The element of naturalness when evaluating image quality of digital photo documentation after sexual assault.

Digital photography is a valuable adjunct to document physical injuries after sexual assault. In order for a digital photograph to have high image quality, there must exist a high level of naturalness. Digital photo documentation has varying degrees of naturalness; however, for a photograph to be natural, specific technical elements for the viewer must be satisfied. No tool was available to rate the naturalness of digital photo documentation of female genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate technical elements for naturalness. Using this tool, experts evaluated randomly selected digital photographs of female genital injuries captured following sexual assault. Naturalness of female genital injuries following sexual assault was demonstrated when measured in all dimensions.

Usefulness: forensic photo documentation after sexual assault.

The forensic medical legal evaluation following sexual assault establishes evidence for law enforcement's investigation and criminal prosecution by the legal system. The sexual assault nurse examiner performs the forensic evaluation and uses digital photography to document physical injuries after sexual assault. Photographs have varying degrees of usefulness, but for a photograph to be useful, it must exhibit technical elements for the viewer. There was no tool available to evaluate the usefulness of digital photographs taken during forensic evaluation of genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate photographic technical elements for usefulness. Using this tool, three experts on two separate occasions evaluated a series of digital photographs taken following sexual assault. The PDIQSS tool predicted usefulness in digital photography of female genital injuries following sexual assault when measured in all dimensions.

Vulnerability in palliative care research: findings from a qualitative study of black Caribbean and white British patients with advanced cancer.

INTRODUCTION: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. AIM: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. METHOD: Secondary analysis of qualitative data from 26 black Caribbean and 19 white British patients with advanced cancer. RESULTS: Four domains of vulnerability derived from Kipnis's taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others--for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. CONCLUSIONS: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualize vulnerability using the domains identified in this study and consider the research context and interviewers' skills.

The views of patients with advanced cancer regarding participation in serial questionnaire studies.

Longitudinal research helps to clarify changing needs and the timing of treatments and referral but is hampered by poor recruitment and retention of participants. We explored, using semi-structured interviews in a cross-sectional design, the views and preferences of patients with advanced cancer on taking part in planned longitudinal questionnaire-based research studies. Patients with advanced lung and colorectal cancer were recruited from outpatient clinics in a London hospital. Semi-structured interviews were undertaken to explore their views about taking part in a specific future questionnaire study and their preferences regarding format. In all, 20 of 47 patients initially identified were recruited. Their preferences for the planned questionnaire study were for face-to-face interviews undertaken at home from late morning onwards with recontact at a mean of 6 weeks. Fluctuating symptom control needs could result in unexpected admission to or discharge from hospital. Developing flexible and responsive recruitment procedures is vital to retain patient participation as more than one contact might be required to successfully conclude an interview.

Cultural meanings of pain: a qualitative study of Black Caribbean and White British patients with advanced cancer.

Pain is a common cancer-related symptom, but little research has been conducted that explores the meanings of this symptom across different ethnic groups. This study involved qualitative interviews to explore and compare the meanings of pain among 26 Black Caribbean and 19 White patients with advanced cancer. Patients were recruited from oncology outpatient clinics, a lung clinic and palliative care teams. Interview transcripts were analysed using the framework approach. A total of 23/26 Black Caribbean and 15/19 White patients reported cancer-related pain. Accounts of Black Caribbean and White patients identified pain as a 'challenge' that needed to be mastered by the individual, not necessarily by drugs and identified pain as an 'enemy' that represented an unfair attack. Two further meanings of pain emerged from Black Caribbean patients' accounts: pain as a 'test of faith' that referred to confirmation and strengthening of religious belief, and pain as a 'punishment' that was associated with wrongdoing. These meanings influenced the extent patients were able to accommodate their distress. Pain assessment needs to consider the patients' narratives that include the meanings they attribute to this symptom, and which may be governed by culture.

Effect of variable long-term maternal feed allowance on the development of the ovine placenta and fetus.

