Toward understanding the endocrine regulation of diverse facultative migration strategies.

Migration is an important event in the annual cycle of many animals that facilitates the use of resources that vary across space and time. It can occur with regular and predictable timing, as in obligate migration, or with much greater flexibility, as in facultative migration. Most research aimed at understanding the endocrine mechanisms regulating the transition to a migratory stage has focused on obligate migration, whereas less is known about facultative forms of migration. One challenge for research into the endocrine regulation of facultative migration is that facultative migrations encompass a diverse array of migratory movements. Here, we present a framework to describe and conceptualize variation in facultative migrations that focuses on conditions at departure. Within the context of this framework, we review potential endocrine mechanisms involved in the initiation of facultative migrations in vertebrates. We first focus on glucocorticoids, which have been the subject of most research on the topic. We then examine other potential hormones and neurohormones that have received less attention, but are exciting candidates to consider. We conclude by highlighting areas where future research is particularly needed.

Factors influencing general practice nurse's implementation of culturally responsive care, using normalization process theory: A cross-sectional study.

AIMS: To explore levers and barriers to providing culturally responsive care for general practice nurses (GPNs) using normalization process theory. DESIGN: A self-administered online cross-sectional survey. METHODS: A participatory co-designed adapted version of the normalization of complex interventions measure (NoMAD) validated tool was distributed to a convenience sample of GPNs between December 2022 and February 2023. The sample comprised of GPNs working in general practice services in Ireland (n = 122). Data were analysed using descriptive and analytical statistics (Pearson correlations) and principles of content analysis. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). RESULTS: GPNs in this study indicated their familiarity with, acknowledged the importance of and were committed to, providing culturally responsive care. However, implementing culturally responsive care in daily practice was problematic due to insufficient education and training, scarcity of resources and supports and a lack of organizational leadership. Subsequently, GPNs experience difficulties adapting everyday practices to respond appropriately to the care needs of culturally and linguistically diverse (CaLD) patients. CONCLUSION: This analysis highlights the necessity of exploring the intricacies of factors that influence capabilities and capacity for providing culturally responsive care. Despite demonstrating awareness of the importance of providing nursing care that responds to the needs of CaLD patients, GPNs do not have full confidence or capacity to integrate culturally responsive care into their daily work practices. IMPACT: Using normalization process theory, this study elucidates for the first time how GPNs in Ireland make sense of, legitimize, enact and sustain culturally responsive care as a routine way of working. It illuminates the multitude of micro-level (individual), meso-level (organizational) and macro-level (structural) factors that require attention for normalizing culturally responsive care in general practice services. PATIENT OR PUBLIC CONTRIBUTION: The study question was identified in a participatory research prioritization for Irish research about migrant health that involved migrants in the process.

Recreational-vehicle-dwelling American nomads' experiences seeking healthcare: A qualitative field study.

AIM: To explore the experiences of recreational-vehicle-dwelling American nomads when seeking healthcare in the United States. DESIGN: This exploratory, qualitative study employed interpretive description design to maintain a disciplinary focus in nursing. METHODS: Twenty-five participants were recruited from campgrounds in eight states. Semi-structured interviews were conducted face-to-face. Thematic analysis was conducted using a phronetic iterative approach. RESULTS: Three overarching themes described participants' experiences seeking healthcare: overwhelming logistics, don't need healthcare, and orchestrating a web of care. CONCLUSION: Recreational-vehicle-dwelling nomads in the United States face additional complexity when accessing healthcare related to seeking care in unfamiliar locations and policies that prevent the portability of healthcare across state lines. IMPLICATIONS: More research is needed to evaluate solutions to improve healthcare access for recreational-vehicle-dwelling nomads. Nurses and policymakers should consider healthcare practices through the lens of nomads' lifestyle mobility. The impact of policy decisions on people who are geographically mobile should be considered, and barriers to healthcare portability should be addressed. IMPACT: This was the first study focused on the healthcare experiences of recreational-vehicle-dwelling nomads in the United States. Nomads face additional complexity and barriers to healthcare access. Some nomads developed strategies to overcome barriers, while others disengaged from healthcare. The findings will impact researchers and nurses who study and care for nomads. REPORTING METHOD: The SRQR reporting guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: Recreational-vehicle-dwelling nomads reviewed the recruitment flyer and interview guide and provided input on recruitment methods and sites.

