (HER2/NEU) (17q) oncogenes. Further intrapatient tumor heterogeneity of these highlighted gene copy number changes was analyzed by fluorescence in situ hybridization (FISH) in all available primary and metastatic tumor biopsies, and ErbB2 protein expression was investigated by immunohistochemistry. ERBB2 was heterogeneously amplified by FISH analysis in the primary tumor, as well as liver and bone metastasis, but homogenously amplified in biopsy specimens from a progressing bone metastasis after three initial cycles of chemotherapy, indicating a possible enrichment of erbB2 positive tumor cells in the progressing bone marrow metastasis during chemotherapy. A similar amplification profile was detected for wild-type KRAS, although more heterogeneously

  11. Facilitating the recruitment of minority ethnic people into research: qualitative case study of South Asians and asthma.

    Directory of Open Access Journals (Sweden)

    Aziz Sheikh

    2009-10-01

    Full Text Available There is international interest in enhancing recruitment of minority ethnic people into research, particularly in disease areas with substantial ethnic inequalities. A recent systematic review and meta-analysis found that UK South Asians are at three times increased risk of hospitalisation for asthma when compared to white Europeans. US asthma trials are far more likely to report enrolling minority ethnic people into studies than those conducted in Europe. We investigated approaches to bolster recruitment of South Asians into UK asthma studies through qualitative research with US and UK researchers, and UK community leaders.Interviews were conducted with 36 researchers (19 UK and 17 US from diverse disciplinary backgrounds and ten community leaders from a range of ethnic, religious, and linguistic backgrounds, followed by self-completion questionnaires. Interviews were digitally recorded, translated where necessary, and transcribed. The Framework approach was used for analysis. Barriers to ethnic minority participation revolved around five key themes: (i researchers' own attitudes, which ranged from empathy to antipathy to (in a minority of cases misgivings about the scientific importance of the question under study; (ii stereotypes and prejudices about the difficulties in engaging with minority ethnic populations; (iii the logistical challenges posed by language, cultural differences, and research costs set against the need to demonstrate value for money; (iv the unique contexts of the two countries; and (v poorly developed understanding amongst some minority ethnic leaders of what research entails and aims to achieve. US researchers were considerably more positive than their UK counterparts about the importance and logistics of including ethnic minorities, which appeared to a large extent to reflect the longer-term impact of the National Institutes of Health's requirement to include minority ethnic people.Most researchers and community leaders

  12. Direct percutaneous endoscopic jejunostomy using single-balloon enteroscopy without fluoroscopy: a case series

    Directory of Open Access Journals (Sweden)

    Carlos Bernardes

    Full Text Available Background: Direct percutaneous endoscopic jejunostomy (DPEJ is a useful method to provide enteral nutrition to individuals when gastric feeding is not possible or contraindicated. The aim of this study was to analyze the efficacy and safety of DPEJ tube placement with the Gauderer-Ponsky technique by the pull method, using single-balloon enteroscopy (SBE without fluoroscopy. Methods: This is a retrospective analysis of patients undergoing SBE for DPEJ placement in a referral hospital between January 2010 and March 2016. Technical success, clinical success and procedure related complications were recorded. Results: Twenty-three patients were included (17 males, median age 71 years, range 37-93 years. The most frequent indications for DPEJ were gastroesophageal cancer (n = 10 and neurological disease (n = 8. Eighty-seven percent of the patients had a contraindication to percutaneous endoscopic gastrostomy (PEG and PEG was unsuccessful in the remaining patients. The technical success rate was 83% (19/23, transillumination was not possible in three patients and an accidental exteriorization of the bumper resulting in a jejunal perforation occurred in one patient. The clinical success was 100% (19/19. The median follow-up was five months (range 1-35 months. Apart from the case of jejunal perforation and the two cases of accidental exteriorization, there were no other complications during follow-up. The 6-month survival was 65.8% and the 1-year survival was 49.3%. Conclusion: DPEJ can be carried out successfully via SBE without fluoroscopy with a low rate of significant adverse events. Although, leaving the overtube in place during the bumper pulling can be useful for distal jejunal loops, it can be safely removed in proximal loops to minimize complications.

  13. Effects of Single and Combined Application of Organic, Biological and Chemical Fertilizers on Quantitative and Qualitative Yield of Coriander (Coriandrum sativum

    Directory of Open Access Journals (Sweden)

    M. Aghhavani Shajari

    2016-07-01

    Full Text Available Introduction: Medicinal plants were one of the main natural resources of Iran from ancient times. Coriander (Coriandrum sativum L. is from Apiaceae family that it has cultivated extensively in the world. Management and environmental factors such as nutritional management has a significant impact on the quantity and quality of plants. Application of organic fertilizers in conventional farming systems is not common and most of the nutritional need of plants supply through chemical fertilizers for short period. Excessive and unbalanced use of fertilizers in the long period, reduce crop yield and soil biological activity, accumulation of nitrates and heavy metals, and finally cause negative environmental effects and increase the cost of production. The use of bio-fertilizers and organic matter are taken into consideration to reduce the use of chemical fertilizers and increase the quality of most crops. Stability and soil fertility through the use of organic fertilizers are important due to having most of the elements required by plants and beneficial effects on physical, chemical, biological and soil fertility. Therefore, the aim of this research was to evaluate the effects of organic, biological and chemical fertilizers on quality and quantity characteristics of coriander. Materials and Methods: In order to study the effects of single and combined applications of organic, biological and chemical fertilizers on quantitative and qualitative characteristics of Coriander (Coriandrum sativum, an experiment was conducted based on a randomized complete block design with three replications and 12 treatments at Research Station, Faculty of Agriculture, Ferdowsi University of Mashhad, Iran, in - 2011. Treatments included: (1 mycorrhizae (Glomus mosseae (2 biosulfur (Thiobacillus sp., (3 chemical fertilizer (NPK, (4 cow manure, 5( vermin compost, 6( mycorrhizae + chemical fertilizer, 7( mycorrhizae + cow manure, 8( mycorrhizae + vermicompost, 9( biosulfur

  14. Qualitative research.

    Science.gov (United States)

    Gelling, Leslie

    2015-03-25

    Qualitative research has an important role in helping nurses and other healthcare professionals understand patient experiences of health and illness. Qualitative researchers have a large number of methodological options and therefore should take care in planning and conducting their research. This article offers a brief overview of some of the key issues qualitative researchers should consider.

  15. Imagery Rescripting for Body Dysmorphic Disorder: A Multiple-Baseline Single-Case Experimental Design.

    Science.gov (United States)

    Willson, Rob; Veale, David; Freeston, Mark

    2016-03-01

    Individuals with body dysmorphic disorder (BDD) often experience negative distorted images of their appearance, and research suggests these may be linked to memories of adverse events such as bullying or teasing. This study evaluates imagery rescripting (ImR) as an intervention for BDD. In this article, we present a multiple-baseline single-case experimental design testing imagery rescripting as a brief, stand-alone intervention, with six individuals with BDD that related to aversive memories. The impact of the intervention was assessed by self-reported daily measures of symptom severity (preoccupation with appearance, appearance-related checking behaviors, appearance-related distress, and strength of belief that their main problem is their appearance) and standardized clinician ratings of BDD severity (Yale-Brown Obsessive Compulsive Scale modified for BDD). Four out of six of the participants responded positively to the intervention, with clinically meaningful improvement in symptomatology. Overall response was rapid; improvements began within the first week post-ImR intervention. From a small sample it is cautiously concluded that imagery rescripting may show promise as a module in cognitive-behavioral therapy for BDD, and is worthy of further investigation. Copyright © 2015. Published by Elsevier Ltd.

  16. An introduction to modeling longitudinal data with generalized additive models: applications to single-case designs.

    Science.gov (United States)

    Sullivan, Kristynn J; Shadish, William R; Steiner, Peter M

    2015-03-01

    Single-case designs (SCDs) are short time series that assess intervention effects by measuring units repeatedly over time in both the presence and absence of treatment. This article introduces a statistical technique for analyzing SCD data that has not been much used in psychological and educational research: generalized additive models (GAMs). In parametric regression, the researcher must choose a functional form to impose on the data, for example, that trend over time is linear. GAMs reverse this process by letting the data inform the choice of functional form. In this article we review the problem that trend poses in SCDs, discuss how current SCD analytic methods approach trend, describe GAMs as a possible solution, suggest a GAM model testing procedure for examining the presence of trend in SCDs, present a small simulation to show the statistical properties of GAMs, and illustrate the procedure on 3 examples of different lengths. Results suggest that GAMs may be very useful both as a form of sensitivity analysis for checking the plausibility of assumptions about trend and as a primary data analysis strategy for testing treatment effects. We conclude with a discussion of some problems with GAMs and some future directions for research on the application of GAMs to SCDs. (c) 2015 APA, all rights reserved).

  17. Case Study: Physical Capacity and Nutritional Status Before and After a Single-Handed Yacht Race.

    Science.gov (United States)

    Ghiani, Giovanna; Magnani, Sara; Doneddu, Azzurra; Sainas, Gianmarco; Pinna, Virginia; Caboi, Marco; Palazzolo, Girolamo; Tocco, Filippo; Crisafulli, Antonio

    2017-12-18

    During solitary sailing the sailor is exposed to sleep deprivation and difficulties in consuming regular meals. Sailor weight loss is often reported. In the present case study we describe changes in the physical capacity and the nutritional status of an athlete attempting a single-handed yacht race around the globe. An Italian male ocean racer (GM) asked for our help to reach an optimum level of physical and nutritional preparation. We planned his diet after assessing his anthropometric parameters and body composition as well as his usual energy intake and nutritional expenditure. The diet consisted in 120 meals stored in sealed plastic bags. Before his departure, GM performed two incremental exercise tests (cycle- and arm crank- ergometry) to assess his physical capacity. Cardiac functions were also estimated by Doppler echocardiography. All measures and exercise tests were repeated 10 days after GM finished the race, which lasted 64 days. Anthropometric measures did not change significantly, with the exception of Arm Fat Area and Thigh Muscle area, which decreased. There were evident increments in maximum oxygen intake and maximum workload during arm cranking after the race. On the contrary, maximum oxygen uptake and maximum workload decreased during cycling. Finally, End Diastolic and Stroke Volume decreased after the race. It was concluded that nutritional counseling was useful to avoid excessive changes in the nutritional status and body composition due to 64 days of solitary navigation. However, a reduction in physical leg capacity and cardiovascular functions secondary to legs disuse were present.

  18. A Single-Case Study of Resiliency After Extreme Incest in an Old Order Amish Family.

    Science.gov (United States)

    McGuigan, William M; Stephenson, Sarah J

    2015-01-01

    This exploratory research brief presents a single case study of the resiliency of "Mary B." She grew up in an Old Order Amish family where isolation, secrecy, and patriarchy masked repeated sexual assaults by her older brothers that began at age 7. By the age of 20, Mary alleged she had been raped on more than 200 separate occasions by members of her Amish family. After years of pleading with her mother and church officials to intervene, she sought therapy outside the Amish community. This led to three of her brothers being incarcerated. Her family disowned her and she was banned from the Amish community, leaving with an 8th grade education and little more than the clothes she was wearing. In less than 2 years, Mary had moved to a new town, completed her GED, obtained a car and driving license, maintained a small home, and worked as a certified nursing assistant. She consented to tape recorded interviews and completed several quantitative diagnostic measures. Scores on the diagnostic measures placed her within the normal range on self-esteem, competency, depression, stress, social support, and life skills. Analysis of interviews revealed Mary rebounded from her past by reframing her experiences. Themes identified within the interviews supported 6 of the 7 types of resiliencies (insight, independence, initiative, relationships, humor, and morality) outlined in the therapeutic Challenge Model.

  19. An Examination of XMOOCs: An Embedded Single Case Study Based on Conole’s 12 Dimensions

    Directory of Open Access Journals (Sweden)

    Serpil KOCDAR

    2017-10-01

    Full Text Available This study intends to examine the xMOOCs offered by one of the mainstream MOOC platforms in Conole’s 12 dimensions. For this purpose, the research employed an embedded single case study using heuristic inquiry to collect data. The researchers participated in three xMOOCs and took into consideration the characteristics of these MOOCs by rating them as low, medium or high in terms of Conole’s 12 dimensions. Inter-rater reliability was 92 percent. The study showed that the openness, massiveness, diversity, use of multimedia, communication among learners, learning pathway and amount of reflection dimensions were high. The communication with instructors, degree of collaboration and autonomy dimensions were medium, and the quality assurance, certification, and formal learning dimensions were low. After explaining characteristics of xMOOCs from the perspective of open learning, the study highlighted that xMOOCs dramatically differ with regard to the implementation of the freemium business model to education and course delivery methods. It was concluded that MOOCs are not a new form of learning, but a new form of organizing learning similar to the open university movement, but which promises more flexibility and access than open universities.

  20. Single incision vs conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study.

    Science.gov (United States)

    Kwag, Seung-Jin; Kim, Jun-Gi; Oh, Seong-Taek; Kang, Won-Kyung

    2013-09-01

    The purpose of the study was to evaluate the safety and effects of single-incision laparoscopic anterior resection (SILAR) for sigmoid colon cancer by comparing it with conventional laparoscopic anterior resection (CLAR). Twenty-four patients who underwent SILAR between April 2010 and July 2011 were case matched 1:2 with patients who underwent CLAR, with respect to age, sex, body mass index, tumor location, and history of abdominal surgery. Two patients in the SILAR group and 1 patient in the CLAR group experienced anastomotic leakage. The operative time was longer in the SILAR group than in the CLAR group (251 ± 50 vs 237 ± 49 minutes; P = .253). The number of harvested lymph nodes (19.6 ± 10.7 vs 20.8 ± 7.7; P = .630) was not different. The postoperative hospital stay was shorter in the SILAR group (7.1 ± 3.4 days) than in the CLAR group (8.1 ± 3.5 days) (P = .234). On the basis of the early outcomes, we conclude that SILAR is feasible and safe. Moreover, the adequate lymph node harvest and free margins support the use of this procedure. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Tau-U: A Quantitative Approach for Analysis of Single-Case Experimental Data in Aphasia.

    Science.gov (United States)

    Lee, Jaime B; Cherney, Leora R

    2018-03-01

    Tau-U is a quantitative approach for analyzing single-case experimental design (SCED) data. It combines nonoverlap between phases with intervention phase trend and can correct for a baseline trend (Parker, Vannest, & Davis, 2011). We demonstrate the utility of Tau-U by comparing it with the standardized mean difference approach (Busk & Serlin, 1992) that is widely reported within the aphasia SCED literature. Repeated writing measures from 3 participants with chronic aphasia who received computer-based writing treatment are analyzed visually and quantitatively using both Tau-U and the standardized mean difference approach. Visual analysis alone was insufficient for determining an effect between the intervention and writing improvement. The standardized mean difference yielded effect sizes ranging from 4.18 to 26.72 for trained items and 1.25 to 3.20 for untrained items. Tau-U yielded significant (p data from 2 of 3 participants. Tau-U has the unique advantage of allowing for the correction of an undesirable baseline trend. Although further study is needed, Tau-U shows promise as a quantitative approach to augment visual analysis of SCED data in aphasia.

  2. A case of a resectable single hepatic epithelioid hemangioendothelioma with characteristic imaging by ADC map.

    Science.gov (United States)

    Okano, Hiroshi; Nakajima, Hideki; Tochio, Tomomasa; Suga, Daisuke; Kumazawa, Hiroaki; Isono, Yoshiaki; Tanaka, Hiroki; Matsusaki, Shimpei; Sase, Tomohiro; Saito, Tomonori; Mukai, Katsumi; Nishimura, Akira; Matsushima, Nobuyoshi; Baba, Youichirou; Murata, Tetsuya; Hamada, Takashi; Taoka, Hiroki

    2015-12-01

    A 47-year-old woman with a single-nodule hepatic tumor was referred to our hospital. She had no symptoms. The tumor was located at the surface of the right lobe of the liver; it showed peripheral low signal intensity on a magnetic resonance imaging apparent diffusion coefficient (ADC) map, and an influx of blood flow into the peripheral area of the tumor at the early vascular phase on perflubutane microbubble (Sonazoid(®)) contrast-enhanced (CE) ultrasonography. Since we suspected a malignant tumor, the patient underwent surgical resection. The hepatic tumor was resected curatively. Pathological examination revealed that the tumor was composed of epithelioid cells with an epithelioid structure and/or cord-like structure. Immunohistochemical staining was positive for cluster of differentiation 34 and factor VIII-related antigen. Based on the above, a final diagnosis of hepatic epithelioid hemangioendothelioma (EHE) was made. Hepatic EHE is a rare hepatic tumor: only a few cases of hepatic EHE with curative resection have been reported. We were unable to reach a diagnosis of hepatic EHE by imaging studies; however, an ADC map was useful in showing the malignant potential of the tumor, and CE ultrasonography was useful in revealing the peripheral blood flow of the tumor. When an unusual hepatic mass is encountered, hepatic EHE should be kept in mind, and the mass should be inspected with more than one imaging modality, including an ADC map, in the process of differential diagnosis.

  3. [Gas tamponade following intraoperative pneumothorax on a single lung: A case study].

    Science.gov (United States)

    El Jaouhari, S D; Mamane Nassirou, O; Meziane, M; Bensghir, M; Haimeur, C

    2017-04-01

    Intraoperative pneumothorax is a rare complication with a high risk of cardiorespiratory arrest by gas tamponade especially on a single lung. We report the case of a female patient aged 53 years who benefited from a left pneumonectomy on pulmonary tuberculosis sequelae. The patient presented early postoperative anemia with a left hemothorax requiring an emergency thoracotomy. In perioperative, the patient had a gas tamponade following a pneumothorax of the remaining lung, and the fate has been avoided by an exsufflation. Intraoperative pneumothorax can occur due to lesions of the tracheobronchial airway, of the brachial plexus, the placement of a central venous catheter or barotrauma. The diagnosis of pneumothorax during unipulmonary ventilation is posed by the sudden onset of hypoxia associated with increased airway pressures and hypercapnia. The immediate life-saving procedure involves fine needle exsufflation before the placement of a chest tube. Prevention involves reducing the risk of barotrauma by infusing patients with low flow volumes and the proper use of positive airway pressure, knowing that despite protective ventilation, barotraumas risk still exists. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. “REPRESENTATION, PROJECTION AND COCHLEAR IMPLANT: A SINGLE CASE STUDY”

    Directory of Open Access Journals (Sweden)

    Carmela Mento

    2014-06-01

    Full Text Available From the psychological point of view hearing is an essential sensory modality for the human species, because it contributes to the formation of the first relational connections and emotions. It is important to make a diagnosis early to intervene and limit negative effects.  Deafness is a particular phenomenon (onset, types,  in this paper we undertake a thorough descriptive analysis on all aspects of deafness, in particular the use of a prosthetic device known as cochlear implant.  We have deepened personality variables in a single case with the use of Rorschach Test and Draw-a-person-Test.  We aimed to study, with the clinical interpretation of instruments, which personality variables could be involved in hearing loss condition and Cochlear Implant (CI.  This observational study highlights the psychological dynamics that should be taken into account by operators team, in order to improve the quality of life of these patients and increase their long-term therapeutic outcome.

  5. Single-Case Research Methods: History and Suitability for a Psychological Science in Need of Alternatives.

    Science.gov (United States)

    Hurtado-Parrado, Camilo; López-López, Wilson

    2015-09-01

    This paper presents a historical and conceptual analysis of a group of research strategies known as the Single-Case Methods (SCMs). First, we present an overview of the SCMs, their history, and their major proponents. We will argue that the philosophical roots of SCMs can be found in the ideas of authors who recognized the importance of understanding both the generality and individuality of psychological functioning. Second, we will discuss the influence that the natural sciences' attitude toward measurement and experimentation has had on SCMs. Although this influence can be traced back to the early days of experimental psychology, during which incipient forms of SCMs appeared, SCMs reached full development during the subsequent advent of Behavior Analysis (BA). Third, we will show that despite the success of SCMs in BA and other (mainly applied) disciplines, these designs are currently not prominent in psychology. More importantly, they have been neglected as a possible alternative to one of the mainstream approaches in psychology, the Null Hypothesis Significance Testing (NHST), despite serious controversies about the limitations of this prevailing method. Our thesis throughout this section will be that SCMs should be considered as an alternative to NHST because many of the recommendations for improving the use of significance testing (Wilkinson & the TFSI, 1999) are main characteristics of SCMs. The paper finishes with a discussion of a number of the possible reasons why SCMs have been neglected.

  6. Validity of the diagnosis of a single depressive episode in a case register

    DEFF Research Database (Denmark)

    Bock, Camilla; Bukh, Jens Drachmann; Vinberg, Maj

    2009-01-01

    .8% for severe type of a single depression, 76.0% for moderate type of a single depression and 65.2% for mild type of a single depression). CONCLUSION: The ICD-10 diagnosis of a single depressive episode can be used in daily clinical practice with sufficient precision. The validity of the diagnosis is highest...... for severe and moderate type of depression and decreases for mild depression....

  7. Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders.

    Science.gov (United States)

    Byun, Tara McAllister; Hitchcock, Elaine R; Ferron, John

    2017-06-10

    Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

  8. Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study.

    Science.gov (United States)

    Thoma, Jorun E; Waite, Marion A

    2018-03-01

    To gain knowledge of nurse case managers' experiences within the German acute care context of collaboration with patients and physicians in a discharge planning role; further to learn about patients' assignment to the management of the nurse case managers; and explicitly to explore critical incidences of interactions between nurse case managers, patients and healthcare practitioner in discharge planning to understand the factor that contributes to effective collaboration. The defined role of nurse case managers in many contexts is a patient-centred responsibility for a central task of discharge management of patients with complex physical and social needs. Some studies have indicated that the general impact of the role reduces readmission rates. Given the necessity to work interprofessionally to achieve a safe discharge, little is known about how nurse case managers achieve this collaboratively. A qualitative case study within a German teaching hospital of nurse case managers (N = 8). Data were collected through semi-structured interviews prompted by a critical incident technique and rigorously analysed through the lenses of sociocultural theory. Consistent object being worked upon was a safe and effective discharge from hospital with a focus on patient advocacy. Significant themes were a self-value or recognition by others of professional expertise, reciprocal value on the capabilities of others thorough relational expertise and negotiation with patients and an identification of case trajectories. More continuity of nurse case managers' care and management, clarity of role and transparency to peers, physicians and other professionals would be beneficial in ensuring appropriate referral of complex patients to nurse case managers responsibility. Clearer role description and benefit realisation of the nurse case managers could be achieved by interventions that are interprofessional and focus on the tasks that matter from a collaborative perspective. This could lead

  9. Students' Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study.

    Science.gov (United States)

    Pedersen, Kamilla; Moeller, Martin Holdgaard; Paltved, Charlotte; Mors, Ole; Ringsted, Charlotte; Morcke, Anne Mette

    2017-10-06

    The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' perceptions of psychiatric patients and students' reflections on meeting and communicating with psychiatric patients. The authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews. Students taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients. The format of patient cases included in teaching may have a substantial impact on students' patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.

  10. Evolution of Choroidal Neovascular Membrane in Best Disease after Single Intravitreal Bevacizumab. Case Report.

    Science.gov (United States)

    Celea, Christiana; Pop, Mihai; Avidis-Zamfiroiu, Nicoleta; Celea, Cristian

    2015-03-01

    Best's disease is a hereditary form of macular dystrophy that starts in childhood and progresses until visual symptoms occur. In evolution it can be complicated with choroidal neovascularization, condition very rare in children. We report an important visual improvement in a 8-year-old caucasian girl after successful treatment with one intravitreal bevacizumab injection. There are few cases reported in literature (1-7), and the patient presented here have important particularities: one of the youngest children ever-mentioned with this complication, the third-member of her family with this disease and the first patient who didn't receive a second intravitreal bevacizumab at six weeks after first treatment, even though BCVA was lower than expected. The girl accused decrease of vision in the RE for the past 3-4 months. BCVA at presentation was 1/10. After 6 weeks from the intravitreal treatment, BCVA improved, but not very satisfactory (5/10). Because fundus and OCT aspects were encouraging, we waited another 4 weeks before the second injection. BCVA doubled in this period (8/10). Visual acuity, fundus and OCT aspects stabilized for 18 months of follow-up. We note that choroidal neovascular membrane associated with Best's disease can appear at such young children, this fact being very important in the phase of diagnosis, when the clinician should also take in consideration this possibility. Another important idea underlined here is the long-term efficacy of a single intravitreal anti-VEGF injection and also the no-need for imminent, fast re-treatment when the fundus and OCT aspects are encouraging through the follow-up.

  11. Single Case Method in Psychology: How to Improve as a Possible Methodology in Quantitative Research.

    Science.gov (United States)

    Krause-Kjær, Elisa; Nedergaard, Jensine I

    2015-09-01

    Awareness of including Single-Case Method (SCM), as a possible methodology in quantitative research in the field of psychology, has been argued as useful, e.g., by Hurtado-Parrado and López-López (IPBS: Integrative Psychological & Behavioral Science, 49:2, 2015). Their article introduces a historical and conceptual analysis of SCMs and proposes changing the, often prevailing, tendency of neglecting SCM as an alternative to Null Hypothesis Significance Testing (NHST). This article contributes by putting a new light on SCM as an equally important methodology in psychology. The intention of the present article is to elaborate this point of view further by discussing one of the most fundamental requirements as well as main characteristics of SCM regarding temporality. In this respect that; "…performance is assessed continuously over time and under different conditions…" Hurtado-Parrado and López-López (IPBS: Integrative Psychological & Behavioral Science, 49:2, 2015). Defining principles when it comes to particular units of analysis, both synchronic (spatial) and diachronic (temporal) elements should be incorporated. In this article misunderstandings of the SCM will be adduced, and further the temporality will be described in order to propose how the SCM could have a more severe usability in psychological research. It is further discussed how to implement SCM in psychological methodology. It is suggested that one solution might be to reconsider the notion of time in psychological research to cover more than a variable of control and in this respect also include the notion of time as an irreversible unity within life.

  12. 'Silk Road', the virtual drug marketplace: a single case study of user experiences.

