bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis of Mg2SiO4 Whiskers by an Oxidation‐Reduction Reaction
Authors: Hashimoto Shinobu , Yamaguchi Akira
Published: July 2005

Magnesium orthosilicate (forsterite) whiskers were synthesized by an oxidation‐reduction reaction in the present investigation. These whiskers were rectangular parallelepipeds, with long sides in a cross‐sectional view from two to ten times as long as the short sides, and measuring from several micrometers to 200 μm wide and ∼15 mm in the elongated direction. The Mg2SiO4 elongation was on the c‐axis. The growth mechanism of the whiskers was investigated on the basis of chemical thermodynamics, and the present study revealed that the Mg2SiO4 whiskers grew by a VS (vapor‐solid) mechanism.
Microstructural Stability of Nicalon at 1000deg;C in Air after Exposure to Salt (NaCl) Water
Authors: Parthasarathy Triplicane A. , Mah Tai‐Il , Folsom Craig A. , Katz Allan P.
Published: July 2005

When either uncoated or BN‐coated Nicalon fibers are exposed to water saturated with NaCl before being annealed in air at 1000deg;C, accelerated degradation of the structure of the fiber occurs. The fiber surface oxidizes to tridymite instead of vitreous silica, and the crystallites of SiC in Nicalon begin to grow. These findings suggest that prior exposure to salt water may cause appreciable debit in the mechanical strength of Nicalon fibers with time at 1000deg;C in air.
The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?
Authors: Abbott David , Watson Debby , Townsley Ruth
Published: July 2005

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.
Collaboration between service users and professionals: Legitimate decisions in child protection – a Norwegian model
Authors: Willumsen Elisabeth , Skivenes Marit
Published: July 2005

The aim of this study is to examine the conditions for achieving free and open communication in collaboration. The context is child protection where ‘the best interest of the child’ is at stake. First, a theoretical standard based on free and open communication and equal partnership (deliberation) is presented. Secondly, an explorative analysis is undertaken of the collaboration process between professionals and service users in two review groups regarding two young people, Jane and Tom, both of whom appear to have psychosocial  problems  living  in  residential  care.  Thirdly,  on  the  basis  of this analysis, recommendations on how to improve collaboration in review groups are made. The findings show that collaboration has several functions: formal decision‐making, legitimate decision‐making and learning. There is a need to clarify the purpose of collaboration and strengthen structural arrangements as well as develop guidelines for handling challenges at different levels.
Practice challenges at the intersection of child protection and mental health
Authors: Darlington Yvonne , Feeney Judith A. , Rixon Kylie
Published: July 2005

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.
The SESS multisite collaborative research initiative: establishing common ground
Authors: Iida Elizabeth E. , Springer J. Fred , Pecora Peter J. , Bandstra Emmalee S. , Edwards Mark C. , Basen Michele M.
Published: July 2005

Multidisciplinary intervention approaches are needed for meeting service needs for families in which substance abuse and mental health disorders may be interfering with child‐rearing. Experiences from the Starting Early Starting Smart (SESS) initiative, a 12‐site national collaborative investigation of integrating behavioural health services in early childhood and primary health care service settings for children aged 0–5 years and their families and caregivers, are described. This 4‐year applied research initiative was co‐funded by the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services and Casey Family Programs, a private operating foundation. SESS, which was developed and implemented in 12 geographically and culturally diverse cities in the USA during 1997–2001, encouraged federal, state, and local public/private partnerships. Opportunities and challenges in using an inclusive, consensus‐based, stakeholder model to maximize study relevance and utility for researchers, practitioners, and fiscal sponsors are discussed, and lessons for multidisciplinary, multisite research collaborations are identified.
A study of the rheological properties of endodontic sealers
Authors: Lacey S. , Pitt Ford T. R. , Watson T. F. , Sherriff M.
Published: July 2005

Aim  To test the hypothesis that there would be no statistically significant difference in viscosity‐related measures of endodontic sealers or change in these with strain rate, internal diameter or powder : liquid ratio in a capillary system.

Methodology  Materials used were Apexit, Tubliseal EWT, Grossman's sealer and Ketac‐endo. Viscosity‐related measures were tested in a two‐plate test, and in a capillary rheometer. The mean values (n = 12) for thickness and diameter of material formed between two glass plates were tested with one‐way analysis of variance. Pressure was applied to a capillary rheometer at strain rates 5 and 10 mm min−1 in tubes of internal diameter 0.6 and 1.2 mm.

