The influence of care home managers on the implementation of a complex intervention: findings from the process evaluation of a randomised controlled trial of dementia care mapping.

BACKGROUND: Many people with dementia live in care homes, where staff can struggle to meet their complex needs. Successful practice improvement interventions in these settings require strong managerial support, but little is known about how managers can support implementation in practice, or what factors support or hinder care home managers in providing this support. Using Dementia Care Mapping™ (DCM) as an example, this study explored how care home managers can support the implementation of complex interventions, and identified factors affecting their ability to provide this support. METHODS: We undertook interviews with 48 staff members (managers and intervention leads) from care homes participating in the intervention arm of the DCM EPIC trial of DCM implementation. RESULTS: Managerial support played a key role in facilitating the implementation of a complex intervention in care home settings. Managers could provide practical and financial support in many forms. However, managerial support and leadership approaches towards implementation were highly variable in practice, and implementation was easily de-stabilised by management changes or competing managerial priorities. How well managers understood, valued and engaged with the intervention, alongside the leadership style they adopted to support implementation, were key influences on implementation success. CONCLUSIONS: For care home managers to effectively support interventions they must fully understand the proposed intervention and its potential value. This is especially important during times of managerial or practice changes, when managers lack the skills required to effectively support implementation, or when the intervention is complex. It may be unfeasible to successfully implement new interventions during times of managerial or practice instability. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82288852 , registered 16/01/2014.

Dental Professionals' Engagement in Tobacco, Electronic Cigarette, and Cannabis Patient Counseling.

OBJECTIVES: California features low smoking prevalence, cautionary electronic cigarette (e-cigarette) public messaging, and legal recreational cannabis: a unique landscape for dental professionals to navigate tobacco cessation promotion. This cross-sectional study assessed California dental professionals' self-reported tobacco patient counseling behaviors and the correlates of providing such assistance. METHODS: Statewide surveys of dental hygienists (n = 701) and dentists (n = 725) were distributed electronically. The dentist survey was weighted for sampling and nonresponse. Prevalence of asking patients about use was compared for cigarette and noncigarette products (e.g., e-cigarettes, cannabis). Multivariable models identified independent correlates of providing cessation assistance to tobacco-using patients. RESULTS: Respondents reported frequently (often/always) documenting patient tobacco use (hygienists: 80%; dentists: 73%) but less commonly provided forms of assistance (hygienists: 27%-49%; dentists: 10%-31%). Most respondents asked patients about cigarette smoking, but noncigarette product use (cigar, hookah, pipe, e-cigarette, or cannabis) was not commonly assessed. Greater confidence and willingness to assist were positively associated with providing assistance in multivariable models, but perceived barriers (e.g., lack of time and remuneration) were not. Results were robust to model specifications. CONCLUSIONS: California dental professionals often ask about smoking but lag in providing cessation assistance and inquiring about noncigarette products. Successful efforts to encourage dental professionals' engagement in tobacco prevention and cessation must enhance providers' self-efficacy and motivation and likely will require system and organizational change. KNOWLEDGE TRANSFER STATEMENT: Study findings identify substantial gaps in dental professionals' engagement in patient tobacco cessation. The results identify correlates of providing assistance and of dental professionals' willingness and confidence to do so, which could serve to inform interventions to support and enhance engagement.

The structure and function of folliculo-stellate cells in the anterior pituitary gland.

The folliculo-stellate cells (FS cells) in the anterior pituitary gland are characterized by their star-like appearance and their ability to form follicles. Although FS cells do not produce any pituitary hormones, their special tendency to surrounding endocrine cells with their long cytoplasmic processes suggests that they regulate endocrine cells by intercellular communication. In spite of many morphological and cytophysiological studies recently performed, a precise understanding of the major functions of FS cells in the pituitary gland remains obscure. We review here the morphological characteristics of FS cells and their suspected functions in the anterior pituitary gland. It is well established that the FS cell produces many kinds of growth factors, i.e., fibroblast growth factor, vascular endothelial cell growth factor and interleukin 6. The biological significances of these growth factors in the anterior pituitary gland are also discussed in this paper. The origin and differentiation of FS cells, especially the possibility that the FS cell is a kind of stem cell which has the potential to differentiate into endocrine cells, is also presented.

Histochemical study of follicles in the senescent porcine pituitary gland.

