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A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making
Manns PJ, Darrah J
Advances in Medical Education and Practice , 2012, DOI: http://dx.doi.org/10.2147/AMEP.S37510
Abstract: structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making Original Research (1202) Total Article Views Authors: Manns PJ, Darrah J Published Date November 2012 Volume 2012:3 Pages 113 - 119 DOI: http://dx.doi.org/10.2147/AMEP.S37510 Received: 30 August 2012 Accepted: 17 October 2012 Published: 27 November 2012 Patricia J Manns, Johanna Darrah Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada Background and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study. Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1) identify prevalent condition and brainstorm interventions; (2) literature search; (3) develop scenario framework; and (4) write scenario. Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation. Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.
A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making
Manns PJ,Darrah J
Advances in Medical Education and Practice , 2012,
Abstract: Patricia J Manns, Johanna DarrahDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaBackground and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study.Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1) identify prevalent condition and brainstorm interventions; (2) literature search; (3) develop scenario framework; and (4) write scenario.Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation.Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.Keywords: physical therapists, clinical decision making, evaluation, curriculum
Protocol: Streamlined sub-protocols for floral-dip transformation and selection of transformants in Arabidopsis thaliana
Amanda M Davis, Anthony Hall, Andrew J Millar, Chiarina Darrah, Seth J Davis
Plant Methods , 2009, DOI: 10.1186/1746-4811-5-3
Abstract: The generation of transgenic plants has allowed for new insights into gene function. The creation of the floral-dip protocol [1] markedly advanced the ease of creating transformants in Arabidopsis thaliana. Transformation can now be performed at very large scales leading to near saturating mutagenesis [2,3]. It has also allowed the systematic study of gene function through transgenic approaches. Nevertheless, there is room to improve this protocol.There are three steps that we find to be both time-consuming and costly. These are, firstly, the step following growth of the Agrobacterium tumefaciens (recently reclassified as Rhizobium radiobacter [4]) strain in liquid culture. Here, the protocol calls for pelleting the culture and resuspending in a buffered media. This typically takes one hour after the time spent preparing the buffered media (itself a time and cost consuming process). A second time-consuming step occurs when two separate transgenic constructs are to be introduced into a single A. thaliana line. This is accomplished by transformation with the first construct, followed by "stacking" the second transgene, either by transforming the first transgenic line with a second construct, or by crossing two independently derived transgenic lines and obtaining the resultant F1 progeny. Both approaches are multi-generational to obtain the double transgenic plant, representing a significant time cost. Thirdly, in the selection of marker genes from transgenic seed in a population dominated by non-transformed lines, existing protocols for selection of lines typically requires surface sterilization of seed (a time-consuming process) and the plating of these seed on a sterile agar substrate (a costly process).Clearly there is scope for improvements in steps within the floral-dip protocol. Evidence for this can be found in recently published protocols that target improvements in various stages of the transformation process [5-9]. Here, we present our simplified methods tha
Increased Expression of RhoA in Epithelium and Smooth Muscle of Obese Mouse Models: Implications for Isoprenoid Control of Airway Smooth Muscle and Fibroblasts
Kristie R. Ross,Rebecca J. Darrah,Craig A. Hodges,LaTresa Lang,Thomas J. Kelley
Journal of Allergy , 2013, DOI: 10.1155/2013/740973
Abstract: The simultaneous rise in the prevalence of asthma and obesity has prompted epidemiologic studies that establish obesity as a risk factor for asthma. The alterations in cell signaling that explain this link are not well understood and warrant investigation so that therapies that target this asthma phenotype can be developed. We identified a significant increase in expression of the small GTPase RhoA in nasal epithelial cells and tracheal smooth muscle cells from leptin-deficient (ob/ob) mice compared to their wild-type counterparts. Since RhoA function is dependent on isoprenoid modification, we sought to determine the role of isoprenoid-mediated signaling in regulating the viability and proliferation of human airway smooth muscle cells (ASM) and normal human lung fibroblasts (NHLF). Inhibiting isoprenoid signaling with mevastatin significantly decreased the viability of ASM and NHLF. This inhibition was reversed by geranylgeranyl pyrophosphate (GGPP), but not farnesyl pyrophosphate (FPP), suggesting specificity to the Rho GTPases. Conversely, increasing isoprenoid synthesis significantly increased ASM proliferation and RhoA protein expression. RhoA expression is inherently increased in airway tissue from ob/ob mice, and obesity-entrained alterations in this pathway may make it a novel therapeutic target for treating airway disease in the obese population. 1. Introduction The prevalence of both obesity and asthma has increased dramatically in the past two decades [1–3]; over 35% of adults and 17% of children in the USA are categorized as obese [2], and the prevalence of asthma in children under 14 years increased more than 150% between 1980 and 1999 [3]. While numerous epidemiological studies have shown that obesity is associated with the development of asthma [4–8], the alterations in cell signaling induced by obesity that might lead to airway disease are not well understood. Understanding the pathophysiology of airway disease in the growing population of obese asthmatic children is critical to the development of novel therapies specific to this phenotype. Obesity has been shown to influence a number of signaling pathways involved in inflammation and airway hyperresponsiveness [9–14]. Airway responsiveness can be impacted by remodeling of the airways, a process considered to be irreversible. Although the study by Aaron et al. only provides indirect evidence of a relationship between obesity and airway smooth muscle remodeling, it is consistent with the relationship between obesity and vascular remodeling. The increase in airway smooth muscle mass is