Results  Tubliseal EWT had a thinner film thickness than the other sealers (α = 0.05). The difference in diameter between Tubliseal EWT and the other sealers was significant apart from Apexit. Increased strain rate gave a significant increase (α = 0.05) in the flow of all sealers. Narrower tubes produced increased velocity, which was significant for all sealers, and reduced volumetric flow, which was significant for all sealers except Grossman's 2 : 1 (Wilcoxon signed rank test). Reduction in powder : liquid ratio of Grossman's significantly increased flow in narrow tubes and at higher strain rate (Mann–Whitney test).

Conclusion  There was a significant difference between the flow of Tubliseal EWT and the other sealers tested in the two‐plate test; capillary flow was affected by sealer, internal diameter, strain rate and powder : liquid ratio. The null hypotheses were rejected.
Cytotoxicity of substances leached or dissolved from pulp capping materials
Authors: Cavalcanti B. N. , Rode S. M. , Marques M. M.
Published: July 2005

Aim  To evaluate the cytotoxic effects of substances leached or dissolved from pulp capping materials on human pulp fibroblasts.

Methodology  The substances were applied to cell cultures in conditioned media. The experimental groups were: GI (control; n = 24) – cultures treated with fresh medium; GII (n = 24) – cultures treated with calcium hydroxide cement; GIII (n = 24) – cultures treated with adhesive resin and GIV (n = 24) – cultures treated with 37% orthophosphoric acid. The media were conditioned by placing the crude materials in contact with fresh culture medium for 1 h. The cytotoxicity analysis was performed using the Trypan blue dye exclusion assay at times of 0, 6, 12 and 24 h for cell viability assay, and at 1, 3, 5 and 7 days for survival assay. Data were treated by anova (P < 0.05) and Tukey's test (P < 0.05).

Results  GI and II presented similar cell viability and cell growth. GIII and IV exhibited statistically significant lower percentages of cell viability: GIV only at the 0 h experimental time, whereas in GIII this viability markedly diminished reaching values of 10% by 12 h. Cell growth was impaired only in cultures of GIII.

Conclusions  Substances dissolved from the adhesive system tested were cytotoxic for human dental pulp fibroblasts in culture, whilst substances leached from calcium hydroxide were biocompatible.
Anatomic Endodontic Technology (AET) – a crown‐down root canal preparation technique: basic concepts, operative procedure and instruments
Authors: Riitano F.
Published: July 2005

Aim  To illustrate the conceptual basis and the operative procedure of the Anatomic Endodontic TechnologyTM (AET) technique and to illustrate the specific instruments used in each phase.

Summary  The basic characteristics of the AETTM technique are reported. The instruments and procedure are described in three phases: coronal access, coronal‐middle preparation and apical preparation. In the first phase, correct cavity design is described. In the coronal‐middle phase, the use of four stainless steel shaping instruments, powered by a reciprocating handpiece is described, incorporating a brushing‐milling action against canal walls. During the apical phase, dedicated apical stainless steel and NiTi hand instruments are used to complete the preparation. The stainless steel apical files are used with a 1/4 turn and withdrawal movement whilst the NiTi are used in 360° rotary motion.

Key learning points

• Most current canal shaping techniques do not prepare all the canal walls and can result in over‐enlargement in some areas.

• AETTM defines three regions of the canal: coronal (from the cavo‐surface of the access cavity), coronal‐middle, and apical.

• Coronal‐middle instrumentation is undertaken with four mechanically driven stainless steel shaping instrument used in brushing‐milling action against canal walls.

• Apical preparation is completed by hand and with the formation of a stop.
In vitro peroxide penetration into the pulp chamber from newer bleaching products
Authors: Gökay O. , Müjdeci A. , Algin E.
Published: July 2005

Aim  To investigate peroxide penetration from newer bleaching products into the pulp chamber.

