Characteristics of people with high visit-to-visit glycaemic variability in Type 2 diabetes.

AIMS: Increased visit-to-visit glycaemic variability is independently associated with adverse outcomes in Type 2 diabetes. Our aim was to identify the patient characteristics associated with raised visit-to-visit glycaemic variability in people with Type 2 diabetes. METHODS: A case-control study was conducted to establish associations between HbA1c variability and clinical covariates in 10 130 people with Type 2 diabetes. Variability was calculated by two metrics [sd and coefficient of variation (CV)] from a minimum of four HbA1c readings obtained over a 4-year period. High and low variability groups were defined as the top and bottom tertile of the sd or CV, and used in logistic regression analyses including a number of clinical and biochemical covariates. The analyses were stratified into low mean (< 53 mmol/mol; 7%) and high mean (≥ 53 mmol/mol; 7%) HbA1c groups. RESULTS: Findings were consistent across both HbA1c groups and variability metrics. Treatment, independent of other factors, was the most strongly associated covariate for the risk of high HbA1c variability. A six-fold increased risk was observed in the low HbA1c group, between the most and least intense treatment regimens (P < 0.001). Similar findings were present in the high HbA1c group with a three-fold increase in risk (P < 0.001). In addition, male gender, younger age, reduced HDL-cholesterol and increased BMI were all found to be independently associated with raised visit-to-visit glycaemic variability. CONCLUSIONS: Intensive treatment resulting in low mean HbA1c was associated with marked increase in HbA1c variability. Irrespective of diabetes control, the greatest visit-to-visit variability was observed in young, insulin resistant men.

Protocol-developing meta-ethnography reporting guidelines (eMERGe).

BACKGROUND: Designing and implementing high-quality health care services and interventions requires robustly synthesised evidence. Syntheses of qualitative research studies can provide evidence of patients' experiences of health conditions; intervention feasibility, appropriateness and acceptability to patients; and advance understanding of health care issues. The unique, interpretive, theory-based meta-ethnography synthesis approach is suited to conveying patients' views and developing theory to inform service design and delivery. However, meta-ethnography reporting is often poor quality, which discourages trust in, and use of, meta-ethnography findings. Users of evidence syntheses require reports that clearly articulate analytical processes and findings. Tailored research reporting guidelines can raise reporting standards but none exists for meta-ethnography. This study aims to create an evidence-based meta-ethnography reporting guideline articulating the methodological standards and depth of reporting required to improve reporting quality. METHODS/DESIGN: The mixed-methods design of this National Institute of Health Research-funded study (http://www.stir.ac.uk/emerge/) follows good practice in research reporting guideline development comprising: (1) a methodological systematic review (PROSPERO registration: CRD42015024709) to identify recommendations and guidance in conducting/reporting meta-ethnography; (2) a review and audit of published meta-ethnographies to identify good practice principles and develop standards in conduct/reporting; (3) an online workshop and Delphi studies to agree guideline content with 45 international qualitative synthesis experts and 45 other stakeholders including patients; (4) development and wide dissemination of the guideline and its accompanying detailed explanatory document, a report template for National Institute of Health Research commissioned meta-ethnographies, and training materials on guideline use. DISCUSSION: Meta-ethnography, devised in the field of education, is now used widely in other disciplines. Methodological advances relevant to meta-ethnography conduct exist. The extent of discipline-specific adaptations of meta-ethnography and the fit of any adaptions with the underpinning philosophy of meta-ethnography require investigation. Well-reported meta-ethnography findings could inform clinical decision-making. A bespoke meta-ethnography reporting guideline is needed to improve reporting quality, but to be effective potential users must know it exists, trust it and use it. Therefore, a rigorous study has been designed to develop and promote a guideline. By raising reporting quality, the guideline will maximise the likelihood that high-quality meta-ethnographies will contribute robust evidence to improve health care and patient outcomes.

Intervention Now To Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, qualitative and realist synthesis of implementation factors and user engagement.