    Science.gov (United States)

    Van Hout, Marie Claire; Bingham, Tim

    2013-09-01

    The online promotion of 'drug shopping' and user information networks is of increasing public health and law enforcement concern. An online drug marketplace called 'Silk Road' has been operating on the 'Deep Web' since February 2011 and was designed to revolutionise contemporary drug consumerism. A single case study approach explored a 'Silk Road' user's motives for online drug purchasing, experiences of accessing and using the website, drug information sourcing, decision making and purchasing, outcomes and settings for use, and perspectives around security. The participant was recruited following a lengthy relationship building phase on the 'Silk Road' chat forum. The male participant described his motives, experiences of purchasing processes and drugs used from 'Silk Road'. Consumer experiences on 'Silk Road' were described as 'euphoric' due to the wide choice of drugs available, relatively easy once navigating the Tor Browser (encryption software) and using 'Bitcoins' for transactions, and perceived as safer than negotiating illicit drug markets. Online researching of drug outcomes, particularly for new psychoactive substances was reported. Relationships between vendors and consumers were described as based on cyber levels of trust and professionalism, and supported by 'stealth modes', user feedback and resolution modes. The reality of his drug use was described as covert and solitary with psychonautic characteristics, which contrasted with his membership, participation and feelings of safety within the 'Silk Road' community. 'Silk Road' as online drug marketplace presents an interesting displacement away from 'traditional' online and street sources of drug supply. Member support and harm reduction ethos within this virtual community maximises consumer decision-making and positive drug experiences, and minimises potential harms and consumer perceived risks. Future research is necessary to explore experiences and backgrounds of other users. Copyright © 2013

  13. An analysis of single amino acid repeats as use case for application specific background models

    Directory of Open Access Journals (Sweden)

    Sykacek Peter

    2011-05-01

    Full Text Available Abstract Background Sequence analysis aims to identify biologically relevant signals against a backdrop of functionally meaningless variation. Increasingly, it is recognized that the quality of the background model directly affects the performance of analyses. State-of-the-art approaches rely on classical sequence models that are adapted to the studied dataset. Although performing well in the analysis of globular protein domains, these models break down in regions of stronger compositional bias or low complexity. While these regions are typically filtered, there is increasing anecdotal evidence of functional roles. This motivates an exploration of more complex sequence models and application-specific approaches for the investigation of biased regions. Results Traditional Markov-chains and application-specific regression models are compared using the example of predicting runs of single amino acids, a particularly simple class of biased regions. Cross-fold validation experiments reveal that the alternative regression models capture the multi-variate trends well, despite their low dimensionality and in contrast even to higher-order Markov-predictors. We show how the significance of unusual observations can be computed for such empirical models. The power of a dedicated model in the detection of biologically interesting signals is then demonstrated in an analysis identifying the unexpected enrichment of contiguous leucine-repeats in signal-peptides. Considering different reference sets, we show how the question examined actually defines what constitutes the 'background'. Results can thus be highly sensitive to the choice of appropriate model training sets. Conversely, the choice of reference data determines the questions that can be investigated in an analysis. Conclusions Using a specific case of studying biased regions as an example, we have demonstrated that the construction of application-specific background models is both necessary and

  14. Radiation treatment for medulloblastoma. A review of 64 cases at a single institute

    International Nuclear Information System (INIS)

    Liu Yueping; Gao Li; Xu Guozhen; Yi Junhin; Liu Xinfan; Li Yexiong

    2005-01-01

    Although the optimal treatment mode for medulloblastoma is frequently discussed, results based on large series of cases, especially those treated in Asia, have rarely been reported. Our purpose was to evaluate the efficacy of postoperative radiation therapy, and to identify prognostic factors, in a relatively large cohort of patients with limited-stage medulloblastoma treated at a single institute in China. Between January 1996 and April 2001, 69 patients with Chang stage M0/M1 medulloblastoma were referred to our hospital for radiation therapy after total or subtotal resection of the primary tumor. All patients received 30 Gy to the craniospinal axis followed by a 20-25 Gy boost to the posterior fossa (median fraction, 1.8 Gy). Sixty-four patients were followed for a median period of 38.5 months. The rates of 3-year and 5-year overall survival were 68.8% and 55.7%, respectively; corresponding disease-free survival were 57.8% and 51.4%, respectively. Patients who had received radiation treatment within 25 days after resection had a greater probability of 3-year survival (81.5% versus 59.5%; P=0.11) and 3-year disease-free survival (74.1% versus 46.0%; P=0.03) than patients who began radiation treatment later. No relationship was found between survival and age, sex or tumor size. This regimen was comparatively ineffective in preventing recurrence of postoperative medulloblastoma; however, we found that the interval between surgery and radiation is a significant prognostic factor for disease-free survival. (author)

  15. Promoting Positive Behavior Using the Good Behavior Game: A Meta-Analysis of Single-Case Research

    Science.gov (United States)

    Bowman-Perrott, Lisa; Burke, Mack D.; Zaini, Samar; Zhang, Nan; Vannest, Kimberly

    2016-01-01

    The Good Behavior Game (GBG) is a classroom management strategy that uses an interdependent group-oriented contingency to promote prosocial behavior and decrease problem behavior. This meta-analysis synthesized single-case research (SCR) on the GBG across 21 studies, representing 1,580 students in pre-kindergarten through Grade 12. The TauU effect…

  16. A Generalized Least Squares Regression Approach for Computing Effect Sizes in Single-Case Research: Application Examples

    Science.gov (United States)

    Maggin, Daniel M.; Swaminathan, Hariharan; Rogers, Helen J.; O'Keeffe, Breda V.; Sugai, George; Horner, Robert H.

    2011-01-01

    A new method for deriving effect sizes from single-case designs is proposed. The strategy is applicable to small-sample time-series data with autoregressive errors. The method uses Generalized Least Squares (GLS) to model the autocorrelation of the data and estimate regression parameters to produce an effect size that represents the magnitude of…

  17. Quality Indicators for Single-Case Research on Social Skill Interventions for Children with Autistic Spectrum Disorder

    Science.gov (United States)

    Wang, Shin-Yi; Parrila, Rauno

    2008-01-01

    In this paper, we describe a quality checklist that parents, teachers, clinicians, and policy-makers with basic research skills can use to systematically evaluate the methodological quality of single-case studies on social skill training of children with autistic spectrum disorder (ASD). We provide a rationale for included quality indicators, and…

  18. Therapeutic Assessment for Preadolescent Boys with Oppositional Defiant Disorder: A Replicated Single-Case Time-Series Design

    Science.gov (United States)

    Smith, Justin D.; Handler, Leonard; Nash, Michael R.

    2010-01-01

    The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to…

  19. Explaining Variance and Identifying Predictors of Children's Communication via a Multilevel Model of Single-Case Design Research: Brief Report

    Science.gov (United States)

    Ottley, Jennifer Riggie; Ferron, John M.; Hanline, Mary Frances

    2016-01-01

    The purpose of this study was to explain the variability in data collected from a single-case design study and to identify predictors of communicative outcomes for children with developmental delays or disabilities (n = 4). Using SAS® University Edition, we fit multilevel models with time nested within children. Children's level of baseline…

  20. The Influence of Visual Word Form in Reading: Single Case Study of an Arabic Patient with Deep Dyslexia

    Science.gov (United States)

    Boumaraf, Assia; Macoir, Joël

    2016-01-01

    Deep dyslexia is a written language disorder characterized by poor reading of non-words, and advantage for concrete over abstract words with production of semantic, visual and morphological errors. In this single case study of an Arabic patient with input deep dyslexia, we investigated the impact of graphic features of Arabic on manifestations of…

  1. Meta-Analysis of Single-Case Design Research on Self-Regulatory Interventions for Academic Performance

    Science.gov (United States)

    Perry, Valerie; Albeg, Loren; Tung, Catherine

    2012-01-01

    The current study examined the effects of self-regulatory interventions on reading, writing, and math by conducting a meta-analysis of single-case design research. Self-regulatory interventions have promise as an effective approach that is both minimally invasive and involves minimal resources. Effects of the interventions were analyzed by…

  2. The use of exploratory analyses within the National Institute for Health and Care Excellence single technology appraisal process: an evaluation and qualitative analysis.

    Science.gov (United States)

    Kaltenthaler, Eva; Carroll, Christopher; Hill-McManus, Daniel; Scope, Alison; Holmes, Michael; Rice, Stephen; Rose, Micah; Tappenden, Paul; Woolacott, Nerys

    2016-04-01

    As part of the National Institute for Health and Care Excellence (NICE) single technology appraisal (STA) process, independent Evidence Review Groups (ERGs) critically appraise the company submission. During the critical appraisal process the ERG may undertake analyses to explore uncertainties around the company's model and their implications for decision-making. The ERG reports are a central component of the evidence considered by the NICE Technology Appraisal Committees (ACs) in their deliberations. The aim of this research was to develop an understanding of the number and type of exploratory analyses undertaken by the ERGs within the STA process and to understand how these analyses are used by the NICE ACs in their decision-making. The 100 most recently completed STAs with published guidance were selected for inclusion in the analysis. The documents considered were ERG reports, clarification letters, the first appraisal consultation document and the final appraisal determination. Over 400 documents were assessed in this study. The categories of types of exploratory analyses included fixing errors, fixing violations, addressing matters of judgement and the ERG-preferred base case. A content analysis of documents (documentary analysis) was undertaken to identify and extract relevant data, and narrative synthesis was then used to rationalise and present these data. The level and type of detail in ERG reports and clarification letters varied considerably. The vast majority (93%) of ERG reports reported one or more exploratory analyses. The most frequently reported type of analysis in these 93 ERG reports related to the category 'matters of judgement', which was reported in 83 (89%) reports. The category 'ERG base-case/preferred analysis' was reported in 45 (48%) reports, the category 'fixing errors' was reported in 33 (35%) reports and the category 'fixing violations' was reported in 17 (18%) reports. The exploratory analyses performed were the result of issues

  3. Family caregiver burden in mental illnesses: The case of affective disorders and schizophrenia - a qualitative exploratory study.

    Science.gov (United States)

    von Kardorff, Ernst; Soltaninejad, Ali; Kamali, Mohammad; Eslami Shahrbabaki, Mahin

    2016-01-01

    Caregivers of people with mental illnesses often experience a wide range of burdens. Although many studies have confirmed burdens among family caregivers of mentally ill relatives in general, specific knowledge regarding the concrete everyday hassle and existential sorrows from the caregiverś subjective reasoning perspective is lacking. Furthermore, there is little evidence on the possible different effects of affective disorders and schizophrenia on the quality of burden; this is also true with regard to the role of cultural traditions and lay beliefs. The aim of this study was to explore the specific burdens experienced by caregivers of patients with schizophrenia and affective disorders. A qualitative study was conducted by semi-structured interviews with 45 caregivers of patients with schizophrenia and affective disorders. Data were analysed by qualitative content analysis. Eleven encumbering themes resulted from the interviews including incertitude, unawareness, emotional burden, stigma and blame, financial burden, physical burden, restriction in routine, disruption in routine, dissatisfaction with family, relatives, and acquaintances, troubles with patients' adherence to medication, and problems with health services and governmental support. Caring for a person with mental illness affects caregivers emotionally, financially, physically, and it elicits some restrictions in their routine (daily hassles). Finally, it causes conflicts in family relationships. Despite some differences regarding perceived burden among caregivers of schizophrenia and affective disorders, a common pattern of burden could be identified. Thus, authorities should provide adequate financial, educational, and psychosocial supports for caregivers of mental illnesses.

  4. Use of a single implant to retain mandibular overdenture: A preliminary clinical trial of 13 cases

    Directory of Open Access Journals (Sweden)

    Tao Cheng

    2012-09-01

    Conclusion: Within the limitations of this preliminary prospective clinical study, single-implant-supported mandibular overdentures were a successful alternative treatment option for elderly edentulous patients.

  5. Collaboration between non-governmental organizations and public services in health – a qualitative case study from rural Ecuador

    Directory of Open Access Journals (Sweden)

    Olivia Biermann

    2016-11-01

    Full Text Available Background: Non-governmental organizations (NGOs have a key role in improving health in low- and middle-income countries. Their work needs to be synergistic, complementary to public services, and rooted in community mobilization and collective action. The study explores how an NGO and its health services are perceived by the population that it serves, and how it can contribute to reducing barriers to care. Design: A qualitative exploratory study was conducted in remote Ecuador, characterized by its widespread poverty and lack of official governance. An international NGO collaborated closely with the public services to deliver preventative and curative health services. Data were collected using focus group discussions and semistructured interviews with purposively sampled community members, healthcare personnel, and community health workers based on their links to the health services. Conventional qualitative content analysis was used, focusing on manifest content. Results: Emerging themes relate to the public private partnership (PPP, the NGO and its services, and community participation. The population perceives the NGO positively, linking it to healthcare improvements. Their priority is to get services, irrespective of the provider's structure. The presence of an NGO in the operation may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively. Conclusions: To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the population's trust in the organization, an NGO should operate in a manner that is as integrated as possible within the existing structure. The NGO should work close to the population it serves, with services anchored in the community. PPP parties should develop a common platform with joint messages to the target population on the provider's structure, and regarding partners’ roles and responsibilities. Interaction between the population and the providers

  6. Hearing the voices of service user researchers in collaborative qualitative data analysis: the case for multiple coding.

    Science.gov (United States)

    Sweeney, Angela; Greenwood, Kathryn E; Williams, Sally; Wykes, Til; Rose, Diana S

    2013-12-01

    Health research is frequently conducted in multi-disciplinary teams, with these teams increasingly including service user researchers. Whilst it is common for service user researchers to be involved in data collection--most typically interviewing other service users--it is less common for service user researchers to be involved in data analysis and interpretation. This means that a unique and significant perspective on the data is absent. This study aims to use an empirical report of a study on Cognitive Behavioural Therapy for psychosis (CBTp) to demonstrate the value of multiple coding in enabling service users voices to be heard in team-based qualitative data analysis. The CBTp study employed multiple coding to analyse service users' discussions of CBT for psychosis (CBTp) from the perspectives of a service user researcher, clinical researcher and psychology assistant. Multiple coding was selected to enable multiple perspectives to analyse and interpret data, to understand and explore differences and to build multi-disciplinary consensus. Multiple coding enabled the team to understand where our views were commensurate and incommensurate and to discuss and debate differences. Through the process of multiple coding, we were able to build strong consensus about the data from multiple perspectives, including that of the service user researcher. Multiple coding is an important method for understanding and exploring multiple perspectives on data and building team consensus. This can be contrasted with inter-rater reliability which is only appropriate in limited circumstances. We conclude that multiple coding is an appropriate and important means of hearing service users' voices in qualitative data analysis. © 2012 John Wiley & Sons Ltd.

  7. Management of a patient's gait abnormality using smartphone technology in-clinic for improved qualitative analysis: A case report.

    Science.gov (United States)

    VanWye, William R; Hoover, Donald L

    2018-05-01

    Qualitative analysis has its limitations as the speed of human movement often occurs more quickly than can be comprehended. Digital video allows for frame-by-frame analysis, and therefore likely more effective interventions for gait dysfunction. Although the use of digital video outside laboratory settings, just a decade ago, was challenging due to cost and time constraints, rapid use of smartphones and software applications has made this technology much more practical for clinical usage. A 35-year-old man presented for evaluation with the chief complaint of knee pain 24 months status-post triple arthrodesis following a work-related crush injury. In-clinic qualitative gait analysis revealed gait dysfunction, which was augmented by using a standard IPhone® 3GS camera. After video capture, an IPhone® application (Speed Up TV®, https://itunes.apple.com/us/app/speeduptv/id386986953?mt=8 ) allowed for frame-by-frame analysis. Corrective techniques were employed using in-clinic equipment to develop and apply a temporary heel-to-toe rocker sole (HTRS) to the patient's shoe. Post-intervention video revealed significantly improved gait efficiency with a decrease in pain. The patient was promptly fitted with a permanent HTRS orthosis. This intervention enabled the patient to successfully complete a work conditioning program and progress to job retraining. Video allows for multiple views, which can be further enhanced by using applications for frame-by-frame analysis and zoom capabilities. This is especially useful for less experienced observers of human motion, as well as for establishing comparative signs prior to implementation of training and/or permanent devices.

  8. Students’ Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study

    DEFF Research Database (Denmark)

    Pedersen, Kamilla; Holdgaard, Martin Møller; Paltved, Charlotte

    2017-01-01

    ' perceptions of psychiatric patients and students' reflections on meeting and communicating with psychiatric patients. METHODS: The authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed....... Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients. CONCLUSION: The format of patient cases included in teaching may have a substantial impact...... unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry....

  9. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases

    DEFF Research Database (Denmark)

    Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels

    2011-01-01

    Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined.......Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined....

  10. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles

    NARCIS (Netherlands)

    Oerlemans, M.; Dielissen, P.W.; Timmerman, A.; Ram, P.; Maiburg, B.; Muris, J.; Vleuten, C. van der

    2017-01-01

    BACKGROUND: A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors' perceptions of behavioral

  11. Qualitative Identification of Fentanyl Analogs and Other Opioids in Postmortem Cases by UHPLC-Ion Trap-MSn.

    Science.gov (United States)

    Shoff, Elisa N; Zaney, M Elizabeth; Kahl, Joseph H; Hime, George W; Boland, Diane M

    2017-07-01

    Since 2013, the Miami-Dade County Medical Examiner Department has experienced an increase in the number of opioid-related deaths. The majority of cases coincided with the introduction of fentanyl into the local heroin supply. From 2014 to 2015, Miami-Dade County experienced a near 600% increase in fentanyl-related deaths, followed by an additional 200% increase in 2016. In 2015, two novel fentanyl analogs were identified in medical examiner cases: beta-hydroxythiofentanyl and acetyl fentanyl. In 2016, four additional fentanyl analogs emerged: para-fluoroisobutyryl fentanyl, butyryl fentanyl, furanyl fentanyl and carfentanil, as well as the synthetic opioid U-47700. In order to address this epidemic, a method was developed and validated to identify 44 opioid-related and analgesic compounds in postmortem samples using ultra high performance liquid chromatography ion trap mass spectrometry with MSn capabilities. The limit of detection for all compounds ranged from 0.1 to 5 ng/mL, with a majority having MS3 spectral fragmentation. Blood, urine, liver or brain specimens from ~500 postmortem cases were submitted for analysis based on case history and/or initial screening results. Of those cases, 375 were positive for illicit fentanyl and/or one or more fentanyl analogs. Due to the potency of these compounds, they were almost always included in the cause of death. Worth emphasizing and extremely alarming is the detection of carfentanil in 134 cases, 104 of which were initially missed by gas chromatography mass spectrometry. By incorporating this sensitive, highly specific, and evolving screening procedure into the workflow, the toxicology laboratory continues to effectively assist the medical examiners in determining the cause and manner of death of decedents in Miami-Dade County. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Provider perspectives on drug-resistant tuberculosis and human immunodeficiency virus care in South Africa: a qualitative case study.

    Science.gov (United States)

    Daftary, A; Padayatchi, N

    2016-11-01

    To examine influences on health care workers' (HCWs') capacity to deliver health care for multi- and/or extensively drug-resistant tuberculosis (MDR/XDR-TB) and human immunodeficiency virus (HIV) infection in South Africa. Qualitative data were collected via group and individual interviews with a purposive sample of 17 HCWs at a centralised, tertiary TB facility and analysed using grounded theory. Four themes were identified: 1) personal infection control practices among HCWs may be weakened by a workplace culture comprising low motivation, disparate risk perceptions and practices across workforce hierarchies, physical discomfort, and problems managing patients with treatment-induced hearing loss. 2) Patient-provider interactions are likely stronger among nurses, and in HIV vs. MDR/XDR-TB service delivery, due to greater attention to patient empowerment and support. Stigma associated with MDR/XDR-TB, considered worse than HIV, may be perpetuated within non-specialised facilities less familiar with MDR/XDR-TB. 3) HCWs who struggle with the daily tedium of MDR/XDR-TB treatment supervision are becoming increasingly supportive of treatment literacy and self-administration. 4) Effective integration of HIV and MDR/XDR-TB services may be impeded by administrative restrictions, workplace norms and provider mindsets. Comprehensive, decentralised management of MDR/XDR-TB and HIV coinfection requires the creation of patient-provider trust and treatment literacy in MDR/XDR-TB programmes, and defying workplace norms that could provoke nosocomial TB exposure and fragmented service provision.

  13. Competition in collaborative clothing: a qualitative case study of influences on collaborative quality improvement in the ICU.

    Science.gov (United States)

    Dainty, Katie N; Scales, Damon C; Sinuff, Tasnim; Zwarenstein, Merrick

    2013-04-01

    Multiorganisational quality improvement (QI) collaborative networks are promoted for improving quality within healthcare. Recently, several large-scale QI initiatives have been conducted in the intensive care unit (ICU) environment with successful quantitative results. However, the mechanisms through which such networks lead to QI success remain uncertain. We aim to understand ICU staff perspectives on collaborative QI based on involvement in a multiorganisational improvement network and hypothesise about theoretical constructs that might explain the effect of collaboration in such networks. Qualitative study using a modified grounded theory approach. Key informant interviews were conducted with staff from 12 community hospital ICUs that participated in a cluster randomized control trial (RCT) of a QI intervention using a collaborative approach between 2006 and 2008. Data analysis followed the standard procedure for grounded theory using constant comparative methodology. The collaborative network was perceived to promote increased intrateam cooperation over interorganisational cooperation, but friendly competition with other ICUs appeared to be a prominent driver of behaviour change. Bedsides, clinicians reported that belonging to a collaborative network provided recognition for the high-quality patient care that they already provided. However, the existing communication structure was perceived to be ineffective for staff engagement since it was based on a hierarchical approach to knowledge transfer and project awareness. QI collaborative networks may promote behaviour change by improving intrateam communication, fostering competition with other institutions, and increasing recognition for providing high-quality care. Other commonly held assumptions about their potential impact, for instance, increasing interorganisational legitimisation, communication and collaboration, may be less important.

  14. Retrospective qualitative analysis of ecological networks under environmental perturbation: a copper-polluted intertidal community as a case study.

    Science.gov (United States)

    Ramos-Jiliberto, Rodrigo; Garay-Narváez, Leslie; Medina, Matías H

    2012-01-01

    The coast of Chañaral Bay in northern Chile has been affected by copper mine wastes for decades. This sustained perturbation has disrupted the intertidal community in several ways, but the mechanisms behind the observed shifts in local biodiversity remain poorly understood. Our main goal was to identify the species (lumped into trophic groups) belonging to the Chañaral intertidal community that, being directly affected by copper pollution, contributed primarily to the generation of the observed changes in community structure. These groups of species were called initiators. We applied a qualitative modelling approach based only on the sign and direction of effects among species, and present a formula for predicting changes in equilibrium abundances considering stress on multiple variables simultaneously. We then applied this technique retrospectively to identify the most likely set of initiators. Our analyses allowed identification of a unique set of four initiators in the studied intertidal system (a group of algae, sessile invertebrates, a group of herbivores and starfish), which were hypothesized to be the primary drivers of the observed changes in community structure. In addition, a hypothesis was derived about how the perturbation affected these initiators. The hypothesis is that pollution affected negatively the population growth rate of both algae and sessile invertebrates and suppressed the interaction between herbivores and starfish. Our analytic approach, focused on identifying initiators, constitutes an advance towards understanding the mechanisms underlying human-driven ecosystem disruption and permits identifying species that may serve as a focal point for community management and restoration.

  15. Proposing a Qualitative Approach for Corporate Competitive Capability Modeling in High-Tech Business (Case study: Software Industry

    Directory of Open Access Journals (Sweden)

    Mahmoud Saremi Saremi

    2010-09-01

    Full Text Available The evolution of global business trend for ICT-based products in recent decades shows the intensive activity of pioneer developing countries to gain a powerful competitive position in global software industry. In this research, with regard to importance of competition issue for top managers of Iranian software companies, a conceptual model has been developed for Corporate Competitive Capability concept. First, after describing the research problem, we present a comparative review of recent theories of firm and competition that has been applied by different researchers in the High-Tech and Knowledge Intensive Organization filed. Afterwards, with a detailed review of literature and previous research papers, an initial research framework and applied research method has been proposed. The main and final section of paper assigned to describing the result of research in different steps of qualitative modeling process. The agreed concepts are related to corporate competitive capability, the elicited and analyzed experts Cause Map, the elicited collective causal maps, and the final proposed model for software industry are the modeling results for this paper.

  16. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes.

    Science.gov (United States)

    Carlisle, Karen; Warren, Robin

    2013-10-01

    The present study formed part of a randomised controlled trial of telehealth for in-home monitoring to support people with poorly controlled type 2 diabetes. We explored the experiences of patients and healthcare practitioners, and their perceptions of the telehealth model of care used in the trial. In addition to their usual diabetes care, participants receive diabetes care from a diabetes educator nurse via an in-home broadband communication device. On average, each patient participated in 14 videoconferences with a diabetes care coordinator during the 12-month trial period. Qualitative data was collected from two general practices and included semi-structured interviews and document review of patient clinical notes. A total of 12 people were interviewed: 8 health practitioners and 4 patients. Patients and health practitioners expressed a high level of satisfaction with the model of care provided. Patients also reported positive health and social outcomes as a result of being involved in the trial and indicated that in the main they had achieved their goals and were happy with their progress over the 12-month period. Analysis of interviews revealed three broad elements associated with the implementation of telehealth: interpersonal factors, operational problems and the wider health system context within which the general practices and trial team were operating. The findings suggest that adopting telehealth in the management of type 2 diabetes can lead to improved diabetes control, but more support is required to ensure sustainability and widespread implementation.

  17. A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; Gholipour, Kamal; Iezadi, Shabnam; Farahbakhsh, Mostafa; Ghiasi, Akbar

    2018-01-01

    The aim was to design a district health management performance framework for Iran's healthcare system. The mixed-method study was conducted between September 2015 and May 2016 in Tabriz, Iran. In this study, the indicators of district health management performance were obtained by analyzing the 45 semi-structured surveys of experts in the public health system. Content validity of performance indicators which were generated in qualitative part were reviewed and confirmed based on content validity index (CVI). Also content validity ratio (CVR) was calculated using data acquired from a survey of 21 experts in quantitative part. The result of this study indicated that, initially, 81 indicators were considered in framework of district health management performance and, at the end, 53 indicators were validated and confirmed. These indicators were classified in 11 categories which include: human resources and organizational creativity, management and leadership, rules and ethics, planning and evaluation, district managing, health resources management and economics, community participation, quality improvement, research in health system, health information management, epidemiology and situation analysis. The designed framework model can be used to assess the district health management and facilitates performance improvement at the district level.

  18. A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2018-04-01

    Full Text Available The aim was to design a district health management performance framework for Iran’s healthcare system. The mixed-method study was conducted between September 2015 and May 2016 in Tabriz, Iran. In this study, the indicators of district health management performance were obtained by analyzing the 45 semi-structured surveys of experts in the public health system. Content validity of performance indicators which were generated in qualitative part were reviewed and confirmed based on content validity index (CVI. Also content validity ratio (CVR was calculated using data acquired from a survey of 21 experts in quantitative part. The result of this study indicated that, initially, 81 indicators were considered in framework of district health management performance and, at the end, 53 indicators were validated and confirmed. These indicators were classified in 11 categories which include: human resources and organizational creativity, management and leadership, rules and ethics, planning and evaluation, district managing, health resources management and economics, community participation, quality improvement, research in health system, health information management, epidemiology and situation analysis. The designed framework model can be used to assess the district health management and facilitates performance improvement at the district level.

  19. Mental health status of unmarried youth living in single parent families: a case study from India.

    Science.gov (United States)

    Sinha, Atreyee; Ram, Faujdar

    2018-02-16

    In South Asian countries like India, family system lays a strong foundation in societies and therefore, the context and consequences of single parent family structures are markedly different from that of the West. In these societies single parenthood is mainly an outcome of untimely death of any one of the parents. This study tried to examine the influence of parents' survival status on the mental health of youth in India. "Youth in India: situation and Needs (2006-2007)" survey data was used in the present study. We compared two groups of unmarried young population aged 15-24 y (n = 28 637): one having both parents alive and another having only one parent alive. Bivariate and multivariate techniques were applied to analyze the data. Results revealed that around 11% of the unmarried youth belonged to single parent families. Findings underscored a significant association between parent's survival and mental health of youth; respondents from single parent families were more likely to report metal health problems Moreover, effects of parents' survival were significant on females' mental health rather than males'. Policies must focus on reducing stress of young people growing up in single parent families through enhanced educational and employment opportunities.

  20. Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

    Directory of Open Access Journals (Sweden)

    Kathrin M Cresswell

    Full Text Available There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making.We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9.We drew on data from 17 participants (approximately eight per roundtable, six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs".Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

  1. Integrating Qualitative and Quantitative Methods in Participatory Modeling to Elicit Behavioral Drivers in Environmental Dilemmas: the Case of Air Pollution in Talca, Chile.

    Science.gov (United States)

    Meinherz, Franziska; Videira, Nuno

    2018-04-10

    The aim of this paper is to contribute to the exploration of environmental modeling methods based on the elicitation of stakeholders' mental models. This aim is motivated by the necessity to understand the dilemmas and behavioral rationales of individuals for supporting the management of environmental problems. The methodology developed for this paper integrates qualitative and quantitative methods by deploying focus groups for the elicitation of the behavioral rationales of the target population, and grounded theory to code the information gained in the focus groups and to guide the development of a dynamic simulation model. The approach is applied to a case of urban air pollution caused by residential heating with wood in central Chile. The results show how the households' behavior interrelates with the governmental management strategies and provide valuable and novel insights into potential challenges to the implementation of policies to manage the local air pollution problem. The experience further shows that the developed participatory modeling approach allows to overcome some of the issues currently encountered in the elicitation of individuals' behavioral rationales and in the quantification of qualitative information.

