Showing papers by "University of Salford published in 1998"

Rationale and Standards for the Systematic Review of Qualitative Literature in Health Services Research

Abstract: Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the desirability of a plurality of standards. However, it is argued that three interrelated criteria can be identified as the foundation of good qualitative health research: interpretation of subjective meaning, description of social context, and attention to lay knowledge. These criteria can be examined in relation to different dimensions of any research report, including theoretical basis, sampling strategy, scope of data collection, description of data collected, and concern with generalizability or typicality. But if the concern is with the appropriateness of care and with understanding the factors that shape lay and clinical behavior, then these criteria must form the basis of a hierarchy of qualitative research evidence.

Diversity in information systems action research methods

Abstract: Discussions of action research in information systems (IS) often proceed as if there were one definitive action research method. This paper describes and analyses the different frameworks, assumptions and goals that characterise the diverse forms of action research. A more inclusive action research paradigm is delineated that offers a basis for validating a wider range of IS research. Acceptance of the full range of the diverse forms of action research may enable the IS field to be more explicit about its research methodology, thereby enabling criteria to be improved and applied to a broader range of IS research.

Long-term reorganization of human motor cortex driven by short-term sensory stimulation.

Abstract: Removal of sensory input can induce changes in cortical motor representation that reverse when sensation is restored. Here we ask whether manipulation of sensory input can induce long-term reorganization in human motor cortex that outlasts the initial conditioning. We report that for at least 30 minutes after pharyngeal stimulation, motor cortex excitability and area of representation for the pharynx increased, while esophagus representation decreased, without parallel changes in the excitability of brainstem-mediated reflexes. Therefore increased sensory input can drive long-term cross-system changes in motor areas of the cerebral cortex, which suggests that sensory stimulation might rehabilitate dysphagia, a frequent consequence of cerebral injury.

Psychological stress and burnout in medical students: a five-year prospective longitudinal study:

Abstract: The aim of this study was to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4 and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory. 172 (84.3%), 157 (77.0%) and 155 (75.9%) students out of an original group of 204 completed assessments in years 1, 4 and 5, respectively. 18 students were above threshold on the GHQ-12 on all three occasions, 25 on two occasions and 43 on one occasion; 69 students were never a 'case'. Students who were cases on two or more occasions were more likely to find the medical course stressful during the first year, but not subsequent years. There was no significant difference between the percentages of men and women who scored as cases on the GHQ-12 in any of the years. The best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1. This study suggests that a small group of students repeatedly experience psychological distress during their medical training.

The measurement of lumbar proprioception in individuals with and without low back pain.

Abstract: Study design A clinical trial comparing a back pain group with a pain-free group. Objectives To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain. Summary of background data Little work has so far been conducted on the measurement of proprioception in the spine. Those studies that have been carried out, however, have failed to identify proprioceptive deficits in individuals with back pain. Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration. Methods Forty individuals took part in the study, 20 with back pain and 20 with no pain. Participants were required to reproduce a predetermined target position, in standing and four-point kneeling, 10 times in 30 seconds. A computer screen was used to provide visual feedback on position. A mean deviation from the target position was obtained for each individual. A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short-term motor memory between the groups. Results There were no differences between the subject groups in terms of short-term motor memory (P > 0.05). A two-way analysis of variance between subject groups and position to identify differences in accuracy (deviation from the target) found that there were differences between subject groups in either position (P 0.05). Conclusions Differences in proprioception do exist between individuals with back pain and those free from back pain. Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain.

Theorising inequalities in health : the place of lay knowledge.

Abstract: This paper contributes to the development of theory and research on inequalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship between agency and structure, and that lay knowledge in the form of narrative has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly review the existing, largely quantitative research on inequalities in health. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within 'risk factor' epidemiology and the (probably inevitable) inability of this research tradition to encompass the full complexity of social processes; the failure to consider the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thirdly, the need for 'place' and 'time' (both historical and biographical) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of 'place' and 'lay knowledge', and the relationship between these concepts, in inequalities research is explored. Here we suggest three developments as a necessary condition for a more adequate theoretical framework in this field. We consider first the need for the conceptualisation and measurement of 'place' within a historical context, as the location in which macro social structures impact on people's lives. Second, we argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why – and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves within the places they inhabit and determine how to act within and upon them. Lay knowledge therefore offers a vitally important but neglected perspective on the relationship between social context and the experience of health and illness at the individual and population level.