BACKGROUND: The UK has the highest rate of teenage pregnancies in Western Europe, a fifth are repeat pregnancies. Unintended conceptions can result in emotional, psychological and educational harm to teenage girls, often with enduring implications for their life chances. Babies of teenage mothers have increased mortality in their first year and increased risk of poverty, educational underachievement and unemployment later in life, with associated societal costs. METHODS AND ANALYSIS: We will conduct a streamed, mixed-methods systematic review to find and evaluate interventions designed to reduce repeat unintended teen pregnancies. OUR AIMS ARE TO IDENTIFY:  Who is at greater risk of repeat unintended pregnancies? Which interventions are effective, cost-effective, how they work, in what setting and for whom? What are the barriers and facilitators to intervention uptake? Traditional electronic database searches will be augmented by targeted searches for evidence 'clusters' and guided by an advisory group of experts and stakeholders. To address the topic's inherent complexities, we will use a highly structured, innovative and iterative approach combining methodological techniques tailored to each stream of evidence. Quantitative data will be synthesised with reference to Cochrane guidelines for public health interventions. Qualitative evidence addressing facilitators and barriers to the uptake of interventions, experience and acceptability of interventions will be synthesised thematically. We will apply the principles of realist synthesis to uncover theories and mechanisms underpinning interventions. We will conduct an integration and overarching narrative of findings authenticated by client group feedback. ETHICS AND DISSEMINATION: We will publish the complete review in 'Health Technology Assessment' and sections in specialist peer-reviewed journals. We will present at national and international conferences in the fields of public health, reproductive medicine and review methodology. Findings will be fed back to service users and practitioners via workshops run by the partner collaborators. TRAIL REGISTRATION NUMBER: PROSPERO CRD42012003168. COCHRANE REGISTRATION NUMBER: i=fertility/0068.

Description of a new species of Anagyrus Howard (Hymenoptera: Chalcidoidea: Encyrtidae), a promising biological control agent of the invasive Madeira mealybug, Phenacoccus madeirensis Green (Hemiptera: Sternorrhyncha: Pseudococcidae).

Anagyrus amnestos sp. n. (Hymenoptera: Encyrtidae), a promising parasitoid of the invasive Madeira mealybug, Phenacoccus madeirensis Green (Hemiptera: Pseudococcidae), is described based on material collected from India. This parasitoid was identified as Anagyrus sp. nov. nr. sinope Noyes & Menezes in recent literature, and was initially collected in Georgia, USA. It was found to be a specific parasitoid of the Madeira mealybug and its biological attributes and potential as a biological control agent of this pest were studied. In what appears to be a case of fortuitous introduction, we detected this parasitoid in large numbers on Madeira mealybugs from the southern Indian state of Karnataka, where the mealybug is a recently introduced invasive pest. In view of its economic importance as a potential biological control agent of the Madeira mealybug, it is formally described and illustrated here. Comparative accounts of the new species vis-a-vis its close relatives in India and the Americas are provided.

EQ-5D for the assessment of health-related quality of life and resource allocation in children: a systematic methodological review.

OBJECTIVES: EQ-5D is widely used in studies with adults as a source of generic health-related quality of life information and utility weights to inform resource allocation decisions. This methodological systematic review describes the extent to which EQ-5D has been used in the evaluation of children's health care, assesses psychometric properties, and makes recommendations for future good practice. METHODS: Systematic searches of databases and the Internet to identify studies published during 2000-2010 that either used EQ-5D with children younger than age 19 years as an outcome measure or reported psychometric data. Study characteristics, including measures and psychometric data, were extracted into tables for analysis. RESULTS: We identified 29 studies that used four versions of the EQ-5D: adult EQ-5D, EQ-5D-Y, Dutch EQ-5D child, and extended with cognitive dimension, EQ-5D+C. Twelve of 29 studies did not specify the EQ-5D version used. Existing literature lacks detail on the specific use of EQ-5D and its potential effects on findings. Version use and psychometric properties were inadequately reported. There are large gaps in current knowledge of psychometric properties across all versions when used with children. CONCLUSIONS: For reasons of comparability with resource use across adult and children's services, there are arguments for continued use of EQ-5D in studies with children. We recommend use of EQ-5D alongside children-specific quality of life measures and disease-specific measures. Researchers are encouraged to undertake methodological and philosophical analyses to better understand and improve evidence as to how adults who make decisions about resource allocation can best take account of children in decision making.