  2. Meta-Analysis of Incremental Rehearsal Using Phi Coefficients to Compare Single-Case and Group Designs

    Science.gov (United States)

    Burns, Matthew K.; Zaslofsky, Anne F.; Kanive, Rebecca; Parker, David C.

    2012-01-01

    The current study meta-analyzed single-case design (SCD) and group research regarding incremental rehearsal (IR). We used phi to meta-analyze data from 19 IR studies. Data from the SCD studies resulted in a nonoverlap of all pairs (NAP) score of 98.9% (95% CI = 97.6-100%), which resulted in a weighted phi of 0.77 (95% CI = 0.69-0.83). The group…

  3. Role of social workers to support single mothers: A case study of welfare receivers in Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Iravani

    2012-01-01

    Full Text Available The women who lose their partners normally face tremendous challenges among their parents and in society. Women may lose their husbands for different reasons such as divorce, drug addiction, violence and migration. They may often look to build a new life very quickly but will find out that society does not treat them, properly. It is more difficult to find job and even a job opportunity does not provide sufficient pay. In this paper, we study the impact of different affecting parameters on empowering single mothers such as audacity, social responsibility, trouble shooting, flexibility, stress tolerance, etc. We choose 200 single mothers who receive welfare from the government of Iran and distribute a questionnaire among them based on four different questions associated with social, economical, feeling and empowering. The results indicate that audacity and social responsibility are the most important items while being optimistic, independent and flexibility are counted as having the least impact on empowering single mothers.

  4. Perspectives on econometric modelling to inform policy: a UK qualitative case study of minimum unit pricing of alcohol.

    Science.gov (United States)

    Katikireddi, Srinivasa V; Bond, Lyndal; Hilton, Shona

    2014-06-01

    Novel policy interventions may lack evaluation-based evidence. Considerations to introduce minimum unit pricing (MUP) of alcohol in the UK were informed by econometric modelling (the 'Sheffield model'). We aim to investigate policy stakeholders' views of the utility of modelling studies for public health policy. In-depth qualitative interviews with 36 individuals involved in MUP policy debates (purposively sampled to include civil servants, politicians, academics, advocates and industry-related actors) were conducted and thematically analysed. Interviewees felt familiar with modelling studies and often displayed detailed understandings of the Sheffield model. Despite this, many were uneasy about the extent to which the Sheffield model could be relied on for informing policymaking and preferred traditional evaluations. A tension was identified between this preference for post hoc evaluations and a desire for evidence derived from local data, with modelling seen to offer high external validity. MUP critics expressed concern that the Sheffield model did not adequately capture the 'real life' world of the alcohol market, which was conceptualized as a complex and, to some extent, inherently unpredictable system. Communication of modelling results was considered intrinsically difficult but presenting an appropriate picture of the uncertainties inherent in modelling was viewed as desirable. There was general enthusiasm for increased use of econometric modelling to inform future policymaking but an appreciation that such evidence should only form one input into the process. Modelling studies are valued by policymakers as they provide contextually relevant evidence for novel policies, but tensions exist with views of traditional evaluation-based evidence. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association.

  5. Down the local: A qualitative case study of daytime drinking spaces in the London Borough of Islington.

    Science.gov (United States)

    Thompson, Claire; Milton, Sarah; Egan, Matt; Lock, Karen

    2018-02-01

    Recognising the lack of research on daytime drinking practices in areas with managed night-time economies (NTEs), this qualitative study explores the phenomena in the London Borough of Islington; a rapidly gentrifying area with a highly regulated night-time economy (NTE). The objectives were to (i) Characterise the daytime drinking spaces of the local alcohol environment and (ii) Theorise the ways in which these spaces, and the practices and performativities within them, are situated within broader social and economic trends. Adopting a legitimate peripheral participation approach to data collection, 39 licensed premises were visited in Islington and on-site observations carried out between the hours of 12 pm and 6 pm using a semi-structured observation guide. Observations were written-up into detailed fieldnotes, uploaded to NVivo and subject to a thematic analysis. The daytime on-premises alcohol environment was characterised by two main trends: the decline of traditional pubs and a proliferation of hybrid establishments in which alcohol was framed as part of a suite of attractions. The consumption trends that the latter exemplify are implicated in processes of micro-cultural production and 'hipster capitalism'; and it is via this framing that we explore the way the diverse local drinking spaces were gendered and classed. Hybrid establishments have been regarded as positive in terms of public health, crime and safety. However, they could also help introduce drinking within times and contexts where it was not previously present. The intersection of an expanding hipster habitus with Local Authority efforts to tackle 'determined drunkenness' create very particular challenges. The operating practices of hybrid venues may feed into current alcohol industry strategies of promoting 'new moments' in which consumers can drink. They blur the divisions between work and play and produce temporal and classed divisions of drinking. Copyright © 2017 Elsevier B.V. All rights

  6. "There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

    2012-01-01

    We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

  7. “There Are Too Many, but Never Enough": Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

    2012-01-01

    Background We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined. PMID:22937106

  8. Parental decision-making on utilisation of out-of-home respite in children's palliative care: findings of qualitative case study research - a proposed new model.

    Science.gov (United States)

    Ling, J; Payne, S; Connaire, K; McCarron, M

    2016-01-01

    Respite in children's palliative care aims to provide a break for family's from the routine of caring. Parental decision-making regarding the utilisation of out-of-home respite is dependent on many interlinking factors including the child's age, diagnosis, geographical location and the family's capacity to meet their child's care needs. A proposed model for out-of-home respite has been developed based on the findings of qualitative case study research. Utilising multiple, longitudinal, qualitative case study design, the respite needs and experiences of parents caring for a child with a life-limiting condition were explored. Multiple, in-depth interviews were undertaken with the parents identified by a hospital-based children's palliative care team. Data were analysed using thematic analysis. Each individual case consists of a whole study. Cross-case comparison was also conducted. Nine families were recruited and followed for two years. A total of 19 in-depth interviews were conducted with mothers and fathers (one or both) caring for a child with a life-limiting condition in Ireland. Each family reported vastly different needs and experiences of respite from their own unique perspective. Cross-case comparison showed that for all parents utilising respite care, regardless of their child's age and condition, home was the location of choice. Many interlinking factors influencing these decisions included: past experience of in-patient care, and trust and confidence in care providers. Issues were raised regarding the impact of care provision in the home on family life, siblings and the concept of home. Respite is an essential element of children's palliative care. Utilisation of out-of-home respite is heavily dependent on a number of interlinked and intertwined factors. The proposed model of care offers an opportunity to identify how these decisions are made and may ultimately assist in identifying the elements of responsive and family-focused respite that are important

  9. Qualitative Analysis of Round-Table Discussions on the Business Case and Procurement Challenges for Hospital Electronic Prescribing Systems

    Science.gov (United States)

    Cresswell, Kathrin M.; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W.; Sheikh, Aziz

    2013-01-01

    Objectives There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. Materials and Methods We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. Results We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing “wants” and aspirations from organizational “needs”. Discussion and conclusions Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management. PMID:24260213

  10. Validation of key indicators in cattle farms at high risk of animal welfare problems: a qualitative case-control study.

    Science.gov (United States)

    Kelly, P C; More, S J; Blake, M; Higgins, I; Clegg, T; Hanlon, A

    2013-03-23

    The objective of this study was to validate four key farmer performance indicators (KFPI), identified in a previous study, as indicators of on-farm cattle welfare incidents in Ireland, through comparison of the distribution of these KPFIs in the national herd (n=109,925) and in case herds (n=18), where welfare incidents were previously studied. The KFPIs identified were late registrations, and exits from the herd by on-farm burial, by moves to knackeries and by moves to 'herd unknown'. Data were extracted from two Department of Agriculture, Food and the Marine databases for the national herd and the case herds. All four KFPIs differed significantly between the case herds and the national herd, and one further KFPI was identified, namely moves to factories. The data for these KFPIs are routinely stored on national databases, which were established in order to comply with Regulation (EC) 1760/2000. Based on the results obtained in this study, it may be possible in the future to use routine data capture to improve strategy towards on-farm animal welfare. At this point, however, based on calculated specificities and sensitivities, none of these five KFPIs, at the cut-offs investigated and using several combinations, are able to distinguish herds with and without on-farm animal welfare problems at an accuracy suitable for routine national use in Ireland.

  11. The Impact of Psychotherapeutic Reiki on Anxiety and Mindfulness: A Single-Case Design

    Science.gov (United States)

    Webster, Lindsay C.

    2016-01-01

    Reiki healing is one of several complementary and integrative therapies becoming increasingly prevalent in mental health counseling. It has been identified in the medical field for its usefulness in treating anxiety, depression, distress, and pain but has rarely been studied for its counseling impact on client wellness. I conducted single-case…

  12. A Behavioral Analysis of Figurative Language in Psychotherapy: One Session in a Single Case Study.

    Science.gov (United States)

    Pollio, Howard R.; Barlow, Jack M.

    Assuming that all problem solving has both its rational and poetic aspects and that the solution to a problem is often found in the poetic well before it surfaces in the rational, this study examined in detail the ebb and flow of figurative language as it occurred in the course of a single, highly successful hour of gestalt therapy involving both…

  13. Meta-Analysis of Behavioral Self-Management Interventions in Single-Case Research

    Science.gov (United States)

    Briesch, Amy M.; Briesch, Jacquelyn M.

    2016-01-01

    The current study meta-analyzed 47 single-subject studies of behavioral self-management interventions that were published between 1971 and 2011. In addition to obtaining an overall measure of effect across all self-management studies (f = 0.93), analyses were conducted to assess whether treatment effectiveness was moderated by factors such as…

  14. Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.

    Science.gov (United States)

    Burn, Anne-Marie; Fleming, Jane; Brayne, Carol; Fox, Chris; Bunn, Frances

    2018-03-17

    In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. Qualitative study involving interviews, focus groups and thematic content analysis. Primary care and secondary care across six counties in the East of England. Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care

  15. A single case study of treating hypertrophic lichen planus with Ayurvedic medicine.

    Science.gov (United States)

    Ratha, Kshirod Kumar; Barik, Laxmidhar; Panda, Ashok Kumar; Hazra, Jayram

    2016-01-01

    Ayurvedic medicines are often considered effective for chronic and lifestyle disorders. Hypertrophic lichen planus (HLP) is a rare inflammatory skin condition and develops into squamous cell carcinoma in few cases. It has resemblance with Charma Kushtha mentioned in Ayurvedic classics. Conventional therapy used in this condition is unsatisfactory and is not free from side effects. A case of long-standing systemic steroid-dependent HLP is presented here which was intervened successfully with Ayurvedic modalities.

  16. Qualitative relation between heavy metal concentration in soil and agricultural products: a Chinese peri-urban case study

    Science.gov (United States)

    Kikuchi, Ryunosuke; Ferreira, Carla Sofia; Dinis Ferreira, Antonio

    2017-04-01

    A peri-urban area refers to a transition or interaction zone, where urban and rural activities are juxtaposed, and landscape features are subject to rapid modifications, mainly due to human activities. It is reported that peri-urban areas which might include valuable protected areas (e.g. forested hills, preserved woodlands, prime agricultural lands, etc.) can provide essential life support services for urban residents. A peri-urban area is not only a zone experiencing the immediate impacts of land demands from urban growth and pollution, but it is also a wider market-related zone of influence, recognized for the supply of agricultural and natural resource products. It is reported that China's environmental crisis is one of the most pressing challenges to emerge from the country's rapid industrialization; therefore a field study was carried out to investigate the qualitative relation of soil property with vegetable agricultural products in the Chinese peri-urban area located in Luoyang city (34°37'N and 112°27'E). Soil, water and plant (e.g. squash, Cucurbita maxima) samples were taken over the study site, and heavy metal concentrations were analyzed. All the soil samples showed Cd concentrations exceeded the permissible level established by Chinese guidelines for soil quality (0.3 mg/kg). The contents of Zn, Pb and Cu also surpassed the Chinese guideline levels (Zn = 250 mg/kg, Pb = 50 mg/kg and Cu = 100 mg/kg) in several soil samples. Although the sampled plants contained some degree of all the heavy metals, only the Al concentration was high in the Cucurbita maxima samples (317 mg/kg), which is a specie of cultivated squash. Considering the world market and the global trade of agricultural products, it can be said that the food risk associated with farm products containing Al is not local but global. It is concluded that an environmental contamination of the peri-urban areas may lead to the threat to food security.

  17. Girl Talk: A Qualitative Study of Girls Talking about the Meaning of Their Lives in an Urban Single-Sex Elementary School

    Science.gov (United States)

    Ridenour, Carolyn S.; Hassell Hughes, Sheila

    2016-01-01

    The suburban-urban achievement gap (diminishing until the 1980s) has stopped its narrowing trend, and single-sex schools are proliferating as a reform model, especially in urban areas. In this study researchers interviewed eight elementary school girls (in an all-girls school) three times over 2 years, and the resulting 23 transcripts were…

  18. Stall inception and warning in a single-stage transonic axial compressor with axial skewed slot casing treatment

    International Nuclear Information System (INIS)

    Lim, Byeung Jun; Kwon, Se Jin; Park, Tae Choon

    2014-01-01

    Characteristic changes in the stall inception in a single-stage transonic axial compressor with an axial skewed slot casing treatment were investigated experimentally. A rotating stall occurred intermittently in a compressor with an axial skewed slot, whereas spike-type rotating stalls occurred in the case of smooth casing. The axial skewed slot suppressed stall cell growth and increased the operating range. A mild surge, the frequency of which is the Helmholtz frequency of the compressor system, occurred with the rotating stall. The irregularity in the pressure signals at the slot bottom increased decreasing flow rate. An autocorrelation-based stall warning method was applied to the measured pressure signals. Results estimate and warn against the stall margin in a compressor with an axial skewed slot.

  19. Single Nucleotide Polymorphisms in IL1B and the Risk of Acute Coronary Syndrome: A Danish Case-Cohort Study

    DEFF Research Database (Denmark)

    Stegger, Jakob Gerhard; Schmidt, Erik Berg; Tjonneland, Anne

    2012-01-01

    Background: Interleukin-1B (IL-1B) is a key pro-inflammatory cytokine that has been associated with the development of atherosclerosis and myocardial infarction. However, the prospective associations between functional single nucleotide polymorphisms (SNPs) in IL1B and incident acute coronary...... and 234 women). All cases were validated by review of medical records, and information on covariates was collected by study technicians. The study was conducted according to a case-cohort study design including ACS cases and a sex-stratified sub cohort of 1663 participants drawn randomly from the entire...... IL1B haplotypes and risk factors, respectively. Conclusions/Significance: Genetic variation in the promoter region of IL1B may not be associated with incident ACS in men or women above the age of 50 years....

  20. Radical university-industry innovation – research design and preliminary findings from an on-going qualitative case study

    DEFF Research Database (Denmark)

    Gertsen, Frank; Nielsen, René Nesgaard

    and it is arguing that there is a lack of in-depth understanding of such collaborative radical innovation processes. The paper then suggests an abductive research design for an explorative in-depth case study of collaborative radical innovation involving a university and an established Danish manufacturing firm....... Some preliminary findings are presented and briefly discussed, including the role of the university’s formal set-up to deal with IPR/commercialisation and the researchers’ personal networking with industry as well as challenges concerning the sharing of IPR/commercialisation outcomes....

  1. A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model.

    Science.gov (United States)

    Sinha, Samir K; Bessman, Edward S; Flomenbaum, Neal; Leff, Bruce

    2011-06-01

    We inform the future development of a new geriatric emergency management practice model. We perform a systematic review of the existing evidence for emergency department (ED)-based case management models designed to improve the health, social, and health service utilization outcomes for noninstitutionalized older patients within the context of an index ED visit. This was a systematic review of English-language articles indexed in MEDLINE and CINAHL (1966 to 2010), describing ED-based case management models for older adults. Bibliographies of the retrieved articles were reviewed to identify additional references. A systematic qualitative case study analytic approach was used to identify the core operational components and outcome measures of the described clinical interventions. The authors of the included studies were also invited to verify our interpretations of their work. The determined patterns of component adherence were then used to postulate the relative importance and effect of the presence or absence of a particular component in influencing the overall effectiveness of their respective interventions. Eighteen of 352 studies (reported in 20 articles) met study criteria. Qualitative analyses identified 28 outcome measures and 8 distinct model characteristic components that included having an evidence-based practice model, nursing clinical involvement or leadership, high-risk screening processes, focused geriatric assessments, the initiation of care and disposition planning in the ED, interprofessional and capacity-building work practices, post-ED discharge follow-up with patients, and evaluation and monitoring processes. Of the 15 positive study results, 6 had all 8 characteristic components and 9 were found to be lacking at least 1 component. Two studies with positive results lacked 2 characteristic components and none lacked more than 2 components. Of the 3 studies with negative results demonstrating no positive effects based on any outcome tested, one

  2. Analysis and meta-analysis of single-case designs with a standardized mean difference statistic: a primer and applications.

    Science.gov (United States)

    Shadish, William R; Hedges, Larry V; Pustejovsky, James E

    2014-04-01

    This article presents a d-statistic for single-case designs that is in the same metric as the d-statistic used in between-subjects designs such as randomized experiments and offers some reasons why such a statistic would be useful in SCD research. The d has a formal statistical development, is accompanied by appropriate power analyses, and can be estimated using user-friendly SPSS macros. We discuss both advantages and disadvantages of d compared to other approaches such as previous d-statistics, overlap statistics, and multilevel modeling. It requires at least three cases for computation and assumes normally distributed outcomes and stationarity, assumptions that are discussed in some detail. We also show how to test these assumptions. The core of the article then demonstrates in depth how to compute d for one study, including estimation of the autocorrelation and the ratio of between case variance to total variance (between case plus within case variance), how to compute power using a macro, and how to use the d to conduct a meta-analysis of studies using single-case designs in the free program R, including syntax in an appendix. This syntax includes how to read data, compute fixed and random effect average effect sizes, prepare a forest plot and a cumulative meta-analysis, estimate various influence statistics to identify studies contributing to heterogeneity and effect size, and do various kinds of publication bias analyses. This d may prove useful for both the analysis and meta-analysis of data from SCDs. Copyright © 2013 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  3. Epistaxis as a Common Presenting Symptom of Glanzmann’s Thrombasthenia, a Rare Qualitative Platelet Disorder: Illustrative Case Examples

    Directory of Open Access Journals (Sweden)

    Michael Recht

    2017-01-01

    Full Text Available Children often present to emergency departments (EDs with uncontrollable nose bleeding. Although usually due to benign etiologies, epistaxis may be the presenting symptom of an inherited bleeding disorder. Whereas most bleeding disorders are detected through standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. Here we present two case reports and review diagnostic and management challenges of platelet function disorders with a focus on Glanzmann’s thrombasthenia (GT. Patient 1 was a 4-year-old boy with uncontrolled epistaxis. His medical history included frequent and easy bruising. Previous laboratory evaluation revealed only mild microcytic anemia. An otolaryngologist stopped the bleeding, and referral to a pediatric hematologist led to the definitive diagnosis of GT. Patient 2 was a 2.5-year-old girl with severe epistaxis and a history of milder recurrent epistaxis. She had a bruise on her abdomen with a palpable hematoma and many scattered petechiae. Previous assessments revealed no demonstrable hemostatic anomalies. Platelet aggregation studies were performed following referral to a pediatric hematologist, leading to the diagnosis of GT. As evidenced by these cases, the ED physician may often be the first to evaluate severe or recurrent epistaxis and should recognize indications for coagulation testing and hematology consultation/referral for advanced hematologic assessments.

  4. Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study.

    Science.gov (United States)

    Ridde, Valéry; Yaogo, Maurice; Zongo, Sylvie; Somé, Paul-André; Turcotte-Tremblay, Anne-Marie

    2018-01-01

    To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies. © 2017 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  5. The Influence of Single - Sex Tourist Groups on Creating the Identity of Their Members - Case Study

    OpenAIRE

    Švorcová, Tereza

    2016-01-01

    This MA thesis deals with the influence of single-sex tourist groups on creating the identity of their members. The aim is to discover the effect of membership in such a non-coeducational tourist clubs on children, and also how this leisure activity affects children's identity and what impact it has on their development.
 The theoretical part discusses socializing, social environment, gender, gender socialization and gender stereotypes. Furthermore, it also deals with the influence of peers a...

  6. Endodontic Treatment of Hypertaurodontic Mandibular Molar Using Reciprocating Single-file System: A Case Report.

    Science.gov (United States)

    C do Nascimento, Adriano; A F Marques, André; C Sponchiado-Júnior, Emílio; F R Garcia, Lucas; M A de Carvalho, Fredson

    2016-01-01

    Taurodontism is a developmental tooth disorder characterized by lack of constriction in the cementoenamel junction and consequent vertical stretch of the pulp chamber, accompanied by apical displacement of the pulpal floor. The endodontic treatment of teeth with this type of morpho-anatomical anomaly is challenging. The purpose of this article is to report the successful endodontic treatment of a hypertaurodontic mandibular molar using a reciprocating single-file system.

  7. Facile growth of a single-crystal pattern: a case study of HKUST-1.

    Science.gov (United States)

    Li, Shaozhou; Lu, Guang; Huang, Xiao; Li, Hai; Sun, Yinghui; Zhang, Hua; Chen, Xiaodong; Huo, Fengwei

    2012-12-18

    In order to fabricate metal-organic framework (MOF) based devices, it is desirable to precisely position high-quality and mono-sized MOF crystals on supports. In this work, we demonstrate a facile solution procedure for the fabrication of oriented and monodispersed single-crystal MOF pattern. We expect that such capability will expand the scope of applications of MOFs to advanced fields.

  8. Comparing a single case to a control group - Applying linear mixed effects models to repeated measures data.

    Science.gov (United States)

    Huber, Stefan; Klein, Elise; Moeller, Korbinian; Willmes, Klaus

    2015-10-01

    In neuropsychological research, single-cases are often compared with a small control sample. Crawford and colleagues developed inferential methods (i.e., the modified t-test) for such a research design. In the present article, we suggest an extension of the methods of Crawford and colleagues employing linear mixed models (LMM). We first show that a t-test for the significance of a dummy coded predictor variable in a linear regression is equivalent to the modified t-test of Crawford and colleagues. As an extension to this idea, we then generalized the modified t-test to repeated measures data by using LMMs to compare the performance difference in two conditions observed in a single participant to that of a small control group. The performance of LMMs regarding Type I error rates and statistical power were tested based on Monte-Carlo simulations. We found that starting with about 15-20 participants in the control sample Type I error rates were close to the nominal Type I error rate using the Satterthwaite approximation for the degrees of freedom. Moreover, statistical power was acceptable. Therefore, we conclude that LMMs can be applied successfully to statistically evaluate performance differences between a single-case and a control sample. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. An Examination of Fluoxetine for the Treatment of Selective Mutism Using a Nonconcurrent Multiple-Baseline Single-Case Design Across 5 Cases.

    Science.gov (United States)

    Barterian, Justin A; Sanchez, Joel M; Magen, Jed; Siroky, Allison K; Mash, Brittany L; Carlson, John S

    2018-01-01

    This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. Treatment outcomes were evaluated by calculating effect sizes for each participant as an individual and for the participants as a group. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention was gathered. All 5 children experienced improvement in social anxiety, responsive speech, and spontaneous speech with medium to large effect sizes; however, children still met criteria for selective mutism at the end of the study. Adverse events were minimal, with only 2 children experiencing brief occurrences of minor behavioral disinhibition. Parents found the treatment highly acceptable.

  10. Single-Case Analysis to Determine Reasons for Failure of Behavioral Treatment via Telehealth

    Science.gov (United States)

    Schieltz, Kelly M.; Romani, Patrick W.; Wacker, David P.; Suess, Alyssa N.; Huang, Pei; Berg, Wendy K.; Lindgren, Scott D.; Kopelman, Todd G.

    2018-01-01

    Functional communication training (FCT) is a widely used and effective function-based treatment for problem behavior. The purpose of this article is to present two cases in which FCT was unsuccessful in reducing the occurrence of problem behavior displayed by two young children with an autism spectrum disorder. Both children received the same…

  11. Transradial access for coronary angiography: a single operator's experience of 500 cases

    International Nuclear Information System (INIS)

    Ali, J.; Aziz, S.; Javed, A.; Kayani, A.M.

    2011-01-01

    Objective: The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for diagnostic coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) over a period of ten months from June 2009 to March 2010. Patients and Methods: We collected data of 500 consecutive patients who underwent coronary catheterization by the transradial approach. Transradial access was performed only if the Allen's test was normal (positive). Patients with previous CABG or requiring right heart catheterization were excluded from this study. Study endpoints included procedure success rate, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization. Results: Mean age of the patients was 52 years (range 33-77 yrs) and 72.8% (n= 364) were men and 27.2% (n=136) were females. The vast majority of cases (98.4%) were elective. The right radial artery was used in 98% of cases. Procedural success was achieved in 90.6% cases (453/500). No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Conclusion: Transradial access for coronary angiography is a safe, effective and elegant alternative to trans femoral access. (author)

  12. Self-destruction by multiple methods during a single episode: a case ...

    African Journals Online (AJOL)

    Results: Three different methods of suicide were apparent in this instance: hanging, leaping down the cliff and drowning as was evidenced by the autopsy and positive diatom test. The complexity of this case was the planned protection against the failure of one method employed to commit suicide. The methods used were ...

  13. Behavioral Experiments in the Treatment of Paranoid Schizophrenia: A Single Case Study

    Science.gov (United States)

    Hagen, Roger; Nordahl, Hans M.

    2008-01-01

    Since the first description of cognitive therapy of paranoid delusions appeared in the literature, the empirical support for cognitive behavioral therapy in treating psychotic symptoms has been widely established. The aim of the present case study is to show how the behavioral experiment can be used as a powerful tool to change delusional thinking…

  14. First-Case Operating Room Delays: Patterns Across Urban Hospitals of a Single Health Care System

    Directory of Open Access Journals (Sweden)

    Callie M. Cox Bauer

    2016-08-01

    Full Text Available Purpose: Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs. Methods: We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of planned procedures, years of surgeon experience, service department and hospital facility on odds of delay were examined using logistic regression. Results: Of 5,598 cases examined, 88% were delayed. Patients arrived late to the hospital (surgery in 65% of first cases. Mean time from arrival to scheduled surgery and in-room placement was 104.6 and 127.4 minutes, respectively. Mean delay time was 28.2 minutes. Nearly 60% of delayed cases had no documented reason for delay. For cases with documentation, causes included the physician (52%, anesthesia (15%, patient (13%, staff (9%, other sources (6% and facility (5%. Regression analysis revealed age, late arrival, department and facility as significant predictors of delay. Estimated delay costs, based on published figures and representing lost revenue, were $519,388. Conclusions: To improve operating room efficiency, multidisciplinary strategies are needed for increasing patient adherence to recommended arrival times, documentation of delay by medical staff and consistency in workflow patterns among facilities and departments.