Contractor selection using multicriteria utility theory: an additive model

Abstract: A systematic multicriteria decision analysis technique is described for contractor selection and bid evaluation based on utility theory and which permits different types of contractor capabilities to be evaluated A UK case study is used to illustrate the technique The theoretical basis and the advantages of the technique are also presented

Towards dissolution of the IS research debate: from polarization to polarity

Abstract: The debate between ‘hard’ and ‘soft’ research approaches continues in the IS field, but with little prospect of resolution. The debate is typically characterized by tendentious arguments as advocates from each approach offer a somewhat one-sided condemnation of the counterpart from the inimical research tradition. This paper begins by relating two fictitious tales which serve to highlight the futility of research conducted at the extremity of each research approach. The dichotomies which characterize these rival factions are also summarized. The debate is then framed in terms of the polarization problem whereby IS researchers are divided geographically and paradigmatically into ‘hard’ and ‘soft’ camps. A variety of different strategies have been proposed for resolving the debate and these are discussed in detail. They are grouped into four categories, referred to as supremacism, isolationism, integration, and pluralism. Finally, the paper contends that the debate cannot be resolved, and offers the metaphor of magnetic polarity as a means of reflecting this. The paper concludes by arguing that it would be more appropriate to recast the debate at a macro level in order to accommodate different research agenda and recognize the strengths within each tradition.

Qualitative research and evidence-based healthcare.

Abstract: This is a particularly powerful illustration of the grows ing legitimation afforded to the methods and findings of qualitative research within health services research in general and, albeit perhaps to a lesser extent, within the EBM movement in particular. But, whilst it may be a necessary condition, acknowledgement from leaders in a field is not sufficient to change knowledge, attitudes or behaviour as those involvecd in the EBM are only too well aware. It is almost certainly the case that there are many proponents of evidence-based decision making wvithin healthcare Nho cannot and/or will not accept that qualitative research has an important part to play in the pursuit of this aim. We seek to address three issues. First, we want briefly to highlight some limitations of the EBM movement identified by social scientists. Second, we wish to explore the implications of the apparent shift away from a focus on medicine towards healthcare for the nature of the evidence which can legitimately be used. Finally, we consider some of the Nways in which qualitative research can contribute to this broader agenda and point to some of the constraints on the achievement of this potential.

A further exploration into information systems development: the evolution of Multiview2

Abstract: Multiview was defined in 1985 and has been since refined to become an influential approach to information systems development. It has soft and hard aspects and, as a contingency approach, is not prescriptive but adapted to the particular situation in the organization and the application. Observations and reflections on Multiview in action over the last ten years together with more recent literature based on, for example, holism, emergence, multi‐causality, ethical analysis and technology foresight, form the basis for a new definition of Multiview. Changes in the domain of information systems are also taken into account. Away from centralized technology, long lead times and hierarchical organizations, towards networks, new organizational forms, business processes, informational products and services, and the removal of time and space constraints on human activity. This paper underlines the need for IS researchers to learn about methodologies as they are used in practice (rather than as described in text books) and for methodologies to evolve in response to changes in the domain in which they are applied.

Loneliness: an epidemic in modern society

Abstract: Loneliness is a little discussed concept in today's self-obsessed climate, where it is seen as a negative embarrassing condition. It is unique for every individual, and as such, it is difficult to define. There are other closely related concepts, for example, aloneness and solitude, that further complicate an already complex issue. Loneliness also has various causes and effects that can be one and the same, and so it can be confused with similar but different conditions, for example, depression and self-esteem. But, at the end of the day, if the word loneliness is mentioned in conversation, everybody will understand what it means to them, and how distressing an ordeal it can be. Everyone is lonely to some degree, no matter how much they pretend they are not: it is part of being human. Nursing literature looks at loneliness from a rather basic, superficial perspective, when discussing whether such a traumatic state of being can be solved, but this is not a solution as such. It is such an innate part of the human psyche, that it cannot be solved like a puzzle; it can only be alleviated and made less painful. This can only be achieved by increasing humankind's awareness of this distressing condition that everyone has to endure in some way, shape or form, some time during their lives, about which there is nothing to be embarrassed. If non-lonely individuals could spare a smile or a word for people who might be perceived as being lonely, even if in doing so they selfishly think 'there but for the grace of God go I', such a small gesture might just make their day a little less of an ordeal.