Experimental method for reliably establishing the refractive index of buprestid beetle exocuticle.

In this study we apply an existing optical characterisation technique to establish reliably the complex refractive indices of layers comprising a natural multilayer reflector in the beetle Chrysochroa raja. Its reflector characteristics, ultrastructure and layer thicknesses were established using electron and optical microscopy. We recorded a significant number of wavelength dependent optical data sets from the same regions of sample using both linear polarisations and from a variety of different angles. These optical data sets were modelled simultaneously in order to significantly reduce the degeneracy of the fitting process. For the C. raja sample in question, the fitted complex refractive indices of both layer types were determined to be n=1.68 k=0.03 and n=1.55 k=0.14.

The perceived learning needs of paediatric intensive care nurses caring for children requiring haemofiltration.

This paper reports on a small exploratory phenomenological study to describe the lived experiences of paediatric intensive care nurses, who extended their roles to care for critically ill children requiring continuous veno-venous haemofiltration. In describing and understanding this learning experience, an insight into the educational and support needs of these nurses is offered. From the insight shared, five main themes were identified. These included the overwhelming need to be a competent practitioner, which was perceived within the context of knowledge for effective practice and technical dexterity.While generalizability of findings is not intended, the findings could be of value to other intensive care settings to guide the identification and implementation of strategies to meet the needs of nurses undertaking similar roles.

Enabling young 'ventilator-dependent' people to express their views and experiences of their care in hospital.

Discussion in this paper is drawn from a phenomenological study carried out in England describing the views and experiences of young 'ventilator-dependent' people aged 6-18 years, regarding their health and social care, education, and aspirations for the future. This study presented many methodological and ethical challenges in order to elicit and present their views in a meaningful way. Data were elicited through focused face-to-face interviews with 18 young people. Innovative methods of data collection were used with younger children and those who had a range of communication impairments. In addition, family members of 15 young people were interviewed. Presentation of findings is limited to views and experiences of the young people's care in hospitals. Findings reveal that a significant number of Articles in the United Nations (UN) Convention on the Rights of the Child were not respected or upheld. Young 'ventilator-dependent' people were discriminated against when trying to access health services because of their need for assisted ventilation. They were particularly excluded from making important decisions about their lives and were not always offered the full protection of the Children Act 1989 (England). Some young people were not able to maintain adequate contact with their families, first language, culture, nationality and religion. Almost all spent prolonged periods of time (in some cases years) in hospital when they no longer wanted or needed to be there. All those interviewed wanted to be discharged home far sooner. The generalizability of findings is unknown; however, important questions are posed in relation to nursing practice and research regarding the overall management of this group of young people. Issues include: respecting and upholding human rights; and challenging the boundaries of current nursing practice in order to move towards child-centred, appropriate and effective models of care.

Are nurses respecting and upholding the human rights of children and young people in their care?

Children's nurses may assume that the care they provide for children and their families is family centred and meets their holistic needs. However, very little objective evaluation has been undertaken with children and young people regarding the health services and nursing care they receive. In this study, data were collected from 18 young ventilator-dependent people and their families in order to evaluate their experiences of health and social care. The UN Convention and other policy documents advocating client-focused services were used as benchmarks for analysis, demonstrating that the needs and aspirations of the young people are not being addressed and raising questions for nurses and other professionals.

Isolation, purification, and characterization of pregnancy-specific protein B from elk and moose placenta.