  15. ACCESS OF SINGLE WOMEN TO FERTILITY TREATMENT: A CASE OF INCIDENTAL DISCRIMINATION?

    Science.gov (United States)

    Krajewska, Atina

    2015-01-01

    The purpose of this article is to evaluate the extent to which single women have access to publicly funded fertility treatment. It claims that, despite the fact that great progress has been made in removing gender inequalities in the area of assisted reproduction in England and Wales in recent years, there are points in the regulatory framework that still allow for discrimination against single women. The article builds on recent studies concerning the reforms brought about by the Human Fertilisation and Embryology Act 2008 (HFEA 2008). However, it focusses on publicly funded treatment, thus directing scholarly attention away from the controversies over the amended s 13(5) HFEA 1990. It argues that the primary reason for remaining inequalities can be traced back to (a) the limitations of the current legislative framework; (b) the ambiguities inherent in the regulatory framework, which in the context of publicly funded fertility treatment is determined by the National Institute for Health and Care Excellence clinical guidelines and Clinical Commissioning Groups and Health Boards' resource allocation policies; and (c) the remaining confusion about the relationship between 'welfare of the child' assessments and eligibility criteria in National Health Service rationing decisions. The article argues that the current regulation does not go far enough in acknowledging the inability of single women to conceive naturally, but at the same time that it struggles to address the fluidity of contemporary familial relationships. The analysis presents an opportunity to contribute to debates about the role of law in shaping the scope of reproductive autonomy, gender equality and social justice. © The Author 2015. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. POLITICAL MONETARY CYCLES IN COALITION AND SINGLE PARTY GOVERNMENT PERIODS: A CASE STUDY ON TURKEY

    Directory of Open Access Journals (Sweden)

    AHMET EMRAH TAYYAR

    2017-12-01

    Full Text Available According to the theory of political monetary cycles, the government manipulates monetary policy during election periods in order to be re-elected. According to the said theory, expansionary monetary policies are implemented before the elections with opportunistic objective, while the contractionary monetary policies are implemented to stabilize the economy immediately after the elections. The use of monetary policy instruments for political purposes depends on the presence of a non-autonomous central bank, flexible exchange rate regime in the country, and the coordination between fiscal and monetary policies. Thus, the changes in the monetary policy indicators in election periods during coalition and single party governments in Turkey between 1990 and 2016 were examined in the present study. The money in circulation (M0, M1 money supply, domestic loans and inflation series were analyzed with the seasonal Box-Jenkins method for the above mentioned periods. Based on the findings of the study, political monetary cycles were not observed during the 1990-2000 coalition governments. It was determined that there were political monetary cycles during the single party government period between 2000 and 2016.Furthermore, although it could be expected that the political monetary cycles would be removed with the liberalization of the Turkish central bank on 25 April 2001, the existence of political monetary cycles during the period of 2000-2016 indicates that central bank independence was not fully achieved in Turkey. Based on another finding of the present study, the lack of political monetary cycles during the coalition government periods could lead to the failure in financing the budget deficit that increase due to political reasons with monetary policies. However, due to the existence of political monetary cycles during the single party government period, it could be argued that politically induced budget deficits changed in consistence with the

  17. Maintaining animal assemblages through single-species management: the case of threatened caribou in boreal forest.

    Science.gov (United States)

    Bichet, Orphé; Dupuch, Angélique; Hébert, Christian; Le Borgne, Hélène Le; Fortin, Daniel

    2016-03-01

    With the intensification of human activities, preserving animal populations is a contemporary challenge of critical importance. In this context, the umbrella species concept is appealing because preserving a single species should result in the protection of multiple co-occurring species. Practitioners, though, face the task of having to find suitable umbrellas to develop single-species management guidelines. In North America, boreal forests must be managed to facilitate the recovery of the threatened boreal caribou (Rangifer tarandus). Yet, the effect of caribou conservation on co-occurring animal species remains poorly documented. We tested if boreal caribou can constitute an effective umbrella for boreal fauna. Birds, small mammals, and insects were sampled along gradients of post-harvest and post-fire forest succession. Predictive models of occupancy were developed from the responses of 95 species to characteristics of forest stands and their surroundings. We then assessed the similarity of species occupancy expected between simulated harvested landscapes and a 90 000-km2 uncut landscape. Managed landscapes were simulated based on three levels of disturbance, two timber-harvest rotation cycles, and dispersed or aggregated cut-blocks. We found that management guidelines that were more likely to maintain caribou populations should also better preserve animal assemblages. Relative to fragmentation or harvest cycle, we detected a stronger effect of habitat loss on species assemblages. Disturbing 22%, 35%, and 45% of the landscape should result, respectively, in 80%, 60%, and 40% probability for caribou populations to be sustainable; in turn, this should result in regional species assemblages with Jaccard similarity indices of 0.86, 0.79, and 0.74, respectively, relative to the uncut landscape. Our study thus demonstrates the value of single-species management for animal conservation. Our quantitative approach allows for the evaluation of management guidelines prior

  18. Rehabilitation of a Distressed Single Storied Building Founded on Expansive Soil: A Case Study

    Science.gov (United States)

    Pakrashi, Somdev

    2017-12-01

    A single storied building was constructed on strip foundation system—on a subsoil, with high expansivity, without taking necessary precautions and it suffered extensive cracks and damages in roof slab, beams, columns and brick walls, subsidence /upheavals in floors etc. within 2/3 years of its construction and consequently it had to be abandoned. The study examines the reasons for the severe damages, cracks etc. and also suggests remediation by ground improvement and other necessary measures that were actually taken up, to rehabilitate the highly distressed and abandoned building within a reasonably short period of time—at a reasonable cost.

  19. Laparoendoscopic Single-Site Surgery (LESS for a Large Ovarian Tumour: First Clinical Case Report

    Directory of Open Access Journals (Sweden)

    Yao Dong Chua

    2011-01-01

    Main Outcome Measure(s. Conversion to standard laparoscopic technique or laparotomy, estimated blood loss, operative time , extent of scarring, occurrence of intra- and perioperative surgical complications, technical adequacy, and clinical outcome. Result(s. No conversion to standard laparoscopic technique or laparotomy, and no intraoperative or postoperative complications were observed. Total operative time was 99 minutes. The patient was discharged home on postoperative day one. Conclusion(s. Laparoendoscopic single-site bilateral salpingo-oophorectomy of a large ovarian tumour is feasible with standard laparoscopic instruments. It is safe and effective, with good results in terms of excellent cosmesis and minimal postoperative pain.

  20. Public engagement with information on renewable energy developments: The case of single, semi-urban wind turbines.

    Science.gov (United States)

    Parks, J M; Theobald, K S

    2013-01-01

    This paper explores perceptions of public engagement with information on renewable energy developments. It draws on a case study of proposals by a major supermarket chain to construct single wind turbines in two semi-urban locations in the UK, analysing data from interviews with key actors in the planning process and focus groups with local residents. The paper concludes that key actors often had high expectations of how local people should engage with information, and sometimes implied that members of the public who were incapable of filtering or processing information in an organised or targeted fashion had no productive role to play in the planning process. It shows how the specific nature of the proposals (single wind turbines in semi-urban locations proposed by a commercial private sector developer) shaped local residents' information needs and concerns in a way that challenged key actors' expectations of how the public should engage with information.

  1. Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines.

    Science.gov (United States)

    Coombs, Maureen A; Davidson, Judy E; Nunnally, Mark E; Wickline, Mary A; Curtis, J Randall

    2017-08-01

    To explore the importance, challenges, and opportunities using qualitative research to enhance development of clinical practice guidelines, using recent guidelines for family-centered care in the ICU as an example. In developing the Society of Critical Care Medicine guidelines for family-centered care in the neonatal ICU, PICU, and adult ICU, we developed an innovative adaptation of the Grading of Recommendations, Assessments, Development and Evaluations approach to explicitly incorporate qualitative research. Using Grading of Recommendations, Assessments, Development and Evaluations and the Council of Medical Specialty Societies principles, we conducted a systematic review of qualitative research to establish family-centered domains and outcomes. Thematic analyses were undertaken on study findings and used to support Population, Intervention, Comparison, Outcome question development. We identified and employed three approaches using qualitative research in these guidelines. First, previously published qualitative research was used to identify important domains for the Population, Intervention, Comparison, Outcome questions. Second, this qualitative research was used to identify and prioritize key outcomes to be evaluated. Finally, we used qualitative methods, member checking with patients and families, to validate the process and outcome of the guideline development. In this, a novel report, we provide direction for standardizing the use of qualitative evidence in future guidelines. Recommendations are made to incorporate qualitative literature review and appraisal, include qualitative methodologists in guideline taskforce teams, and develop training for evaluation of qualitative research into guideline development procedures. Effective methods of involving patients and families as members of guideline development represent opportunities for future work.

  2. Finding your way through EOL challenges in the ICU using Adaptive Leadership behaviours: A qualitative descriptive case study.

    Science.gov (United States)

    Adams, Judith A; Bailey, Donald E; Anderson, Ruth A; Thygeson, Marcus

    2013-12-01

    Using the Adaptive Leadership framework, we describe behaviours that providers used while interacting with family members facing the challenges of recognising that their loved one was dying in the ICU. In this prospective pilot case study, we selected one ICU patient with end-stage illness who lacked decision-making capacity. Participants included four family members, one nurse and two physicians. The principle investigator observed and recorded three family conferences and conducted one in-depth interview with the family. Three members of the research team independently coded the transcripts using a priori codes to describe the Adaptive Leadership behaviours that providers used to facilitate the family's adaptive work, met to compare and discuss the codes and resolved all discrepancies. We identified behaviours used by nurses and physicians that facilitated the family's ability to adapt to the impending death of a loved one. Examples of these behaviours include defining the adaptive challenges for families and foreshadowing a poor prognosis. Nurse and physician Adaptive Leadership behaviours can facilitate the transition from curative to palliative care by helping family members do the adaptive work of letting go. Further research is warranted to create knowledge for providers to help family members adapt. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. 'I could not join because I had to work for pay.': A qualitative evaluation of falciparum malaria pro-active case detection in three rural Cambodian villages.

    Science.gov (United States)

    Taffon, Pierluigi; Rossi, Gabriele; Kindermans, Jean-Marie; Van den Bergh, Rafael; Nguon, Chea; Debackere, Mark; Vernaeve, Lieven; De Smet, Martin; Venables, Emilie

    2018-01-01

    Pro-active case detection (Pro-ACD), in the form of voluntary screening and treatment (VSAT) following community mobilisation about 'asymptomatic malaria', is currently being evaluated as a tool for Plasmodium falciparum elimination in Preah Vihear Province, Cambodia. A qualitative study was conducted to explore community understanding, perceptions, expectations and acceptability of the Pro-ACD intervention in order to identify aspects that could be improved in future Pro-ACD activities. This was ancillary to a three-round VSAT campaign, carried out in three villages between December 2015 and March 2016. Qualitative data collection began shortly after the end of the three rounds of screening. Purposive sampling was used to select participants. Nine focus group discussions with participants (n = 46) and non-participants (n = 40) in the Pro-ACD screening were conducted, in addition to in-depth interviews with key village figures (n = 9). Health promotion messages were well delivered and received, but it was difficult for many villagers to understand the messages around 'asymptomatic malaria'. Overall, villagers and village leaders had a positive opinion about the VSAT intervention. Acceptability was high, as a direct consequence of favourable perceptions towards the screening activity: the Pro-ACD intervention was seen by the local population as an effective, inexpensive, reliable and readily available tool to protect individuals and the community from the insurgence of malaria. Physical absence and lack of time (both linked to work-related activities) were the main reasons for non-participation. Although VSAT was generally well perceived and accepted, the 'time factor' related to the need to satisfy essential daily subsistence requirements played a significant role in determining participation in the screening. More well-adapted and meaningful Pro-ACD approaches could be implemented by improving the timing of the testing activites, and strengthening community

  4. Benefits of a single payment system: case study of Abu Dhabi health system reforms.

    Science.gov (United States)

    Vetter, Philipp; Boecker, Klaus

    2012-12-01

    In 2005 leaders in the wealthy Emirate of Abu Dhabi inherited an health system from their predecessors that was well-intentioned in its historic design, but that did not live up to aspirations in any dimension. First, the Emirate defined a vision to deliver "world-class" quality care in response to citizen's needs. It has since introduced tiered mandatory health insurance for all inhabitants linked to a single standard payment system, which generates accurate data as an invaluable by-product. A newly created independent health system regulator monitors these data and licenses, audits, and inspects all health service professionals, facilities, and insurers accordingly. We analyse these health system reforms using the "Getting Health Reform Right" framework. Our analysis suggests that an integrated set of reforms addressing all reform levers is critical to achieving the outcomes observed. The reform programme has improved access, by giving all residents health cards. The approximate doubling of demand has been matched by flexible supply, with the private sector adding 5 new hospitals and 93 clinics to the health system infrastructure since 2006. The focus on reliable raw-data flows through the single standard payment system functions as a motor for improvement services, innovation, and investment, for instance by allowing payers to 'pay for quality', which may well be applicable in other contexts. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. [The phonological variant of primary progressive aphasia, a single case study].

    Science.gov (United States)

    Diesfeldt, H F A

    2011-04-01

    Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by an insidious onset and gradual progression of deficits that can involve any aspect of language, including word finding, object naming, fluency, syntax, phonology and word comprehension. The initial symptoms occur in the absence of major deficits in other cognitive domains, including episodic memory, visuospatial abilities and visuoconstruction. According to recent diagnostic guidelines, PPA is typically divided into three variants: nonfluent variant PPA (also termed progressive nonfluent aphasia), semantic variant PPA (also termed semantic dementia) and logopenic/phonological variant PPA (also termed logopenic progressive aphasia). The paper describes a 79-yr old man, who presented with normal motor speech and production rate, impaired single word retrieval and phonemic errors in spontaneous speech and confrontational naming. Confrontation naming was strongly affected by lexical frequency. He was impaired on repetition of sentences and phrases. Reading was intact for regularly spelled words but not for irregular words (surface dyslexia). Comprehension was spared at the single word level, but impaired for complex sentences. He performed within the normal range on the Dutch equivalent of the Pyramids and Palm Trees (PPT) Pictures Test, indicating that semantic processing was preserved. There was, however, a slight deficiency on the PPT Words Test, which appeals to semantic knowledge of verbal associations. His core deficit was interpreted as an inability to retrieve stored lexical-phonological information for spoken word production in spontaneous speech, confrontation naming, repetition and reading aloud.

  6. Analysis of fuel pin mechanics in case of flow blockage of a single RBMK channel

    International Nuclear Information System (INIS)

    Pierro, F.; Moretti, F.; Mazzini, D.; D'Auria, F.

    2005-01-01

    The evaluation of the consequences of the pressure tube rupture due to accidental overheating is one of the key elements for addressing an RBMK safety analysis, since it causes the lost of design boundaries against the fission products release. Several events are expected to take place: thermal hydraulic crisis (energy unbalance), fuel overheating, fuel rod damage, pressure tube overheating, pressure tube failure and graphite stack damage, Hydrogen and fission products release. The present work deals with the research activity carried out at ''Dipartimento di Ingegneria Meccanica, Nucleare e della Produzione'' (DIMNP) of the University of Pisa aimed at assessing numerical models for safety analysis of the RBMK-1000. The attention is focused on the modelling of (1) a single fuel channel and its surrounding graphite column for evaluating the transient conditions enabling the different damaging phenomena, (2) a single fuel rod for investigating fuel pin behaviour, (3) the ruptured fuel channel for figuring the magnitude of the hydrodynamic loads acting on fuel rods. Different codes were employed to cover the competences for the investigation of each field; in particular, RELAP5 code for thermal-hydraulics, FRAPCON-3 and FRAPTRAN1-2 codes for fuel pin mechanics, FLUENT-6 for fluid dynamics. The paper discusses the numerical models, the analysis capabilities of numerical models in comparison with available data about the Leningrad NPP 1992 accident. Furthermore, the possibility to draw a failure map identifying the range of the cladding safety respect to the transient condition is outlined. (author)

  7. Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

    Science.gov (United States)

    Stiles, Mandy; Case, J Brad; Coisman, James

    2016-08-01

    OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

  8. Estimation of geothermal gradients from single temperature log-field cases

    International Nuclear Information System (INIS)

    Kutasov, I M; Eppelbaum, L V

    2009-01-01

    A geothermal gradient is one of the most frequently used parameters in logging geophysics. However, the drilling process greatly disturbs the temperature of the formations around the wellbore. For this reason, in order to determine with the required accuracy the formation temperatures and geothermal gradients, a certain length of shut-in time is required. It was shown earlier (Kutasov 1968 Freiberger Forshungshefte C 238 55–61, 1987 Geothermics 16 467–72) that at least two transient temperature surveys are needed to determine the geothermal gradient with adequate accuracy. However, in many cases only one temperature log is conducted in a shut-in borehole. For these cases, we propose an approximate method for the estimation of the geothermal gradient. The utilization of this method is demonstrated on four field examples

  9. A Single Case of Tourette’s Syndrome Treated with Traditional Chinese Medicine

    Directory of Open Access Journals (Sweden)

    Min-Hwa Lee

    2017-02-01

    Full Text Available The objective of this case study was to investigate the effectiveness of Chinese medicine in treating Tourette's syndrome. Tourette's syndrome is a childhood- onset disorder that is characterized by sudden, involuntary movements or tics. The participant in this study was a 33-year-old male who had been diagnosed with Tourette's syndrome at the age of 9 years. His major complaints included facial tics, shoulder shrugging, and clearing the throat. Using a combination of acupuncture, herbs, Gua-Sha, and lifestyle changes once a week for 35 treatments, all the symptoms were reduced by 70%, as reported by the patient. In this case, the results indicated that Chinese medicine was able to minimize the symptoms of Tourette's syndrome. Further investigation is needed to support this argument. Tourette's syndrome, which was first described in 1885 by a French physician named Gilles de la Tourette, is characterized by facial tics, involuntary body movements from the head to the extremities, or vocal tics, and it usually has its onset in childhood. It is a neuropsychiatric disorder. The treatment for Tourette's syndrome is based on pharmacological treatment, behavior treatment, and deep brain stimulation. Unfortunately, none of these could completely control the symptoms; furthermore, antipsychiatric drugs might cause additional side effects, such as Parkinson symptoms, tardive dyskinesia, and metabolic disturbances. Finding acupuncture and oriental medicine literature on treatment of Tourette's syndrome was difficult, especially that written in English. Some research papers that have been translated into English indicated that Chinese herbs and acupuncture could reduce the tics significantly. For example, a study by Dr Pao-Hua Lin reported the significant effects of using acupuncture and oriental medicine in treating 1000 Tourette's syndrome cases. This case was treated to further investigate the principles of Dr Lin's study.

  10. Megalourethra: a case report managed with a single intrauterine bladder aspiration.

    Science.gov (United States)

    Asma, Basha; Jumana, Baramki

    2012-02-01

    Congenital megalourethra is a rare mesenchymal anomaly of the male urethra, characterised by severe dilatation of the penile urethra due to congenital absence of the corpus spongiosum and/or corpus cavernosum. Postnatal complications include voiding and erectile dysfunction as well as renal insufficiency and pulmonary hypoplasia. We present a unique case of congenital megalourethra diagnosed prenatally in the early second trimester. The parents opted to continue pregnancy and vaginal delivery of a live neonate occurred with a favourable outcome.

  11. Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions

    Directory of Open Access Journals (Sweden)

    Duplantie Julie

    2007-01-01

    Full Text Available Abstract Background The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. Methods A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. Results Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. Conclusion Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice.

  12. Myocardial gated single photon emission tomography (GSPECT) in men and women with low probability of coronary artery disease - qualitative assessment of beating slices and polar plots

    International Nuclear Information System (INIS)

    Dziuk, M.; Canizales, A.; Britton, K.E.

    2001-01-01

    Assessment of the variability of regional wall motion and thickening in men and women with normal left ventricular contraction and low probability of CAD by GSPECT. The rest 99mTcMyoview GSPECT protocol (700 Mbq) was performed in 28 women and 14 men. Qualitative beating slices - QLGS and polar plots - QGS were analyzed independently by scoring the colour scale (1 - severe impairment, 4 - normal). Then the regional wall motion and thickening in the anterior, lateral, inferior walls, the septum and apex were estimated. In all patients the motion in the inferior wall and septum assessed on polar maps were significantly different than one in QLGS but better in the apex. Regional wall thickening was underestimated in QGS polar plots in the anterior wall, septum, inferior and lateral wall. End diastolic and end systolic volumes were significantly greater in men (90±29, 69±25, p<0.02 and 40±20, 22±12, p<0.002 for EDV and ESV respectively). In the later group all walls except the inferior showed higher QGS thickening score in comparison to men. The motion score in the anterior wall was also significantly bigger (p<0.05). The visual regional motion and thickening assessment on beating slices in gated SPECT seems to be more reliable than polar plots in patients with normal left ventricular contraction and low probability of coronary artery disease. Gated SPECT polar maps show better myocardial thickening in women probably due to the smaller left ventricle size and subsequent partial volume effect. (author)

  13. Early Loading of Single-Piece Implant for Partially Edentulous Posterior Arch: A Prospective One-Year Case Report

    Directory of Open Access Journals (Sweden)

    Amol Beldar

    2013-01-01

    Full Text Available Implant therapy is now well established, and there is an increasing need for shorter rehabilitation time. Original prerequisites of osseointegration have been reassessed to satisfy continuously increasing patient's expectation of reduced treatment time, improved esthetics, and increased comfort. Shorter healing time may be appropriate in some circumstances, and examples of early loading have been reported in animal and human studies. However, to date there are insufficient data to determine a universally acceptable opinion on early loading of implants for single-tooth replacement. This case report involves early loading, combined with construction of a restoration, inserted directly after 6 weeks of implant surgery and followup of one year.

  14. Qualitative and quantitative comparison of geostatistical techniques of porosity prediction from the seismic and logging data: a case study from the Blackfoot Field, Alberta, Canada

    Science.gov (United States)

    Maurya, S. P.; Singh, K. H.; Singh, N. P.

    2018-05-01

    In present study, three recently developed geostatistical methods, single attribute analysis, multi-attribute analysis and probabilistic neural network algorithm have been used to predict porosity in inter well region for Blackfoot field, Alberta, Canada, an offshore oil field. These techniques make use of seismic attributes, generated by model based inversion and colored inversion techniques. The principle objective of the study is to find the suitable combination of seismic inversion and geostatistical techniques to predict porosity and identification of prospective zones in 3D seismic volume. The porosity estimated from these geostatistical approaches is corroborated with the well log porosity. The results suggest that all the three implemented geostatistical methods are efficient and reliable to predict the porosity but the multi-attribute and probabilistic neural network analysis provide more accurate and high resolution porosity sections. A low impedance (6000-8000 m/s g/cc) and high porosity (> 15%) zone is interpreted from inverted impedance and porosity sections respectively between 1060 and 1075 ms time interval and is characterized as reservoir. The qualitative and quantitative results demonstrate that of all the employed geostatistical methods, the probabilistic neural network along with model based inversion is the most efficient method for predicting porosity in inter well region.

  15. Visioning for secondary palliative care service hubs in rural communities: a qualitative case study from British Columbia's interior

    Directory of Open Access Journals (Sweden)

    Hanlon Neil

    2009-10-01

    Full Text Available Abstract Background As the populations of many developed nations continue to age at rapid rates it is becoming increasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areas face a number of challenges in doing this, and thus dedicated attention must be given to determining how to best enhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are to determine the vision for establishing secondary palliative care service hubs (SPCH in rural communities through undertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs. Methods A rural region of British Columbia, Canada was selected for primary data collection, which took place over a five-month period in 2008. Formal and informal palliative care providers (n = 31 were interviewed. A purposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews were conducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim. Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation to strengthen interpretation. Results Four themes emerged from the dataset: (1 main SPCH features; (2 determining a location; (3 value-added outcomes; and (4 key considerations. It was found that participants generally supported implementing a SPCH in the rural region of focus. Several consistent messages emerged, including that: (1 SPCHs must create opportunities for two-way information exchange between specialists and generalists and communities; (2 SPCHs should diffuse information and ideas throughout the region, thus serving as a locus for education and a means of enhancing training opportunities; and (3 hubs need not be physical sites in the community (e.g., an office in a hospice or hospital, but may be virtual or take other forms based upon local needs

  16. The IHO as Actor The case of cannabis and the Single Convention on Narcotic Drugs 1961

    Directory of Open Access Journals (Sweden)

    James H. Mills

    2016-12-01

    Full Text Available After the Second World War the United Nations (UN assumed the role of the League of Nations in formulating and operating the international regulatory framework for narcotic drugs. It gathered masses of information from across countries and continents while acting as both a forum and an agent for the emergence of agreed approaches to a heterodox array of substances. This article will examine the story of the inclusion of cannabis in the 1961 Single Convention on Narcotic Drugs. It will argue that in the years after 1945, it was officials at the UN and the WHO that played crucial roles in shaping opinions of the drug and in securing its place in the Convention.

  17. Nano-modified adhesive by graphene: the single lap-joint case

    Energy Technology Data Exchange (ETDEWEB)

    Silva Neto, Almir; Cruz, Diego Thadeu Lopes da; Avila, Antonio Ferreira, E-mail: aavila@netuno.lcc.ufmg.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Engenharia Mecanica

    2013-11-01

    This paper addresses the performance study on, low viscosity, nano-modified adhesives by graphene. For achieving this goal, single-lap joints following ASTM D 5868-01 were manufactured and tested. X-ray diffraction, scanning electron microscopy and nanoindentation were employed for graphene based nanostructures characterization. The increase on joint strength was around 57% when compared against the control group. Furthermore, all failures for the nano-modified adhesive were cohesive failure for the carbon fibre/epoxy composites indicating that the adhesive was tested. X-ray diffractions signatures indicate formation of nano-structures with 17-19 nm diameters. Moreover, nanoindentation tests revealed a homogeneous dispersion of graphene. (author)

  18. Outcomes of Single-Incision Laparoscopic Surgery for Colon Cancer: A Case-Matched Comparative Study

    Directory of Open Access Journals (Sweden)

    Atthaphorn Trakarnsanga

    2016-03-01

    Full Text Available Background: Single-incisionlaparoscopiccolectomy(SILC isanevolvingtechnique withpotentialadvantages by reducing number of incisions that can reduce port-related complications and improve cosmetic results. The purposeof thisstudy wastocomparetheshort-termoutcomesbetweenSILC,hand-assistedlaparoscopiccolectomy (HALC andstandard multi-port laparoscopic colectomy (MLC. Methods: Retrospectiveanalysesofatotalof90patientsbetweenMay2010and December2011, whounderwent SILC for coloncancer surgery, wereperformedin30patients. Clinicopathologicalparameters were matched1:1 withpatients whounderwent HALC (n=30andMLC (n=30.Short-term outcomes werecollectedandanalyzed. Results: Operativetime wassignificantlyshorter inSILC comparedto HALC andMLC (p<0.001,as wellasless estimatedbloodloss (p=0.02. There werenosignificantdifferences inconversionrateandnumberofharvested lymphnodes.SILChadtheadvantageofless24-hrpostoperativepainscorecomparedtoHALCandMLC(p<0.001, whereas length of stayandtime to full diet werenotdifferent. Conclusion: Inselectedpatients,SILC canbesuccessfullyandsafelyperformed withshorteroperativetime, less estimated blood loss andless postoperativepainscore.

  19. Immediate provisional restoration of a single-tooth implant in the esthetic zone: A case report

    Directory of Open Access Journals (Sweden)

    Po-Sung Fu

    2011-02-01

    Full Text Available Immediate implant restoration of single implants may demonstrate a positive effect on peri-implant soft tissue. Placement of a provisional restoration following implant surgery can create soft tissue contours that resemble normal gingival topography before placement of the definitive prosthesis. This article describes a staged approach of the mandibular permanent right central incisor, which was congenital missing. The proper space for restoration of the missing incisor was created through orthodontic treatment. The scheduled implant site was reconstructed using autogenous bone harvested from the chin region. After a healing period of four months, an implant was installed with the connection of a fixed provisional crown to a prefabricated temporary abutment. The soft tissue around the implant healed according to the contours of the provisional restoration and the emergence profile was used to duplicate the definitive restoration. Peri-implant esthetics was achieved through the staged approach and immediate restoration of the implant.