Methodology  Fifty extracted human maxillary central incisor teeth were separated into five groups (n = 10). All the teeth were sectioned 3 mm apical to the cemento‐enamel junction; the intracoronal pulp tissue was removed, and the pulp chamber filled with acetate buffer. Buccal crown surfaces of teeth in the experimental groups were subjected to either a whitening strip (containing 5.3% hydrogen peroxide‐G1) or one of three paint‐on liquid whiteners (containing 19% sodium percarbonate peroxide‐G2, 18% carbamide peroxide‐G3 and 8.7% hydrogen peroxide‐G4). The teeth in the control group (G5) were exposed only to distilled water. The acetate buffer solution in each tooth was then transferred to a glass test tube after 30 min and leuco‐crystal violet and enzyme horseradish peroxidase were added, producing a blue solution. The optical density of the resultant blue colour in the tubes was measured by a UV‐visible spectrophotometer at a wavelength of 596 nm. The values were converted into microgram equivalents of HP using a spectrophotometric calibration curve. Data were analysed statistically using the Kruskal–Wallis Analysis of Variance and the Mann–Whitney U‐test.

Results  Statistically significant differences were found between all of the groups (P < 0.05). Pulpal peroxide was not observed in the control group. The amount of hydrogen peroxide (μg) found in the pulp chamber of G1 (0.726 ± 0.024) > G4 (0.443 ± 0.017) > G3 (0.231 ± 0.011) > G2 (0.175 ± 0.012).

Conclusions  The peroxides from the whitening strip and paint‐on whiteners penetrated into the pulp chamber to varying degrees.
Fate of vital pulps beneath a metal‐ceramic crown or a bridge retainer
Authors: Cheung G. S. P. , Lai S. C. N. , Ng R. P. Y.
Published: July 2005

Aim  To investigate the incidence of and factors associated with pulpal necrosis in vital teeth restored with metal‐ceramic crowns (CMCs) or crowned as part of a fixed–fixed bridge.

Methodology  Patients who had a CMC or bridge retainer (BR) placed on a tooth with no previous history of root canal treatment from 1981 to 1989 were retrieved from computer records. The collated patients were randomly selected and their clinical records examined. Those who satisfied the inclusion criteria were contacted and offered a review. After clinical examination, long‐cone paralleling periapical radiographs were taken of the selected teeth, which were then assessed by two precalibrated operators to ascertain the pulpal status. Factors that might contribute to loss of pulp vitality and the tooth type were also recorded. The collected data were analysed statistically using the chi‐square test and subject to Bonferroni adjustment where indicated.

Results  The numbers of preoperatively vital teeth in the CMC and BR groups were 122 and 77, and the mean observation periods were 169 ± 25 (SD) and 187 ± 23 months, respectively. In the CMC group, 19 failed cases (15.6%) were due to an endodontic reason; total number of failures was 34. In the BR group, 25 (32.5%) showed signs of pulpal necrosis; a significant association with maxillary anterior teeth was noted. The survival rates for pulp vitality were 84.4% (CMC) and 70.8% (BR) after 10 years, and 81.2% (SC) and 66.2% (BR) after 15 years. The difference between the two groups was significant.

Conclusion  The survival of the vital pulp in teeth restored with a single‐unit CMC was significantly higher than those serving as an abutment of a fixed–fixed bridge. Maxillary anterior teeth used as bridge abutments had a higher rate of pulpal necrosis than any other tooth types.
The effect of high‐frequency electrical pulses on organic tissue in root canals
Authors: Lendini M. , Alemanno E. , Migliaretti G. , Berutti E.
Published: July 2005

Aims  To evaluate debris and smear layer scores after application of high‐frequency electrical pulses produced by the Endox Endodontic System (Lysis Srl, Nova Milanese, Italy) on intact pulp tissue and organic and inorganic residues after endodontic instrumentation.

Methodology  The study comprised 75 teeth planned for extraction. The teeth were randomly divided into two groups (60 teeth) and a control group (15 teeth): group 1 (30 teeth) was not subjected to instrumentation; group 2 (30 teeth) was instrumented by Hero Shaper instruments and apical stops were prepared to size 40. Each group was subdivided into subgroups A and B (15 teeth); two electrical pulses were applied to subgroups 1A and 2A (one in the apical third and one in the middle third, respectively, at 3 and 6 mm from the root apices); four electrical pulses were applied to subgroups 1B and 2B (two in the apical third, two in the middle third). The control group (15 teeth) was prepared with Hero Shapers and irrigated with 5 mL of EDTA (10%) and 5 mL of 5% NaOCl at 50 °C but not subjected to the electrical pulse treatment. Roots were split longitudinally and canal walls were examined at 80×, 200×, 750×, 1500× and 15 000× magnifications, using a scanning electron microscope. Smear layer and debris scores were recorded at the 3 and 6 mm levels using a five‐step scoring scale and a 200‐μm grid. Means were tested for significance using the one‐way anova model and the Bonferroni post‐hoc test. The differences between groups were considered to be statistically significant when P < 0.05.