Pregnancy-specific protein B (PSPB) was isolated, purified, and partially characterized from elk and moose placenta. The procedure, which was monitored by bovine PSPB (bPSPB) RIA, included homogenization and extraction in aqueous solution, acidic and ammonium sulfate precipitation, and ion exchange, gel filtration, and affinity chromatographies. The estimated molecular sizes of moose PSPB (mPSPB) were 58 kDa and 31 kDa, and of elk PSPB (ePSPB) were 57 kDa, 45 kDa, and 31 kDa by SDS-PAGE. The isoelectric points of mPSPB were 4.8, 6.6, and 6.7, and of ePSPB were 4.8, 4.9, 6.1, and 6.2 as determined by isoelectric focusing and two-dimensional gel electrophoresis. The carbohydrate contents of mPSPB and ePSPB were approximately 3.15% and 4.98%, respectively. Although ePSPB and mPSPB were recognized by anti-bPSPB in an Ouchterlony double immunodiffusion test, they were found to share identical epitopes and partial identities compared to bPSPB. After treatment at different temperatures (20-60 degrees C) for 1 h, the immunoreactivities of ePSPB and mPSPB in serum were very stable. Only ePSPB in serum treated at 60 degrees C lost some immunoreactivity. After alteration of serum pH (pH 3-11) for 2 h, the immunoreactivities of ePSPB and mPSPB became lower at pH 3 and 4, and remained stable from pH 5 to 11. These data show that moose and elk PSPB have properties similar to those of bovine and ovine PSPB.

Children's behaviour and the design of school furniture.

Children spend a large part of their school days in the classroom, and yet the effect of the design of school furniture on their behaviour and health has received comparatively little attention in the UK. An experimental study is reported that compares the effects on children's behaviour and sitting position of traditional classroom furniture with a recently designed chair known as 'Chair 2000' and associated tables. It was found that children showed a modest but significant improvement in on-task behaviour and a marked change in sitting positions following the introduction of the newly-designed furniture. However, these benefits need to be considered in the light of polarized opinion for and against the new furniture, and a high level of reported incidence of back pain significantly related to the frequency of non-standard sitting. In the absence of radically redesigned furniture, it is suggested that children should be given more choice in their seating, and better guidance should be given to individuals involved in education in order to inform their decision-making about classroom furniture and the postural, anthropometric and orthopaedic aspects of sitting and related activities.

The impact of knowing your child is critically ill: a qualitative study of mothers' experiences.

Discussion in this paper is drawn from an exploratory study designed to elicit mothers' lived experiences of crisis and coping, and their experiences of nursing following the unexpected emergency admission of their child to the paediatric intensive care unit (PICU). An in-depth critique of literature supporting this study has been published. Two theoretical perspectives serve as a basis for this exploratory study: firstly, the idea that in a crisis situation, a mother's ability to cope and function is influenced by therapeutic interventions of nurses by meeting her needs in a holistic way; and secondly, symbolic interactionism, that focuses on the meaning of events to mothers. Data were elicited through focused interviews with 10 mothers of children aged between 3 months and 15 years who had been admitted unexpectedly to the PICU with a life threatening condition. Findings reveal the major impact of crisis on mothers immediately following their child's critical illness and admission to PICU, and this specific aspect therefore warrants in-depth discussion and analysis. The study did not generate a theory; however, important recommendations are made for nursing practice and research in relation to the impact of crisis experienced by mothers. Nursing practice issues include meeting the psychosocial needs of parents prior to and immediately after admission, and the importance of family-centred nursing care. Issues for nursing research include exploring how families cope with the impact of crisis and critical illness.

The experiences and views of parents who care for ventilator-dependent children.

Discussion in this paper is drawn from the literature examining the management of children with long-term assisted ventilation, and a study of parents' experiences and views of caring for their ventilator-dependent child at home. Difficulties in undertaking research into this group of children are highlighted. Recommendations are proposed regarding future multidisciplinary, multiagency service development in order to meet the needs of ventilator-dependent children and their families.

A critique of studies exploring the experiences and needs of parents of children admitted to paediatric intensive care units.

This paper is based on a critique of studies exploring the experiences and needs of parents whose children are admitted to paediatric intensive care units (PICU). The majority of studies have been conducted in North America and attempt to quantify parental feelings and experiences. Few qualitative studies have been published. Major theoretical concerns are developed in relation to the validity of quantitative and qualitative methods of data collection which currently serve to inform nursing practice. While methodological issues abound, consistency across studies supports the importance of certain features of parents' experiences, such as being with their child and role conflict. None of the literature reviewed considered the specific needs of different ethnic and cultural groups, siblings, grandparents or the family as a unit. The views of fathers are also under-represented. Recommendations are made for future well-designed qualitative studies to be undertaken by experienced qualitative researchers from a holistic insider family perspective.