  20. Endoscopic Transsphenoidal Surgery Outcomes in 331 Nonfunctioning Pituitary Adenoma Cases After a Single Surgeon Learning Curve.

    Science.gov (United States)

    Kim, Jung Hee; Lee, Jung Hyun; Lee, Ji Hyun; Hong, A Ram; Kim, Yoon Ji; Kim, Yong Hwy

    2018-01-01

    The outcomes of recent endoscopic surgery of nonfunctioning pituitary adenomas (NFPAs) are controversial when compared with traditional microscopic surgery. We aimed to assess the outcomes of endoscopic transsphenoidal surgeries performed by 1 surgeon with 7 years of experience and elucidate the predictive factors for surgical outcomes for NFPAs. We included 331 patients (155 men and 176 women) with clinical NFPAs who underwent transsphenoidal surgery because of visual symptoms by a single surgeon in Seoul National University Hospital from March 2010 to May 2016. We assessed the tumor removal rate, hormonal outcomes, visual outcomes, and complications. The gross total resection rate of endoscopic transsphenoidal surgery for NFPAs by a single surgeon was 74.9%. Cavernous sinus invasion, a high Knosp grade, large tumor size, previous surgery, and lack of surgical experience in the neurosurgeon elevated the risk for residual tumors. Visual deficits were improved in 73.4% of the patients, which was associated with tumor size, preoperative visual impairment score, previous radiation, and surgical experience. Hormonal status was improved in 15.4% and aggravated in 32.9% after surgery. There were no predictors for hormonal recovery. Transient diabetes insipidus (DI) was the most common complication (9.1%), and among these patients, 3.0% had persistent DI. Endoscopic transsphenoidal surgery by a well-experienced surgeon was an effective and safe treatment for NFPAs, but the hormonal outcomes were not changed compared with previous reports of microscopic surgery. Large tumor size and cavernous sinus invasion were still the barriers for achieving total resection. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

    Science.gov (United States)

    Goh, Brian K P; Low, Tze-Yi; Lee, Ser-Yee; Chan, Chung-Yip; Chung, Alexander Y F; Ooi, London L P J

    2018-05-24

    Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy. © 2018 Royal Australasian College of Surgeons.

  2. Single Nanorod Devices for Battery Diagnostics: A Case Study on LiMn 2 O 4

    KAUST Repository

    Yang, Yuan

    2009-12-09

    This paper presents single nanostructure devices as a powerful new diagnostic tool for batteries with LiMn2O4 nanorod materials as an example. LiMn2O4 and Al-doped LiMn2O4 nanorods were synthesized by a two-step method that combines hydrothermal synthesis of β-MnO2 nanorods and a solid state reaction to convert them to LiMn2O4 nanorods. λ-MnO2 nanorods were also prepared by acid treatment of LiMn2O4 nanorods. The effect of electrolyte etching on these LiMn2O 4-related nanorods is investigated by both SEM and single-nanorod transport measurement, and this is the first time that the transport properties of this material have been studied at the level of an individual singlecrystalline particle. Experiments show that Al dopants reduce the dissolution of Mn3+ ions significantly and make the LiAl 0.1Mn1.9O4 nanorods much more stable than LiMn2O4 against electrolyte etching, which is reflected by the magnification of both size shrinkage and conductance decrease. These results correlate well with the better cycling performance of Al-doped LiMn 2O4 in our Li-ion battery tests: LiAl0.1Mn 1.9O4 nanorods achieve 96% capacity retention after 100 cycles at 1C rate at room temperature, and 80% at 60 °C, whereas LiMn 2O4 shows worse retention of 91% at room temperature, and 69% at 60 °C. Moreover, temperature-dependent I - V measurements indicate that the sharp electronic resistance increase due to charge ordering transition at 290 K does not appear in our LiMn2O4 nanorod samples, suggesting good battery performance at low temperature. © 2009 American Chemical Society.

  3. Studies on water turbine runner which fish can pass through: In case of single stage axial runner

    International Nuclear Information System (INIS)

    Shimizu, Yukimari; Maeda, Takao; Nagoshi, Osamu; Ieda, Kazuma; Shinma, Hisako; Hagimoto, Michiko

    1994-01-01

    The relationship between water turbine runner design and operation and the safe passage of fish through the turbine is studied. The kinds of fish used in the tests are a dace, a sweet fish and a small salmon. A single stage axial runner is used. The velocity and pressure distributions were measured inside the turbine casing and along the casing wall. Many pictures showing fish passing through the rotating runner were taken and analyzed. The swimming speed of the fish was examined from video recordings. Fish pass through the runner more rapidly when they can determine and choose the easier path. Injury and mortality of fish are affected by the runner speed and the location of impact of the runner on the fish body

  4. Chemical pneumonitis and subsequent reactive airways dysfunction syndrome after a single exposure to a household product: a case report

    Directory of Open Access Journals (Sweden)

    Khalid Imran

    2009-11-01

    Full Text Available Abstract Introduction Household products are usually safe to use. Adverse events arising from their use are mostly reported in patients with pre-existing atopy or pulmonary problems and usually only after a prolonged exposure to such products. We report the case of a patient with no prior problems who developed significant side effects from a single exposure to a domestic product. Case presentation A 43-year-old Caucasian American man, previously in good health, used a domestic aerosol product called 'Stand N' Seal "Spray-On" Grout Sealer' in an enclosed room in his house. The product contained n-butyl acetate ( Conclusion A household product may still prove unsafe to use even after it has gone through vigorous testing and approval processes. Even healthy individuals are susceptible to adverse outcomes after a brief exposure. Extra precautions should be taken when using any chemical product at home.

  5. Radiotherapy of Painful Vertebral Hemangiomas: The Single Center Retrospective Analysis of 137 Cases

    International Nuclear Information System (INIS)

    Miszczyk, Leszek; Tukiendorf, Andrzej

    2012-01-01

    Purpose: An evaluation of dose–response relationship and an attempt to define predictive factors. Methods and Materials: A total of 137 cases of painful vertebral hemangioma irradiations (101 patients). Fraction dose (fd) varied from 2 to 15 Gy (123 fractionated and 14 radiosurgical treatments), and total dose (TD) from 8 to 30 Gy (111 cases irradiated with fd of 2 GY to TD of 24 Gy). We evaluated pain relief, changes in analgesic requirements, and reossification. Results: Means of pain relief 1, 6, 12, and 18 months after radiotherapy (defined as a decrease of primary pain level expressed in percent) were 60.5%, 65.4%, 68.3%, and 78.4%, respectively. Proportion of patients with no need for analgesics and patients using tramadol were 39%, 40%, 44%, 57%, and 20%, 17%, 22%, and 11% in these times. The proportion of patients experiencing complete/partial pain relief changed from 36/48% 1 month, to 64/22% 1.5 years after radiotherapy. No impact of radiotherapy on reossification was found. The positive impact of fd and TD increase for analgesics uptake reduction and pain relief was found. An increase of the fd by 1 Gy results in 27% chance of analgesics uptake reduction and 3.8% reduction of pain, whereas 14% analgesics uptake reduction and 2.2% of pain reduction in case of the TD. The predictive factors improving results were found: female gender, older age, better performance states (the chance of the lower analgesic treatment decreases over 2.5 times in comparison to the higher Zubrod degree), bigger Hb concentration, shorter symptoms duration and lower analgesics uptake before radiotherapy. Conclusions: The obtained data support the efficacy of radiotherapy in improving pain secondary to vertebral hemangioma, with the degree of pain amelioration being related to increasing fd and TD. The positive predictive factors were defined: female gender, older age, better performance status, increased Hb concentration, shorter symptoms duration, and lower analgesics uptake

  6. [Development of lipoma following a single cupping massage - a case report].

    Science.gov (United States)

    Schumann, Stefan; Lauche, Romy; Hohmann, Claudia; Zirbes, Thomas; Dobos, Gustav; Saha, Felix Joyonto

    2012-01-01

    The cupping massage is a form of bloodless cupping. This type of cupping is particularly used to treat muscular tension and musculoskeletal pain, such as chronic neck pain; however the data records on mechanisms and potential side effects are not satisfactory. In a study on the effectiveness of cupping massage in patients with chronic neck pain, one patient showed a formation of a lipoma in the cupping area after the first treatment session. Because of the short time interval between therapy and development of the lipoma, a primary cause is not realistic. This adverse event has not been described in the literature before, and the present report describes the case in summary.

  7. [Renal oncocytoma in the single kidney after previous surgery of renal carcinoma. Apropos of 2 cases].

    Science.gov (United States)

    Veneroni, L; Canclini, L; Berti, G L; Giola, V; Leidi, G L; Maccaroni, A; Raimoldi, A; Sironi, M; Assi, A; Bacchioni, A M

    1997-12-01

    Renal oncocytoma is a neoplasm which rarely occurs in patients with solitary kidney, the other being absent because of a previous nephrectomy performed for renal cancer. We present two case reports and a literature review. We have studied some important problems such as the histogenesis, the potential for malignancy, the diagnosis, the treatment and the follow up. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. We would like to emphasize the importance of preoperatory FNAB, nephron sparing surgery and very careful follow up.

  8. Gifles de la Tourett's Disease a Single case study A Discussion on Aetiology and Treatment

    Directory of Open Access Journals (Sweden)

    C. Izadi

    1978-06-01

    Full Text Available A case of Gille de la Tourett's syndrome is reported and discussed 111 the light of conflicting views on the aetiology of the condition. It is hypothesized that if Tourette's syndrome is to be considered as a sort of reaction against adaption to an unhealthy environment, this reaction and its continuity can be attributed to permanent eNS damage (Probably in the area of corpora striata beginning in childhood. Treatment with haloperidol is suggested as a most effective method of symptomatic treatment.

  9. A Case of Arterial and Venous Tear during Single Lead Extraction

    Directory of Open Access Journals (Sweden)

    Michael S. Green

    2016-01-01

    Full Text Available Transcutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extraction of a 6-year-old implantable cardioverter-defibrillator lead due to fracture from insulation break. During the lead extraction, blood pressure fell precipitously and echocardiographic findings were consistent with pericardial effusion. After unsuccessful pericardiocentesis, open chest sternotomy and evacuation of hematoma was performed. Subsequent surgical repair of several injuries was completed including the distal coronary sinus, a large degloving injury of posterior portion of the heart, and first obtuse marginal branch bleed. This case demonstrates that when performing transcutaneous lead extraction (TLE with laser sheath, a degloving injury can cause arterial rupture with concomitant coronary sinus injury. A multidisciplinary team-based approach can ensure patient safety. Learning Objective. Implantable cardioverter-defibrillator leads will falter over time. With the advancement of new technology for extraction more frequent and serious complications will occur. Active fixation CS leads present unique challenges. In the presence of hemodynamic changes during extraction the occurrence of both an arterial and venous injury must be considered.

  10. Pneumococcal polyarticular septic arthritis after a single infusion of infliximab in a rheumatoid arthritis patient: a case report

    Directory of Open Access Journals (Sweden)

    Hayashi Masatoshi

    2012-03-01

    Full Text Available Abstract Introduction We present a case of Streptococcus pneumoniae polyarticular septic arthritis in a patient with rheumatoid arthritis receiving a single infusion of infliximab. Case presentation A 38-year-old Japanese man with a 5-year history of seronegative rheumatoid arthritis had previously received sulphasalazine and methotrexate therapies and was on regular low-dose prednisolone therapy. Despite these treatments, his disease activity remained high and infliximab was introduced in addition to methotrexate, prednisolone, and folic acid. However, he was admitted to hospital with a fever of 40.6°C, chills, and polyarthralgia eight days after the first infusion of infliximab. His joints were swollen, painful, and warm. Laboratory data showed marked acute inflammation. He was diagnosed with bacterial septic polyarthritis, and emergency surgical joint lavage and drainage was performed at the knees along with needle aspiration and lavage of the ankles and right wrist. He was then given intravenous antibiotic therapy for 31 days. He made a good recovery and was discharged on day 37. Conclusions We believe this is the first reported case of severe pneumococcal septic arthritis requiring hospitalization in a patient treated with infliximab. S. pneumonia is now a well-recognized but uncommon cause of polyarticular septic arthritis that can lead to cessation of therapy, as in our patient's case.

  11. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

    Science.gov (United States)

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2009-01-01

    Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes

  12. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

    Directory of Open Access Journals (Sweden)

    Beaulieu Marie-Dominique

    2009-02-01

    Full Text Available Abstract Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs. The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis and field of family medicine (macro-level of analysis. The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original

  13. Qualitative analysis of homogeneous universes

    International Nuclear Information System (INIS)

    Novello, M.; Araujo, R.A.

    1980-01-01

    The qualitative behaviour of cosmological models is investigated in two cases: Homogeneous and isotropic Universes containing viscous fluids in a stokesian non-linear regime; Rotating expanding universes in a state which matter is off thermal equilibrium. (Author) [pt

  14. Adult bacterial myositis: report of a single-center series of 26 cases

    Directory of Open Access Journals (Sweden)

    Fernando Gallucci

    2016-09-01

    Full Text Available Bacterial infections involving muscle are quite uncommon and generally require specific predisposing factors. Bacterial myositis is more rarely described in the typical kind of patients observed in Internal Medicine (presence of multiple co-morbidities, partial/limited immune-deficiency, advanced age. Twenty-six patients suffering from bacterial myositis (8 women and 18 men; mean age 58.5 years, range 27-82 observed in a single Internal Medicine Unit were reported. Muscles involved were ileopsoas, thigh, paravertebral, gluteus, calf, forearm and rectus abdomen. Simultaneous presence of arthritis was registered in 17 patients and all patients presented relevant comorbidity. Main cultured bacteria were Staphylococcus aureus, Escherichia coli, other Gram-negative bacteria, Streptococcus spp. Multi-drug-resistance was observed in 14 out 26 (53.8%. Computed tomography, ultrasound and magnetic resonance imaging were utilized for diagnostic purposes. Antibiotic treatment was administered to all patients. Surgical debridement and drainage were performed in 12 patients; 7 patients were treated with percutaneous aspiration and drainage. At discharge, relevant functional impairment was present in 17 patients (65.3%. Four patients died (in-hospital mortality 7.6%, global mortality at three months 15.3%. Management of bacterial myositis is difficult and its prognosis is poor. In the near future, this demanding infection will be more frequently observed in Internal Medicine setting as comorbidity, which is very often the main characteristic of these patients.

  15. On-Site Chiropractic Care as an Employee Benefit: A Single-Location Case Study.

    Science.gov (United States)

    Minicozzi, Salvatore J; Russell, Brent S

    2017-09-01

    The purpose of this report is to describe the role of on-site chiropractic care in one corporate environment. A part-time chiropractic practice that provides services to a single company on site, 1 day per week, is described. Most care is oriented toward "wellness," is paid for by the employer, and is limited only by the chiropractor's few weekly hours of on-site availability. With approval from the company, the authors conducted an absenteeism analysis after obtaining ethics approval and consent from employee-patients who received care between 2012 and 2014. Comparisons of absenteeism rates of the sample were compared with lost worktime rates from the US Bureau of Labor Statistics' Labor Force Statistics. Of 40 current employees, 35 used chiropractic services; 17 employee-patients met the inclusion criteria. The lost worktime rates of those using chiropractic services (0.72%, 0.55%, and 0.67%, for 2012, 2013, and 2014, respectively) were lower than corresponding rates from Labor Force Statistics (1.5%, 1.2%, and 1.1%). Absenteeism for the employee-patients was lower than equivalent national figures in this sample of workers. Though these results may or may not be related to the chiropractic care, these findings prompt further investigation into this relationship.

  16. The measurement of the vertical component of hydraulic conductivity in single-cased and uncased boreholes

    International Nuclear Information System (INIS)

    Black, J.H.; Noy, D.J.; Brightman, M.A.

    1987-01-01

    The project aimed to assess the different existing methods of measuring vertical hydraulic conductivity in single boreholes by carrying out some actual field testing. A review of existing techniques for both field practice and analysis of the results is reported. After consideration of the various techniques a combination method of testing is proposed. A set of equipment to carry out this combination of tests was designed and built. The uncased testing revealed that it was possible to derive a value for vertical hydraulic conductivity. The doublet method, however, was not particularly successful and numerical simulation was cumbersome. The type-curve approach of appraising whether or not analysis concepts were appropriate proved the most robust method. It is clear that reconnaissance measurements of environmental pressure are very useful in defining where detailed testing should take place. The second phase of testing through perforations proved very difficult. There were many problems associated with location both of the wireline testing system within the borehole and especially of the previous measurements. However, analysis of the results in terms of skin indicated that the perforations produced a negative skin. The measurement of vertical hydraulic conductivity cannot at the moment be regarded as routine

  17. Perceptual relearning of binocular fusion after hypoxic brain damage: four controlled single-case treatment studies.

    Science.gov (United States)

    Schaadt, Anna-Katharina; Schmidt, Lena; Kuhn, Caroline; Summ, Miriam; Adams, Michaela; Garbacenkaite, Ruta; Leonhardt, Eva; Reinhart, Stefan; Kerkhoff, Georg

    2014-05-01

    Hypoxic brain damage is characterized by widespread, diffuse-disseminated brain lesions, which may cause severe disturbances in binocular vision, leading to diplopia and loss of stereopsis, for which no evaluated treatment is currently available. The study evaluated the effects of a novel binocular vision treatment designed to improve binocular fusion and stereopsis as well as to reduce diplopia in patients with cerebral hypoxia. Four patients with severely reduced convergent fusion, stereopsis, and reading duration due to hypoxic brain damage were treated in a single-subject baseline design, with three baseline assessments before treatment to control for spontaneous recovery (pretherapy), an assessment immediately after a treatment period of 6 weeks (posttherapy), and two follow-up tests 3 and 6 months after treatment to assess stability of improvements. Patients received a novel fusion and dichoptic training using 3 different devices designed to slowly increase fusional and disparity angle. After the treatment, all 4 patients improved significantly in binocular fusion, subjective reading duration until diplopia emerged, and 2 of 4 patients improved significantly in local stereopsis. No significant changes were observed during the pretherapy baseline period and the follow-up period, thus ruling out spontaneous recovery and demonstrating long-term stability of treatment effects. This proof-of-principle study indicates a substantial treatment-induced plasticity after hypoxia in the relearning of binocular vision and offers a viable treatment option. Moreover, it provides new hope and direction for the development of effective rehabilitation strategies to treat neurovisual deficits resulting from hypoxic brain damage.

  18. Variational analysis of topological stationary barotropic MHD in the case of single-valued magnetic surfaces

    International Nuclear Information System (INIS)

    Yahalom, A

    2014-01-01

    Variational principles for magnetohydrodynamics have been introduced by previous authors both in Lagrangian and Eulerian form. Yahalom and Lynden-Bell (2008) have previously introduced simpler Eulerian variational principles from which all the relevant equations of barotropic magnetohydrodynamics can be derived. These variational principles were given in terms of six independent functions for non-stationary barotropic flows with given topologies and three independent functions for stationary barotropic flows. This is less then the seven variables which appear in the standard equations of barotropic magnetohydrodynamics which are the magnetic field B-vector the velocity field v-vector and the density ρ. Later, Yahalom (2010) introduced a simpler variational principle in terms of four functions for non-stationary barotropic magnetohydrodynamics. It was shown that the above variational principles are also relevant for flows of non-trivial topologies and in fact using those variational variables one arrives at additional topological conservation laws in terms of cuts of variables which have close resemblance to the Aharonov- Bohm phase (Yahalom (2013)). In previous examples (Yahalom and Lynden-Bell (2008); Yahalom (2013)) the magnetic field lines with non-trivial topology were at the intersection of two surface one of which was always multivalued; in this paper an example is introduced in which the magnetic helicity is not zero yet both surfaces are single-valued

  19. Erica the Rhino: A Case Study in Using Raspberry Pi Single Board Computers for Interactive Art

    Directory of Open Access Journals (Sweden)

    Philip J. Basford

    2016-06-01

    Full Text Available Erica the Rhino is an interactive art exhibit created by the University of Southampton, UK. Erica was created as part of a city wide art trail in 2013 called “Go! Rhinos”, curated by Marwell Wildlife, to raise awareness of Rhino conservation. Erica arrived as a white fibreglass shell which was then painted and equipped with five Raspberry Pi Single Board Computers (SBC. These computers allowed the audience to interact with Erica through a range of sensors and actuators. In particular, the audience could feed and stroke her to prompt reactions, as well as send her Tweets to change her behaviour. Pi SBCs were chosen because of their ready availability and their educational pedigree. During the deployment, ‘coding clubs’ were run in the shopping centre where Erica was located, and these allowed children to experiment with and program the same components used in Erica. The experience gained through numerous deployments around the country has enabled Erica to be upgraded to increase reliability and ease of maintenance, whilst the release of the Pi 2 has allowed her responsiveness to be improved.

  20. Current trend of annotating single nucleotide variation in humans--A case study on SNVrap.

    Science.gov (United States)

    Li, Mulin Jun; Wang, Junwen

    2015-06-01

    As high throughput methods, such as whole genome genotyping arrays, whole exome sequencing (WES) and whole genome sequencing (WGS), have detected huge amounts of genetic variants associated with human diseases, function annotation of these variants is an indispensable step in understanding disease etiology. Large-scale functional genomics projects, such as The ENCODE Project and Roadmap Epigenomics Project, provide genome-wide profiling of functional elements across different human cell types and tissues. With the urgent demands for identification of disease-causal variants, comprehensive and easy-to-use annotation tool is highly in demand. Here we review and discuss current progress and trend of the variant annotation field. Furthermore, we introduce a comprehensive web portal for annotating human genetic variants. We use gene-based features and the latest functional genomics datasets to annotate single nucleotide variation (SNVs) in human, at whole genome scale. We further apply several function prediction algorithms to annotate SNVs that might affect different biological processes, including transcriptional gene regulation, alternative splicing, post-transcriptional regulation, translation and post-translational modifications. The SNVrap web portal is freely available at http://jjwanglab.org/snvrap. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Five Simultaneous Primary Tumors in a Single Patient: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Casey W. Williamson

    2015-10-01

    Full Text Available Multiple primary malignancies (MPMs are present when a patient is diagnosed with more than one primary malignancy and when each tumor is histologically unrelated to the others. MPMs are considered synchronous when they present within 6 months of one another. Here, we report the case of a 57-year-old woman with a past medical history significant for melanoma in 1988, who presented in 2014 with 5 distinct tumors within 4 months: malignant melanoma of the right popliteal fossa, invasive lobular breast carcinoma, diffuse large B cell lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, and a giant cell tumor of tendon sheath/pigmented villonodular synovitis. We discuss her treatment and also present a brief review of the literature. The incidence of MPMs appears to be on the rise, which demands an interdisciplinary, multimodal, and personalized approach to care.

  2. Gabapentin pharmacotherapy for antipsychotic-induced akathisia: single-patient experiment and case report.

    Science.gov (United States)

    Sullivan, Maria A; Wilbur, Robert

    2014-04-01

    This clinical study reports upon the efficacy of gabapentin (Neurontin) for treating severe akathisia (3 on the Barnes Akathisia Rating Scale) in two patients receiving quetiapine (Seroquel), one of whom also received olanzapine (Zyprexa) for a short period. The first patient participated in an open-label experiment in which the bedtime dose of gabapentin was discontinued three times at intervals 1 week apart, resulting in severe akathisia which was quickly terminated by taking his usual 1200 mg gabapentin dose. This patient was also taking high doses of two benzodiazepines and a beta blocker, without therapeutic effect upon his akathisia; only gabapentin was efficacious. The second case is a report of a woman taking a high dose of quetiapine for anxiety who experienced severe akathisia which was relieved by taking 1200 mg of gabapentin. Possible mechanisms of action of gabapentin are discussed. Particular attention is drawn to the difference between neuroleptic-induced akathisia and the neurological condition of restless legs syndrome.

  3. Why Public Comments Matter: The Case of the National Institutes of Health Policy on Single Institutional Review Board Review of Multicenter Studies.

    Science.gov (United States)

    Ervin, Ann-Margret; Taylor, Holly A; Ehrhardt, Stephan; Meinert, Curtis L

    2018-03-06

    In 2014, the National Institutes of Health (NIH) requested public comments on a draft policy requiring NIH-funded, U.S.-based investigators to use a single institutional review board (sIRB) for ethical review of multicenter studies. The authors conducted a directed content analysis and qualitative summary of the comments and discuss how they shaped the final policy. Two reviewers independently assessed support for the policy from a review of comments responding to the draft policy in 2016. A reviewer conducted an open text review to identify prespecified and additional comment themes. A second researcher reviewed 20% of the comments; discrepancies were resolved through discussion. The NIH received 167 comments: 65% (108/167) supportive of the policy, 23% (38/167) not supportive, and 12% (21/167) not indicating support. Clarifications or changes to the policy were suggested in 102/167 comments (61%). Criteria for selecting sIRBs were addressed in 32/102 comments (31%). Also addressed were IRB responsibilities (39/102; 38%), cost (27/102; 26%), the role of local IRBs (14/102; 14%), and allowable policy exceptions (19/102; 19%). The NIH further clarified or provided additional guidance for selection criteria, IRB responsibilities, and cost in the final policy (June 2016). Local IRB reviews and exemptions guidance were unchanged. In this case study, public comments were effective in shaping policy as the NIH modified provisions or planned supplemental guidance in response to comments. Yet critical knowledge gaps remain and empirical data are necessary. The NIH is considering mechanisms to support the establishment of best practices for sIRB implementation.

  4. Early management of mesenteric cyst prevents catastrophes: A single centre analysis of 17 cases

    Directory of Open Access Journals (Sweden)

    Prakash Advait

    2010-01-01

    Full Text Available Background: Mesenteric cysts are rare intra-abdominal masses in the paediatric age group with varied presentation, ranging from an asymptomatic mass to acute abdomen. This study reviews our experience in the diagnosis and treatment of 17 mesenteric cysts in our centre, with especial reference to acute abdominal symptoms. Patients and Methods: Seventeen patients (age less than 10 years with mesenteric cysts were managed in our hospital. The age ranged from 15 days to 10 years. Patients were admitted with acute or chronic symptoms. They were evaluated with complete history, clinical examination, blood investigations and radiological investigations (x-ray abdomen erect, ultrasound abdomen (USG and computed tomography (CT scan in selected cases to reach a provisional diagnosis. The diagnosis was proven on laparotomy and histologically confirmed. Results: The main presenting symptoms were abdominal pain or lump. The most common mode of presentation was acute small intestinal obstruction. USG was not conclusive in all. Abdominal CT scan with intravenous contrast was diagnostic in nine patients. Five patients had volvulus on exploration. Cysts were located in small intestinal mesentery in 14 cases and three were in the sigmoid mesentery. Seven patients had complete excision, intestinal resection was required in four and marsupialisation with cauterisation of margins was done in six patients. Histologically, all were lymphangiomatous mesenteric cysts. Conclusion: The diagnosis of mesenteric cysts should be kept in mind in any patient presenting with acute abdominal symptoms. Small bowel volvulus with mesenteric cyst constituted a significant number in children with acute abdominal symptoms. Early diagnosis and treatment yields excellent outcome.

  5. Long-lasting changes in brain activation induced by a single REAC technology pulse in Wi-Fi bands. Randomized double-blind fMRI qualitative study.