Maternal feed allowance during pregnancy can affect the development of the ovine placenta and fetus. The impact of variations in feed allowance prior to as well as throughout pregnancy has received less attention. Ewes were offered 0.6 (R), 1.2 (C) or 1.8 (AL) maintenance requirements from 89 days before conception until day 133 of pregnancy. Ewes were euthanised on days 50, 92 and 133 of pregnancy. Ewe live weight and body condition score, maternal and fetal metabolic and hormonal profiles, fetal body dimensions and organ weights, and the number, weight and morphology of placentomes were measured. Maternal live weight and condition score were lower in R compared to AL ewes at all stages of pregnancy (P<0.05). Plasma glucose and albumin concentrations of R ewes were significantly reduced (P<0.05) at mid and late gestation, respectively. Placental components were generally unresponsive to long term variations in maternal feed allowance. However, placental weight was significantly (P<0.05) correlated with fetal weight at days 50 (r=0.59) and 133 (r=0.69) of gestation. By late gestation growth-retarded singleton fetuses from R ewes were 19% lighter (P<0.05), with reduced abdominal (9%) and thoracic (10%) girths (P<0.05) but of similar crown-rump length compared with fetuses from AL ewes. These differences were associated with significantly reduced IGF-I concentrations in fetal plasma (P<0.05). In conclusion, maternal, placental and fetal adaptations to long established planes of variable maternal feed allowance were able to maintain fetal growth during early and mid-pregnancy while fetal growth restriction, associated with reduced fetal IGF-I levels, became apparent in late pregnancy.

Pre-slaughter stress arising from on-farm handling and its interactions with electrical stimulation on tenderness of lambs.

The effect of electrical stimulation of lamb carcasses (n=269) or its absence (n=257) on shear force of m. longissimus thoracis et lumborum (LT) was monitored during ageing in pasture-fed merino lambs (n=526). The lambs were slaughtered on four different days allowing durations of between one to 10 days of recovery from pre-slaughter handling (yarding, weighing and crutching) that affected ultimate pH (pH(u)). The right LT was removed 20-40min post-slaughter, tightly-wrapped in cling film (prevents the muscle cross-section increasing and thus minimising shortening) and rapidly cooled to 15°C to enter rigor mortis and age. At 0, 4, 24 and 72h post-slaughter, pH measurements and samples for shear force measurement were taken. Pre-slaughter handling had a significant negative effect on pH(u) and several days recovery were required for pH(u) to reach values associated with optimal meat quality as reflected by pH(u). Lambs with one and three days recovery (no significant difference between them) had a pH(u)>5.7 in 50% of the muscles and 19.4%>pH(u) 5.8. Whereas, in lambs with 8-10 days recovery (no significant difference between them), only 8% had a pH(u)>5.7 and 3.1%>pH(u) 5.8. Within each slaughter day electrically stimulated lambs were always more tender than non-stimulated lambs. For non-stimulated muscles at 72h, shear force values >40N occurred for 11.2% of the muscles: for electrically stimulated muscles at 72h, shear force values >40N occurred for 1.9% of the muscles. The rates of tenderisation were slower for intermediate pH(u) values resulting in higher shear force values at all ageing durations. With ageing at 72h for intermediate pH(u), non-stimulated muscles (n=38) 17.64% were >40N and for stimulated muscles (n=34), 7.9% were >40N.

The royal free interview for spiritual and religious beliefs: development and validation of a self-report version.