Objective and automatic grading system of facial signs from smartphones' pictures in South African men: Validation versus dermatologists and characterization of changes with age.

OBJECTIVE: To evaluate the capacity of the automatic detection system to accurately grade, from selfie pictures, the severity of eight facial signs in South African men. METHODS: Selfie pictures (obtained from frontal and back cameras) of 281 South African men differently aged (20-70 years) were obtained and analyzed by an automatic artificial intelligence (AI)-based automatic grading system. Data were compared with the clinical gradings made by experts and dermatologists. RESULTS: In all facial signs, both series of gradings were found highly correlated with, however, different coefficients (0.59-0.95), those of marionette lines and cheek pores being of lower values. No differences were observed between data obtained by frontal and back cameras. With age, in most cases, gradings show up to the 50-59 year age-class, linear-like changes. When compared to men of other ancestries, South African men present lower wrinkles/texture, pigmentation, and ptosis/sagging scores till 50-59 years, albeit not much different in the cheek pores sign. The early onset (mean age) of visibility of wrinkles/texture for South African men were (i.e., reaching grade >1) 39 and 45 years for ptosis/sagging. CONCLUSION: This study completes and enlarges the previous works conducted on men of other ancestries by showing some South African specificities and slight differences with men of comparable phototypes (Afro American).

Social environment influences termination of nomadic migration.

The final stage of migration, when animals terminate migratory movements and transition to a more sedentary state, remains the least understood phase of migration. Whereas migrants that return to the same locations each year may use mechanisms associated with locating a specific destination, migrants with low site fidelity, such as nomadic migrants, may rely on local environmental cues to determine when to cease migratory movements. Using an experiment with captive birds, we tested whether the presence of a conspecific influences the termination of migration, indicated by changes in behaviour and physiology, in a nomadic migrant (the pine siskin, Spinus pinus). We paired migratory birds with a non-migratory individual or left migratory and non-migratory individuals unpaired. Migratory paired birds had a significant decline in nocturnal activity immediately after pairing and activity levels remained lower two weeks later, with significant declines in energetic reserves and flight muscle size also observed. By contrast, migratory unpaired birds maintained high levels of activity and energetic reserves. These results provide evidence for a role of the social environment in migratory termination decisions. Social cues may be particularly useful in nomadic migrants, such as pine siskins, to facilitate settling in high quality, but unfamiliar, habitats.

Telomere length predicts timing and intensity of migratory behaviour in a nomadic songbird.

Our understanding of state-dependent behaviour is reliant on identifying physiological indicators of condition. Telomeres are of growing interest for understanding behaviour as they capture differences in biological state and residual lifespan. To understand the significance of variable telomere lengths for behaviour and test two hypotheses describing the relationship between telomeres and behaviour (i.e. the causation and the selective adoption hypotheses), we assessed if telomere lengths are longitudinally repeatable traits related to spring migratory behaviour in captive pine siskins (Spinus pinus). Pine siskins are nomadic songbirds that exhibit highly flexible, facultative migrations, including a period of spring nomadism. Captive individuals exhibit extensive variation in spring migratory restlessness and are an excellent system for mechanistic studies of migratory behaviour. Telomere lengths were found to be significantly repeatable (R = 0.51) over four months, and shorter pre-migratory telomeres were associated with earlier and more intense expression of spring nocturnal migratory restlessness. Telomere dynamics did not vary with migratory behaviour. Our results describe the relationship between telomere length and migratory behaviour and provide support for the selective adoption hypothesis. More broadly, we provide a novel perspective on the significance of variable telomere lengths for animal behaviour and the timing of annual cycle events.

The implementation and validation of the NoMAD during a complex primary care intervention.