    Science.gov (United States)

    Rinaldi, Salvatore; Mura, Marco; Castagna, Alessandro; Fontani, Vania

    2014-07-11

    The aim of this randomized double-blind study was to evaluate in healthy adult subjects, with functional magnetic resonance imaging (fMRI), long lasting changes in brain activation patterns following administration of a single, 250 milliseconds pulse emitted with radio-electric asymmetric conveyer (REAC) technology in the Wi-Fi bands. The REAC impulse was not administered during the scan, but after this, according to a protocol that has previously been demonstrated to be effective in improving motor control and postural balance, in healthy subjects and patients. The study was conducted on 33 healthy volunteers, performed with a 1.5 T unit while operating a motor block task involving cyclical and alternating flexion and extension of one leg. Subsequently subjects were randomly divided into a treatment and a sham treatment control group. Repeated fMRI examinations were performed following the administration of the REAC pulse or sham treatment. The Treated group showed cerebellar and ponto-mesencephalic activation components that disappeared in the second scan, while these activation components persisted in the Sham group. This study shows that a very weak signal, such as 250 milliseconds Wi-Fi pulse, administered with REAC technology, could lead to lasting effects on brain activity modification.

  6. Familiarity and recollection vs representational models of medial temporal lobe structures: A single-case study.

    Science.gov (United States)

    Lacot, Emilie; Vautier, Stéphane; Kőhler, Stefan; Pariente, Jérémie; Martin, Chris B; Puel, Michèle; Lotterie, Jean-Albert; Barbeau, Emmanuel J

    2017-09-01

    Although it is known that medial temporal lobe (MTL) structures support declarative memory, the fact these structures have different architectonics and circuitry suggests they may also play different functional roles. Selective lesions of MTL structures offer an opportunity to understand these roles. We report, in this study, on JMG, a patient who presents highly unusual lesions that completely affected all MTL structures except for the right hippocampus and parts of neighbouring medial parahippocampal cortex. We first demonstrate that JMG shows preserved recall for visual material on 5 experimental tasks. This finding suggests that his right hippocampus is functional, even though it appears largely disconnected from most of its MTL afferents. In contrast, JMG performed very poorly, as compared to control subjects, on 7 tasks of visual recognition memory for single items. Although he sometimes performed above chance, neither familiarity nor recollection appeared fully preserved. These results indicate that extrahippocampal structures, damaged bilaterally in JMG, perform critical operations for item recognition; and that the hippocampus cannot take over that role, including recollection, when these structures are largely damaged. Finally, in a set of 3 recognition memory tasks with scenes as stimuli, JMG performed at the level of control participants and obtained normal indices of familiarity and recollection. Overall, our findings suggest that the right hippocampus and remnants of parahippocampal cortex can support recognition memory for scenes in the absence of preserved item-recognition memory. The patterns of dissociations, which we report in the present study, provide support for a representational account of the functional organization of MTL structures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Specific heat of Nb{sub 3}Sn: The case for a single gap

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Y. J., E-mail: jophy@knu.ac.kr [Department of Physics, Kyungpook National University, Daegu 702-701 (Korea, Republic of); Zhou, Jian; Sung, Zu Hawn; Lee, Peter J.; Larbalestier, D. C. [National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310 (United States)

    2014-10-01

    The important influence of multiple gaps in the superconductivity of MgB{sub 2} and Fe-based compounds, especially because of the possibility that manipulation of a second gap can significantly raise the upper critical field H{sub c2}, has refocused attention on Nb{sub 3}Sn because anomalies in both specific heat and point-contact tunneling studies have led to the proposal that Nb{sub 3}Sn is also a two-gap superconductor. Here, we search for evidence of the second gap in a careful study of the influence of the homogenization temperature on the sample uniformity. We show that it is very difficult to fabricate samples that are both homogeneous and stoichiometric. We find so-called “second-gap” anomalies disappear only after high temperature and long-term annealing. Such a well-annealed sample shows only a strong, electron-phonon-coupled, single-gap behavior. In contrast, samples reacted and annealed at lower temperatures, as in the earlier two-gap studies, show small chemical composition variations of the A15 phase. We propose that the second gap sightings are actually due to variation of T{sub c} within very difficult-to-fully homogenize samples. A curiosity of the A15 Nb{sub 3}Sn phase is that almost any mixture of Nb and Sn tries to form a stoichiometric A15 composition, but the residue of course contains off-stoichiometric A15, Nb, and other phases when the Nb:Sn ratio departs from the true 3:1 stoichiometry.

  8. Robotic surgery for rectal cancer: a single center experience of 100 consecutive cases.

    Science.gov (United States)

    Stănciulea, O; Eftimie, M; David, L; Tomulescu, V; Vasilescu, C; Popescu, I

    2013-01-01

    Minimally invasive techniques have revolutionized the field of general surgery over the few last decades. Despite its advantages, in complex procedures such as rectal surgery, laparoscopy has not achieved a high penetration rate because of its steep learning curve, its relatively high conversion rate and technical challenges. The aim of this study was to present a single center experience with robotic surgery for rectal cancer focusing mainly on early and mid-term postoperative outcome. A series of 100 consecutive patients who underwent robotic rectal surgery between January 2008 and June 2012 was analyzed retrospectively in terms of demographics, pathological data, surgical and oncological outcomes. Seventy-seven patients underwent robotic sphincter-saving resection, and 23 patients underwent robotic abdominoperineal resection. There were 4 conversions. The median operative time for sphincter-saving procedures was 180 min. The median time for robotic abdominoperineal resection was 160 min. The median distal resection margin of the operative specimen was 3 cm. The median number of retrieved lymph nodes was 14. The median hospital stay was 10 days. In-hospital mortality was nil. The overall morbidity was 30%. Four patients presented transitory postoperative urinary dysfunction. Severe erectile dysfunction was reported by 3 patients. The median length of follow-up was 24 months. The 3-year overall survival rate was 90%. Robotic surgery is advantageous for both surgeons (in that it facilitates dissection in a narrow pelvis) and patients (in that it affords a very good quality of life via the preservation of sexual and urinary function in the vast majority of patients and it has low morbidity and good midterm oncological outcomes). In rectal cancer surgery, the robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field. Celsius.

  9. Evaluating statistical and clinical significance of intervention effects in single-case experimental designs: An SPSS method to analyze univariate data

    NARCIS (Netherlands)

    Maric, M.; de Haan, M.; Hogendoorn, S.M.; Wolters, L.H.; Huizenga, H.M.

    2015-01-01

    Single-case experimental designs are useful methods in clinical research practice to investigate individual client progress. Their proliferation might have been hampered by methodological challenges such as the difficulty applying existing statistical procedures. In this article, we describe a

  10. Evaluating statistical and clinical significance of intervention effects in single-case experimental designs: an SPSS method to analyze univariate data

    NARCIS (Netherlands)

    Maric, Marija; de Haan, Else; Hogendoorn, Sanne M.; Wolters, Lidewij H.; Huizenga, Hilde M.

    2015-01-01

    Single-case experimental designs are useful methods in clinical research practice to investigate individual client progress. Their proliferation might have been hampered by methodological challenges such as the difficulty applying existing statistical procedures. In this article, we describe a

  11. Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

    Directory of Open Access Journals (Sweden)

    Irene Capizzi

    2017-10-01

    Full Text Available In advanced chronic kidney disease, obesity may bring a survival advantage, but many transplant centres demand weight loss before wait-listing for kidney graft. The case here described regards a 71-year-old man, with obesity-related glomerulopathy; referral data were: weight 110 kg, Body Mass Index (BMI 37 kg/m2, serum creatinine (sCr 5 mg/dL, estimated glomerular filtration rate (eGFR 23 mL/min, blood urea nitrogen (BUN 75 mg/dL, proteinuria 2.3 g/day. A moderately restricted, low-protein diet allowed reduction in BUN (45–55 mg/dL and good metabolic and kidney function stability, with a weight increase of 6 kg. Therefore, he asked to be enrolled in a weight-loss program to be wait-listed (the two nearest transplant centres required a BMI below 30 or 35 kg/m2. Since previous low-calorie diets were not successful and he was against a surgical approach, we chose a qualitative, ad libitum coach-assisted diet, freely available in our unit. In the first phase, the diet is dissociated; he lost 16 kg in 2 months, without need for dialysis. In the second maintenance phase, in which foods are progressively combined, he lost 4 kg in 5 months, allowing wait-listing. Dialysis started one year later, and was followed by weight gain of about 5 kg. He resumed the maintenance diet, and his current body weight, 35 months after the start of the diet, is 94 kg, with a BMI of 31.7 kg/m2, without clinical or biochemical signs of malnutrition. This case suggests that our patients can benefit from the same options available to non-CKD (chronic kidney disease individuals, provided that strict multidisciplinary surveillance is assured.

  12. Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities - A qualitative case study in Bangladesh.

    Science.gov (United States)

    Biswas, Animesh; Anderson, Rondi; Doraiswamy, Sathyanarayanan; Abdullah, Abu Sayeed Md; Purno, Nabila; Rahman, Fazlur; Halim, Abdul

    2018-01-01

    Background: Prompt and efficient identification, referral of pregnancy related complications and emergencies are key factors to the reduction of maternal and newborn morbidity and mortality. As a response to this critical need, a midwifery led continuum of reproductive health care was introduced in five teagardens in the Sylhet division, Bangladesh during 2016. Within this intervention, professional midwives provided reproductive healthcare to pregnant teagarden women in the community.  This study evaluates the effect of the referral of pregnancy related complications. Methods: A qualitative case study design by reviewing records retrospectively was used to explore the effect of deploying midwives on referrals of pregnancy related complications from the selected teagardens to the referral health facilities in Moulvibazar district of the Sylhet division during 2016.  In depth analyses was also performed on 15 randomly selected cases to understand the facts behind the referral. Results: Out of a total population of 450 pregnant women identified by the midwives, 72 complicated mothers were referred from the five teagardens to the facilities. 76.4% of mothers were referred to conduct delivery at facilities, and 31.1% of them were referred with the complication of prolonged labour. Other major complications were pre-eclampsia (17.8%), retention of the placenta with post-partum hemorrhage (11.1%) and premature rupture of the membrane (8.9%). About 60% of complicated mothers were referred to the primary health care centre, and among them 14% of mothers were delivered by caesarean section. 94% deliveries resulted in livebirths and only 6% were stillbirths. Conclusions: This study reveals that early detection of pregnancy complications by skilled professionals and timely referral to a facility is beneficial in saving the majority of baby's as well as mother's lives in resource-poor teagardens with a considerable access barrier to health facilities.

  13. Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities – A qualitative case study in Bangladesh

    Science.gov (United States)

    Biswas, Animesh; Anderson, Rondi; Doraiswamy, Sathyanarayanan; Abdullah, Abu Sayeed Md.; Purno, Nabila; Rahman, Fazlur; Halim, Abdul

    2018-01-01

    Background: Prompt and efficient identification, referral of pregnancy related complications and emergencies are key factors to the reduction of maternal and newborn morbidity and mortality. As a response to this critical need, a midwifery led continuum of reproductive health care was introduced in five teagardens in the Sylhet division, Bangladesh during 2016. Within this intervention, professional midwives provided reproductive healthcare to pregnant teagarden women in the community.  This study evaluates the effect of the referral of pregnancy related complications. Methods: A qualitative case study design by reviewing records retrospectively was used to explore the effect of deploying midwives on referrals of pregnancy related complications from the selected teagardens to the referral health facilities in Moulvibazar district of the Sylhet division during 2016.  In depth analyses was also performed on 15 randomly selected cases to understand the facts behind the referral. Results: Out of a total population of 450 pregnant women identified by the midwives, 72 complicated mothers were referred from the five teagardens to the facilities. 76.4% of mothers were referred to conduct delivery at facilities, and 31.1% of them were referred with the complication of prolonged labour. Other major complications were pre-eclampsia (17.8%), retention of the placenta with post-partum hemorrhage (11.1%) and premature rupture of the membrane (8.9%). About 60% of complicated mothers were referred to the primary health care centre, and among them 14% of mothers were delivered by caesarean section. 94% deliveries resulted in livebirths and only 6% were stillbirths. Conclusions: This study reveals that early detection of pregnancy complications by skilled professionals and timely referral to a facility is beneficial in saving the majority of baby’s as well as mother’s lives in resource-poor teagardens with a considerable access barrier to health facilities. PMID:29707205

  14. Qualitative Economics

    DEFF Research Database (Denmark)

    Fast, Michael; Clark, Woodrow

    2012-01-01

    the everyday economic life is the central issue and is discussed from the perspective of interactionism. It is a perspective developed from the Lifeworld philosophical traditions, such as symbolic interactionism and phenomenology, seeking to develop the thinking of economics. The argument is that economics...... and the process of thinking, e.g. the ontology and the epistemology. Keywords: qualitative, interaction, process, organizing, thinking, perspective, epistemology....

  15. Solid pseudopapillary tumors of the pancreas: 27 cases from a single institution

    Directory of Open Access Journals (Sweden)

    ZHOU Haiyang

    2013-01-01

    Full Text Available ObjectiveTo summarize the clinicopathologic features and treatment outcomes of solid pseudopapillary tumors (SPTs of the pancreas. MethodsTwenty-seven cases of SPT of the pancreas admitted for treatment to the Peking University Cancer Hospital between September 2008 and September 2012 were retrospectively analyzed. ResultsThe majority of the pancreatic SPT patients were young adults (median age: 29 years old and females (85.2%. All 27 patients were treated with surgical resection using pancreaticoduodenectomy (n=4, duodenum preserving pancreatic tumor resection (n=6, middle pancreatectomy (n=5, distal pancreatectomy (n=5, or distal pancreatectomy plus splenectomy (n=7. The minimum tumor diameter was 1.5 cm, the maximum diameter was 12.0 cm, and the average diameter was 5.4 cm. Twelve patients developed pancreatic leakage and pyrexia following the operation. One patient suffered splenic artery hemorrhage. All 27 patients survived and completed follow-up. Only one patient developed recurrence, which was treated by a second surgical resection, and all other patients showed no clinical signs of recurrence or metastasis. ConclusionSPT of the pancreas has uncertain malignant potential with good prognosis. Radical resection with preservation of the surrounding tissues is an effective and safe treatment for SPT.

  16. Rituximab for the therapy of systemic sclerosis: a series of 10 cases in a single center.

    Science.gov (United States)

    Vilela, Verônica Silva; Maretti, Giselle Baptista; Gama, Lívia Marques da Silva; Costa, Claudia Henrique da; Rufino, Rogério Lopes; Levy, Roger A

    Systemic sclerosis (SSc) is a chronic autoimmune disease with a high morbidity and mortality. Although cyclophosphamide is effective for severe and refractory cases, there is demand for new treatments. The biological treatment with B-cell depletion with rituximab (RTX) has demonstrated efficacy for this demand in open-label studies. This study was conducted with the aim to retrospectively evaluate all patients who used RTX for the treatment of SSc in our center. We retrospectively evaluated medical records of all patients with SSc who used RTX to treat this disease from January 2009 to January 2015. Systemic, cutaneous, and pulmonary involvement data and laboratory results before and six months after the first infusion of RTX were collected. Ten patients received treatment during the study period and were included in this series. All patients had a diffuse form of the disease. Five patients suffered from an early (duration of disease shorter or equal to four years), rapidly progressive disease, and another five received RTX at late stages of the disease. In both groups of patients, stabilization of the pulmonary picture was observed, with a fall in the skin score in those patients with early forms of the disease. Similar to findings in previous studies, RTX was effective in treating early and rapidly progressive forms of SSc. We also found that patients with long-term illness may benefit from the treatment. Copyright © 2016. Published by Elsevier Editora Ltda.

  17. A novel virtual motor rehabilitation system for Guillain-Barré syndrome. Two single case studies.

    Science.gov (United States)

    Albiol-Pérez, S; Forcano-García, M; Muñoz-Tomás, M T; Manzano-Fernández, P; Solsona-Hernández, S; Mashat, M A; Gil-Gómez, J A

    2015-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation". For Guillain-Barré patients, motor rehabilitation programs are helpful at the onset to prevent the complications of paralysis and in cases of persistent motor impairment. Traditional motor rehabilitation programs may be tedious and monotonous, resulting in low adherence to the treatments. A Virtual Motor Rehabilitation system has been tested in Guillain-Barré patients to increase patient adherence and to improve clinical results. Two people with Guillain-Barré performed 20 rehabilitation sessions. We tested a novel system based on Motor Virtual Rehabilitation in three periods of time (baseline evaluation, final evaluation, and follow-up. In the training program, the participants carried out a specific treatment using the Active Balance Rehabilitation system (ABAR). The system is composed of customizable virtual games to perform static and dynamic balance rehabilitation. Significant improvements in clinical results were obtained by both participants, with significant results in the static balance clinical test of the Anterior Reach test in the standing position and unipedal stance time. Other significant results were found in dynamic balance clinical tests in the Berg Balance Scale test and the 30-second Sit-to-Stand test. With regard to acceptance of the system, both patients enjoyed the experience, and both patients thought that this system was helpful for their rehabilitation. The results show that Virtual Motor Rehabilitation for Guillain-Barré patients provides clinical improvements in an entertaining way.

  18. Qualitative Methodology in Unfamiliar Cultures

    DEFF Research Database (Denmark)

    Svensson, Christian Franklin

    2014-01-01

    on a qualitative methodology, conscious reflection on research design and objectivity is important when doing fieldwork. This case study discusses such reflections. Emphasis throughout is given to applied qualitative methodology and its contributions to the social sciences, in particular having to do......This case study discusses qualitative fieldwork in Malaysia. The trends in higher education led to investigating how and why young Indians and Chinese in Malaysia are using the university to pursue a life strategy. Given the importance of field context in designing and analysing research based...

  19. The nursing contribution to chronic disease management: a case of public expectation? Qualitative findings from a multiple case study design in England and Wales.

    Science.gov (United States)

    Wilson, Patricia Mary; Brooks, Fiona; Procter, Susan; Kendall, Sally

    2012-01-01

    The global response to the rise in prevalence of chronic disease is a focus on the way services are managed and delivered, in which nurses are seen as central in shaping patient experience. However, there is relatively little known on how patients perceive the changes to service delivery envisaged by chronic care models. The PEARLE project aimed to explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to the models. Design, settings and participants Case study design of seven sites in England and Wales ensuring a range of chronic disease management models. Participants included over ninety patients and family carers ranging in age from children to older people with conditions such as diabetes, respiratory disease, epilepsy, or coronary heart disease. Semi-structured interviews with patients and family carers. Focus groups were conducted with adolescents and children. A whole systems approach guided data collection and data were thematically analysed. Despite nurses' role and skill development and the shift away from the acute care model, the results suggested that patients had a persisting belief in the monopoly of expertise continuing to exist in the acute care setting. Patients were more satisfied if they saw the nurse as diagnostician, prescriber and medical manager of the condition. Patients were less satisfied when they had been transferred from an established doctor-led to nurse-led service. While nurses within the study were highly skilled, patient perception was guided by the familiar rather than most appropriate service delivery. Most patients saw chronic disease management as a medicalised approach and the nursing contribution was most valued when emulating it. Patients' preferences and expectations of chronic disease management were framed by a strongly biomedical discourse. Perceptions of nurse-led chronic disease management were often shaped by what was

  20. Percutaneous Nephrolithotomy: Our Results of a Single-Centre Analysis in 2300 Cases

    Directory of Open Access Journals (Sweden)

    Akif Erbin

    2014-03-01

    Full Text Available Aim: In this study, we evaluated the results of 2300 patients who underwent percutaneous nephrolithotomy (PNL between March 2002 and April 2013. Methods: In our clinic, a total of 2300 PNL operations were performed between March 2002 - April 2013. Demographic characteristics (age, gender, body mass index, stone features (side, size, location, clinical characteristics of the urinary tract (renal anomaly, previous surgery, previous extracorporeal shock wave lithotripsy, operation parameters (duration of the intervention and fluoroscopy, number of access, location of access, transfusion, complications, post-operative data (length of hospital stay, transfusion, complications, stone-free were recorded on PNL forms. The data were analyzed retrospectively. Results: Of all the PNL operations, 1225 (53.2% were left-sided, 1074 (46.6% were right-sided and 1 was bilateral. The mean age of the subjects was 43.5 (7-83 years and the mean body mass index was 26.6 kg/m2 (12-51. A total of 46 (2% cases had renal anomalies. There were 16 patients with horseshoe kidney. More than one accesses was performed in 18.6% of the patient and intercostal access was done in 9.8%. Perioperative and post-operative transfusion rates were 1.4% and 2.9%, respectively. The mean stone size was 7.5±4.1 cm2. Stone-free (SF rate was 65.1% and success rate was 78.5%. Conclusion: With increasing experience and advances in endourology, PNL is being widely performed with low morbidity and high success in our country as in the world. (The Me­di­cal Bul­le­tin of Ha­se­ki 2013; 51: 19-24

  1. Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution.

    Science.gov (United States)

    Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Gorodner, Veronica; Ayloo, Subhashini M; Elli, Enrique F; Oberholzer, José; Benedetti, Enrico; Giulianotti, Pier C

    2012-08-01

    To assess factors associated with morbidity and mortality following the use of robotics in general surgery. Case series. University of Illinois at Chicago. Eight hundred eighty-four consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. Perioperative morbidity and mortality. During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patient-related (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥ 3, body mass index [calculated as weight in kilograms divided by height in meters squared] surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality. Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery

  2. An empirical analysis of mental state talk and affect regulation in two single-cases of psychodynamic child therapy.

    Science.gov (United States)

    Halfon, Sibel; Bekar, Ozlem; Gürleyen, Büşra

    2017-06-01

    Literature has shown the importance of mentalizing techniques in symptom remission and emotional understanding; however, no study to date has looked at the dynamic relations between mental state talk and affect regulation in the psychotherapy process. From a psychodynamic perspective, the emergence of the child's capacity to regulate affect through the therapist's reflection on the child's mental states is a core aspect of treatment. In an empirical investigation of 2 single cases with separation anxiety disorder, who were treated in long-term psychodynamic play therapy informed with mentalization principles, the effect of therapists' and children's use of mental state talk on children's subsequent capacity to regulate affect in play was assessed. One case was a positive outcome case, whereas the other did not show symptomatic improvement at the end of treatment. Children's and therapists' utterances in the sessions were coded using the Coding System for Mental State Talk in Narratives, and children's play was coded by Children's Play Therapy Instrument, which generated an index of children's "affect regulation." Time-series Granger Causality tests showed that even though both therapists' use of mental state talk significantly predicted children's subsequent affect regulation, the association between child's mental state talk and affect regulation was only supported for the child who showed clinically significant symptom reduction. This study provided preliminary support that mental state talk in psychodynamic psychotherapy facilitates emotion regulation in play. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. Perceptions on use of home telemonitoring in patients with long term conditions - concordance with the Health Information Technology Acceptance Model: a qualitative collective case study.

    Science.gov (United States)

    Middlemass, Jo B; Vos, Jolien; Siriwardena, A Niroshan

    2017-06-26

    Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). An instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data. Participants included 21 patients aged between 60-99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the 'sick-role'. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced. HITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors

  4. A socio-ecological perspective of access to and acceptability of HIV/AIDS treatment and care services: a qualitative case study research

    Directory of Open Access Journals (Sweden)

    Bereket Yakob

    2016-02-01

    Full Text Available Abstract Background Access to healthcare is an essential element of health development and a fundamental human right. While access to and acceptability of healthcare are complex concepts that interact with different socio-ecological factors (individual, community, institutional and policy, it is not known how these factors affect HIV care. This study investigated the impact of socio-ecological factors on access to and acceptability of HIV/AIDS treatment and care services (HATCS in Wolaita Zone of Ethiopia. Method Qualitative case study research was conducted in six woredas (districts. Focus group discussions (FGDs were conducted with 68 participants in 11 groups (six with people using antiretroviral therapy (ART and five with general community members. Key informant interviews (KIIs were conducted with 28 people involved in HIV care, support services and health administration at different levels. Individual in-depth interviews (IDIs were conducted with eight traditional healers and seven defaulters from (ART. NVIVO 10 was used to assist qualitative content data analysis. Results A total of 111 people participated in the study, of which 51 (45.9 % were male and 60 (54.1 % were female, while 58 (53.3 % and 53 (47.7 % were urban and rural residents, respectively. The factors that affect access to and acceptability of HATCS were categorized in four socio-ecological units of analysis: client-based factors (awareness, experiences, expectations, income, employment, family, HIV disclosure and food availability; community-based factors (care and support, stigma and discrimination and traditional healing; health facility-based factors (interactions with care providers, availability of care, quality of care, distance, affordability, logistics availability, follow up and service administration; and policy and standards (healthcare financing, service standards, implementation manuals and policy documents. Conclusions A socio-ecological perspective

  5. An intronic single-nucleotide polymorphism (rs13217795) in FOXO3 is associated with asthma and allergic rhinitis: a case-case-control study.

    Science.gov (United States)

    Amarin, Justin Z; Naffa, Randa G; Suradi, Haya H; Alsaket, Yousof M; Obeidat, Nathir M; Mahafza, Tareq M; Zihlif, Malek A

    2017-11-15

    Asthma and allergic rhinitis are respiratory diseases with a significant global burden. Forkhead box O3 (FOXO3) is a gene involved in the etiology of a number of respiratory diseases. The objective of this study is to assess the association of rs13217795, an intronic FOXO3 single-nucleotide polymorphism, with asthma and allergic rhinitis. In this case-case-control genetic association study, genotyping was conducted using the PCR-RFLP method. Genotype-based associations were investigated under the general, recessive, and dominant models of disease penetrance using binomial logistic regression; and, allele-based associations were tested using Pearson's chi-squared test. The final study population consisted of 94 controls, 124 asthmatics, and 110 allergic rhinitis patients. The general and recessive models of disease penetrance were statistically significant for both case-control comparisons. Under the general model, the odds of the asthma phenotype were 1.46 (0.64 to 3.34) and 3.42 (1.37 to 8.57) times higher in heterozygotes and derived allele homozygotes, respectively, compared to ancestral allele homozygotes. The corresponding odds ratios for the allergic rhinitis phenotype were 1.05 (0.46 to 2.40) and 2.35 (0.96 to 5.73), respectively. The dominant model of disease penetrance was not statistically significant. The minor allele in all study groups was the ancestral allele, with a frequency of 0.49 in controls. There was no deviation from Hardy-Weinberg equilibrium in controls. Both case-control allele-based associations were statistically significant. Herein we present the first report of the association between rs13217795 and allergic rhinitis, and the first independent verification of the association between rs13217795 and asthma. Marker selection in future genetic association studies of asthma and allergic rhinitis should include functional polymorphisms in linkage disequilibrium with rs13217795.

  6. Capitalizing on technology for developing communication skills in autism spectrum disorder: a single case study.

    Science.gov (United States)

    Mohan, Veena; Kunnath, Suja Kurian; Philip, Vineetha Sara; Mohan, Lakshmi Santha; Thampi, Neethu

    2017-12-15

    In this case study, we discuss the application of a patient-centred clinical approach that led to the use of an assisted communication platform to combat severe communicative deficit in a child with autism spectrum disorder (ASD). Initial assessment at four years of age revealed that the patient had rudimentary communication skills, with significant sensory integration dysfunction manifested as oral, olfactory, and tactile seeking behaviours; self-stimulatory behaviour; and complete dependence on caregiver for activities of daily living. Intensive, multi-disciplinary intervention resulted in minimal improvement in communicative skills and sensory seeking over six months. Subsequently, a tailor-made picture-assisted communication training with the mother as the communication facilitator was adopted. This approach was abandoned due to the patient's poor response and mother's low acceptance of picture-based interaction. A preference for printed material was observed in the patient. Accordingly, further management was focused on employing a computer-based interactive platform that the patient was taught to use over the course of a few months as a part of augmentative and alternative communication (AAC) intervention program. This resulted in a remarkable improvement in the child's skills that now allowed for a better intentional communication of his thoughts and needs. This study highlights the importance of revisiting conventional rehabilitation strategies for communicative deficits and tailoring them according to the patient's needs and preferences. It also emphasises that besides excellent observation skills, clinicians must be willing to consider technology based approaches in patients responding poorly to traditional approaches in order to develop effective interventional programmes. Implication for Rehabilitation The current study highlights the importance of exploring the application of technology based intervention for building communication skills in the early

  7. Ensembles generated from crystal structures of single distant homologues solve challenging molecular-replacement cases in AMPLE.

