Predicted relative prevalence estimates for obstructive sleep apnoea and the associated healthcare provision across the UK.

We surveyed the UK distribution of five factors commonly associated with obstructive sleep apnoea (OSA) to produce an overall risk map that could be used to predict relative prevalence estimates. The weighting and mapping of selected risk factors associated with OSA highlighted significant regional variation in predicted prevalence estimates. These data provide the first attempt to systematically map the UK for OSA and identify areas where the condition is likely to be more prevalent. The data show a significant mismatch between areas identified as having a high predicted prevalence estimate and the distribution of existing sleep centres.

Establishing measurement invariance: English and Spanish Paediatric Asthma Quality of Life Questionnaire.

BACKGROUND: Registered nurses and nurse researchers often use questionnaires to measure patient outcomes. When questionnaires or other multiple-item instruments have been developed using a relatively homogeneous sample, the suitability of even a psychometrically well-developed instrument for the new population comes into question. Bias or lack of equivalence can be introduced into instruments through differences in perceptions of the meaning of the measured items, constructs, or both in the two groups. OBJECTIVE: To explain measurement invariance and illustrate how it can be tested using the English and Spanish versions of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ). METHODS: A sample of 607 children from the Phoenix Children's Hospital Breathmobile was selected for this analysis. The children were of ages 6-18 years; 61.2% completed the PAQLQ in Spanish. Testing measurement invariance using multiple-group confirmatory factor analysis, a series of hierarchical nested models, is demonstrated. In assessing the adequacy of the fit of each model at each stage, both χ2 tests and goodness-of-fit indexes were used. RESULTS: The test of measurement invariance for the one-factor model showed that the English and Spanish versions of the scale met the criteria for measurement invariance. The level of strict invariance (equal factor loadings, intercepts, and residual variances between groups) was achieved. DISCUSSION: Confirmatory factor analysis is used to evaluate the structural integrity of a measurement instrument; multiple confirmatory factor analyses are used to assess measurement invariance across different groups and to stamp the data as valid or invalid. The PAQLQ, a widely used instrument having evidence to support reliability and validity was used separately in English- and Spanish-speaking groups. Traditional methods for evaluating measurement instruments have been less than thorough, and this article demonstrates a well-developed approach, allowing for confident comparisons between populations.

Peer assessment in large undergraduate classes: an evaluation of a procedure for marking laboratory reports and a review of related practices.

This study provides evidence that peer marking can be a reliable tool for assessing laboratory reports in large cohorts. It was conducted over a 4-yr period with first-year undergraduates (∼180 students/cohort) taking a mammalian physiology course, but the procedure adopted would be applicable to any other laboratory-based discipline. The process was found to be efficient in staff time, enabling a summative practical report to be marked in <1 h (<5% of the time that had previously been required for staff marking), facilitating rapid feedback to students on their performance. When samples of the peer-assessed reports were marked by a single member of staff, there was excellent correlation between peer and staff marks (r = 0.96-0.98), although peer-awarded marks exceeded staff marks by an average of 2.5-3.0%. The validity of peer marking was independent of both the sex of the marker and the staff score awarded to the marker for the same piece of work. Feedback from students was largely positive; they reported that the procedure adopted was effective in increasing their understanding of the underlying physiology and contributed to their understanding of best practice in presenting a laboratory report. Seventy percent of students agreed that it was acceptable for peer assessment to contribute a small (up to 5%) component of the overall mark for the course. The results are discussed in relation to other reports of peer marking, particularly when used to assess an academic product or process in a scientific discipline.

American Indians Have a Higher Risk of Sjögren's Syndrome and More Disease Activity Than European Americans and African Americans.