Results  The mean value for debris scores for the three groups varied from 1.80 (±0.77) to 4.50 (±0.68). The smear layer scores for group 2 and the control specimens varied from 2.00 (±0.91) to 2.33 (±0.99). A significant difference was found in mean debris scores at the 3 and 6 mm levels between the three groups (P < 0.001). The Bonferroni post‐hoc test confirmed that the difference was due to group 1. In the two subgroups treated with four high‐frequency pulses (1B and 2B) a substantial reduction in mean debris scores was found at the 3 and 6 mm level; subgroup 2B was practically free of organic residue. No significant differences for mean smear layer and debris scores were recorded between group 2 and the control group at the two levels; a significant difference was found only for mean smear layer scores at the 3 mm level between subgroup 2B and the control group (P < 0.05).

Conclusions  The Endox device used with four electrical pulses had optimal efficacy when used after mechanical instrumentation. Traditional canal shaping and cleaning was essential to ensure an effective use of high‐frequency electrical pulses in eliminating residues of pulp tissue and inorganic debris.
In vitro antimicrobial activity of Fill Canal, Sealapex, Mineral Trioxide Aggregate, Portland cement and EndoRez
Authors: Sipert C. R. , Hussne R. P. , Nishiyama C. K. , Torres S. A.
Published: July 2005

Aim  To determine in vitro the antimicrobial activity of Fill Canal, Sealapex, Mineral Trioxide Aggregate (MTA), Portland cement and EndoRez on various species of microorganisms.

Methodology  The diffusion method on Müller–Hinton agar (MH) was employed. A base layer was made using MH agar and five wells were made by removing agar at equidistant points. Sealers were placed into the wells immediatelly after manipulation. The microorganisms Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Micrococcus luteus ATCC 9341, Staphylococcus aureus ATCC 25923, Staphylococcus epidermidis ATCC 12228, Pseudomonas aeruginosa ATCC 27853 and Candida albicans ATCC 10231 were seeded by pour plate. The plates were kept at room temperature for 2 h for prediffusion and then incubated at 37 °C for 24 h. Aliquots of 10 mL of 0.05% triphenyltetrazolium chloride gel were added for optimization and the zones of inhibition were measured.

Results  Sealapex and Fill Canal demonstrated antimicrobial activity for all strains. For MTA and Portland cement, only E. coli was not inhibited. No antimicrobial activity was detected for EndoRez.

Conclusions  In this laboratory study, Fill Canal, Sealapex, MTA and Portland cement presented antimicrobial activity whilst EndoRez did not.
Defects in ProTaper S1 instruments after clinical use: longitudinal examination
Authors: Peng B. , Shen Y. , Cheung G. S. P. , Xia T. J.
Published: July 2005

Aim  To evaluate defects in ProTaper shaping instrument S1 after a defined schedule of clinical use.

Methodology  Among all ProTaper files discarded from an endodontic clinic at a stomatological school in China over a period of 17 months, 122 S1 instruments were collected. They were ultrasonically cleaned, autoclaved and then examined in the laboratory. Any instrument separation was noted; the average length involved was determined. The 0.5 mm region on either side of this length of discarded but intact instruments was examined circumferentially by scanning electron microscope. The region adjacent to the broken end of the fractured instruments was also examined in the same way.

Results  One specimen was lost during processing. Of the remaining 121 instruments, 27 were separated with a mean fracture length of 3.67 mm from the tip. Of these, two files showed macroscopically torsional fracture and the others showed signs of flexural fatigue. Only one file that had not fractured showed visible unwinding defects. Examination of the 3.1–4.1 mm region of other unfractured instruments revealed the presence of microcracks, surface debris, pitting and/or wear of their cutting edges. Some debris particles seemed to have been trapped in crack‐like structures.