Follicles displaying a positive periodic acid-Schiff reaction to a colloid substance in the anterior pituitary gland have been observed in many vertebrates, including humans. It is also known that these follicles greatly increase in number and size with age. We therefore performed histochemical analysis of these colloid follicles in the senescent porcine pituitary gland in order to clarify their nature and biological significance. Results from various histological stains suggest that the colloid contains some polysaccharides or glycoproteins. In addition to the histological stains, lectin histochemistry revealed that the colloid contains sialic acid, N-acetyl galactosamine and galactose. Also, lectin staining indicated that some glycoproteins, most likely Asn-linked sialoglycoproteins, are localized in the colloid. The cells (FS cells) surrounding the colloid were densely stained with an antibody to S-100 protein but were not stained with antibodies to any other anterior pituitary hormones. Frequently mammotrophs (PRL cells), and occasionally gonadotrophs (LH cells) were found closely associated with folliculo-stellate cells (FS cells which lay next to the large colloid containing follicles. This suggests that not only are the FS cells important in the production of the colloids, but the adjacent LH and PRL cells in some way also contribute to their formation.

Regional Differences in Methyl Farnesoate Production by the Lobster Mandibular Organ.

Visual examination of the mandibular organ (MO) from the lobster, Homarus americanus, disclosed two distinct morphological regions: a fan-folded region along one edge of the gland, and a smooth, unfolded region comprising the rest of the gland. Because MOs produce methyl farnesoate (MF), the MF content of both regions was measured. In freshly dissected glands, more than 95% of the MF was found in the fan-folded region of the gland. In MO sections incubated with [3H-methyl]methionine (a radiolabeled precursor of MF), more than 90% of MF synthesis was found in the fan-folded region. Eyestalk ablation, a procedure that increases MO activity, caused the MF content of MOs to increase more than 130-fold, but had little effect on the regional distribution of MF. Histological observations indicated that these two regions had different cellular compositions. The fan-folded region contained two cell types (A and B). The A cells were mitotically active and appeared to be undifferentiated. The B cells contained a large number of small vacuoles. The unfolded region was largely composed of a third cell type (C). The C cells were large and morphologically complex, containing many mitochondria and large vacuolar-like structures. They contained relatively few small vacuoles. On the basis of appearance and location, B cells appear to be the likely site of MF synthesis. The physiological importance of C cells is unknown.

Affinity fractionation and characterization of chick brain synaptosomes.

Chick brain synaptosomes were fractionated by affinity chromatography on concanavalin A-Sepharose. Three subfractions were obtained. One, designated UBF, was not bound to the affinity adsorbent and represented 36% of the total synaptosomal protein treated with the beads. A second fraction, designated BF1, adhered to concanavalin A-Sepharose exclusively through its carbohydrate recognition site. The third fraction, called BF2, bound to the beads through hydrophobic interactions and represented about 20% of the total synaptosomal protein. About 20% of the total synaptosomal protein was found to be retarded on three ligand-less gels, with potential for only hydrophobic interactions. This binding can be reversed, however, by ethylene glycol, a result indicating hydrophobic binding sites on the synaptosomes. Enzyme marker studies and electron microscopy showed differences between UBF, BF1, and BF2, mainly with respect to mitochondrial contamination. Binding studies with [3H]-Con A show the absence of Con A-specific carbohydrates from the surface of UBF or BF2. As expected strong and specific binding between [3H]-Con A and [3H] BF1 was observed. These findings are discussed in relation to a model for the interior working of the synaptosomes.

Optimal fixation of chick synaptosomes using different osmotic pressures.

Chick synaptosomes were found to remain intact following fixation in the presence of 0.2 M sucrose or 0.3 M sucrose. Increasing the sucrose concentration up to 0.4 M significantly decreased the number of intact synaptosomes; however, typical intrasynaptosomal organelles such as synaptic vesicles and mitochondria were visible in all preparations. This work suggests possibly important species differences in synaptosomal structure between chick and rat synaptosomes.

Effect of centrifugation and microagglutination techniques on Brucella agglutinin titers.

The microagglutination technique without centrifugation was more effective than centrifugation of the standard tube test for increasing Brucella agglutinin titers of specimens with a titer greater than or equal to 160 but was less effective than centrifugation of the standard tube test for specimens with a titer less than 160.

Control of lower-esophageal-sphincter contractile activity by motilin in conscious dogs.

The effect of synthetic motilin on contractile activity in the lower esophageal sphincter (LES) and the stomach has been studied in 5 healthy dogs by means of chronically implanted strain gage force transducers. Motilin produced strong contractions in the LES and the stomach simultaneously after intravenous doses ranging from 0.3 to 2.7 microgram/kg hr, which were similar to the naturally occurring interdigestive contractions in the LES and the stomach. However, these contractions could be induced only in the interdigestive state; infusion of motilin into dogs in the digestive state brought about no significant effect on either the LES or the stomach. Motilin-induced contractions in the LES and the stomach were instantly abolished by ingestion of food. It is considered that the contractions induced by motilin are identical with the naturally occurring interdigestive contractions in the LES and these contractions are the most orad component of the interdigestive cyclic recurring caudad-moving bands of strong contractions in the dogs.

