Parent and adolescent communication with healthcare professionals about Type 1 diabetes management at adolescents' outpatient clinic appointments.

AIM: This study aimed to identify the ways in which adolescents living with Type 1 diabetes and their parents communicate about Type 1 diabetes management with healthcare professionals in a clinical setting. METHODS: Twenty-nine adolescents (aged 11-17 years) and their parents were purposively recruited from two outpatient clinics for non-participant observations. Outpatient clinic appointments, which consisted of multiple consultations with healthcare professionals, were observed and audio-recorded. Outpatient clinic appointments were categorized based on the nature and extent of communication by the adolescent and their parent(s) in relation to Type 1 diabetes management activities. RESULTS: Data from 29 outpatient clinic appointments, consisting of a total of 68 observed consultations, were analysed and a continuum consisting of three patterns of communication was identified (parent-led, collaborative and adolescent-led). Healthcare professionals should attend to the nature and extent of communication by adolescents and their parents in relation to Type 1 diabetes management activities because parent and adolescent engagement in communication during clinic appointments may also reflect their degree of involvement in daily Type 1 diabetes management. CONCLUSIONS: This continuum provides a framework for healthcare professionals to use to identify communication patterns in consultations which in turn may allow healthcare professionals to encourage more effective communication about Type 1 diabetes management from adolescents and their parents in clinic consultations. This may have a positive impact on the sharing of Type 1 diabetes management responsibilities and adolescents' developing self-management skills as roles change during this developmental period.

Experience of skin disease and relationships with healthcare providers: a qualitative study of Traveller women in Ireland.

BACKGROUND: Significant health disparities exist between members of the Travelling community and those of the general population. Barriers to Traveller engagement with health services include the experience or perception of discrimination, and cultural and health literacy barriers. Experience of skin disease and interactions with healthcare providers has not been widely explored in this ethnic minority. The formation of positive relationships between the Travelling community and healthcare providers is important in the promotion of treatment adherence and improving health outcomes. OBJECTIVES: To investigate Travellers' experience of skin disease and their relationships with healthcare providers. METHODS: Focus groups were conducted with a purposive sample of female members of the Irish Travelling community with experience of skin health issues, between January 2018 and April 2018. Three focus groups were conducted at three separate locations with 10 participants in each group. Themes were identified from the focus group transcripts using an inductive thematic analysis framework. RESULTS: Emergent themes surrounding relationships between Travellers and healthcare providers included health literacy, discrimination, information inconsistency, trust and communication. Factors that were valued in the creation of positive relationships included an appreciation of varying degrees of health literacy, the provision of sufficient information tailored to an individual's needs and a demonstration of cultural competence. CONCLUSIONS: Dermatologists are well placed to provide practical, customized, treatment guidance and engage patients while integrating their culturally based beliefs.

A review of bed utilisation in the west of Ireland.

To ensure efficient use of Irish acute hospitals, the study aimed to assess the appropriateness of admission and days of care. The Appropriateness Evaluation Protocol (AEP) was applied to a stratified random sample of 286 medical and surgical, elective and non-elective patients from four acute hospitals in the west of Ireland. A total of 23 patients (8%) were inappropriately admitted. Of these 15 (65%) could have been avoided. Of the 34 elective/booked admissions, seven (21%) were inappropriate in terms of location of surgery criteria. Over three quarters of elective patients (77%) were admitted one or more days prior to surgery which was not justified for 13 (57%) of these patients. Over a quarter of days of care (n = 73, 26%) were inappropriate. Evidence of discharge planning was found for 48% of patients. The study provides a benchmark to monitor progress. Existing policies and programmes should be implemented and monitored.

Social spaces for young children in hospital.