Conclusions  Multiple use of ProTaper S1 pre‐disposed the instrument to microcrack formation and wear of the cutting edges. There was a low prevalence of plastic deformation and most ProTaper S1 instruments failed without discernible sign of unwinding of the flutes. Further studies should address the mode of failure and the role of debris particles in the fracture mechanism.
The isthmuses of the mesial root of mandibular molars: a micro‐computed tomographic study
Authors: Mannocci F. , Peru M. , Sherriff M. , Cook R. , Pitt Ford T. R.
Published: July 2005

Aim  To investigate the prevalence of root canal isthmuses in the apical 5 mm of the mesial root of mandibular molars by means of micro‐computed tomography (MCT) and to describe the morphology of the isthmuses.

Methodology  Twenty extracted mandibular first molars that had fully formed roots were selected. The mesial roots were sectioned from the distal roots and subjected to MCT. The number of sections showing isthmuses in each of the apical 5 mm of the root canals was recorded. In each one of the apical 5 mm of the 20 roots examined, 40 sections were observed, giving a total of 800 sections observed in each group. Data were analysed as a contingency table using the chi‐square statistic to test the null hypothesis that location of the sections in each of the apical 5 mm and presence of the isthmus were independent.

Results  Isthmuses were found to be present at all levels with prevalence figures between 17.25 and 50.25%. The chi‐square test indicated a significant difference in the distribution of isthmuses with section (P = 0.001). It was found that sections in the first millimetre from the apex had fewer isthmuses than expected and that sections in the third millimetre from the apex had more isthmuses than expected under the null hypothesis. Calcifications were found to be present in most isthmuses, occasionally lateral canals originated from the central part of the isthmuses.

Conclusions  Isthmuses were present in the vast majority of roots observed. The third millimetre from the apex showed more isthmuses than expected. The results of clinical and surgical endodontic procedures performed in the mesial root of mandibular molars may be affected by this aspect of the root canal anatomy.
Microhardness changes in dentine after neonatal capsaicin application
Authors: Krage T. L. , Stiefel A. , Stephan B. M. , Zimmer S. , Lambrichts I. , Raab W. H.‐M.
Published: July 2005

Aim  To determine if desensitization of the nociceptive innervation in the dental pulp has an effect on odontoblast function in the rat.

Methodology  Neonatal systemic application of capsaicin was used to selectively eliminate nociceptive innervation. 12 capsaicin‐treated rats were intravitally perfused at 150 days of life with 4% formaldehyde and jaws were prepared for Vicker's microhardness (VMH) measurement. As a control, 12 rats were injected with vehicle on the 3rd day of life and intravital perfusion was carried out exactly as those used for the experimental group. Immunohistological labeling of CGRP was carried out in both groups to assure the efficiency of desensitization in the experimental group. The VMH was measured in the incisors of each animal for a quantitative analysis of dentine quality.

Results  Vicker's microhardness was significantly higher in the control rats compared with the capsaicin‐treated rats (P < 0.001).

Conclusions  Neonatal systemic application of capsaicin produces changes in the quality of dentine in the rat over time and therefore it is suggestive that selective elimination of the nociceptive innervation in pulpal tissue may effect odontoblast function.
Learning through inquiry: student difficulties with online course‐based Material
Authors: Ellis R. A. , Marcus G. , Taylor R.
Published: July 2005

Abstract
This study investigates the case‐based learning experience of 133 undergraduate veterinarian science students. Using qualitative methodologies from relational Student Learning Research, variation in the quality of the learning experience was identified, ranging from coherent, deep, quality experiences of the cases, to experiences that separated significant aspects, such as the online case histories, laboratory test results, and annotated images emphasizing symptoms, from the meaning of the experience. A key outcome of this study was that a significant percentage of the students surveyed adopted a poor approach to learning with online resources in a blended experience even when their overall learning experience was related to cohesive conceptions of veterinary science, and that the difference was even more marked for less successful students. The outcomes from the study suggest that many students are unsure of how to approach the use of online resources in ways that are likely to maximise benefits for learning in blended experiences, and that the benefits from case‐based learning such as authenticity and active learning can be threatened if issues closely associated with qualitative variation arising from incoherence in the experience are not addressed.
Students' experience of component versus integrated virtual learning environments
Authors: Weller M. , Pegler C. , Mason R.
Published: July 2005