BACKGROUND: Normalization process theory (NPT) has been widely used to better understand how new interventions are implemented and embedded. The NoMAD (Normalization Measurement Development questionnaire) is a 23-item NPT instrument based on NPT. As the NoMAD is a relatively new instrument, the objectives of this paper are: to describe the experience of implementing the NoMAD, to describe it being used as a feedback mechanism to gain insight into the normalization process of a complex health intervention, and to further explore the psychometric properties of the instrument. METHODS: Health TAPESTRY was implemented in six Family Health Teams (total of seven sites) across Ontario. Healthcare team members at each site were invited to complete the NoMAD, and three general questions about normalization, six times over a 12-month period. Each site was then provided a visual traffic light summary (TLS) reflecting the implementation of the Health TAPESTRY. The internal consistency of each sub-scale and validity of the NoMAD were assessed. Learnings from the implementation of the NoMAD and subsequent feedback mechanism (TLS) are reported descriptively. RESULTS: In total, 56 diverse health care team members from six implementation sites completed the NoMAD. Each used it at least once during the 12-month study period. The implementation of the NoMAD and TLS was time consuming to do with multiple collection (and feedback) points. Most (60%) internal consistency values of the four subscales (pooled across site) across each collection point were satisfactory. All correlations were positive, and most (86%) were statistically significant among NoMAD subscales. All but one correlation between the NoMAD subscales and the general questions were positive, and most (72%) were significant. Generally, scores on the subscales were higher at 12-month than baseline, albeit did not follow a linear pattern of change across implementation. Generally, scores were higher for experienced sites compared to first-time implementors. CONCLUSION: Our experience would suggest fewer collection points; three timepoints spaced out by several months are adequate, if repeated administration of the NoMAD is used for feedback loops. We provide additional evidence of the psychometric properties of the NoMAD. TRIAL REGISTRATION: Registered at ClinicalTrials.gov: NCT03397836 .

Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus.

BACKGROUND: Improvement in the accuracy of identifying women who are at risk to develop gestational diabetes mellitus (GDM) is warranted, since timely diagnosis and treatment improves the outcomes of this common pregnancy disorder. Although prognostic models for GDM are externally validated and outperform current risk factor based selective approaches, there is little known about the impact of such models in day-to-day obstetric care. METHODS: A prognostic model was implemented as a directive clinical prediction rule, classifying women as low- or high-risk for GDM, with subsequent distinctive care pathways including selective midpregnancy testing for GDM in high-risk women in a prospective multicenter birth cohort comprising 1073 pregnant women without pre-existing diabetes and 60 obstetric healthcare professionals included in nine independent midwifery practices and three hospitals in the Netherlands (effectiveness-implementation hybrid type 2 study). Model performance (c-statistic) and implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability) were evaluated after 6 months by indicators and implementation instruments (NoMAD; MIDI). RESULTS: The adherence to the prognostic model (c-statistic 0.85 (95%CI 0.81-0.90)) was 95% (n = 1021). Healthcare professionals scored 3.7 (IQR 3.3-4.0) on implementation instruments on a 5-point Likert scale. Important facilitators were knowledge, willingness and confidence to use the model, client cooperation and opportunities for reconfiguration. Identified barriers mostly related to operational and organizational issues. Regardless of risk-status, pregnant women appreciated first-trimester information on GDM risk-status and lifestyle advice to achieve risk reduction, respectively 89% (n = 556) and 90% (n = 564)). CONCLUSIONS: The prognostic model was successfully implemented and well received by healthcare professionals and pregnant women. Prognostic models should be recommended for adoption in guidelines.

Skin moisture assessment using Hydration Sensor Patches coupled with smartphones via Near Field Communication (NFC). A pilot study with the first generation of patches that allow self-recordings of skin hydration.

OBJECTIVES: To evaluate the potency of a new skin hydration sensor patch in the fast self-recording of skin hydration. MATERIAL AND METHODS: The Skin Hydration Sensor Patch (SHSP) turns the user's smartphone into a wireless skin moisture measuring device. The SHSP combines a capacitive measurement unit and Near Field Communication technology (NFC) for transmitting data and energy. The probe is fixed onto the back of the smartphone and pressed to the skin for a few seconds where the application immediately calculates the capacitance value. Once recorded, the probe is then immediately taken off from the skin. In a first study, this system was compared to the Corneometer® technique, in vivo, on various skin sites of 23 healthy French women. In a second study, 20 women with moderate dry skin on face and forearm self-recorded, through the SHSP the changes in skin hydration induced by a Xanthan gel containing 3% (w/w) of Glycerol, along 24 hours. A questionnaire based on 5 types of questions was established to be filled by subjects about their perception of the use of this new system. RESULTS: In the first study, the values recorded by the SHSP were found highly correlated with those provided by the Corneometer® . The second study allowed to observe significant differences in skin hydration of both sites at all times, as compared to values obtained before the application of the gel. Differences between both sites were observed, the face being less hydrated than forearm. From a practical aspect, the self-recordings on the face show a higher variability (approx. 10% than those of the forearm). The questionnaire led to positive answers on almost all points. CONCLUSION: This SHSP appears as a promising approach in the field of connected skin-related devices. As such, it opens or enlarges a new paradigm in the relationships between a consumer and a cosmetic product.