Fibrillin microfibrils are reduced in skin exhibiting striae distensae

Abstract: Striae distensae (striae: stretch marks) are a common disfiguring condition associated with continuous and progressive stretching of the skin--as occurs during pregnancy. The pathogenesis of striae is unknown but probably relates to changes in those structures that provide skin with its tensile strength and elasticity. Such structures are components of the extracellular matrix, including fibrillin, elastin and collagens. Using a variety of histological techniques, we assessed the distribution of these extracellular matrix components in skin affected by striae. Pregnant women were assessed for the presence of striae, and punch biopsies were obtained from lesional striae and adjacent normal skin. Biopsies were processed for electron microscopy, light microscopy and immunohistochemistry. For histological examination, 7 microns frozen sections were stained so as to identify the elastic fibre network and glycosaminoglycans. Biopsies were also examined with a panel of polyclonal antibodies against collagens I and III, and fibrillin and elastin. Ultrastructural analysis revealed alterations in the appearance of skin affected by striae compared with that of normal skin in that the dermal matrix of striae was looser and more floccular. Light microscopy revealed an increase in glycosaminoglycan content in striae. Furthermore, the number of vertical fibrillin fibres subjacent to the dermal-epidermal junction (DEJ) and elastin fibres in the papillary dermis was significantly reduced in striae compared with normal skin. The orientation of elastin and fibrillin fibres in the deep dermis showed realignment in that the fibres ran parallel to the DEJ. However, no significant alterations were observed in any other extracellular matrix components. This study identifies a reorganization and diminution of the elastic fibre network of skin affected by striae. Continuous strain on the dermal extracellular matrix, as occurs during pregnancy, may remodel the elastic fibre network in susceptible individuals and manifest clinically as striae distensae.

Noise versus Access: The Impact of an Airport in an Urban Property Market

Abstract: The effects of a major airport are unlikely to exhibit a uniform spatial distribution. The benefits to industries and individual households may extend well beyond the local economy, whereas many of the costs are spatially concentrated in the immediate environment. In particular, the problems of noise and traffic generation can be expected to fall principally upon adjacent populations. This paper addresses the general question of whether the costs to local economies of airport proximity, which are in the nature of externalities, outweigh the benefits of access, employment and improved infrastructure. Based on data relating to Manchester airport and its surrounding areas, the specific approach adopted in the paper involves an investigation of the extent to which such proximity effects are capitalised into residential property prices. Our results provide some evidence to suggest that circumstances may exist where positive attributes, such as improved access and employment opportunities, may be more highly va...

Well-being and treatment satisfaction in older people with diabetes.

Abstract: OBJECTIVE To measure well-being and treatment satisfaction and their correlates in older people with diabetes. RESEARCH DESIGN AND METHODS A postal survey was conducted of 1,000 diabetic patients aged ≥ 60 years, representing 56% of the resident older diabetic population in an inner-city health district with a largely indigenous population of 230,000 people and a widely varied socioeconomic mix. Well-being and treatment satisfaction were measured with diabetes-specific instruments and correlated with patient data held in a central register. RESULTS There was an 81% response. The general well-being scores (median [interquartile range]) for patients on diet alone, tablets, and insulin were 54 (44–60), 53 (42–61), and 48 (35–56) ( P P 1c concentrations were 5.0 ± 1.4% (for patients on diet alone), 5.8 ± 1.6% (tablets), and 6.6 ± 1.7% (insulin) ( P 1c . Insulin-treated patients were younger and had been diabetic longer than non-insulin-treated patients; their well-being remained slightly, but significantly, lower when adjusted for age, sex, BMI, and diabetes duration, but treatment satisfaction was no longer significantly different. Women had lower well-being than men. CONCLUSIONS It has proved possible to measure well-being and treatment satisfaction in a large community-based samples of older people with diabetes. At the level of glycemic control in this population, neither parameter correlated with HbA 1c . The lower well-being in insulin-treated patients remained significant in multivariate analysis.