Abstract
The use of virtual learning environments (VLEs) has become increasingly common in most higher education (HE) institutions. Recent developments have proposed the interoperability of software systems and content, to create component VLEs in contrast with the integrated, monolithic ones that are currently prevalent. This paper examines the student experience of two VLEs, one integrated approach and the other component. In general, students preferred the component system, although this may have been influenced by other factors such as performance. Although the study is limited to one cohort of student it makes a number of suggestions relevant to anyone deploying a VLE. These are that the component approach is a viable one from a student perspective, the broader context in which the VLE operates is important in student perception and that poor system performance may have unpredictable consequences for the learning experience.
The association between students' use of an electronic voting system and their learning outcomes
Authors: Kennedy G. E. , Cutts Q. I.
Published: July 2005

Abstract
This paper reports on the use of an electronic voting system (EVS) in a first‐year computing science subject. Previous investigations suggest that students' use of an EVS would be positively associated with their learning outcomes. However, no research has established this relationship empirically. This study sought to establish whether there was an association between students' use of an EVS over one semester and their performance in the subject's assessment tasks. The results from two stages of analysis are broadly consistent in showing a positive association between EVS usage and learning outcomes for students who are, relative to their class, more correct in their EVS responses. Potential explanations for this finding are discussed as well as modifications and future directions of this program of research.
Designing good institutional contexts for innovation in a technology‐mediated learning environment
Authors: Chou S.‐W.
Published: July 2005

Abstract
How to innovate information technology (IT) effectively in a technology‐mediated learning (TML) environment remains a problem. To better understand how knowledge sharing (KS) and ‘coordination and support of TML environment’ (i.e. CTML) influence the propensity for TML innovation, this study develops a research framework to delineate the relationships among KS, CTML, and three antecedents of TML innovation – cognizance of technology, ability to explore TML, and intention to explore. In order to test the impact of KS and CTML on the propensity for TML innovation, we collected data from elementary schools of Taiwan through a survey instrument. Our results indicate that KS has a positive effect on all the three antecedents of TML innovation, while CTML exerts a positive impact only on instructors' ability to explore. The implications of the study are discussed, and future research directions are proposed.
Preservice elementary teachers as information and communication technology designers: an instructional systems design model based on an expanded view of pedagogical content knowledge
Authors: Angeli C. , Valanides N.
Published: July 2005

Abstract
This study discusses the evolution of an instructional systems design (ISD) model that is based on an expanded view of Shulman's concept of pedagogical content knowledge (PCK). An initial model was evaluated in the first iteration of a design experiment, and then it was changed and assessed in two other iterations that followed. The proposed ISD model can be used in educational technology courses, elementary teacher education method courses, and teacher professional development courses to develop information and communication technology (ICT)‐related PCK. ICT‐related PCK comprises a body of knowledge that educators need to be able to teach with ICT. Evidence from the present study, with preservice elementary teachers, indicates that the evolved model was effective in developing some aspects of ICT‐related PCK. Based on the results of the study, more systematic efforts are needed to engage preservice teachers in technology‐rich design activities, so that they can adequately develop all aspects of ICT‐related PCK. Finally, this study provides baseline data that can be used for comparison purposes in future studies that may be conducted to further validate or modify the suggested ISD model.
Questioning skills facilitate online synchronous discussions
Authors: Wang C.‐H.
Published: July 2005

AbstractThe results of this study show that effective questioning skills increase student intellectual moves that, in turn, facilitate the process of knowledge construction in online synchronous discussion (OSD). The open‐ended questions elicited multiple perspectives by promoting student participation, while OSD enabled them to share and debate multiple perspectives simultaneously without worrying about interrupting the flow of a conversation that had moved on. Furthermore, the high level of questions engaged students in higher order thinking. That is, OSD can be productive for learning when organised with appropriate questioning skills. The implication is that educators have to re‐engineer their thinking to teach with OSD in order to discover effective pedagogy that uses OSD as an integral component in teaching. Research on educational OSD should focus on how and when it is an appropriate learning tool that enhances learning processes and outcomes.
Older people specific health status and quality of life: a structured review of self‐assessed instruments
Authors: Haywood Kirstie L. , Garratt Andrew M. , Fitzpatrick Raymond
Published: July 2005

Objectives  To review evidence relating to the measurement properties of older people specific self‐assessed, multi‐dimensional measures of health status.

Design  Systematic literature searches to identify instruments. Pre‐defined criteria relating to reliability, validity, responsiveness, precision and acceptability.

