Patellofemoral and tibiofemoral alignment in a fully weight-bearing upright MR: Implementation and repeatability.

PURPOSE: To develop methods for evaluating 3D patellofemoral and tibiofemoral alignment in vertical open-bore magnetic resonance (MR) scanners, with participants upright and fully weight-bearing; and to evaluate the repeatability of these methods in individuals with patellofemoral osteoarthritis (OA) and in asymptomatic knees. MATERIALS AND METHODS: Our methods extend previously validated, reliable methods for evaluating alignment into an upright MR environment. In 10 participants with early patellofemoral OA and 10 with asymptomatic knees, we acquired sagittal T1 -weighted turbo spin echo images in a 3T scanner to create accurate participant-specific 3D anatomical surface models. In a vertical open-bore 0.5T MR scanner, we obtained lower-resolution sagittal gradient echo images to capture bony position and orientation data. Participants were scanned in a position of squatting with the knees flexed 30°, three separate times to evaluate repeatability. Bone segmentation was performed manually, surface models were registered to data from the 0.5T scanner, and 3D patellofemoral and tibiofemoral alignment was calculated in all six degrees of freedom (three rotations and three translations). RESULTS: Intraclass correlation coefficients (ICCs) were ≥0.94, with the exception of patellar spin (0.79). Standard errors of measure (SEM) were <2° rotation and <0.9 mm translation. Repeatability remained adequate when stratified by group, with the exception of patellar spin (ICC 0.57 for asymptomatic knees vs. 0.91 for OA knees). CONCLUSION: We demonstrate methods for evaluating 3D alignment in upright fully weight-bearing participant positions in a vertical open-bore MR scanner. With the exception of patellar spin, repeatability was good to excellent. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:841-847.

Use of online health information to manage children's health care: a prospective study investigating parental decisions.

BACKGROUND: The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents' decisions to use online information to manage their child's health care, a behaviour which has not yet been explored systematically. METHODS: Parents (N = 391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child's health care during the previous 2 months. RESULTS: We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents' intentions to use online information to manage their child's health care, with further support found for intentions, but not PBC, in predicting parents' behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents' decisions to engage in this child health management behaviour. CONCLUSIONS: This theory-based investigation to understand parents' motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

Natural killer cell-mediated innate sieve effect on HIV-1: the impact of KIR/HLA polymorphism on HIV-1 subtype-specific acquisition in east Africa.

Here we explore the association between killer cell immunoglobulin-like receptor (KIR)/HLA and human immunodeficiency virus type 1 (HIV-1) acquisition with different viral subtypes circulating in East Africa. In the prospective Cohort Development (CODE) cohort (Mbeya, Tanzania), carriers of KIR3DS1 and its putative ligand (HLA-A or HLA-B Bw4-80Ile alleles) showed increased HIV-1 acquisition risk (odds ratio [OR] = 3.46; 95% confidence interval [CI], 1.12-10.63; P = .04) and a trend for enrichment for subtype A and A-containing recombinants (78% vs. 46%; OR = 4.05; 95% CI, .91-28.30; P = .09) at the expense of subtype C (11% vs. 43%; OR = 0.17; 95% CI, .01-.97; P = .08). In vitro, only natural killer cells from KIR3DS1(+)/HLA-Bw4-80Ile(+) healthy donors showed a 2-fold increased capacity to inhibit replication of subtype C vs subtype A viruses (P = .01). These findings suggest the presence of an innate sieve effect and may inform HIV-1 vaccine development.

Predictive modelling: parents' decision making to use online child health information to increase their understanding and/or diagnose or treat their child's health.

BACKGROUND: The quantum increases in home Internet access and available online health information with limited control over information quality highlight the necessity of exploring decision making processes in accessing and using online information, specifically in relation to children who do not make their health decisions. The aim of this study was to understand the processes explaining parents' decisions to use online health information for child health care. METHODS: Parents (N = 391) completed an initial questionnaire assessing the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as perceived risk, group norm, and additional demographic factors. Two months later, 187 parents completed a follow-up questionnaire assessing their decisions to use online information for their child's health care, specifically to 1) diagnose and/or treat their child's suspected medical condition/illness and 2) increase understanding about a diagnosis or treatment recommended by a health professional. RESULTS: Hierarchical multiple regression showed that, for both behaviours, attitude, subjective norm, perceived behavioural control, (less) perceived risk, group norm, and (non) medical background were the significant predictors of intention. For parents' use of online child health information, for both behaviours, intention was the sole significant predictor of behaviour. The findings explain 77% of the variance in parents' intention to treat/diagnose a child health problem and 74% of the variance in their intentions to increase their understanding about child health concerns. CONCLUSIONS: Understanding parents' socio-cognitive processes that guide their use of online information for child health care is important given the increase in Internet usage and the sometimes-questionable quality of health information provided online. Findings highlight parents' thirst for information; there is an urgent need for health professionals to provide parents with evidence-based child health websites in addition to general population education on how to evaluate the quality of online health information.