Nomadic Tibetan women's reproductive health: findings from cross-sectional surveys with a hard-to-reach population.

BACKGROUND: Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. METHODS: We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). RESULTS: On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (< 40) were more likely to report having had had an STI symptom, as compared to older women (84% versus 71%; p < 0.05). CONCLUSIONS: We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.

Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (less than 40 years old) were more likely to report having had had an STI symptom, as compared to women over 40 years old (84% versus 71%; p < 0.05). We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.

Factors determining sexual behaviour amongst siddi tribe migrating to Udupi district, India: A cross-sectional study.

BACKGROUND: Afro-Indians, locally known as Siddi, are the tribal community descended from the Bantu populace from eastern Africa found in Goa, Gujarat and Karnataka along the Indian west coast. This study determines knowledge, attitude and sexual behaviour amongst the Siddi population in the Udupi district. MATERIALS AND METHODS: A cross-sectional study was conducted from October 2018 to September 2019; men and women aged above 18 years who lived in the locality at the time of the survey were included in the study. RESULTS: A total of 108 Siddi individuals participated in this study. The mean age of the respondents was 31.8 ± 9.5 years. More than half (51.8%) of the respondents received information on sexual matters through friends. Awareness regarding the usage of condoms and other preventive measures was poor (34.7%). Around 65.7% of the respondents felt that sex education in school encourages sex amongst youngsters. The mean age at the first sexual intercourse amongst men and women was 20.3 years and 16.2 years, respectively. About 18.7% of the respondents had sex with a new partner in the migrated place within the last 1 month, of which 80% were married. Only 5% of the respondents used condoms while indulging in sex with a new partner at the migrated place. Factors such as age at marriage, age at the first sexual act and attitude towards sexual activity were significantly associated with a new sex partner at the arrival site. CONCLUSION: There is a high prevalence of unsafe sexual practices amongst the migrated Siddi tribe at the place of destination. This poses the risk of sexually transmitted infections amongst the migrant tribes and local communities at the place of destination and the location of origin. The study finding shows that measures should be taken to create awareness, and change in attitude towards sexual matter should be channelised at an early age amongst the Siddi population.

Self-recording the skin hydration and Trans-Epidermal Water Loss parameters: A pilot study.

OBJECTIVE: To evaluate the reliability of data self-recorded by subjects enrolled in a study for skin surface hydration and Trans-Epidermal Water Loss (TEWL). METHODS: A connected device, previously described, simultaneously records both the hydration status and the TEWL on the same skin site. The effects of a Xanthane-based gel containing low concentrations of glycerol (3% or 7%) applied on both face and forearms of Caucasian women, were self-recorded at various times for 24 hours, outside of Research facility. RESULTS: In the first-hour post application, the skin hydration and TEWL values show a sharp increase and decrease, respectively. They progressively recover their initial values 24 hours post washing, on both skin sites. A significant dose effect of glycerol (ie, 3% vs 7%) was obtained on both skin sites. The repeatability of data was found acceptable in both parameters, although more precise on arms than face, probably linked to an easier handling of the device. CONCLUSION: The use of this skin measuring connected device outside of Research facility, following a training of subjects, leads to reliable data. Such approach could be extended to other connected devices.

Developing oral health risk assessment as routine practice during early stages of clinical careers: A cross-sectional study of dental students using the NoMAD questionnaire.