Forging the nation: National identity and nation building in post‐communist Russia

Abstract: AFTER THE DOWNFALL OF THE USSR all the newly independent states had to embark on the road of nation building (defining 'who are we the people' and fostering the people's national identity, i.e. their sense of belonging to one distinct community) and state building (defining state boundaries which can be accepted by all major political players and creating new political institutions which can inspire the loyalty of the people). By now they have achieved varying degrees of success, depending on the demographic and ethnic composition of a country, its political culture, and its economic situation. In the case of the Russian Federation (RF) this set of issues is further complicated by the fact that Russia has traditionally been the centre of an empire, and therefore confusion over the 'just borders' of the new state is greater among politicians, intellectuals and even ordinary people than is the case in the non-Russian newly independent states. Thus more ideas about what is the Russian nation and what should be the geography of the new Russian state are currently to be found in the RF than is the case in the other 14 former Soviet republics. However, in both Russia and other newly independent states, the main problem of nation building is the same-namely, how to reconcile civic identities based on inclusive citizenship and exclusive ethnic identities based on such common characteristics as culture, religion, language and a common ancestor of a dominant nationality, on the one hand, and of ethnic minorities, on the other. Civic nations (communities of participating citizens) and ethnic nations (communities bound together by common language, culture and history) are only ideal types, which rarely exist in pure forms, and even civic nations are usually strongly connected with earlier ethnic communities.' In the countries of the former USSR the confusion between ethnic and civic identities is especially strong, as reflected in the newly adopted constitutions and legislation on citizenship and minority rights. Partly this confusion stems from the fact that political institutions, which are supposed to inspire the loyalty of members of a civic community, are still in the process of formation; partly, as elsewhere, accommodation of the interests of ethnic minorities poses problems which do not have immediate solutions. The aim of this article is to show that not only do these objective factors influence nation building, but the very structure of nationalist discourse, which is shaped through intellectual debates, has an impact on policy making in the RF. In other

Capillary growth in relation to blood flow and performance in overloaded rat skeletal muscle

Abstract: Rat extensor digitorum longus muscles were overloaded by stretch after removal of the synergist tibialis anterior muscle to determine the relationship between capillary growth, muscle blood flow, a...

Efficacy of LY303366 against Amphotericin B-Susceptible and -Resistant Aspergillus fumigatus in a Murine Model of Invasive Aspergillosis

Abstract: LY303366 is a novel antifungal echinocandin with excellent in vitro activity against Aspergillus spp. We compared four doses (1, 2.5, 10, and 25 mg/kg of body weight) of LY303366 with amphotericin B (0.5 to 5 mg/kg) in a temporarily neutropenic murine model of invasive aspergillosis against an amphotericin B-susceptible (AF210) and an amphotericin B-resistant (AF65) Aspergillus fumigatus isolate based on in vivo response. Mice were immunosuppressed with cyclophosphamide (200 mg/kg) and infected 3 days later. Treatment started 18 h after infection and lasted for 10 days. LY303366 was given once daily intravenously for 10 days, and amphotericin B (at 0.5, 2, and 5 mg/kg) was given once daily intraperitoneally for 10 days, or only on days 1, 2, 4, and 7 (at 5 mg/kg). Kidneys and lungs from survivors were cultured on day 11. Control mice in both experiments had 90 to 100% mortality. Amphotericin B at 0.5 mg/kg and LY303366 at 1 mg/kg yielded 10 to 20% survival rates for mice infected with either AF210 or AF65. Amphotericin B at 2 and 5 (both regimens) mg/kg yielded a 70 to 100% survival rate for mice infected with AF210 but a 10 to 30% survival rate for mice infected with AF65 (P = 0.01 to 0.04 compared with AF210). Against AF210 and AF65, LY303366 at 2.5, 10, and 25 mg/kg produced a survival rate of 70 to 80%, which was as effective as amphotericin B for AF210, but superior to amphotericin B for AF65 (P < 0.03 to 0.0006). For AF65, LY303366 at 10 and 25 mg/kg/day was superior to amphotericin B at 2 and 5 mg/kg/day in reducing tissue colony counts (P = 0.01 to 0.003), and for AF210, amphotericin B at 5 mg/kg/day and at 5 mg/kg in four doses was more effective than all four regimens of LY303366 in reducing renal culture counts (P = 0.01 to 0.0001). The present study shows, for the first time, that in vivo resistance of A. fumigatus to amphotericin B exists, although this could not be detected by in vitro susceptibility assays. Furthermore, LY303366 appears to be effective against amphotericin B-susceptible and -resistant A. fumigatus infection in this model and should be further evaluated clinically.