Class I HLA-A*7401 is associated with protection from HIV-1 acquisition and disease progression in Mbeya, Tanzania.

Here we explore associations between HLA variation and human immunodeficiency virus type 1 (HIV-1) acquisition and disease progression in a community cohort in Mbeya, Tanzania, a region that, despite harboring high rates of HIV-1 infection, remains understudied. African-specific allele HLA-A*74:01 was associated with decreased risk of infection (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14-0.80; P = .011) and with protection from CD4(+) cell counts <200 cells/uL in women (OR, 0.31; 95% CI, 0.07-0.91; P = .032) and men (OR, 0.15; 95% CI, 0.01-0.78; P = .020). These associations remained significant after adjustment for linkage disequilibrium with HLA-B and HLA-C alleles. This observation calls for additional investigation of mechanisms by which HLA-A*74:01 may influence HIV-1 acquisition and control of the infection.

Paediatric fever management: continuing education for clinical nurses.

PURPOSE: This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. METHOD: Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. RESULTS: Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. CONCLUSIONS: Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

A psychosocial analysis of parents' decisions for limiting their young child's screen time: An examination of attitudes, social norms and roles, and control perceptions.

OBJECTIVES: Preschool-aged children spend substantial amounts of time engaged in screen-based activities. As parents have considerable control over their child's health behaviours during the younger years, it is important to understand those influences that guide parents' decisions about their child's screen time behaviours. DESIGN: A prospective design with two waves of data collection, 1 week apart, was adopted. METHODS: Parents (n = 207) completed a Theory of Planned Behaviour (TPB)-based questionnaire, with the addition of parental role construction (i.e., parents' expectations and beliefs of responsibility for their child's behaviour) and past behaviour. A number of underlying beliefs identified in a prior pilot study were also assessed. RESULTS: The model explained 77% (with past behaviour accounting for 5%) of the variance in intention and 50% (with past behaviour accounting for 3%) of the variance in parental decisions to limit child screen time. Attitude, subjective norms, perceived behavioural control, parental role construction, and past behaviour predicted intentions, and intentions and past behaviour predicted follow-up behaviour. Underlying screen time beliefs (e.g., increased parental distress, pressure from friends, inconvenience) were also identified as guiding parents' decisions. CONCLUSION: Results support the TPB and highlight the importance of beliefs for understanding parental decisions for children's screen time behaviours, as well as the addition of parental role construction. This formative research provides necessary depth of understanding of sedentary lifestyle behaviours in young children which can be adopted in future interventions to test the efficacy of the TPB mechanisms in changing parental behaviour for their child's health. STATEMENT OF CONTRIBUTION: What is already known on this subject? Identifying determinants of child screen time behaviour is vital to the health of young people. Social-cognitive and parental role constructions are key influences of parental decision-making. Little is known about the processes guiding parents' decisions to limit their child's screen time. What does this study add? Parental role construction and TPB social-cognitive factors influence parental decisions. The beliefs of parents for their child's behaviour were identified. A range of beliefs guide parents' decisions for their child's screen time viewing.

Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia.

The purpose of this study was to examine attitudinal barriers to effective pain management in a consecutively recruited cohort of 114 cancer patients from four Australian hospitals. When surveyed, 48% of this sample reported experiencing pain within the previous 24 hours. Of these, 56% reported this pain to be "distressing, horrible or excruciating," with large proportions indicating that this pain had affected their movement, sleep and emotional well-being. Three factors were identified as potentially impacting on patients' responses to pain-poor levels of patient knowledge about pain, low perceived control over pain, and a deficit in communication about pain. A trend for older patients to experience more severe pain was also identified. These older patients reported being more willing to tolerate pain and perceive less control over their pain. Suggestions are made for developing patient education programs and further research using concepts drawn from broader social and behavioral models.

Sustaining the edge: factors influencing strategy selection in academic health centers.

Competition within the acute care sector as well as increased penetration by managed care organizations has influenced the structure and role of academic health centers during the past decade. The market factors confronting academic health centers are not dissimilar from conditions that confront other organizations competing in mature industries characterized by declining profitability and intense rivalry for market share. When confronted with intense competition or adverse external events, organizations in other industries have responded to potential threats by forming alliances, developing joint ventures, or merging with another firm to maintain their competitive advantage. Although mergers and acquisitions dominated the strategic landscape in the healthcare industry during the past decade, recent evidence suggests that other types of strategic ventures may offer similar economic and contracting benefits to member organizations. Academic health centers have traditionally been involved in network relationships with multiple partners via their shared technology, collaborative research, and joint educational endeavors. These quasi-organizational relationships appear to have provided a framework for strategic decisions and allowed executives of academic health centers to select strategies that were competitive yet closely aligned with their organizational mission. The analysis of factors that influenced strategy selection by executives of academic health centers suggests a deliberate and methodical approach to achieving market share objectives, expanding managed care contracts, and developing physician networks.

Fever management audit: Australian nurses' antipyretic usage.