BACKGROUND: Effective implementation of healthcare initiatives is of key importance for ensuring high-quality clinical and health outcomes. Using Normalization Process Theory, this study investigates the implementation behaviour of dental students in relation to a novel oral health risk assessment tool. It considers the impact of advancing learning on normalisation of innovative healthcare practice. METHODS: Students completed the NoMAD (normalisation of complex interventions-measure development) questionnaire and an additional scale to assess perceived value of the oral health risk assessment tool, after having used the tool for nearly one academic year. The sample comprised third- (n = 75), fourth- (n = 77) and fifth-year (n = 37) students. Differences between groups in relation to the four generative processes of normalisation were analysed using ANOVA. Cohen's d effect sizes were calculated between groups. Multiple linear regression was undertaken to investigate the impact of normalisation level on value/utility judgements. RESULTS: There were significant group differences for three of the four generative processes of normalisation (coherence, cognitive participation and reflexive monitoring). Third- and fourth-year students were highly similar but these groups showed lower normalisation compared to fifth years. Normalisation assessment predicted perceived value and utility of the oral health risk assessment tool. CONCLUSIONS: The findings suggest that dental students show lower normalisation of novel tools at earlier stages in their course, possibly due to increased cognitive load, and that perceived value and utility of a novel tool is related to increased normalisation.

An Empirical and Mechanistic Explanation of Abundance-Occupancy Relationships for a Critically Endangered Nomadic Migrant.

The positive abundance-occupancy relationship (AOR) is a pervasive pattern in macroecology. Similarly, the association between occupancy (or probability of occurrence) and abundance is also usually assumed to be positive and in most cases constant. Examples of AORs for nomadic species with variable distributions are extremely rare. Here we examined temporal and spatial trends in the AOR over 7 years for a critically endangered nomadic migrant that relies on dynamic pulses in food availability to breed. We predicted a negative temporal relationship, where local mean abundances increase when the number of occupied sites decreases, and a positive relationship between local abundances and the probability of occurrence. We also predicted that these patterns are largely attributable to spatiotemporal variation in food abundance. The temporal AOR was significantly negative, and annual food availability was significantly positively correlated with the number of occupied sites but negatively correlated with abundance. Thus, as food availability decreased, local densities of birds increased, and vice versa. The abundance-probability of occurrence relationship was positive and nonlinear but varied between years due to differing degrees of spatial aggregation caused by changing food availability. Importantly, high abundance (or occupancy) did not necessarily equate to high-quality habitat and may be indicative of resource bottlenecks or exposure to other processes affecting vital rates. Our results provide a rare empirical example that highlights the complexity of AORs for species that target aggregated food resources in dynamic environments.

'Leaving no one behind': a scoping review on the provision of sexual and reproductive health care to nomadic populations.

BACKGRUND: Marginalized groups, such as nomadic populations across the world, have perhaps the least access to modern reproductive health (RH) services. This scoping review aims to identify barriers to access to RH services faced by nomadic populations from the existing literature and to highlight possible opportunities to address them. METHODS: Key databases, including PubMed, Popline, Google Scholar, and Google Advanced were searched for relevant articles published between 2002 and 2019. A total 344 articles were identified through database online searches, and 31 were included in the review. RESULTS: Nomadic people face complex barriers to healthcare access that can be broadly categorized as external (geographic isolation, socio-cultural dynamics, logistical and political factors) and internal (lifestyle, norms and practices, perceptions) factors. To effectively address the needs of nomadic populations, RH services must be available, accessible and acceptable through tailored and culturally sensitive approaches. A combination of fixed and mobile services has proven effective among mobile populations. Low awareness of modern RH services and their benefits is a major barrier to utilization. Partnership with communities through leveraging existing structures, networks and decision-making patterns can ensure that the programmes are effectively implemented. CONCLUSION: Further research is needed to better understand and address the RH needs of nomadic populations. Though existing evidence is limited, opportunities do exist and should be explored. Raising awareness and sensitization training among health providers about the specific needs of nomads is important. Improved education and access to information about the benefits of modern RH care among nomadic communities is needed. Ensuring community participation through involvement of nomadic women and girls, community leaders, male partners, and trained traditional birth attendants are key facilitators in reaching nomads. However, participatory programmes also need to be recognized and supported by governments and existing health systems.

Synchronized in vivo measurements of skin hydration and trans-epidermal water loss. Exploring their mutual influences.