OBJECTIVE: To describe the clinical and serologic manifestations of Sjögren's syndrome (SS) in ethnic groups of the US. METHODS: This was a cross-sectional study of 648 patients with primary SS: 20 African American (AA), 164 American Indian (AI), 426 European American (EA), and 38 patients of other races evaluated in a multidisciplinary Sjögren's International Collaborative Clinical Alliance research clinic. RESULTS: AA subjects comprised 3.1% of the SS cohort, much lower than the percentage of AA in the state of Oklahoma (P = 3.01 × E - 05), the US (P = 2.24E - 13), or a systemic lupus erythematosus (SLE) cohort at the same institution (P = 4.26 × 10E - 27). In contrast, the percentage of AI in the SS cohort (25.3%) was much higher than expected (P = 3.17E - 09 versus SLE cohort, P = 6.36 - 26 versus Oklahoma, and P = 8.14E - 96 versus US population). The SS classification criteria were similar between AA and EA, but subjects of AI ancestry had lower rates of abnormal tear and salivary flow, as well as anti-Ro/SSA and anti-La/SSB antibodies. Paradoxically, AI had higher levels of disease activity (mean ± SD European League Against Rheumatism Sjögren's Syndrome Disease Activity Index score 3.77 ± 4.78) in comparison to EA (2.90 ± 4.12; P = 0.011) and more extraglandular manifestations affecting mainly the articular and glandular domains. Meanwhile, AA patients were characterized by higher rates of hypergammaglobulinemia (odds ratio [OR] 1.39 [95% confidence interval (95% CI) 1.39-8.65]; P = 0.01), elevated erythrocyte sedimentation rate (ESR) (OR 3.95 [95% CI 1.46-9.95]; P = 0.009), and parotid enlargement (OR 4.40 [95% CI 1.49-13.07]; P = 0.02). CONCLUSION: AI are affected at high rates with SS but present with few classical features, potentially preventing timely diagnosis. In contrast to SLE, SS is infrequent and not more severe among AA, but the triad of hypergammaglobulinemia, increased ESR, and parotid enlargement warrants extra vigilance for lymphomagenesis.

An examination of interventions to reduce respiratory health and injury hazards in homes of low-income families.

We evaluated whether combining asthma trigger reduction with housing structural repairs, device disbursement and education in low-income households with children would improve self-reported respiratory health and reduce housing-related respiratory health and injury hazards (convenience sample of n=67 homes with 63 asthmatic and 121 non-asthmatic children). At baseline, a visual assessment of the home environment and a structured occupant interview were used to examine 29 potential injury hazards and 7 potential respiratory health hazards. A home-specific intervention was designed to provide the children's parents or caretakers with the knowledge, skills, motivation, supplies, equipment, and minimum housing conditions necessary for a healthy and safe home. The enrolled households were primarily Hispanic and owned their homes. On average, 8 injury hazards were observed in the homes at baseline. Four months following intervention, the average declined to 2.2 hazards per home (p<0.001), with 97% of the parents reporting that their homes were safer following the interventions. An average of 3.3 respiratory health hazards were observed in the homes at baseline. Four months following intervention, the average declined to 0.9 hazards per home (p<0.001), with 96% of parents reporting that the respiratory health of their asthmatic children improved. A tailored healthy homes improvement package significantly improves self-reported respiratory health and safety, reduces respiratory health and injury hazards, and can be implemented in concert with a mobile clinical setting.

Psychometric evaluation of selected pain intensity scales for use with cognitively impaired and cognitively intact older adults.

The purpose of this study was to determine the reliability and validity of selected pain intensity scales such as the Faces Pain Scale (FPS), the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), and the Iowa Pain Thermometer (IPT) to assess pain in cognitively impaired older adults. A descriptive correlational design was used, and a convenience sample of 66 volunteers age 60 and older residing in assisted living facilities in the South was recruited for this study. The sample included 22 (33%) men and 44 (67%) women, with a mean age of 76. Ninety-eight percent (65) of the sample comprised Caucasian participants, with the exception of 1 African-American man. Seventy percent (47) completed high school and/or college. The mean Mini Mental State Exam (MMSE) score was 16, with a range of 1 to 29. Eighty-five percent scored 24 or lower, indicating some degree of cognitive impairment. The remaining 15% were cognitively intact. All but one participant could use each scale to rate their pain. Concurrent validity of the VDS, NRS, and IPT was supported with Spearman rank correlation coefficients ranging from .78 to .86 in the cognitively impaired group. The FPS, however, demonstrated weak correlations with other scales when used with the impaired group, ranging from .48 to .53. In the cognitively intact group, strong correlations ranging from .96 to .97 were found among all of the scales. Test-retest reliability at a 2-week interval was acceptable in the cognitively intact group (Spearman rank correlations ranged from .67 to .85) and unacceptable for most scales in the cognitively impaired group (correlations ranged from .26 to .67). When asked about scale preference, both the cognitively impaired and the intact groups preferred the IPT and the VDS. This study revealed that cognitive impairment did not inhibit participants' ability to use a variety of pain intensity scales, but the stability issue must be considered.