Do nurses manage fevers of children hospitalized for a febrile illness ritualistically or rationally? Nurses recorded temperatures more frequently during the first 8 hours in the ward with a mean frequency of 13.36 (SD = 4.76, range 5 to 24) during the first 24 hours following admission. In the majority of cases, there was a strong second hourly pattern of temperature monitoring according to the time of day (e.g., 0600 hr, 0800 hrs, 1000 hr). Seventy-six percent (51) of the children received at least one antipyretic. The mean temperature when antipyretics were administered was 38.34 degrees C (SD = 1.02, range 35.9 degrees C to 40.8 degrees C). The highest antipyretic administration occurred during the daytime, and the highest temperature recording occurred during the nighttime. Antipyretic administration and mean temperatures generally followed a similar pattern, except at 0800 and 1600 hours when antipyretic administration was high and mean temperatures low. This study revealed a need to further investigate the knowledge, attitudes, and decision-making criteria of nurses toward fever management.

High-throughput high-resolution class I HLA genotyping in East Africa.

HLA, the most genetically diverse loci in the human genome, play a crucial role in host-pathogen interaction by mediating innate and adaptive cellular immune responses. A vast number of infectious diseases affect East Africa, including HIV/AIDS, malaria, and tuberculosis, but the HLA genetic diversity in this region remains incompletely described. This is a major obstacle for the design and evaluation of preventive vaccines. Available HLA typing techniques, that provide the 4-digit level resolution needed to interpret immune responses, lack sufficient throughput for large immunoepidemiological studies. Here we present a novel HLA typing assay bridging the gap between high resolution and high throughput. The assay is based on real-time PCR using sequence-specific primers (SSP) and can genotype carriers of the 49 most common East African class I HLA-A, -B, and -C alleles, at the 4-digit level. Using a validation panel of 175 samples from Kampala, Uganda, previously defined by sequence-based typing, the new assay performed with 100% sensitivity and specificity. The assay was also implemented to define the HLA genetic complexity of a previously uncharacterized Tanzanian population, demonstrating its inclusion in the major East African genetic cluster. The availability of genotyping tools with this capacity will be extremely useful in the identification of correlates of immune protection and the evaluation of candidate vaccine efficacy.

Fever management: paediatric nurses' knowledge, attitudes and influencing factors.

AIMS: This paper describes Australian paediatric nurses' knowledge of and attitudes toward fever and its management and the predictors of their intentions to administer paracetamol to a febrile child. BACKGROUND: Despite evidence-based support for the beneficial effects of fever over the past three decades, health professionals' negative attitudes toward fever and their reliance on antipyretics to reduce it have persisted and continue to be reported in the literature. METHODS: A self-report questionnaire was used. An instrument was developed, piloted by test-retest and revised prior to data collection. Fifty-one paediatric nurses working in medical wards of a metropolitan paediatric hospital in Australia participated. RESULTS: Nurses' mean knowledge score about the physiology of fever, general fever management and antipyretics was 62%, which was not as high as expected. Participants reported positive attitudes toward the benefits of fever, the necessity for its reduction in children with pre-existing cardiac or respiratory conditions and towards regular antipyretic administration masking the infective process. Negative attitudes included disbelief that temperature is often unrelated to illness severity. Conflicting attitudes toward febrile convulsions were highlighted by beliefs that antipyretic therapy prevents these and that antipyretics do not prevent initial febrile convulsions. Predictors of intentions to administer paracetamol were beliefs about the effectiveness of paracetamol and nurses' beliefs about the expectations of others in relation to paracetamol administration. Nurses reported strong intentions to administer paracetamol to the next febrile child they cared for. Limitations of the study include the use of a nurse manager for recruitment and collecting the data at only one site. CONCLUSIONS: Fever management is an integral aspect of paediatric nursing. For its consistent rational management, nurses must have appropriate knowledge and positive attitudes. This highlights the need for continuing education in fever management.

School-based youth health nurses: roles, responsibilities, challenges, and rewards.

A case study and focus-group discussions were conducted with 10 youth health nurses (nurses) employed in the recently introduced School-Based Youth Health Nurse Program (SBYHNP) to identify their roles, responsibilities, and professional development needs. Major roles are support, referral, health promotion, and marketing. Clients include high school students, teachers, and parents; the majority of whom are female and aged 13-16 years. Health issues addressed during individual consultations are predominantly psychosocial but also include medical, sexual health and sexuality issues, health surveillance, and risk-taking behaviors. Nurses also provide clients with health information and promote enhanced personal skill development during these consultations. Health promotion strategies undertaken by nurses were predominantly health education and health information displays. Nurses reported marketing their role and function within the school to be an essential and often difficult aspect of their role. Professional development through the SBYHNP was excellent; however, there was concern relating to the availability of future educational opportunities. The SBYHNP provides nurses with a new, challenging, autonomous role within the school environment and the opportunity to expand their role to incorporate all aspects of the health-promoting schools' framework.