BACKGROUND: In the last number of years heightened interest has been attributed to the impact of hospital environments on children's psychosocial well-being. With policy largely built around adult assumptions, knowledge about what constitutes a child-friendly hospital environment from young children's perspectives has been lacking. If hospital environments are to aspire to being child friendly then the views of younger aged children must be taken into account. The current study investigated young children's perspectives of hospital social spaces to inform the design of the built environment of a new children's hospital. METHODS: An exploratory qualitative participatory design was employed. Data were collected through semi-structured interviews (one-to-one and group workshops) which incorporated art-based activities to actively engage young children. Fifty-five young children aged 5 to 8 years with various acute and chronic illnesses were recruited from inpatient, outpatient and emergency departments of three children's hospitals. RESULTS: Young children want a diversity of readily available, independently accessible, age, gender and developmentally appropriate leisure and entertainment facilities seamlessly integrated throughout the hospital environment. Such activities were invaluable for creating a positive hospital experience for children by combating boredom, enriching choice and control and reducing a sense of isolation through enhanced socialization. When in hospital, young children want to feel socially connected to the internal hospital community as well as to the outside world. Technology can assist to broaden the spectrum of children's social connectivity when in hospital - to home, school and the wider outside world. CONCLUSION: While technology offers many opportunities to support children's psychosocial well-being when in confined healthcare spaces, the implementation and operation of such services and systems require much further research in the areas of ethics, facilitation, organizational impact and evaluation.

Review of acute cancer beds.

A review of admissions to cancer services at University Hospital Galway (UHG) was undertaken to assess the appropriateness of hospital usage. All cancer specialty patients admitted from 26-28 May 2009 were reviewed (n = 82). Chi square tests, Exact tests, and One-way ANOVA were utilised to analyse key issues emerging from the data. Fifty (61%) were classified as emergencies. Twenty three (67%) occupied a designated cancer bed with 24 (30%) in outlying non-oncology wards. The mean length of stay was 29.3 days. Possible alternatives to admission were identified for 15 (19%) patients. There was no evidence of discharge planning for 50 (60%) admissions. There is considerable potential to make more appropriate utilisation of UHG for cancer patients, particularly in terms of reducing bed days and length of stay and the proportion of emergency cancer admissions, and further developing integrated systems of discharge planning.

Childhood obesity: the extent of the problem among 6-year-old Irish national school children.

BACKGROUND: Childhood obesity is rapidly increasing worldwide. In Ireland, the number of overweight children has trebled over the last decade. The study aimed to provide an assessment of the prevalence of obesity of 6-year-old children in one region of Ireland. METHODS: Following training, School Public Health Nurses included the measurement of height and weight as part of the annual 'senior infants' school health check for 5453 6-year-old children in 189 schools between 2004 and 2007. Body mass index (BMI) was calculated using the International Obesity Taskforce cut-off points using lmsGrowth (a Microsoft Excel add-in), which uses a child's exact age. Kendall's Tau b was used to determine the reliability of measurements. Prevalence trends were tested using multinomial logistic regression. Pearson's chi-squared test was utilized to assess the statistical significance of differences in BMI by gender, school year, and to compare with similar other Irish studies. RESULTS: Out of the 5453 children measured, 3493 were aged 6 years old. A further 11 were excluded because of incomplete data. Data were analysed for 3482 6-year-old children. Overall, 27% of 6-year-olds were classified as either overweight or obese. A significantly greater proportion of girls are overweight or obese compared with boys (31% compared with 23%). Gender differences have remained relatively stable from 2004-2007. Overall, there have been no significant changes in the level of obesity from 2004-2007. In addition, when comparing with other Irish studies that collected data for 2001/2, there are no significant differences in obesity levels. CONCLUSIONS: There is a clear need to urgently prioritize the effective management of obesity. Resourses should now be targeted towards ensuring government policies in Ireland and elsewhere are implemented.

Analysis of lymphocyte aggregation using digital image analysis.