Competing dichotomies in IS research and possible strategies for resolution

Abstract: The debate between “hard” positivist and “soft” interpretivist research approaches has been the subject of much discussion in the IS field. Typically, the debate is framed in issues central to the philosophy of science, an area where relatively few IS researchers are truly competent. This paper attempts to illuminate the issue, particularly for students and researchers not entirely familiar with the arguments. The opposing positions are caricatured in two anecdotes which illustrate the futility of research conducted at the cul de sac extremes of each approach. The main dichotomies characteristic of each research tradition are then summarized and categorized according to various levels, namely, paradigmatic, ontological, epistemological, methodological, and axiological. Finally, the paper considers a number of strategies for resolving the

Hydrogen and deuterium in Pd-25 pct Ag alloy: Permeation, diffusion, solubilization, and surface reaction

Abstract: In this work, the hydrogen and deuterium transport parameters such as permeability, diffusivity, and solubility in a Pd-25 pct Ag alloy are studied, using a permeation gas phase technique and, additionally, a computer-controlled microbalance system. In the region in which Sieverts' law is valid, the hydrogen solubilities found using both techniques are in very good agreement. From permeation measurements, the surface constants for the adsorption (σk 1) and release (σk 2) of hydrogen and deuterium in Pd-25 pct Ag alloy are also determined. The measurements cover the temperature range from 323 to 773 K and a pressure range from 1 to 105 Pa.

The effect of addition of calcipotriol ointment (50 micrograms/g) to acitretin therapy in psoriasis.

Abstract: Our purpose was to find out whether the addition of calcipotriol ointment (50 micrograms/g) to systemic treatment with acitretin produces additional therapeutic effects and thereby an acitretin-sparing effect, and further to investigate the safety and tolerability of this combination. A multicentre, randomized, double-blind placebo-controlled study was designed. Patients were randomized to receive calcipotriol or placebo. All patients were treated with a starting dose of 20 mg acitretin per day and doses were adjusted at 2-weekly intervals with increments of 10 mg per day up to a maximum of 70 mg per day. The dose requirement for acitretin, clinical signs and adverse events were recorded. Seventy-six patients were randomized to treatment with calcipotriol 50 micrograms/g ointment twice daily and 59 patients to treatment with the vehicle only twice daily. Clearance or marked improvement was achieved by 67% of the patients in the calcipotriol group and by 41% of the patients in the placebo group (P = 0.006). Calcipotriol treatment proved to have a statistically significant additional effect to acitretin on the Psoriasis Area and Severity Index, redness, thickness and scaliness as compared with placebo. Clearance or marked improvement was achieved with a statistically significantly lower cumulative dose of acitretin by the patients in the calcipotriol group as compared with the placebo group. The number of patients reporting adverse events was pronounced and largely related to acitretin. No significant differences were observed between the two treatment groups with respect to adverse events. Laboratory assessments were essentially normal. The addition of calcipotriol ointment to acitretin treatment contributes to the efficacy, reduces the cumulative dose of acitretin to reach marked improvement or clearance, and is well-tolerated and safe.

Reviewing and selecting outcome measures for use in routine practice

Abstract: For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care.