    Science.gov (United States)

    Rigden, Daniel J; Thomas, Jens M H; Simkovic, Felix; Simpkin, Adam; Winn, Martyn D; Mayans, Olga; Keegan, Ronan M

    2018-03-01

    Molecular replacement (MR) is the predominant route to solution of the phase problem in macromolecular crystallography. Although routine in many cases, it becomes more effortful and often impossible when the available experimental structures typically used as search models are only distantly homologous to the target. Nevertheless, with current powerful MR software, relatively small core structures shared between the target and known structure, of 20-40% of the overall structure for example, can succeed as search models where they can be isolated. Manual sculpting of such small structural cores is rarely attempted and is dependent on the crystallographer's expertise and understanding of the protein family in question. Automated search-model editing has previously been performed on the basis of sequence alignment, in order to eliminate, for example, side chains or loops that are not present in the target, or on the basis of structural features (e.g. solvent accessibility) or crystallographic parameters (e.g. B factors). Here, based on recent work demonstrating a correlation between evolutionary conservation and protein rigidity/packing, novel automated ways to derive edited search models from a given distant homologue over a range of sizes are presented. A variety of structure-based metrics, many readily obtained from online webservers, can be fed to the MR pipeline AMPLE to produce search models that succeed with a set of test cases where expertly manually edited comparators, further processed in diverse ways with MrBUMP, fail. Further significant performance gains result when the structure-based distance geometry method CONCOORD is used to generate ensembles from the distant homologue. To our knowledge, this is the first such approach whereby a single structure is meaningfully transformed into an ensemble for the purposes of MR. Additional cases further demonstrate the advantages of the approach. CONCOORD is freely available and computationally inexpensive, so

  8. Target-mediated drug disposition with drug-drug interaction, Part I: single drug case in alternative formulations.

    Science.gov (United States)

    Koch, Gilbert; Jusko, William J; Schropp, Johannes

    2017-02-01

    Target-mediated drug disposition (TMDD) describes drug binding with high affinity to a target such as a receptor. In application TMDD models are often over-parameterized and quasi-equilibrium (QE) or quasi-steady state (QSS) approximations are essential to reduce the number of parameters. However, implementation of such approximations becomes difficult for TMDD models with drug-drug interaction (DDI) mechanisms. Hence, alternative but equivalent formulations are necessary for QE or QSS approximations. To introduce and develop such formulations, the single drug case is reanalyzed. This work opens the route for straightforward implementation of QE or QSS approximations of DDI TMDD models. The manuscript is the first part to introduce DDI TMDD models with QE or QSS approximations.

  9. Radionuclide deflation effects at contaminated environmental area in case of single and steady discharges to the atmosphere

    International Nuclear Information System (INIS)

    Makhon'ko, K.P.

    1984-01-01

    The effects of wind generation of radioactive dust in the area contaminated as a result of single or steady radionuclide discharges to the atmosphere are considered. Calculations are given on changing in time of the deflation coefficient Ksub(α) cm -1 on the base of the radionuclides migration rate account into the depth from a surface dust-forming soil layer and irradiation dose for account of radionuclides penetrated by food chains and into respiratory organs as a result of dusting of the contaminated zone. It is shown that the deflation effects play an essential part in case of emergency discharges owing to the possibility of including radionuclides in food chains through plants. The numerical calculations are performed for 90 Sr and 137 Cs and for light and heavy natural deposit soils

  10. The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Adigun I

    2008-01-01

    Full Text Available We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7 th postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.

  11. A methodology to compile food metrics related to diet sustainability into a single food database: Application to the French case.

    Science.gov (United States)

    Gazan, Rozenn; Barré, Tangui; Perignon, Marlène; Maillot, Matthieu; Darmon, Nicole; Vieux, Florent

    2018-01-01

    The holistic approach required to assess diet sustainability is hindered by lack of comprehensive databases compiling relevant food metrics. Those metrics are generally scattered in different data sources with various levels of aggregation hampering their matching. The objective was to develop a general methodology to compile food metrics describing diet sustainability dimensions into a single database and to apply it to the French context. Each step of the methodology is detailed: indicators and food metrics identification and selection, food list definition, food matching and values assignment. For the French case, nutrient and contaminant content, bioavailability factors, distribution of dietary intakes, portion sizes, food prices, greenhouse gas emission, acidification and marine eutrophication estimates were allocated to 212 commonly consumed generic foods. This generic database compiling 279 metrics will allow the simultaneous evaluation of the four dimensions of diet sustainability, namely health, economic, social and environmental, dimensions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Classifying the Progression of Ductal Carcinoma from Single-Cell Sampled Data via Integer Linear Programming: A Case Study.

    Science.gov (United States)

    Catanzaro, Daniele; Shackney, Stanley E; Schaffer, Alejandro A; Schwartz, Russell

    2016-01-01

    Ductal Carcinoma In Situ (DCIS) is a precursor lesion of Invasive Ductal Carcinoma (IDC) of the breast. Investigating its temporal progression could provide fundamental new insights for the development of better diagnostic tools to predict which cases of DCIS will progress to IDC. We investigate the problem of reconstructing a plausible progression from single-cell sampled data of an individual with synchronous DCIS and IDC. Specifically, by using a number of assumptions derived from the observation of cellular atypia occurring in IDC, we design a possible predictive model using integer linear programming (ILP). Computational experiments carried out on a preexisting data set of 13 patients with simultaneous DCIS and IDC show that the corresponding predicted progression models are classifiable into categories having specific evolutionary characteristics. The approach provides new insights into mechanisms of clonal progression in breast cancers and helps illustrate the power of the ILP approach for similar problems in reconstructing tumor evolution scenarios under complex sets of constraints.

  13. Automatic feedback to promote safe walking and speech loudness control in persons with multiple disabilities: two single-case studies.

    Science.gov (United States)

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Green, Vanessa A; Alberti, Gloria; Boccasini, Adele; Smaldone, Angela; Oliva, Doretta; Bosco, Andrea

    2014-08-01

    Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively. The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level. The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness. Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.

  14. Reliability centered maintenance : a case study of railway transit maintenance to achieve optimal performance.

    Science.gov (United States)

    2010-12-01

    The purpose of this qualitative case study was to identify the types of obstacles and patterns experienced by a single heavy rail transit agency located in North America that embedded a Reliability Centered Maintenance (RCM) Process. The outcome of t...

  15. Strengths, weaknesses, opportunities, and threats analysis of integrating the World Health Organization patient safety curriculum into undergraduate medical education in Pakistan: a qualitative case study

    Directory of Open Access Journals (Sweden)

    Samreen Misbah

    2017-12-01

    Full Text Available Purpose The purpose of this study was to conduct a strengths, weaknesses, opportunities, and threats (SWOT analysis of integrating the World Health Organization (WHO patient safety curriculum into undergraduate medical education in Pakistan. Methods A qualitative interpretive case study was conducted at Riphah International University, Islamabad, from October 2016 to June 2017. The study included 9 faculty members and 1 expert on patient safety. The interviews were audiotaped, and a thematic analysis of the transcripts was performed using NVivo software. Results Four themes were derived based on the need analysis model. The sub-themes derived from the collected data were arranged under the themes of strengths, weaknesses, opportunities, and threats, in accordance with the principles of SWOT analysis. The strengths identified were the need for a formal patient safety curriculum and its early integration into the undergraduate program. The weaknesses were faculty awareness and participation in development programs. The opportunities were an ongoing effort to develop an appropriate curriculum, to improve the current culture of healthcare, and to use the WHO curricular resource guide. The threats were attitudes towards patient safety in Pakistani culture, resistance to implementation from different levels, and the role of regulatory authorities. Conclusion The theme of patient safety needs to be incorporated early into the formal medical education curriculum, with the main goals of striving to do no harm and seeing mistakes as opportunities to learn. Faculty development activities need to be organized, and faculty members should to be encouraged to participate in them. The lack of a patient safety culture was identified as the primary reason for resistance to this initiative at many levels. The WHO curriculum, amended according to local institutional culture, can be implemented appropriately with support from the corresponding regulatory bodies.

  16. Strengths, weaknesses, opportunities, and threats analysis of integrating the World Health Organization patient safety curriculum into undergraduate medical education in Pakistan: a qualitative case study.

    Science.gov (United States)

    Misbah, Samreen; Mahboob, Usman

    2017-01-01

    The purpose of this study was to conduct a strengths, weaknesses, opportunities, and threats (SWOT) analysis of integrating the World Health Organization (WHO) patient safety curriculum into undergraduate medical education in Pakistan. A qualitative interpretive case study was conducted at Riphah International University, Islamabad, from October 2016 to June 2017. The study included 9 faculty members and 1 expert on patient safety. The interviews were audiotaped, and a thematic analysis of the transcripts was performed using NVivo software. Four themes were derived based on the need analysis model. The sub-themes derived from the collected data were arranged under the themes of strengths, weaknesses, opportunities, and threats, in accordance with the principles of SWOT analysis. The strengths identified were the need for a formal patient safety curriculum and its early integration into the undergraduate program. The weaknesses were faculty awareness and participation in development programs. The opportunities were an ongoing effort to develop an appropriate curriculum, to improve the current culture of healthcare, and to use the WHO curricular resource guide. The threats were attitudes towards patient safety in Pakistani culture, resistance to implementation from different levels, and the role of regulatory authorities. The theme of patient safety needs to be incorporated early into the formal medical education curriculum, with the main goals of striving to do no harm and seeing mistakes as opportunities to learn. Faculty development activities need to be organized, and faculty members should to be encouraged to participate in them. The lack of a patient safety culture was identified as the primary reason for resistance to this initiative at many levels. The WHO curriculum, amended according to local institutional culture, can be implemented appropriately with support from the corresponding regulatory bodies.

  17. Ethical challenges for international collaborative research partnerships in the context of the Zika outbreak in the Dominican Republic: a qualitative case study.

    Science.gov (United States)

    Canario Guzmán, Julio Arturo; Espinal, Roberto; Báez, Jeannette; Melgen, Ricardo Elias; Rosario, Patricia Antonia Pérez; Mendoza, Eddys Rafael

    2017-09-25

    The establishment of international collaborative research partnerships in times of infectious disease outbreaks of international importance has been considered an ethical imperative. Frail health research systems in low- and middle-income countries can be an obstacle to achieve the goal of knowledge generation and the search for health equity before, during and after infectious disease outbreaks. A qualitative case study was conducted to identify the challenges and opportunities facing the Dominican Republic with regards to developing international collaborative research partnerships in the context of the Zika outbreak and its ethical implications. Researchers conducted 34 interviews (n = 30 individual; n = 4 group) with 39 participants (n = 23 males; n = 16 females) representing the government, universities, international donor agencies, non-governmental organisations, community-based organisations and medical societies, in two metropolitan cities. Five international collaborative research projects related to the Zika virus were identified. Major ethical challenges were linked to the governance of health research, training of human resources, the institutionalisation of scientific activity, access to research funds and cultural aspects. Capacity-building was not necessarily a component of some partnership agreements. With few exceptions, local researchers were merely participating in data collection and less on defining the problem. Opportunities for collaborative work included the possibility of participation in international research consortiums through calls for proposals. The Dominican government and research stakeholders can contribute to the international response to the Zika virus through active participation in international collaborative research partnerships; however, public recognition of the need to embrace health research as part of public policy efforts is warranted. A working group led by the government and formed by national and

  18. Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: qualitative comparative case study in primary care.

    Science.gov (United States)

    Wiener-Ogilvie, Sharon; Huby, Guro; Pinnock, Hilary; Gillies, John; Sheikh, Aziz

    2008-06-04

    Although the BTS-SIGN asthma guideline is one of the most well known and widely respected guidelines in the world, implementation in UK primary care remains patchy. Building on extensive earlier descriptive work, we sought to explore the way teamwork and inter-professional relationships impact on the implementation of the BTS-SIGN guideline on asthma in general practice. Qualitative comparative case study using nine in-depth interviews and 2 focus groups with general practitioners and practice nurses, involved in delivering asthma care. Participants were purposively recruited from practices in a Scottish health board with high and low compliance with the BTS-SIGN asthma guideline. There was a marked difference in the way respondents from practices with high compliance and respondents from practices with low compliance spoke about the value of guidelines and the challenges of implementing them. On both accounts, the former were more positive than the latter and were able to be more specific about the strategies they used to overcome barriers to implementation. We explored the reason for this difference in response and identified practice organisation, centring on delegation of work to nurses, as a factor mediating the practice's level of compliance. Effective delegation was underpinned by organisation of asthma work among practice members who have the appropriate level of skills and knowledge, know and understand each others' work and responsibilities, communicate well among themselves and trust each others' skills. It was the combination of these factors which made for successful delegation and guideline implementation, not any one factor in isolation. In our sample of practices, teamwork and organisation of care within practices appeared to impact on guideline implementation and further larger studies are needed to explore this issue further. Isolated interventions such as measures to improve staff's knowledge or increased clinical resource and time, which are

  19. Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report.

    Science.gov (United States)

    Akamatsu, Yosuke; Sato, Kenichi; Endo, Hidenori; Matsumoto, Yasushi; Tominaga, Teiji

    2017-08-01

    Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Limitations of the equivalence between spatial and ensemble estimators in the case of a single-tone excitation.

    Science.gov (United States)

    Monsef, Florian; Cozza, Andrea

    2011-10-01

    The ensemble-average value of the mean-square pressure is often assessed by using the spatial-average technique, underlying an equivalence principle between spatial and ensemble estimators. Using the ideal-diffuse-field model, the accuracy of the spatial-average method has been studied theoretically forty years ago in the case of a single-tone excitation. This study is revisited in the present work on the basis of a more realistic description of the sound field accounting for a finite number of plane waves. The analysis of the spatial-average estimator is based on the study of its convergence rate. Using experimental data from practical examples, it is shown that the classical expression underestimates the estimator uncertainty even for frequencies greater than Schroeder's frequency, and that the number of plane waves may act as lower bound on the spatial-average estimator accuracy. The comparison of the convergence rate with an ensemble-estimator shows that the two statistics cannot be regarded as equivalent in a general case. © 2011 Acoustical Society of America

  1. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases

    Science.gov (United States)

    Limson, Marc Anthony; Kim, Soo-Bum; Arbatin, Jose Joefrey F.; Chang, Kee-Young; Park, Moon-Soo; Shin, Jae-hyuk; Ju, Yeong-Su

    2009-01-01

    The object of this study is to compare radiographic outcomes of anterior cervical decompression and fusion (ACDF) versus cervical disc replacement using the Bryan Cervical Disc Prosthesis (Medtronic Sofamor Danek, Memphis, TN) in terms of range of motion (ROM), Functional spinal unit (FSU), overall sagittal alignment (C2–C7), anterior intervertebral height (AIH), posterior intervertebral height (PIH) and radiographic changes at the implanted and adjacent levels. The study consisted of 105 patients. A total of 63 Bryan disc were placed in 51 patients. A single level procedure was performed in 39 patients and a two-level procedure in the other 12. Fifty-four patients underwent ACDF, 26 single level cases and 28 double level cases. The Bryan group had a mean follow-up 19 months (12–38). Mean follow-up for the ACDF group was 20 months (12–40 months). All patients were evaluated using static and dynamic cervical spine radiographs as well as MR imaging. All patients underwent anterior cervical discectomy followed by autogenous bone graft with plate (or implantation of a cage) or the Bryan artificial disc prosthesis. Clinical evaluation included the visual analogue scale (VAS), and neck disability index (NDI). Radiographic evaluation included static and dynamic flexion-extension radiographs using the computer software (Infinitt PiviewSTAR 5051) program. ROM, disc space angle, intervertebral height were measured at the operative site and adjacent levels. FSU and overall sagittal alignment (C2–C7) were also measured pre-operatively, postoperatively and at final follow-up. Radiological change was analyzed using χ2 test (95% confidence interval). Other data were analyzed using the mixed model (SAS enterprises guide 4.1 versions). There was clinical improvement within each group in terms of VAS and NDI scores from pre-op to final follow-up but not significantly between the two groups for both single (VAS p = 0.8371, NDI p = 0.2872) and double (VAS p = 0

  2. Postoperative Neurosurgical Infection Rates After Shared-Resource Intraoperative Magnetic Resonance Imaging: A Single-Center Experience with 195 Cases.

    Science.gov (United States)

    Dinevski, Nikolaj; Sarnthein, Johannes; Vasella, Flavio; Fierstra, Jorn; Pangalu, Athina; Holzmann, David; Regli, Luca; Bozinov, Oliver

    2017-07-01

    To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. All consecutive neurosurgical procedures that were performed with a high-field, 2-room ioMRI between April 2013 and June 2016 were included (N = 195; 109 craniotomies and 86 endoscopic transsphenoidal procedures). The incidence of SSIs within 3 months after surgery was assessed for both operative groups (craniotomies vs. transsphenoidal approach). Of the 109 craniotomies, 6 patients developed an SSI (5.5%, 95% confidence interval [CI] 1.2-9.8%), including 1 superficial SSI, 2 cases of bone flap osteitis, 1 intracranial abscess, and 2 cases of meningitis/ventriculitis. Wound revision surgery due to infection was necessary in 4 patients (4%). Of the 86 transsphenoidal skull base surgeries, 6 patients (7.0%, 95% CI 1.5-12.4%) developed an infection, including 2 non-central nervous system intranasal SSIs (3%) and 4 cases of meningitis (5%). Logistic regression analysis revealed that the likelihood of infection significantly decreased with the number of operations in the new operational setting (odds ratio 0.982, 95% CI 0.969-0.995, P = 0.008). The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Three independent one-dimensional margins for single-fraction frameless stereotactic radiosurgery brain cases using CBCT

    International Nuclear Information System (INIS)

    Zhang, Qinghui; Chan, Maria F.; Burman, Chandra; Song, Yulin; Zhang, Mutian

    2013-01-01

    Purpose: Setting a proper margin is crucial for not only delivering the required radiation dose to a target volume, but also reducing the unnecessary radiation to the adjacent organs at risk. This study investigated the independent one-dimensional symmetric and asymmetric margins between the clinical target volume (CTV) and the planning target volume (PTV) for linac-based single-fraction frameless stereotactic radiosurgery (SRS).Methods: The authors assumed a Dirac delta function for the systematic error of a specific machine and a Gaussian function for the residual setup errors. Margin formulas were then derived in details to arrive at a suitable CTV-to-PTV margin for single-fraction frameless SRS. Such a margin ensured that the CTV would receive the prescribed dose in 95% of the patients. To validate our margin formalism, the authors retrospectively analyzed nine patients who were previously treated with noncoplanar conformal beams. Cone-beam computed tomography (CBCT) was used in the patient setup. The isocenter shifts between the CBCT and linac were measured for a Varian Trilogy linear accelerator for three months. For each plan, the authors shifted the isocenter of the plan in each direction by ±3 mm simultaneously to simulate the worst setup scenario. Subsequently, the asymptotic behavior of the CTV V 80% for each patient was studied as the setup error approached the CTV-PTV margin.Results: The authors found that the proper margin for single-fraction frameless SRS cases with brain cancer was about 3 mm for the machine investigated in this study. The isocenter shifts between the CBCT and the linac remained almost constant over a period of three months for this specific machine. This confirmed our assumption that the machine systematic error distribution could be approximated as a delta function. This definition is especially relevant to a single-fraction treatment. The prescribed dose coverage for all the patients investigated was 96.1%± 5.5% with an extreme

  4. Diffuse chorioretinal atrophy after a single standard low- dose intravitreal melphalan injection in a child with retinoblastoma: a case report.

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    Chao, An- Ning; Kao, Ling-Yuh; Liu, Laura; Wang, Nan-Kai

    2016-03-15

    Controlling retinoblastoma with seeding is challenging despite advances in treatment modalities. Intravitreal melphalan is an alternative to external beam radiation or enucleation for recurrent or refractory vitreous seeds. Significant ocular side effects following intravitreal melphalan injections are uncommon. Complications have been reported in eyes receiving higher concentrations of melphalan and repetitive injections. We report a case in which diffuse chorioretinal atrophy was developed at the injection site after a single, standard low-dose intravitreal melphalan injection. A 12-month-old female child without a family history of retinoblastoma presented with unilateral group C retinoblastoma in her right eye. A solitary tumour with retinal breaks on the tumour surface, and vitreous seeds overlying the tumour were observed at the 8 o'clock position of the retina. After two cycles of intra-arterial chemotherapy with melphalan, the main tumour displayed significant regression, but the vitreous seeds overlying the main tumour were still active. Because of the persistence of vitreous seeds and the inadequate response to intra-arterial melphalan treatment, intravitreal melphalan (8 μg in 0.05 mL) was injected using a 32-gauge needle 2.5 mm from the 5 o'clock position of the limbus, the meridian opposite to the vitreous seeds. After 1 month, the retina around the injection site demonstrated diffuse retinal pigment epithelium alterations with dense hard exudates. Although the main retinal mass, and vitreous seeds resolved, the hard exudates persisted for more than 2 years after the single low-dose melphalan injection. Intravitreal melphalan injections should be cautiously used for eyes with refractory seeds, particularly when multiple injections are required to control retinoblastoma seeds. Dose- related retinal toxicity could occur in pre-treated eyes even when a relatively low standard dose is used. Such patients should be followed up closely to monitor the

  5. Neuromuscular Control Mechanisms During Single-Leg Jump Landing in Subacute Ankle Sprain Patients: A Case Control Study.

    Science.gov (United States)

    Allet, Lara; Zumstein, Franziska; Eichelberger, Patric; Armand, Stéphane; Punt, Ilona M

    2017-03-01

    Optimal neuromuscular control mechanisms are essential for preparing, maintaining, and restoring functional joint stability during jump landing and to prevent ankle injuries. In subacute ankle sprain patients, neither muscle activity nor kinematics during jump landing has previously been assessed. To compare neuromuscular control mechanisms and kinematics between subacute ankle sprain patients and healthy persons before and during the initial contact phase of a 25-cm single-leg jump. Case-control study. University hospital. Fifteen patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy. Subjects performed alternately 3 single-leg forward jumps of 25 cm (toe-to-heel distance) barefoot. Their results were compared with the data of 15 healthy subjects. Electromyographic (EMG) activity of the musculus (m.) gastrocnemius lateralis, m. tibialis anterior, and m. peroneus longus as well as kinematics for ankle, knee, and hip joint were recorded for pre-initial contact (IC) phase, post-initial contact phase, and reflex-induced phase. The results showed that EMG activity of the 3 muscles did not differ between ankle sprain patients (n = 15) and healthy persons (n = 15) for any of the analyzed time intervals (all P > .05). However, during the pre-IC phase, ankle sprain patients presented less plantar flexion, as well as during the post-IC phase after jump landing, compared to healthy persons (P ankle joint can lead to neuromuscular control mechanism disturbances through which functional instability might arise. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  6. On Generalization in Qualitatively Oriented Research

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    Philipp Mayring

    2007-09-01

    Full Text Available In this article, I open a debate about the importance and possibilities of generalization in qualitative oriented research. Generalization traditionally is seen as a central aim of science, as a process of theory formulation for further applications. Others criticize the concept in general, either because of the insufficiency of inductive arguments (POPPER, 1959 or because of context specificity of all scientific findings (LINCOLN & GUBA, 1985. In this paper, I argue that generalization is necessary in qualitative research, but we have to differentiate different aims of generalization: laws, rules, context specific statements, similarities and differences, and procedures. There are different possibilities to arrive at a generalization: analysis of total population, falsification, random or stratified samples, argumentative generalization, theoretical sampling, variation, and triangulation. Depending on the type of research or research design some of those strategies of generalization can be important for qualitative oriented research. This is discussed especially in respect to single case analysis. URN: urn:nbn:de:0114-fqs0703262

  7. Implementation of a collaborative care model for the treatment of depression and anxiety in a community health center: results from a qualitative case study

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    Eghaneyan BH

    2014-11-01

    Full Text Available Brittany H Eghaneyan,1 Katherine Sanchez,2 Diane B Mitschke2 1Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA; 2School of Social Work, The University of Texas at Arlington, Arlington, TX, USA Background: The collaborative care model is a systematic approach to the treatment of depression and anxiety in primary care settings that involves the integration of care managers and consultant psychiatrists, with primary care physician oversight, to more proactively manage mental disorders as chronic diseases, rather than treating acute symptoms. While collaborative care has been shown to be more effective than usual primary care in improving depression outcomes in a number of studies, less is known about the factors that support the translation of this evidence-based intervention to real-world program implementation. The purpose of this case study was to examine the implementation of a collaborative care model in a community based primary care clinic that primarily serves a low-income, uninsured Latino population, in order to better understand the interdisciplinary relationships and the specific elements that might facilitate broader implementation. Methods: An embedded single-case study design was chosen in order to thoroughly examine the components of one of several programs within a single organization. The main unit of analysis was semi-structured interviews that were conducted with seven clinical and administrative staff members. A grounded theory approach was used to analyze the interviews. Line-by-line initial coding resulted in over 150 initial codes, which were clustered together to rebuild the data into preliminary categories and then divided into four final categories, or main themes. Results: Four unique themes about how the implementation of a collaborative care model worked in this setting emerged from the interviews: organizational change, communication, processes and outcomes of the program, and barriers to

  8. Practice organisational characteristics can impact on compliance with the BTS/SIGN asthma guideline: Qualitative comparative case study in primary care

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    Gillies John

    2008-06-01

    Full Text Available Abstract Background Although the BTS-SIGN asthma guideline is one of the most well known and widely respected guidelines in the world, implementation in UK primary care remains patchy. Building on extensive earlier descriptive work, we sought to explore the way teamwork and inter-professional relationships impact on the implementation of the BTS-SIGN guideline on asthma in general practice. Methods Qualitative comparative case study using nine in-depth interviews and 2 focus groups with general practitioners and practice nurses, involved in delivering asthma care. Participants were purposively recruited from practices in a Scottish health board with high and low compliance with the BTS-SIGN asthma guideline. Results There was a marked difference in the way respondents from practices with high compliance and respondents from practices with low compliance spoke about the value of guidelines and the challenges of implementing them. On both accounts, the former were more positive than the latter and were able to be more specific about the strategies they used to overcome barriers to implementation. We explored the reason for this difference in response and identified practice organisation, centring on delegation of work to nurses, as a factor mediating the practice's level of compliance. Effective delegation was underpinned by organisation of asthma work among practice members who have the appropriate level of skills and knowledge, know and understand each others' work and responsibilities, communicate well among themselves and trust each others' skills. It was the combination of these factors which made for successful delegation and guideline implementation, not any one factor in isolation. Conclusion In our sample of practices, teamwork and organisation of care within practices appeared to impact on guideline implementation and further larger studies are needed to explore this issue further. Isolated interventions such as measures to improve staff

  9. Exploring drivers and challenges in implementation of health promotion in community mental health services: a qualitative multi-site case study using Normalization Process Theory.