Small airway patency in infants with apparent life-threatening events.

UNLABELLED: A reduction in specific airway conductance has been reported in infants with a history of an apparent life-threatening event (ALTE). It is unclear, however, whether this reflects upper or lower airway narrowing. We performed a controlled study to determine small airway patency in infants with ALTE. Lung function tests were performed in 26 infants with a history of ALTE and 27 healthy controls. Partial expiratory flow-volume curves were obtained during quiet sleep using the rapid chest compression technique; thoracic gas volume (TGV) and expiratory airway resistance (RAW) were measured by whole body plethysmography. Compliance of the respiratory system (Crs) was measured using the single breath occlusion technique. The median maximal flow at functional residual capacity (VmaxFRC) was 85 ml/s (range 10-198 ml/s) in patients and 123 (range 47-316 ml/s) in controls (P = 0.003). VmaxFRC corrected for TGV was 0.5 s(-1) (range 0.06-1.3 s[-1]) and 0.9 s(-1) (range 0.4-1.8 s[-1]), respectively (P = 0.001). TGV, RAW and Crs were not significantly different between patients and controls. CONCLUSION: Reduced small airway patency may play a role in the pathogenesis of ALTE.

Home monitoring of infants at increased risk of sudden death.

Home apnoea and cardiorespiratory monitors are commonly used in the UK, the rest of Europe and USA in infants at increased risk of 'sudden infant death'. The efficacy of apnoea and cardiorespiratory monitors remains unknown. The use of transcutaneous oxygen monitoring is presented as an alternative method of home monitoring. Recommendations are proposed regarding nursing practice and the future of home monitoring in infants at increased risk of sudden death.

User involvement in the early stages of the development of an aircraft warning system.

There is an increasing awareness of the importance and the benefits to be attained from consulting the end-users during system and product development. Although the rationale of utilizing the expertise of end-users in the system development life cycle appears to provide an apparently straightforward, even 'ideal' approach, there are many difficulties associated with eliciting the required knowledge from experts, both general and specific to every user group. Furthermore, many developers do not know how to involve users, or if they do, they do not utilize them to best effect. In the avionics sphere, the wealth of knowledge possessed by line pilots and flight engineers represents a vital information resource for the design of future flight-deck systems. As a specific example, this paper overviews some of the considerations which arose from working with these end-users in the early stages of the development of a warning and diagnostic system for civil aircraft. The end-goal of this particular phase of the work was the generation of guidelines for the design of the interface for the software engineers to use when building the prototype, and the methodological approach taken to achieve this is reported here.

An explanation of the differences between expert and novice performance in the administration of an intramuscular injection of an analgesic agent to a patient in pain.

It has been stated that nurse education in the United Kingdom (UK) currently draws upon Schön's concept of the reflective practitioner, and Benner's concept of the expert. Studies have explored the claim that experienced expert practitioners are unable to articulate all they know, and that their theoretical knowledge and clinical skills are of a qualitatively different type from that of novice practitioners. This paper aims to explain the differences between expert and novice performance using the example of administering an intramuscular injection of an analgesic agent to a patient in pain. Theoretical concepts concerning the nature of expertise are used to evaluate novice/expert performance in nursing. Criticisms of Benner's theory are developed in relationship to her methodology and the interpretation and assessment of nursing practice.

The successful use of continuous negative extrathoracic pressure in a child with Glenn shunt and respiratory failure.

Following a Glenn shunt, an infant required mechanical ventilation (IPPV) for pneumonia, a phrenic nerve palsy and chylothoraces. In order to improve her deteriorating clinical condition, we used continuous negative extrathoracic pressure (CNEP) to minimise the deleterious effects of IPPV on pulmonary blood flow. She was successfully weaned from IPPV and supported with CNEP.