Increased Expression of RhoA in Epithelium and Smooth Muscle of Obese Mouse Models: Implications for Isoprenoid Control of Airway Smooth Muscle and Fibroblasts
Kristie R. Ross,Rebecca J. Darrah,Craig A. Hodges,LaTresa Lang
Journal of Allergy , 2013, DOI: 10.1155/2013/740973
Abstract:
Disrupting the Growth Machine: Evidence from Hawai‘i
Jennifer Darrah-Okike
- , 2019, DOI: 10.1177/1078087417704973
Abstract: For much of its modern history, growth machine dynamics in Hawai‘i prevailed on a regional scale. Strikingly, recent events suggest that the hegemony of Hawai‘i’s growth machine has been disrupted. This article offers an in-depth case study of a major luxury development project on the island of Hawai‘i where development interests were thwarted despite the support of growth interests and local government officials. I show how local protesters made use of state-level historic preservation law, Native Hawaiian burial protections, state-level agricultural boundaries, and frames and meanings of land promulgated by the Native Hawaiian movement. Viewing this stalled housing project as an extended case study reveals how regional institutions and flexible social movement frames can be leveraged to promote alternatives to growth machines. I also highlight how distinctive regional institutions—that have evolved over time through institutional layering—may be prompting growth machine disruption in Hawai‘i, an understudied tourism and real-estate dependent economy. Finally, the case study suggests specific ways that local mobilization interacts with global economic downturns to shape spatial outcomes
Does pre-operative psychological distress affect patient satisfaction after primary total hip arthroplasty?
Munier Hossain, Daniel J Parfitt, David J Beard, Clare Darrah, John Nolan, David W Murray, Glynne Andrew
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-122
Abstract: We investigated this in a multi-centre prospective study between January 1999 and January 2002. We dichotomised the patients into the mentally distressed (MHS ≤ 56) and the not mentally distressed (MHS > 56) groups based on their pre-operative Mental Health Score (MHS) of SF36.448 patients (340 not distressed and 108 distressed) completed the patient satisfaction survey. Patient satisfaction rate at five year was 96.66% (415/448). There was no difference in patient satisfaction or willingness to have the surgery between the two groups. None of pre-operative variables predicted five year patient satisfaction in logistic regression.Patient satisfaction after surgery may not be adversely affected by pre-operative psychological distress.Total Hip Replacement (THR) is recognised as a very successful surgical intervention with high patient satisfaction [1]. However, it is estimated that a significant proportion of the patients may remain unsatisfied following THR [2]. Researchers have analysed various preoperative patient characteristics in an attempt to identify the best candidates for surgery and to identify the factors that are likely to predict poor patient satisfaction postoperatively [3-7]. The effect of patients' preoperative mental health on the outcome of joint replacement surgery has become an area of interest and has received some attention [8,9]. Researchers have shown that patients with preoperative mental distress are less likely to benefit after knee arthroplasty but the effect on outcome is less clear with THR [2,8-10].This prospective study investigated what effect preoperative mental health-assessed as psychological distress- had on patient satisfaction after THR. Our null hypothesis was that there was no difference in patient satisfaction after THR between patients who reported mental distress before surgery and those who did not.The Exeter Primary Outcome Study (EPOS) was a multi centre prospective cohort study of outcome after primary THR. Patients we
UNC79 and UNC80, Putative Auxiliary Subunits of the NARROW ABDOMEN Ion Channel, Are Indispensable for Robust Circadian Locomotor Rhythms in Drosophila
Bridget C. Lear, Eric J. Darrah, Benjamin T. Aldrich, Senetibeb Gebre, Robert L. Scott, Howard A. Nash, Ravi Allada
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078147
Abstract: In the fruit fly Drosophila melanogaster, a network of circadian pacemaker neurons drives daily rhythms in rest and activity. The ion channel NARROW ABDOMEN (NA), orthologous to the mammalian sodium leak channel NALCN, functions downstream of the molecular circadian clock in pacemaker neurons to promote behavioral rhythmicity. To better understand the function and regulation of the NA channel, we have characterized two putative auxiliary channel subunits in Drosophila, unc79 (aka dunc79) and unc80 (aka CG18437). We have generated novel unc79 and unc80 mutations that represent strong or complete loss-of-function alleles. These mutants display severe defects in circadian locomotor rhythmicity that are indistinguishable from na mutant phenotypes. Tissue-specific RNA interference and rescue analyses indicate that UNC79 and UNC80 likely function within pacemaker neurons, with similar anatomical requirements to NA. We observe an interdependent, post-transcriptional regulatory relationship among the three gene products, as loss of na, unc79, or unc80 gene function leads to decreased expression of all three proteins, with minimal effect on transcript levels. Yet despite this relationship, we find that the requirement for unc79 and unc80 in circadian rhythmicity cannot be bypassed by increasing NA protein expression, nor can these putative auxiliary subunits substitute for each other. These data indicate functional requirements for UNC79 and UNC80 beyond promoting channel subunit expression. Immunoprecipitation experiments also confirm that UNC79 and UNC80 form a complex with NA in the Drosophila brain. Taken together, these data suggest that Drosophila NA, UNC79, and UNC80 function together in circadian clock neurons to promote rhythmic behavior.