The use of an online pictorial Epworth Sleepiness Scale in the assessment of age and gender specific differences in excessive daytime sleepiness.

BACKGROUND: Excessive daytime sleepiness (EDS) is a non-specific but highly prevalent cardinal symptom of sleep disorders. We hypothesized that with modern media and an online pictorial Epworth Sleepiness Scale (ESS) age and gender specific differences of EDS could be identified on a large scale. This could be helpful in the screening of patients with sleep disorders. PATIENTS AND METHODS: In 8,098 subjects, age and gender were recorded in addition to an online pictorial ESS (range 0-24 points). The cut-off for EDS (ESS >10 points) was chosen in line with the traditional ESS. RESULTS: The prevalence of EDS was slightly higher in male subjects (45% vs. 43%, P=0.033). When age was considered, female subjects tended to be sleepier in their 3(rd) and 4(th) lifetime decade (P=0.01 and P=0.003, respectively), whilst male subjects scored significantly higher in their 7(th) decade (P<0.0001); there was a trend to more daytime symptoms with higher age (P for trend <0.001). CONCLUSIONS: The online pictorial ESS identifies gender differences in EDS and reveals increased levels of sleepiness associated with higher age. The use of modern media facilitates reaching out to the general population to raise awareness of conditions associated with EDS such as sleep apnoea.

Evaluation of usage of virtual microscopy for the study of histology in the medical, dental, and veterinary undergraduate programs of a UK University.

This article describes the introduction of a virtual microscope (VM) that has allowed preclinical histology teaching to be fashioned to better suit the needs of approximately 900 undergraduate students per year studying medicine, dentistry, or veterinary science at the University of Bristol, United Kingdom. Features of the VM implementation include: (1) the facility for students and teachers to make annotations on the digital slides; (2) in-house development of VM-based quizzes that are used for both formative and summative assessments; (3) archiving of teaching materials generated each year, enabling students to access their personalized learning resources throughout their programs; and (4) retention of light microscopy capability alongside the VM. Student feedback on the VM is particularly positive about its ease of use, the value of the annotation tool, the quizzes, and the accessibility of all components off-campus. Analysis of login data indicates considerable, although variable, use of the VM by students outside timetabled teaching. The median number of annual logins per student account for every course exceeded the number of timetabled histology classes for that course (1.6­3.5 times). The total number of annual student logins across all cohorts increased from approximately 9,000 in the year 2007­2008 to 22,000 in the year 2010­2011. The implementation of the VM has improved teaching and learning in practical classes within the histology laboratory and facilitated consolidation and revision of material outside the laboratory. Discussion is provided of some novel strategies that capitalize on the benefits of introducing a VM, as well as strategies adopted to overcome some potential challenges.

Putting knowledge to work: a new approach.