OBJECTIVE: To explore the relationship between skin surface hydration and Trans-Epidermal Water Loss (TEWL) when simultaneously measured. METHODS: Six circular skin areas of the forearms (3 per forearm, 3 cm in diameter) of 12 Caucasian women were used as models. 4 prototypes of formulae of different compositions containing glycerol at different concentrations 7%, 10% and 40% were used as models of hydrating products. One formula (glycerol-free) was used as control vehicle. Standardized applications of formulae (2 mg/cm2 ) were performed on 5 skin sites chosen at random, the other being left as bare/control. A recently marketed instrumental device that records the skin surface hydration and TEWL on a small skin area in a simultaneous manner was used. Measurements were carried out at T0 (pre-application), at 1 h (T1) and 5 h (T5) post applications on two close sites within the 6 defined areas of both forearms. RESULTS: The new instrumental device allowed to clearly differentiate the 5 formulae (i.e. 7% vs. 10%) with regard the dose effect brought by glycerol (7%, 10%, 40%) and to record their lingering effects at T1 and T5. Both parameters were found significantly and negatively correlated, i.e. the higher the skin hydration, the lower the TEWL. The 40% concentration of glycerol, that leads to the highest skin hydration, brings a drop in the TEWL by about a two-fold factor. Skin hydration of bare skin and control/vehicle sites showed minor and non-significant changes along 5 h. Instead, the control/ vehicle slowed down the TEWL to a slight extent. CONCLUSION: The use of this new instrumental device shed a new light on the mutual and inverse relationships between skin hydration and TEWL. Results suggest that, at high concentration, glycerol leads to largely increase the water content of both epidermal and dermal compartments, possibly leading to structural changes in the skin relief.

OBJECTIF: D'explorer les relations mutuelles entre l'hydratation cutanée et la perte insensible en eau (PIE) quand elles sont mesurées simultanément. MÉTHODES: 6 zones circulaires des avant-bras (3 par zone, diamètre 3 cm) de 12 femmes Caucasiennes ont été utilisées comme modèles. 4 prototypes de formules, de compositions différentes contenant du glycérol à différentes concentrations (7%, 10%, 40%) furent réalisés et utilisés comme modèles de produits hydratants. Une formule sans glycérol fut utilisée en tant que contrôle. Des applications standardisées (2 mg/cm2 ) ont été effectuées sur 5 zones de façon aléatoire, la sixième restant nue en tant que contrôle. Un appareil nomade récemment disponible sur le marché qui enregistre l'hydratation et la PIE simultanément sur une petite surface cutanée a été utilisé. Deux mesures à deux endroits voisins de chaque zone ont été conduites à T0 (avant applications), 1 heure (T1) et 5 heures (T5) après. RÉSULTATS: Ce nouvel instrument permet de clairement différencier les 5 formules dans l'effet dose apporté par le glycérol (0, 7%, 10%, 40%) et de suivre leur rémanence dans le temps (T5 vs. T1). Les deux paramètres ont été trouvés négativement corrélés de manière significative, c'est-à-dire qu'une plus forte hydratation correspondant à une plus faible PIE. La formule à 40% de glycérol, qui a conduit à la plus forte hydratation, a ainsi entrainé une chute de la PIE d'environ 50%. La peau nue comme celle de la formule contrôle n'ont pas conduit à de modifications notables et significatives de l'hydratation. La formule contrôle a conduit à une légère chute de la PIE. CONCLUSION: L'utilisation de ce nouvel instrument semble apporter un éclairage nouveau sur les relations mutuelles (et inverses) entre l'hydratation cutanée et la PIE. Les résultats suggèrent qu'à forte concentration, le glycérol conduit à un fort accroissement de la teneur en eau de l'épiderme et du derme, avec de possibles conséquences structurelles du relief cutané.

New Tools for Finding Full-Text Articles Faster: Kopernio, Nomad, Unpaywall, and More.

Portable document format (PDF) electronic files are by far the most popular format used to publish, store, and share scholarly journal articles. Recently, new tools for quickly finding and linking to journal article PDFs have been developed. These tools integrate into the researcher's web browser and scan for unique identifiers associated with a journal article. When a unique identifier is found, the tool attempts to locate a PDF copy of the associated article and provide a link. This article will explore how these full-text finders work and discuss the advantages and disadvantages of these tools. Descriptions of several of the most popular tools are provided, and a short discussion of how librarians can facilitate the use of these tools at their institutions is included.