We present the development and testing of a novel assay of lymphocyte adhesion based on time-resolved morphological measurements of intercellular aggregation. Homotypic lymphocyte aggregation is induced according to various protocols and monitored for several hours using video microscopy and time-lapse recording. Digital images of the aggregating cell population are acquired and analyzed to obtain the size distribution and the shape of cell aggregates. By following the temporal evolution of the size distribution of aggregates, the rates of aggregation events can be accurately quantified and compared. In addition, an analysis of the two- and three-dimensional structures of the aggregates using appropriately defined shape factors allows comparisons of mechanical binding strengths and cytoskeletal activity. To demonstrate the capabilities of the assay, we present results from a series of aggregation experiments with Jurkat cells treated with 33B6, 19H8, IC9, and 20E4 monoclonal antibodies. These monoclonal antibodies bind to various epitopes of known adhesion molecules and induce aggregation phenomena that proceed at different rates. Our results show that the assay has small repeatability error and is sensitive enough to compare aggregation events induced through distinct molecular epitopes. Used in conjunction with current biochemical detection assays and adhesion pathway modulation experiments, the developed assay will facilitate the study of cellular adhesion and aggregation mechanisms.

Large-scale production of mammalian cells and their products: engineering principles and barriers to scale-up.

Mammalian cell products have great medical and clinical importance, but to date, production methods employed to manufacture these products on a large scale are not as cost efficient as they could be. The implementation of process control would greatly improve the productivity of these products. Recently developed methods to produce cells on a large scale, such as microcarriers, artificial capillaries, tubular spiral film, and microencapsulation must be optimized, and the problem of oxygen transfer limitation must be solved. The accumulation of potentially toxic waste products can inhibit growth and reduce productivity. This effect can be reduced by either adjusting the environmental parameters of a fed-batch culture, so that the cell's metabolism is shifted away from producing these compounds, or by continually perfusing medium through the culture. If these technical barriers can be overcome, the cost of producing products derived from mammalian cells can be greatly reduced.

Diagnosed with Hepatitis C: a descriptive exploratory study.

A descriptive exploratory study was carried out to elicit the felt-experience of Hepatitis C infection. A non-probability sampling strategy was employed which generated a sample of nine participants for in-depth interview. Data analysis revealed that the diagnosis had precipitated a transition in the participants' lives. Factors were identified that served as barriers and facilitators to their transition experience. At the time of data collection all of the participants were not experiencing indicators of a healthy transition. It was evident that the transitional experience was neither time-bound nor linear in nature.

The effects of adverse growth conditions on the shedding of carcinoembryonic antigen from cultured LS180 colon cancer cells.

The synthesis and release of the tumor marker carcinoembryonic antigen (CEA) from the colon cancer cell line LS180 has previously been reported to be enhanced during the later stages of in vitro culture after growth has stopped. It has been suggested that CEA expression was inversely related to the growth rate for these cells (Kahan, B.D.; Rutzky, L.P.; Legrue, S.J.; Tom, B.H. Methods Cancer Res. 18:197-275; 1979 and Shi, Z.R.; Tsao, D.; Kim, Y.S. Cancer Res. 43:4045-4049; 1983). Our studies indicate, however, that while certain environmental perturbations that halt growth (e.g., glucose starvation and elevated temperatures) do indeed stimulate CEA expression and release; other growth-arresting conditions, such as oxygen starvation, have no effect. Replacement of spent or conditioned medium with fresh medium during the later culture stages resulted in a 10-fold decrease in CEA release, indicating that either depleted nutrients or accumulating cellular products (such as lactate or ammonium) trigger enhanced CEA production.

Mathematical descriptions of hybridoma culture kinetics: I. Initial metabolic rates.

The lack of quantitative descriptions of mammalian culture kinetics limits the ability to optimally design and control cell culture bioreactors. This limitation is ad dressed by developing mathematical equations relating the initial growth rate and the antibody productivity of the hybridoma cell line, CRL-1606, to its environmental state. This initial rate approach, in contrast with steady state analysis of chemostat cultures, approximates steady state behavior, since the rates were measured over brief time intervals and at low cell concentrations (< 50,000 cells/mL). The advantage of this approach is that it is much faster than the chemostat approach.An equation for the growth rate was developed that superimposed Monod equations in serum and glutamine with "noncompetitive" -type inhibition constants were inversely proportional to the lactate and ammonium concentrations. The Monod constant is critical for relating initial, low cell level culture states to other states.Lactate was found to be the only environmental parameter that significantly inhibited antifibronectin monoclonal antibody production by the CRL-1606 hybridomas. Volumetric productivity was strictly related to culture viability, which was observed to decline at growth rates below 0.02 h(-1). Lactate was also found to significantly inhibit ammonium production.