    Science.gov (United States)

    Burau, Viola; Carstensen, Kathrine; Fredens, Mia; Kousgaard, Marius Brostrøm

    2018-01-24

    There is an increased interest in improving the physical health of people with mental illness. Little is known about implementing health promotion interventions in adult mental health organisations where many users also have physical health problems. The literature suggests that contextual factors are important for implementation in community settings. This study focused on the change process and analysed the implementation of a structural health promotion intervention in community mental health organisations in different contexts in Denmark. The study was based on a qualitative multiple-case design and included two municipal and two regional provider organisations. Data were various written sources and 13 semi-structured interviews with 22 key managers and frontline staff. The analysis was organised around the four main constructs of Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. Coherence: Most respondents found the intervention to be meaningful in that the intervention fitted well into existing goals, practices and treatment approaches. Cognitive Participation: Management engagement varied across providers and low engagement impeded implementation. Engaging all staff was a general problem although some of the initial resistance was apparently overcome. Collective Action: Daily enactment depended on staff being attentive and flexible enough to manage the complex needs and varying capacities of users. Reflexive Monitoring: During implementation, staff evaluations of the progress and impact of the intervention were mostly informal and ad hoc and staff used these to make on-going adjustments to activities. Overall, characteristics of context common to all providers (work force and user groups) seemed to be more important for implementation than differences in the external political-administrative context. In terms of research, future studies should adopt a more bottom-up, grounded description of context

  10. A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech, language and communication needs.

    Science.gov (United States)

    McKean, Cristina; Law, James; Laing, Karen; Cockerill, Maria; Allon-Smith, Jan; McCartney, Elspeth; Forbes, Joan

    2017-07-01

    Effective co-practice is essential to deliver services for children with speech, language and communication needs (SLCN). The necessary skills, knowledge and resources are distributed amongst professionals and agencies. Co-practice is complex and a number of barriers, such as 'border disputes' and poor awareness of respective priorities, have been identified. However social-relational aspects of co-practice have not been explored in sufficient depth to make recommendations for improvements in policy and practice. Here we apply social capital theory to data from practitioners: an analytical framework with the potential to move beyond descriptions of socio-cultural phenomena to inform change. Co-practice in a local authority site was examined to understand: (1) the range of social capital relations extant in the site's co-practice; (2) how these relations affected the abilities of the network to collaborate; (3) whether previously identified barriers to co-practice remain; (4) the nature of any new complexities that may have emerged; and (5) how inter-professional social capital might be fostered. A qualitative case study of SLCN provision within one local authority in England and its linked NHS partner was completed through face-to-face semi-structured interviews with professionals working with children with SLCN across the authority. Interviews, exploring barriers and facilitators to interagency working and social capital themes, were transcribed, subjected to thematic analysis using iterative methods and a thematic framework derived. We identified a number of characteristics important for the effective development of trust, reciprocity and negotiated co-practice at different levels of social capital networks: macro-service governance and policy; meso-school sites; and micro-intra-practitioner knowledge and skills. Barriers to co-practice differed from those found in earlier studies. Some negative aspects of complexity were evident, but only where networked

  11. Shaped by asymmetrical interdependence: a qualitative case study of the external influences on international non-governmental organizations' implementation of equity principles in HIV/AIDS work.

    Science.gov (United States)

    Dyke, Elizabeth; Edwards, Nancy; McDowell, Ian; Muga, Richard; Brown, Stephen

    2014-10-08

    Addressing inequities is a key role for international non-governmental organizations (INGOs) working in health and development. Yet, putting equity principles into practice can prove challenging. In-depth empirical research examining what influences INGOs' implementation of equity principles is limited. This study examined the influences on one INGO's implementation of equity principles in its HIV/AIDS programs. This research employed a case study with nested components (an INGO operating in Kenya, with offices in North America). We used multiple data collection methods, including document reviews, interviews (with staff, partners and clients of the INGO in Kenya), and participant observation (with Kenyan INGO staff). Participant observation was conducted with 10 people over three months. Forty-one interviews were completed, and 127 documents analyzed. Data analysis followed Auerbach and Silverstein's analytic process (2003), with qualitative coding conducted in multiple stages, using descriptive matrices, visual displays and networks (Miles and Huberman, 1994). There was a gap between the INGO's intent to implement equity principles and actual practice due to multiple influences from various players, including donors and country governments. The INGO was reliant on donor funding and needed permission from the Kenyan government to work in-country. Major influences included donor agendas and funding, donor country policies, and Southern country government priorities and legislation. The INGO privileged particular vulnerable populations (based on its reputation, its history, and the priorities of the Kenyan government and the donors). To balance its equity commitment with the influences from other players, the INGO aligned with the system as well as pushed back incrementally on the donors and the Kenyan government to influence these organizations' equity agendas. By moving its equity agenda forward incrementally and using its reputational advantage, the INGO avoided

  12. The web of silence: a qualitative case study of early intervention and support for healthcare workers with mental ill-health.

    Science.gov (United States)

    Moll, Sandra E

    2014-02-08

    There is a high rate of stress and mental illness among healthcare workers, yet many continue to work despite symptoms that affect their performance. Workers with mental health issues are typically ostracized and do not get the support that they need. If issues are not addressed, however, they could become worse and compromise the health and safety, not only of the worker, but his/her colleagues and patients. Early identification and support can improve work outcomes and facilitate recovery, but more information is needed about how to facilitate this process in the context of healthcare work. The purpose of this study was to explore the key individual and organizational forces that shape early intervention and support for healthcare workers who are struggling with mental health issues, and to identify barriers and opportunities for change. A qualitative, case study in a large, urban healthcare organization was conducted in order to explore the perceptions and experiences of employees across the organization. In-depth interviews were conducted with eight healthcare workers who had experienced mental health issues at work as well as eight workplace stakeholders who interacted with workers who were struggling (managers, coworkers, union leaders). An online survey was completed by an additional 67 employees. Analysis of the interviews and surveys was guided by a process of interpretive description to identify key barriers to early intervention and support. There were many reports of silence and inaction in response to employee mental health issues. Uncertainty in identifying mental health problems, stigma regarding mental ill health, a discourse of professional competence, social tensions, workload pressures, confidentiality expectations and lack of timely access to mental health supports were key forces in preventing employees from getting the help that they needed. Although there were a few exceptions, the overall study findings point to many barriers to supporting

  13. “Souls of the ancestor that knock us out” and other tales. A qualitative study to identify demand-side factors influencing malaria case management in Cambodia

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    O’Connell Kathryn A

    2012-10-01

    Full Text Available Abstract Background Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design. Methods The study used in-depth interviews (IDIs (N = 16 and focus group discussions (FGDs (N = 12 with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software. Results Findings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful. Conclusions Treatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected

  14. The web of silence: a qualitative case study of early intervention and support for healthcare workers with mental ill-health

    Science.gov (United States)

    2014-01-01

    Background There is a high rate of stress and mental illness among healthcare workers, yet many continue to work despite symptoms that affect their performance. Workers with mental health issues are typically ostracized and do not get the support that they need. If issues are not addressed, however, they could become worse and compromise the health and safety, not only of the worker, but his/her colleagues and patients. Early identification and support can improve work outcomes and facilitate recovery, but more information is needed about how to facilitate this process in the context of healthcare work. The purpose of this study was to explore the key individual and organizational forces that shape early intervention and support for healthcare workers who are struggling with mental health issues, and to identify barriers and opportunities for change. Methods A qualitative, case study in a large, urban healthcare organization was conducted in order to explore the perceptions and experiences of employees across the organization. In-depth interviews were conducted with eight healthcare workers who had experienced mental health issues at work as well as eight workplace stakeholders who interacted with workers who were struggling (managers, coworkers, union leaders). An online survey was completed by an additional 67 employees. Analysis of the interviews and surveys was guided by a process of interpretive description to identify key barriers to early intervention and support. Results There were many reports of silence and inaction in response to employee mental health issues. Uncertainty in identifying mental health problems, stigma regarding mental ill health, a discourse of professional competence, social tensions, workload pressures, confidentiality expectations and lack of timely access to mental health supports were key forces in preventing employees from getting the help that they needed. Although there were a few exceptions, the overall study findings point to

  15. Aulas de inglés inclusivas: requerimientos, implicaciones y limitaciones: -Un estudio de caso- Inclusive English classrooms: requirements, implications and limitations: -A qualitative case study-

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    Johanna Montaño Moreno

    Full Text Available Resumen Este artículo presenta los resultados de un estudio de caso que buscaba responder a las siguientes preguntas de investigación: ¿Cuáles son las percepciones que tiene la comunidad educativa de un centro educativo distrital acerca de la educación inclusiva en las aulas de inglés?, ¿Cuáles son los parámetros que esta escuela sigue para trabajar con aulas de inglés inclusivas? Y ¿Qué estrategias se utilizan en las aulas de inglés para responder a las necesidades individuales de los estudiantes? El estudio fue realizado durante ocho meses aproximadamente en el centro educativo en mención. Para realizar una descripción completa del proceso de inclusión en la institución se realizaron observaciones de clase, entrevistas a diferentes miembros de la comunidad educativa y se aplicaron cuestionarios a los estudiantes con necesidades educativas especiales y a sus docentes. Los hallazgos revelaron que aunque algunos pocos profesores utilizan estrategias personales para responder a las necesidades individuales de los estudiantes, hay aún muchos obstáculos que se constituyen en una barrera para el desarrollo exitoso de un proceso de inclusión y carencias que se deben atender y suplir.Abstract This article presents the results of a qualitative case study which attempted to answer the following research questions: What are the perceptions that the educational community has of inclusive education in the English language classrooms? What are the parameters that this school follows in order to work with inclusive English classrooms? And what strategies are being used in the classrooms in order to respond to students'individual needs? The study was developed approximately during eight months in a public school in Bogota. Class observations and interviews to different members of the educational community were done and questionnaires to teachers and students with special educational needs were applied in order to provide a thorough

  16. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases.

    Science.gov (United States)

    Yamada, Shozo; Fukuhara, Noriaki; Horiguchi, Kentaro; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Ito, Junko; Inoshita, Naoko

    2014-12-01

    The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)-secreting pituitary adenomas. The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11-74 years). Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical

  17. "I Don't Know That I've Ever Felt Like I Got the Full Story": A Qualitative Study of Courtroom Interactions Between Judges and Litigants in Domestic Violence Protective Order Cases.

    Science.gov (United States)

    Person, Cara J; Moracco, Kathryn E Beth; Agnew-Brune, Christine; Bowling, J Michael

    2018-01-01

    One in three U.S. women has experienced intimate partner violence (IPV) and many seek domestic violence protective orders (DVPOs) for secondary IPV prevention. Because judges have considerable autonomy making DVPO decisions, there is a need to describe how courtroom interactions and information available to judges may influence DVPO dispositions. We conducted DVPO hearing observations and phone interviews with District Court Judges. Qualitative themes emerged that may influence judges' decision making in DVPO hearings: case information availability, judge engagement level, and litigant credibility. Recommendations include more time for judges to review case files, IPV-related training for judges, and increased court advocate use.

  18. Qualitative Economics

    DEFF Research Database (Denmark)

    Fast, Michael; Clark II, Woodrow W

                         This book is about science -- specifically, the science of economics. Or lack thereof is more accurate. The building of any science, let alone economics, is grounded in the understanding of what is beneath the "surface" of economics. Science, and hence economics, should...... be concerned with formulating ideas that express theories which produce descriptions of how to understand phenomenon and real world experiences.                       Economics must become a science, because the essence of economics in terms of human actions, group interactions and communities are in need...... of scientific inquiry. Academics and scholars need a scientific perspective that can hypothesize, theorize document, understand and analyze human dynamics from the individual to more societal interactions. And that is what qualitative economics does; it can make economics into becoming a science. The economic...

  19. Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

    Science.gov (United States)

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino

    2013-07-01

    These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Rehabilitation of the central executive component of working memory: a re-organisation approach applied to a single case.

    Science.gov (United States)

    Duval, J; Coyette, F; Seron, X

    2008-08-01

    This paper describes and evaluates a programme of neuropsychological rehabilitation which aims to improve three sub-components of the working memory central executive: processing load, updating and dual-task monitoring, by the acquisition of three re-organisation strategies (double coding, serial processing and speed reduction). Our programme has two stages: cognitive rehabilitation (graduated exercises subdivided into three sub-programmes each corresponding to a sub-component) which enables the patient to acquire the three specific strategies; and an ecological rehabilitation, including analyses of scenarios and simulations of real-life situations, which aims to transfer the strategies learned to everyday life. The programme also includes information meetings. It was applied to a single case who had working memory deficits after a surgical operation for a cerebral tumour on his left internal temporal ganglioglioma. Multiple baseline tests were used to measure the effectiveness of the rehabilitation. The programme proved to be effective for all three working memory components; a generalisation of its effects to everyday life was observed, and the effects were undiminished three months later.

  1. Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study

    Directory of Open Access Journals (Sweden)

    Matilda Wurm

    2017-12-01

    Full Text Available In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimal treatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarching aim of this study was to test an internet delivered therapist guided transdiagnostic treatment with telephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of Emotional Disorders was used as an intervention for pain patients with residual pain problems and comorbid emotional problems after having received a multimodal pain rehabilitation. The study used a replicated AB single case experimental design (N = 5; 3 females. Outcome measures were depressive and general anxiety symptoms, pain intensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance and patient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP indicate a decrease of anxiety for three participants and a decrease of depression for four participants. Decreases were small and did not always reach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two out of four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnostic criteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patient satisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support may be a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, the effects are unclear. The gap between high patient satisfaction and small changes in symptomatology should be explored further.

  2. Evaluation of electrical aversion therapy for inappropriate sexual behaviour after traumatic brain injury: a single case experimental design study

    Science.gov (United States)

    ter Mors, Bert Jan; van Heugten, Caroline M; van Harten, Peter N

    2012-01-01

    Inappropriate sexual behaviour after acquired brain injury is a severe complication. Evidence for effective treatment is not available. Electrical aversion therapy (EAT) is a behavioural therapeutic option used in persons with intellectual disabilities, which might be suitable for brain-injured individuals for whom other therapies are not effective. The effect of EAT in brain injury has not been investigated previously. A single case experimental design was used. In an ABBA (baseline-treatment-treatment-withdrawal) design the frequency of the target behaviour (ie, inappropriate sexual behaviour) in a 40-year-old man was measured daily. A total of 551 measurements were recorded. A significant reduction of the target behaviour was seen after the first treatment phase (baseline 12.18 (2.59) vs 3.15 (3.19) mean target behaviours daily); this reduction remained stable over time. We conclude that EAT was effective in this patient with inappropriate sexual behaviour due to severe brain injury. EAT can therefore be considered in therapy resistant inappropriate sexual behaviour in brain-injured patients. PMID:22922913

  3. Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy.

    Science.gov (United States)

    Narra, Roberta; Maestri, Marcello; Budke, Christine M; Tamarozzi, Francesca; Mariconti, Mara; Nicoletti, Giovanni J; Rinaldi, Francesca; Brunetti, Enrico

    2016-08-03

    Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach. © The American Society of Tropical Medicine and Hygiene.

  4. Self-Administered, Home-Based SMART (Sensorimotor Active Rehabilitation Training) Arm Training: A Single-Case Report.

    Science.gov (United States)

    Hayward, Kathryn S; Neibling, Bridee A; Barker, Ruth N

    2015-01-01

    This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant's and researchers' journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  5. Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects.

    Science.gov (United States)

    Boersma, Katja; Ljótsson, Brjánn; Edebol-Carlman, Hanna; Schrooten, Martien; Linton, Steven J; Brummer, Robert J

    2016-11-01

    Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

  6. Single case design studies in music therapy: resurrecting experimental evidence in small group and individual music therapy clinical settings.

    Science.gov (United States)

    Geist, Kamile; Hitchcock, John H

    2014-01-01

    The profession would benefit from greater and routine generation of causal evidence pertaining to the impact of music therapy interventions on client outcomes. One way to meet this goal is to revisit the use of Single Case Designs (SCDs) in clinical practice and research endeavors in music therapy. Given the appropriate setting and goals, this design can be accomplished with small sample sizes and it is often appropriate for studying music therapy interventions. In this article, we promote and discuss implementation of SCD studies in music therapy settings, review the meaning of internal study validity and by extension the notion of causality, and describe two of the most commonly used SCDs to demonstrate how they can help generate causal evidence to inform the field. In closing, we describe the need for replication and future meta-analysis of SCD studies completed in music therapy settings. SCD studies are both feasible and appropriate for use in music therapy clinical practice settings, particularly for testing effectiveness of interventions for individuals or small groups. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. The treatment of chronic post-traumatic nightmares using psychodynamic-interpersonal psychotherapy: a single-case study.

    Science.gov (United States)

    Kellett, S; Beail, N

    1997-03-01

    This article presents a single-case experimental study of a woman suffering a traumatized reaction to a road traffic accident (RTA). In addition to meeting the DSM-IV (APA, 1994) criteria for the diagnosis of PTSD, the client suffered recurrent bizarre nightmares. The client reported at assessment, that each night her dreams were dominated by a terrifying hooded cloaked faceless figure. The central aim of the study therefore was to assess the efficacy of a psychodynamic-interpersonal (PI) style psychotherapy in the context of an unusual PTSD reaction. The methodology employed an A/B multiple baseline time series design, with six month follow-up. A and B represent a series of dream diary observations under two conditions: assessment/baseline (A) and treatment/intervention (B). Treatment consisted of a manualized psychodynamic-interpersonal (PI) psychotherapy to facilitate insight into the content and meaning of the nightmares. The intervention reduced the frequency and associated distress of the nightmares to zero. Follow-up at six months noted the long-term efficacy of the psychotherapy. The study is discussed with reference to the assimilation model of psychotherapeutic change.

  8. Attention Process Training-3 to improve reading comprehension in mild aphasia: A single-case experimental design study.

    Science.gov (United States)

    Lee, Jaime B; Sohlberg, McKay Moore; Harn, Beth; Horner, Robert; Cherney, Leora R

    2018-06-04

    People with aphasia frequently present with nonlinguistic deficits, in addition to their compromised language abilities, which may contribute to their problems with reading comprehension. Treatment of attention, working memory and executive control may improve reading comprehension in individuals with aphasia, particularly those with mild reading problems. This single-case experimental design study evaluated the efficacy of Attention Process Training-3, an intervention combining direct attention training and metacognitive facilitation, for improving reading comprehension in individuals with mild aphasia. A multiple baseline design across six participants was used to evaluate treatment effects. The primary outcome measure was a maze reading task. Cognitive measures were administered pre- and post-treatment. Visual inspection of graphed maze reading performance data indicated a basic effect between APT-3 and improved maze reading for three of the six participants. Quantitative analyses, using Tau-U, corroborated findings identified through visual analysis. The overall effect size was significant (Tau = .48, p = .01). Results suggest that APT-3 has the potential to improve reading in individuals with aphasia, but that it may be more efficacious under certain conditions. Treatment and participant variables, including intensity of treatment and metacognitive strategy usage, are discussed as potential influences on participants' responsiveness to APT-3.

  9. [Advantages and disadvantages of incorporating qualitative methodology in the evaluation of health services. A practical case: evaluation of a high-resolution clinic].

    Science.gov (United States)

    Alvarez Del Arco, D; Rodríguez Rieiro, C; Sanchidrián De Blás, C; Alejos, B; Plá Mestre, R

    2012-01-01

    We examined the usefulness of incorporating a qualitative phase in the evaluation of the quality of care in a high-resolution medical service carried out with quantitative methods. A quantitative research was performed using a structured questionnaire and selecting interviewees by systematic randomized sampling methods (n=320). In addition, a qualitative research was carried on through semi-structured interviews with patients selected by convenience criteria (n=11), observations in the care assistance circuit, and a group interview with health professionals working in the service. A multidisciplinary research team conducted an individual analysis of the information collected in both quantitative and qualitative phases. Subsequently, three meetings based on group brainstorming techniques were held to identify the diverse contributions of each of the methodologies employed to the research, using affinity graphs to analyse the different results obtained in both phases and evaluate possible bias arising from the use of qualitative methods. Qualitative research allowed examining specific aspects of the health care service that had been collected in the quantitative phase, harmonizing the results obtained in the previous phase, giving in-depth data on the reasons for patient dissatisfaction with specific aspects, such as waiting times and available infrastructures, and identifying emerging issues of the service which had not been previously assessed. Overall, the qualitative phase enriched the results of the research. It is appropriate and recommendable to incorporate this methodological approach in research aimed at evaluating the quality of the service in specific health care settings, since it is provided first hand, by the voice of the customer. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

  10. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis.

    Science.gov (United States)

    Marty, Francisco M; Ostrosky-Zeichner, Luis; Cornely, Oliver A; Mullane, Kathleen M; Perfect, John R; Thompson, George R; Alangaden, George J; Brown, Janice M; Fredricks, David N; Heinz, Werner J; Herbrecht, Raoul; Klimko, Nikolai; Klyasova, Galina; Maertens, Johan A; Melinkeri, Sameer R; Oren, Ilana; Pappas, Peter G; Ráčil, Zdeněk; Rahav, Galia; Santos, Rodrigo; Schwartz, Stefan; Vehreschild, J Janne; Young, Jo-Anne H; Chetchotisakd, Ploenchan; Jaruratanasirikul, Sutep; Kanj, Souha S; Engelhardt, Marc; Kaufhold, Achim; Ito, Masanori; Lee, Misun; Sasse, Carolyn; Maher, Rochelle M; Zeiher, Bernhardt; Vehreschild, Maria J G T

    2016-07-01

    Mucormycosis is an uncommon invasive fungal disease with high mortality and few treatment options. Isavuconazole is a triazole active in vitro and in animal models against moulds of the order Mucorales. We assessed the efficacy and safety of isavuconazole for treatment of mucormycosis and compared its efficacy with amphotericin B in a matched case-control analysis. In a single-arm open-label trial (VITAL study), adult patients (≥18 years) with invasive fungal disease caused by rare fungi, including mucormycosis, were recruited from 34 centres worldwide. Patients were given isavuconazole 200 mg (as its intravenous or oral water-soluble prodrug, isavuconazonium sulfate) three times daily for six doses, followed by 200 mg/day until invasive fungal disease resolution, failure, or for 180 days or more. The primary endpoint was independent data review committee-determined overall response-ie, complete or partial response (treatment success) or stable or progressive disease (treatment failure)-according to prespecified criteria. Mucormycosis cases treated with isavuconazole as primary treatment were matched with controls from the FungiScope Registry, recruited from 17 centres worldwide, who received primary amphotericin B-based treatment, and were analysed for day-42 all-cause mortality. VITAL is registered with ClinicalTrials.gov, number NCT00634049. FungiScope is registered with ClinicalTrials.gov, number NCT01731353. Within the VITAL study, from April 22, 2008, to June 21, 2013, 37 patients with mucormycosis received isavuconazole for a median of 84 days (IQR 19-179, range 2-882). By day 42, four patients (11%) had a partial response, 16 (43%) had stable invasive fungal disease, one (3%) had invasive fungal disease progression, three (8%) had missing assessments, and 13 (35%) had died. 35 patients (95%) had adverse events (28 [76%] serious). Day-42 crude all-cause mortality in seven (33%) of 21 primary-treatment isavuconazole cases was similar to 13 (39%) of 33

  11. Being together – Exploring the modulation of affect in improvisational music therapy with a man in a persistent vegetative state – a qualitative single case study

    Directory of Open Access Journals (Sweden)

    Wolfgang Schmid

    2016-12-01

    Full Text Available This article explores the role of affective expression and modulation as a means of communication in improvisational music therapy with a 44-year-old man living in a persistent vegetative state. Within a practice-based approach two vignettes from music therapy illustrate the regulation of the intensity of affect in an interpersonal relationship. Perspectives from modern attachment theory, developmental psychology, and embodiment research will be introduced and discussed, to theoretically frame and embed the practical work. It is suggested that the bodily-emotional situatedness of the man and the music therapist form the area of exchange for a non-verbal, affect-driven communication. In this way, playing with the affect is the main topic for the encounter, promoting self-organizational processes in both individuals involved.

  12. Final report on case studies

    DEFF Research Database (Denmark)

    Ljungberg, Daniel; McKelvey, Maureen; Lassen, Astrid Heidemann

    2012-01-01

    Case study as a research design means investigating a single or multiple instance(s) or setting(s) (i.e. a case) and its entire context to explain a phenomenon and its processes. This is achieved through detailed understanding, usually comprised of multiple sources of information. In this way, case...... studies attempt to provide as a complete an understanding of a (complex) phenomenon as possible. Within the AEGIS project, survey and case study research are complementary. They are complementary in the sense that the former can provide more generalizable evidence on a phenomenon in terms of cross......-sectional data, while the latter can provide more in-depth (qualitative) understanding on specific issues. In systematically examining the case studies, however, this report goes beyond a typical single case study. Here we provide a synthesis of 86 case studies. Multiple case studies, following similar focus...

  13. A Framework for Integrating Qualitative and Quantitative Data in Knowledge, Attitude, and Practice Studies: A Case Study of Pesticide Usage in Eastern Uganda

    Directory of Open Access Journals (Sweden)

    James Muleme

    2017-12-01

    Full Text Available Knowledge, attitude, and practice (KAP studies guide the implementation of public health interventions (PHIs, and they are important tools for political persuasion. The design and implementation of PHIs assumes a linear KAP relationship, i.e., an awareness campaign results in the desirable societal behavioral change. However, there is no robust framework for testing this relationship before and after PHIs. Here, we use qualitative and quantitative data on pesticide usage to test this linear relationship, identify associated context specific factors as well as assemble a framework that could be used to guide and evaluate PHIs. We used data from a cross-sectional mixed methods study on pesticide usage. Quantitative data were collected using a structured questionnaire from 167 households representing 1,002 individuals. Qualitative data were collected from key informants and focus group discussions. Quantitative and qualitative data analysis was done in R 3.2.0 as well as qualitative thematic analysis, respectively. Our framework shows that a KAP linear relationship only existed for households with a low knowledge score, suggesting that an awareness campaign would only be effective for ~37% of the households. Context specific socioeconomic factors explain why this relationship does not hold for households with high knowledge scores. These findings are essential for developing targeted cost-effective and sustainable interventions on pesticide usage and other PHIs with context specific modifications.

  14. Horizontal stability of connective tissue grafts at the buccal aspect of single implants: a 1-year prospective case series.

    Science.gov (United States)

    De Bruyckere, Thomas; Eghbali, Aryan; Younes, Faris; De Bruyn, Hugo; Cosyn, Jan

    2015-09-01

    To clinically evaluate the horizontal stability of a connective tissue graft (CTG) at the buccal aspect of single implants (1); to compare actual gingival thickness between thin and thick gingival biotype (2). Periodontally healthy non-smoking patients with a single implant in the anterior maxilla (15-25) were selected for a prospective case series. All demonstrated a horizontal alveolar defect and were in need of contour augmentation by means of CTG for aesthetic reasons. Patients were enrolled 3 months after implant surgery and had been provided with a provisional screw-retained crown. CTG was inserted in the buccal mucosa via the envelope technique using one intrasulcular incision. An ultrasonic device was used to evaluate mucosal thickness (MT) at the buccal aspect. MT was assessed at t0 (before CTG), t1 (immediately after CTG), t2 (2 weeks after CTG = suture removal), t3 (3 months after CTG = permanent crown installation) and t4 (1 year after implant placement). The gingival biotype was categorized as thin or thick based on the transparency of a periodontal probe through the soft tissues while probing the buccal sulcus of the contra-lateral tooth. Gingival thickness (GT) was measured at the contra-lateral tooth using the same ultrasonic device. Thirty-seven patients (19 men, 18 women; mean age 38) met the selection criteria and consented to the treatment. Mean soft tissue gain immediately after CTG was on average 1.07 mm (SD 0.49). What remained of this tissue gain after 1 year was on average 0.97 mm (SD 0.48; 90.5%). Hence, mean soft tissue loss amounted to 0.10 mm (SD 0.23; 9.5%; p = 0.015) with no significant difference between patients with a thin or thick biotype (p ≥ 0.290). Patients with a thin biotype had a mean GT of 1.02 mm (SD 0.21), whereas GT was on average 1.32 mm (SD 0.31) in subjects with a thick biotype (p = 0.004). Connective tissue graft substantially thickens the peri-implant mucosa with acceptable stability over a 1-year period. © 2015

  15. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

    Directory of Open Access Journals (Swede