Improving the normalization of complex interventions: part 1 - development of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT).

BACKGROUND: Understanding and measuring implementation processes is a key challenge for implementation researchers. This study draws on Normalization Process Theory (NPT) to develop an instrument that can be applied to assess, monitor or measure factors likely to affect normalization from the perspective of implementation participants. METHODS: An iterative process of instrument development was undertaken using the following methods: theoretical elaboration, item generation and item reduction (team workshops); item appraisal (QAS-99); cognitive testing with complex intervention teams; theory re-validation with NPT experts; and pilot testing of instrument. RESULTS: We initially generated 112 potential questionnaire items; these were then reduced to 47 through team workshops and item appraisal. No concerns about item wording and construction were raised through the item appraisal process. We undertook three rounds of cognitive interviews with professionals (n = 30) involved in the development, evaluation, delivery or reception of complex interventions. We identified minor issues around wording of some items; universal issues around how to engage with people at different time points in an intervention; and conceptual issues around the types of people for whom the instrument should be designed. We managed these by adding extra items (n = 6) and including a new set of option responses: 'not relevant at this stage', 'not relevant to my role' and 'not relevant to this intervention' and decided to design an instrument explicitly for those people either delivering or receiving an intervention. This version of the instrument had 53 items. Twenty-three people with a good working knowledge of NPT reviewed the items for theoretical drift. Items that displayed a poor alignment with NPT sub-constructs were removed (n = 8) and others revised or combined (n = 6). The final instrument, with 43 items, was successfully piloted with five people, with a 100% completion rate of items. CONCLUSION: The process of moving through cycles of theoretical translation, item generation, cognitive testing, and theoretical (re)validation was essential for maintaining a balance between the theoretical integrity of the NPT concepts and the ease with which intended respondents could answer the questions. The final instrument could be easily understood and completed, while retaining theoretical validity. NoMAD represents a measure that can be used to understand implementation participants' experiences. It is intended as a measure that can be used alongside instruments that measure other dimensions of implementation activity, such as implementation fidelity, adoption, and readiness.

Improving the normalization of complex interventions: part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT).

INTRODUCTION: Successful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated. METHODS: Descriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample. RESULTS: We obtained 831 completed questionnaires, an average response rate of 39% (range: 22-77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach's alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89). CONCLUSIONS: The NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.

Using normalisation process theory to evaluate the implementation of a complex intervention to embed the surgical safety checklist.

BACKGROUND: The surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery. Although mandated in many health care institutions around the world, challenges in implementation of the SSC continue. To use Normalisation Process Theory (NPT) to help understand how/why implementation of a complex intervention coined Pass The Baton (PTB) could help explain what facets of the Surgical Safety Checklist use led to its' integration in practice, while others were not. METHODS: A longitudinal multi-method study using survey and interviews was undertaken. Implementation of PTB involved; change champions, audit and feedback, education and prompts. Following implementation, surgical teams were surveyed using the NOrmalization MeAsure Development (NoMAD) and subsequently interviewed to explore the impact of PTB on their use of the checklist at 6 and 12 months respectively. Respondents' self-reported perceptions of implementation of PTB was explained using the four NPT constructs; coherence, cognitive participation, collective action, and reflexive monitoring. Survey data were analysed using descriptive statistics. Interview data were coded inductively and content analysed using a framework derived from NPT. RESULTS: The NoMAD survey response rate was 59/150 (39.3%). Many (45/59, 77.6%) survey respondents saw the value in PTB, while 50/59 (86.2%) would continue to use it; 45/59 (77.6%) believed that PTB could easily be integrated into existing workflows, and 48/59 (82.8%) thought that feedback could improve PTB in the future. A total of 8 interviews were completed with 26 surgical team members. Nurses and physicians held mixed views towards coherence while buy-in and participation relied on individuals' investment in the implementation process and the ability to modify PTB. Participants generally recognised the benefit and value of using PTB in the ongoing implementation the checklist. CONCLUSIONS: Workarounds and flexible co-construction in implementation designed to improve team communications in surgery may facilitate their normalisation in practice.