Reduction of waste product excretion via nutrient control: Possible strategies for maximizing product and cell yields on serum in cultures of mammalian cells.

Mammalian cells grown in culture excrete lactic acid and ammonium ions in quantities that may limit growth and reduce product synthesis. Frequent replenishment of the culture medium is often necessary to prevent waste product accumulation which could inhibit cell growth. Since increased medium replenishment results in increased usage of animal serum, the most expensive raw material, excessive production of waste products lowers the cell and product yield on serum, and hence increases production costs. Strategies for reducing the production of lactic acid and ammonium bymammalian cells via controlled addition of glucose and glutamine will be demonstrated. Mathematical relations coupling ammonium and glutamine kinetics will be described. Additionally, a method for automatic on-line estimation of the cell concentration was developed. This method involves calculating the ATP production rate from the oxygen uptake rate and the lactic acid production rate. Automatic online estimation of the cell concentration is critical if nutrient levels in large-scale mammaliancell cultures are to be accurately maintained via process control.

Mathematical descriptions of hybridoma culture kinetics: II. The relationship between thiol chemistry and the degradation of serum activity.

The growth rate of the hybridoma cell line ATCC-CRL-1606 in low serum medium declines rapidly with time after inoculation. To characterize this phenomenon, the stability of the growth-promoting activity of serum was investigated. The activity of serum was found to de grade with time, and was stabilized by alterations in the medium formulation that acted to lower the oxidation/reduction potential. This included both the addition of thiols and the elimination of disulfides from the medium. Additionally, cysteine and other thiols were shown to stimulate growth in low serum, low cell density cultures, suggesting that thiols may be rate-limiting in low serum medium. Stimulation of growth by thiol addition was less significant at high cell levels, implying that the cells themselves may be acting to reduce their environment. A hypothesis is presented based on these results which suggests that the actual rate-limiting moieties in low serum cultures may be dithiols.

Providers and reviewers teach informed managed care.

Two utilization review case studies are summarized, with discussion of both the provider's and the reviewer's perspective. This interface between managed care organizations and behavioral health care professionals offers some instructive guidelines on how to best approach the utilization review process.

The role of physical forces on cytotoxic T cell-target cell conjugate stability.

Theoretical considerations suggest that external forces play a significant role in cell-cell conjugate formation and may lead to the misinterpretation of adhesion data. To test this, the stability of conjugates formed between CTL and fibroblast target cells (TC) was examined in the controlled shear environment of a parallel plate flow chamber. Murine fibroblast targets expressing class I maternally transmitted Ag Mtaa or Mtab were grown on a glass slide that formed one wall of the flow chamber and were used in conjunction with anti-Mtaa and anti-Mtab specific mouse CTL clones to establish a panel of Ag-reciprocal targets and lymphocytes. Although cytolysis assays indicated that lymphocytes recognized and destroyed appropriate but not inappropriate targets, the stability of some CTL/TC conjugates was Ag independent. In all cases, the conjugate stability was shear dependent over a 100-fold range (0.04 to 4.0 dynes/cm2). For some clones, the ratio of the stabilities of Ag-specific CTL/TC conjugates to nonspecific conjugates was significantly enhanced with increasing shear. This implies that the role of Ag specificity in CTL/TC adhesion may be misinterpreted if the shear environment of CTL/TC conjugates is unknown or uncontrolled. Kinetic analysis revealed that conjugate stability was dependent on the exposure time to external forces and that there existed two populations of conjugates; weak associations that disengaged within the first 30 s of flow, and strong associations that remained attached even after a 5-min exposure to a steady shear stress. The stability of Ag-specific CTL/TC conjugates at 0.04 dynes/cm2 was enhanced by 50% as the temperature was increased from 25 to 37 degrees C, whereas the stability of nonspecific CTL/TC associations was not affected. This result indicates that significant Ag-specific strengthening may occur at physiologic temperatures. This work suggests the importance of attention to role of fluid mechanical shear stress in standard adhesion assays.