Clinical research coordinators' role in knowledge translation activities in rehabilitation: a mixed methods study.

BACKGROUND: Clinical research coordinators (CRCs) facilitate the interaction between researchers and knowledge users in rehabilitation centres to promote and sustain evidence-informed practices. Despite their presence in rehabilitation settings in Quebec for over 20 years, little is known about their profiles and knowledge translation (KT) activities nor how they can best enact their role. This study explored CRCs' roles and perspectives on the barriers, enablers, and strategies for improving KT activities in rehabilitation settings. METHODS: We conducted a multi-centre, participatory sequential mixed methods study. In the descriptive quantitative phase, we collected data via an online survey to determine CRCs' role in research and KT. In the subsequent qualitative phase, we conducted an in-person focus group to elicit CRCs' perspectives regarding factors influencing their work in KT, and potential solutions for overcoming these challenges. We used a descriptive and an inductive content analysis approach for the data analysis. The data synthesis was inspired by the Promoting Action on Research Implementation in Health Services framework. RESULTS: All nine CRCs from five partner health regions of a large rehabilitation research centre agreed to participate in the study. The data suggest that CRCs are like knowledge brokers and boundary spanners. As information managers, linkage agents and facilitators, CRCs play a pivot role in diffusion, dissemination, synthesis and tailoring of knowledge to improve evidence informed practices and quality of care in rehabilitation. The factors influencing CRCs' KT activities are mostly linked to the context such as the receptivity of the organization as well as the lack of time and resources, and limited understanding of their roles by stakeholders. Two main suggestions made to enhance CRCs' contribution to KT activities include the harmonisation of expectations between the large research centre and their partner health regions, and better promotion of their role to clinical and research teams. CONCLUSIONS: This study provides valuable insights into the scope of CRCs' role. The results shed light on the challenges that they face and potential solutions to overcome them. The knowledge generated in this study can be used to implement this role with similar duties in rehabilitation settings or other health care domains.

Dynamical behavior analysis of the heart system by the bifurcation structures.

The functioning of the heart rhythm can exhibit a wide variety of dynamic behaviours under certain conditions. In the case of rhythm disorders or cardiac arrhythmias, the natural rhythm of the heart is usually involved in the sinoatrial node, the atrioventricular node, the atria of the carotid sinus, etc. The study of heart related disorders requires an important analysis of its rhythm because the regularity of cardiac activity is conditioned by a large number of factors. The cardiac system is made up of a combination of nodes ranging from the sinus node, the atrioventricular node to its Purkinje bundles, which interact with each other via communicative aspects. Due to the nature of their respective dynamics, the above are treated as self-oscillating elements and modelled by nonlinear oscillators. By modelling the cardiac conduction system as a model of three nonlinear oscillators coupled by delayed connections and subjected to external stimuli depicting the behavior of a pacemaker, its dynamic behavior is studied in this paper by nonlinear analysis tools. From an electrocardiogram (ECG) assessment, the heart rhythm reveals normal and pathological rhythms. Three forms of ventricular fibrillation, ventricular flutter, ventricular tachycardia and atrial fibrillation are observed. The results are confirmed by the respective maximum Lyapunov exponents. Considering the cardiac nodes as microchips, using microcontroller simulation technology, the cardiac conduction system was modelled as a network of four ATmega 328P microcontrollers. A similarity with the results obtained numerically can be observed.

Analysis of the dynamics of new models of nonlinear systems with state variable damping and elastic coefficients.

This paper, is an analysis of the dynamics of new models of nonlinear systems in which the state damping variables with elastic coefficients, given by functions c cos ⁡ ( p x ) , c sin ⁡ ( p x ) , c cos ⁡ ( p x ˙ ) and c sin ⁡ ( p x ˙ ) are investigated in their autonomous and excited states. They exhibit periodic regions of stability and instability in their autonomous states and a rich dynamic behavior. The analysis of limit cycles shows the presence of isolated curves around the origin (0.0), which explains the presence of periodic solutions (limit cycles). The dynamics obtained allows to describe qualitatively the cardiac activity (artificial pacemaker). A chaos analysis shows the appearance of regular and chaotic behaviors. These studies allowed us to show the effect of the damping of the state variable and the elastic coefficients on the dynamics of these models. The presence of analog functions makes the experimental study complex. An implementation based on microcontroller simulation technology has been proposed. The microcontroller results are consistent with the numerical results.

Evaluation of the Upgraded Version 2.0 of the Roche COBAS® AmpliPrep/COBAS® TaqMan HIV-1 Qualitative Assay in Central African Children.

BACKGROUND: Several commercially available molecular techniques were developed based on subtype B of HIV-1, which represents only 10% of HIV strains worldwide. Indeed, in sub-Saharan Africa, non-B subtypes of HIV-1 are predominant. The aim of this study was to evaluate the performances of the COBAS® AmpliPrep/COBAS® (CAP/CTM) HIV-1 Qualitative assays to detect the broad range of HIV-1 variants circulating in Central Africa and compare to the outgoing CAP/CTM HIV-1 Quantitative test v2.0 (Roche Molecular Systems), chosen as reference gold standard molecular assay. METHODS: The CAP/CTM HIV-1 Qualitative tests versions 1.0 and 2.0 (Roche Molecular Systems, Inc., Branchburg, NJ, USA) were evaluated compared to CAP/CTM TaqMan HIV-1 Quantitative test v2.0 (Roche Molecular Systems) on 239 dried plasma spot (DPS) from 133 HIV-1-infected (with detectable plasma HIV RNA load) and 106 uninfected children, followed-up at Complexe Pédiatrique, Bangui, Central African Republic. RESULTS: The version 1.0 showed low sensitivity (93.2%), with 9 (6.8%) false negative results, demonstrating under-detection of non-B HIV-1 subtypes. In contrast, the upgraded version 2.0 showed 100%-sensitivity, 100%-specificity and perfect agreement (κ coefficient, 1.0). CONCLUSION: Our evaluation in the Central African Republic demonstrates the clinical implications of the accuracy and reliability of the CAP/CTM HIV-1 Qualitative assay for early diagnosis of HIV-1 in Central African children.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM.

These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.