Approaches to the longstanding challenges of 'integrating' subject-based and work-based knowledge have typically focused on questions of how learning can be 'transferred' from one setting to another, relating the assumed 'abstract' nature of theory to the assumed 'real' nature of practice. This is often seen as a single movement as encapsulated in the term 'from theory to practice'. The authors have developed a fresh approach that concentrates on different forms of knowledge and the ways in which these are contextualised and 're-contextualised' in movements between different sites of learning in colleges and workplaces. While the research has been carried out in a range of professional fields outside nursing, the arguments put forward by the authors are relevant to continuing debates within nursing around the theory-practice gap. The aim has been to explore how the subject-based and work-based aspects of a curriculum or learning programme can articulate with one another more effectively. The potential of the 're-contextualisation' approach for nurse education is outlined, with a view to further research. The original research was sponsored by the London Chamber of Commerce and Industry Commercial Education Trust and the Economic and Social Research Council Teaching and Learning Research Programme.

Optimizing triage consistency in Australian emergency departments: the Emergency Triage Education Kit.

OBJECTIVE: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. METHODS: A postal survey of 237 paper-based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was kappa >or= 0.6. RESULTS: Data were collected during 2 April to 14 May 2007. Agreement for the set was kappa = 0.412 (95% CI 0.410-0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6-45.3) showed concordance >or=70% to the modal triage category (kappa = 0.632, 95% CI 0.629-0.636) and 155/237 (65.4%, 95% CI 59.3-71.5) showed concordance >or=60% to the modal triage category (kappa = 0.507, 95% CI 0.504-0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (kappa = 0.243, 95% CI 0.237-0.249; kappa = 0.319, 95% CI 0.310-0.328). CONCLUSION: All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task-related factors influence consistency of triage.

The development of a tool to assess levels of stress and burnout.

OBJECTIVE: To pilot test the reliability and validity of a newly developed tool measuring nursing and midwifery staff stress and burnout. DESIGN: Descriptive survey. SETTING: Public hospital, aged care facility and university. SUBJECTS: For the pilot study a total of forty-nine (n = 49) nurses and midwives, selected by convenience sampling, were sent an initial pilot questionnaire. The return rate was seventy per cent initially and the return rate on the second mail out was forty-nine per cent. MAIN OUTCOME MEASURE: To determine reliability and validity of a new tool that explores nurses' and midwives' perceptions of stress, burnout and control over their working environment. RESULTS: Face validity, test-retest reliability, internal consistency and principal component analysis were established. Overall Cronbach's alpha was 0.87 indicating good internal consistency for the stress/ burnout element of the questionnaire. The test-retest reliability intraclass correlation coefficient reported 0.30 - 0.90 for all six sub scales which were developed for both parts of the questionnaire. CONCLUSION: The pilot study indicates that it is possible to construct a valid and reliable instrument to assess nurses' and midwives' perception of stress and burnout.

Quantitative inoculation of willow rust Melampsora larici-epitea with the mycoparasite Sphaerellopsis filum (teleomorph Eudarluca caricis).

The mycoparasite Sphaerellopsis filum (teleomorph Eudarluca caricis) was applied simultaneously with Melampsora larici-epitea on to willow leaf discs using eight concentrations of conidia. Inoculum densities were quantified and the numbers of uredinia of the rust, pycnidia and conidia of S. filum and rust spores produced per leaf disc were measured 13 d after inoculation (first assessment). Higher S. filum inoculum densities resulted in more rust uredinia being infected, but did not reduce the number of uredinia produced. The ratios of infected rust pustules: S. filum conidia applied were in a range of 0.25-0.31 when less than 20 S. filum spores were inoculated on to a leaf disc (0.95 cm2). Suppressive effects of S. filum on rust spore production were more obvious in the second assessment, carried out 23 d after inoculation. Inoculum densities of S. filum were significantly (P < 0.001) correlated with the frequency of uredinia infected (% variance accounted for [VAF] = 85.8), the number of S. filum pycnidia (% VAF = 81.4), S. filum spores produced (% VAF = 72.3) and rust spore production (% VAF = 48.6). Rust spore production was significantly (P < 0.001) negatively correlated with the frequency of uredinia infected (% VAF = 51.1), the number of S. filum pycnidia (% VAF = 42.0) and the number of S. filum spores produced (% VAF = 40.6). The best correlation was found between the number of pycnidia and the number of S. filum spores produced (% VAF = 88.8).