BACKGROUND: Spiritual beliefs are rarely considered in psychological or medical publications. We recently published the psychometric properties of an interview designed to measure religious and spiritual belief. In this study, we aimed to develop this instrument further as a self-report questionnaire and to make it more comprehensive by including measurement of spiritual experiences in addition to faith or intellectual assent. METHODS: Based on extensive discussion with colleagues, advice from users of the interview and comments from respondents, a self-report format was designed. We then evaluated the final format of the questionnaire in terms of (1) patterns of response and demographic predictors of beliefs; (2) test-retest reliability and internal consistency; (3) criterion and internal validity; and (4) the nature of spiritual experiences and their relationship to beliefs and strength of beliefs. RESULTS: Two hundred and ninety-seven people took part in the validity and reliability tests of the questionnaire. Criterion validity, predictive validity, internal consistency and test-retest reliability were acceptably high. The instrument consistently differentiated between people with high and low spiritual beliefs. CONCLUSIONS: This instrument is brief and simple to complete. We would recommend that measures of religious and/or spiritual belief like this be more widely applied in health services research as they evaluate aspects of people's lives that go somewhat further than health status or quality of life.

Epstein-Barr virus entry utilizing HLA-DP or HLA-DQ as a coreceptor.

Epstein-Barr virus (EBV) glycoprotein gp350/gp220 association with cellular CD21 facilitates virion attachment to B lymphocytes. Membrane fusion requires the additional interaction between virion gp42 and cellular HLA-DR. This binding is thought to catalyze membrane fusion through a further association with the gp85-gp25 (gH-gL) complex. Cell lines expressing CD21 but lacking expression of HLA class II molecules are resistant to infection by a recombinant EBV expressing enhanced green fluorescent protein. Surface expression of HLA-DR, HLA-DP, or HLA-DQ confers susceptibility to EBV infection on resistant cells that express CD21. Therefore, HLA-DP or HLA-DQ can substitute for HLA-DR and serve as a coreceptor in EBV entry.

Epstein-Barr virus (EBV) infection visualized by EGFP expression demonstrates dependence on known mediators of EBV entry.

Studies of Epstein-Barr virus (EBV) infection and pathogenesis are limited by the lack of recombinant EBV bearing a reporter gene. Currently such studies typically utilize cellular transformation and immortalization as indicators of virus infection which takes several weeks. To investigate the dependence on known cellular receptors for EBV infection, a novel enhanced green fluorescent protein (EGFP) expressing virus, designated EBfaV-GFP, was used to infect a variety of different cell types. EBfaV-GFP infects B lymphoma-derived cell lines, lymphoblastoid cell lines (LCLs) and primary B cells, as judged by expression of EGFP. Ability of clonal cells to be infected with EBfaV-GFP correlates with expression of the known EBV entry mediators CD21 and HLA-DR. EGFP-expressing LCLs were derived by infection of primary B cells with EBfaV-GFP. Cells of the Jurkat line, derived from T lymphocytes, could not be infected, and infected primary lymphocytes did not include appreciable numbers of CD2-positive cells, showing that EBV rarely infects T cells. Expression of EGFP by EBV provides the opportunity to rapidly visualize infection in living cells and better delineate populations of infected cells.

The effect of spiritual beliefs on outcome from illness.

We aimed to assess the role of spiritual belief in clinical outcome of patients nine months after hospital admission. Two hundred and fifty patients admitted to a London teaching hospital were recruited and followed up for nine months. Outcome measures were clinical status as recorded in the outpatient records and patients' self reported health status and beliefs. A hundred and ninety-seven (79%) patients professed some form of spiritual belief, whether or not they engaged in a religious activity. Strength of belief was lower in patients who were in a more serious clinical state on admission (F = 3.099, d.f. = 2 and 192, p = 0.05). Case note information was available nine months later for 234 patients (94%) and contained useful information for judging clinical outcome in 189 (76%). Patients with stronger spiritual beliefs were 2.3 times more likely (CI = 1.1-5.1, p 0.033) to remain the same or deteriorate clinically nine months later. Other predictors of poor outcome were male gender and sleep disturbance at time of admission to hospital. We conclude that a stronger spiritual belief is an independent predictor of poor outcome at nine months in patients admitted to two acute services of a London hospital. It is more predictive of outcome than physical state assessed by clinicians, or self-reported psychological state, at admission.