Using knowledge brokers to facilitate the uptake of pediatric measurement tools into clinical practice: a before-after intervention study
Dianne J Russell, Lisa M Rivard, Stephen D Walter, Peter L Rosenbaum, Lori Roxborough, Dianne Cameron, Johanna Darrah, Doreen J Bartlett, Steven E Hanna, Lisa M Avery
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-92
Abstract: A mixed methods before-after study design was used to evaluate the impact of a six-month KB intervention by 25 KBs on 122 practicing PTs' self-reported knowledge and use of the measurement tools in 28 children's rehabilitation organizations in two regions of Canada. The model was that of PT KBs situated in clinical sites supported by a network of KBs and the research team through a broker to the KBs. Modest financial remuneration to the organizations for the KB time (two hours/week for six months), ongoing resource materials, and personal and intranet support was provided to the KBs. Survey data were collected by questionnaire prior to, immediately following the intervention (six months), and at 12 and 18 months. A mixed effects multinomial logistic regression was used to examine the impact of the intervention over time and by region. The impact of organizational factors was also explored.PTs' self-reported knowledge of all four measurement tools increased significantly over the six-month intervention, and reported use of three of the four measurement tools also increased. Changes were sustained 12 months later. Organizational culture for research and supervisor expectations were significantly associated with uptake of only one of the four measurement tools.KBs positively influenced PTs' self-reported knowledge and self-reported use of the targeted measurement tools. Further research is warranted to investigate whether this is a feasible, cost-effective model that could be used more broadly in a rehabilitation setting to facilitate the uptake of other measurement tools or evidence-based intervention approaches.'Best practice' is defined as the integration of research evidence, client preferences, and clinical experience [1]. In pediatric physical therapy, clinical practice includes examination and evaluation of the client, diagnosis, prognosis, intervention, and evaluation of outcomes [2]. All of these components of practice require documentation and measurement. St
Pseudomonas aeruginosa PA1006 Is a Persulfide-Modified Protein That Is Critical for Molybdenum Homeostasis
Gregory Tombline, Johanna M. Schwingel, John D. Lapek, Alan E. Friedman, Thomas Darrah, Michael Maguire, Nadine E. Van Alst, Melanie J. Filiatrault, Barbara H. Iglewski
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0055593
Abstract: A companion manuscript revealed that deletion of the Pseudomonas aeruginosa (Pae) PA1006 gene caused pleiotropic defects in metabolism including a loss of all nitrate reductase activities, biofilm maturation, and virulence. Herein, several complementary approaches indicate that PA1006 protein serves as a persulfide-modified protein that is critical for molybdenum homeostasis in Pae. Mutation of a highly conserved Cys22 to Ala or Ser resulted in a loss of PA1006 activity. Yeast-two-hybrid and a green-fluorescent protein fragment complementation assay (GFP-PFCA) in Pae itself revealed that PA1006 interacts with Pae PA3667/CsdA and PA3814/IscS Cys desulfurase enzymes. Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) “top-down” analysis of PA1006 purified from Pae revealed that conserved Cys22 is post-translationally modified in vivo in the form a persulfide. Inductively-coupled-plasma (ICP)-MS analysis of ΔPA1006 mutant extracts revealed that the mutant cells contain significantly reduced levels of molybdenum compared to wild-type. GFP-PFCA also revealed that PA1006 interacts with several molybdenum cofactor (MoCo) biosynthesis proteins as well as nitrate reductase maturation factor NarJ and component NarH. These data indicate that a loss of PA1006 protein’s persulfide sulfur and a reduced availability of molybdenum contribute to the phenotype of a ΔPA1006 mutant.
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