Inhibitory effect of pentagastrin and feeding natural and motilin-induced interdigestive contractions in the stomach of conscious dogs.

The interaction between motilin, pentagastrin and feeding was investigated during the interdigestive gastric motor state in 4 healthy conscious dogs. We confirmed previous reports that an i.v. infusion of synthetic motilin always induced a pattern precisely like that of the naturally-occurring interdigestive contractions of the stomach. Pentagastrin inhibited the occurrence of the interdigestive contractions at dose between 0.2-1.6 microgram/kg-hr; this inhibition had a dose-related relationship to the occurrence of the motilin-induced contractions. The ingestion of food strongly inhibited the occurrence of not only the natually-occurring contractions but also the motilin-induced contractions in the stomach and changed the motor pattern to the digestive one. These findings strongly support our hypothesis that the interdigestive contractions in the dog are, at least in part, under the control of motilin. Furthermore, it should be emphasized that pentagastrin not always stimulates gastric motor activity but conversely, in the interdigestive state it inhibits movements characteristic of that condition and replaces them with the digestive pattern.

Motilin-induced mechanical activity in the canine alimentary tract.

Gastrointestinal contractile activity from the lower esophageal sphincter to the terminal ileum in the conscious dogs was continuously recorded on a multi-channel polygraph for several weeks by means of chronically implanted strain gage force transducers. It was found that the 24-hour gastrointestinal motor activity consisted of the two different major patterns; the digestive and interdigestive patterns. The interdigestive motor activity was characterized by a cyclic recurring, caudad-moving band of strong contractions interrupted by long lasting motor quiescence. When one band of strong contractions reached the distal ileum, another developed in the LES, stomach and duodenum again and propagated in a caudad-direction. Such recycling episodes repeatedly occurred until the next meal. After ingestion of food, gastrointestinal motor activity was continous and such characteristic interdigestive patterns were not observed. Synthetic motilin, 0.1-2.7 mug/kg/hr, was assayed for its motor stimulating activity in the both states. In the digestive state, an i.v. infusion of motlin had no influence upon the motor activity even if the dose was increased up to 6.0 mug/kg/hr. On the other hand, when motilin was infused during the interdigestive state, it induced a pattern precisely like the naturally-occurring interdigestive contractions. Not only the naturally-occurring contractions but also motilin-induced contractions were strongly inhibited by the ingestion of food or an i.v. infusion of pentagastrin (0.2-1.8 mug/kg/hr). Duodenal acidification (0.1 N HC1, 3-16 ml/kg/hr) in the interdigestive state disturbed or inhibited the regular cycle of the natural contractions but was counteracted by exogenous i.v. infusion of motilin. These findings strongly suggest the view that the interdigestive gastrointestinal motor activity is at least in part regulated by circulating motilin concentration in the blood, however, its cyclic recurring, caudad propagating mechanism may be controlled in part by the nervous system. Motilin is the only substance known to be active during the interdigestive state and therefore may be called the interdigestive hormone.

Comparative studies on synaptosomes: Applicability of the rapid method for preparing synaptosomes to elasmobranch brain.

A flotation technique for the rapid preparation of synaptosomes, originally developed for invertebrate nervous tissue, has now been successfully applied to that of an elasmobranch fish (Mustelis canis, dogfish). The technique involves submitting the supernatant, obtained after a homogenate has been centrifuged at low speed to remove nuclei and tissue debris to centrifugal fields of intermediate intensity (10(6) g/min), appears to separate well-sealed synaptosomes from those less well sealed as judged by the criteria of osmotic shrinkage, enzyme occlusion, and choline uptake. The sealed synaptosomes do not equilibrate with the 0.8 M sucrose used as the homogenization medium and rise to form a coherent pellicle at the top of the tube. Due to the short (1-1/1/2 hr) preparation time, such synaptosomes may well prove useful in further metabolic studies.

Filamentous structures of type 2 Herpesvirus hominis infection of the chorioallantoic membrane.

In view of recent recognition of the existence of two Herpesvirus hominis (HVH) types with antigenic and biological differences, an electron microscopic study was undertaken of pocks produced on the choriallantoic membrane of embryonated eggs after infection with type 1 and type 2 HVH strains. Besides the typical morphological features of herpesvirus infection noted by several investigators, it was observed that type 2 HVH also produced microtubules measuring approximately 19 nm in both nucleus and cytoplasm. Although the nature of these filamentous structures is still unclear, consideration is given in this paper to the possibility that they may represent viral structural subunits, aberrant forms or neoantigens.