Results  A total of 46 articles relating to 18 instruments met the inclusion criteria. Most evidence was found for the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), CARE, Functional Assessment Inventory (FAI) and Quality of Life Profile – Seniors Version (QOLPSV). Most instruments have been evaluated in single studies. Four instruments have evidence of internal consistency and test–retest reliability – LEIPAD, Philadelphia Geriatrics Centre Multilevel Assessment Inventory, Perceived Well‐being Scale, Wellness Index (WI). Two instruments lack evidence of reliability – Brief Screening Questionnaire, Geriatric Quality of Life Questionnaire (GQLQ). Older people contributed to the content of the GQLQ, QOLPSV and WI. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio‐demographic variables. Limited evidence of responsiveness was found for five instruments – GQLQ, OMFAQ, PGCMAI, QOLPSV, Self‐Evaluation of Life Scale (SELF).

Conclusion  Although most evidence was found for the OMFAQ this was largely for the ADL domain; evidence for reliability and responsiveness is limited. Limited evidence of reliability, validity and responsiveness was found for the PGCMAI, QOLPSV and SELF. The lack of evidence for measurement properties restricts instrument recommendation. Instrument content should be assessed for relevance before application and the concurrent evaluation of specific and widely used generic instruments is recommended. Several instruments, including the BSQ and EASY‐Care, were developed recently and further evidence of instrument performance is required.
Using discrete choice experiments to go beyond clinical outcomes when evaluating clinical practice
Authors: Ryan Mandy , Major Kirsten , Skåtun Diane
Published: July 2005

Background  This study builds on the results of a randomized controlled trial concerned with examining the effect of reducing waiting times on the health status of patients referred for non‐urgent rheumatology opinion. No difference in clinical outcomes was found between a ‘fast‐track’ and ‘ordinary’ appointment system. This suggests that rationing by waiting times is not detrimental to health. However, such an approach ignores the value patients attach to reducing waiting time.

Objectives  To estimate the monetary value of reducing waiting time, as well as changes in duration of appointment and the introduction of a pain management service, in the provision of rheumatology services.

Methods  Discrete choice experiment (DCE).

Setting  The main outpatient clinic of the rheumatology service for the Lothian and Borders region.

Subjects  262 patients who had received a specialist rheumatology opinion – 73 had received fast‐track treatment, 65 standard care and 124 were non‐trial patients.

Results  A response rate of 71% was achieved. Patients valued a 9‐week reduction in waiting time at £131. However, the introduction of a pain management service was valued at £209. Thus, the latter is of more value to respondents. Evidence was also found of the internal consistency and theoretical validity of the DCE approach.

Conclusions  The reduction of waiting times is a central plank of NHS policy. Whilst a reduction in waiting time is of value, a pain management service is of more benefit than a 9‐week reduction in waiting time. DCE were shown to be a potentially useful technique for valuing different aspects of health care interventions.
Provider adherence to COPD guidelines: relationship to organizational factors
Authors: Ward Marcia M. , Yankey Jon W. , Vaughn Thomas E. , BootsMiller Bonnie J. , Flach Stephen D. , Watrin Shea , Doebbeling Bradley N.
Published: July 2005

Rationale, aims and objectives  A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline.

Methods  We administered a survey to key informants that assessed adherence to the COPD guideline, approaches to disseminating and implementing the COPD guideline, providers’ views of the COPD guideline and guidelines in general, and attitudes about the organizational climate.

Results  Surveys were returned by 242 key informants (58%) at 130 of the 143 VHA hospitals (91%). Adherence to the COPD clinical practice guideline is perceived by quality managers within the VHA to be good. The final multivariable predictor model identified five measures that were related to provider adherence with the COPD guideline (R2 = 0.43): responsibilities were changed to support adherence to the COPD guideline, physicians believe that guidelines implemented in the past year were applicable to their practice, patient care providers consistently participate in activities to improve the quality of care, the regional network office monitors the pace at which guidelines are implemented, and there is a system to provide feedback on routinely collected guideline adherence data collected in addition to External Peer Review Program data.

Conclusions  Organizations can play an important role in providing a supportive climate to facilitate their providers’ adherence to guidelines by implementing processes and culture changes that involve these five measures.
Low utilization and wide interhospital variation in investigation of patients after acute myocardial infarction: inadequate resources or insufficient evidence?
Authors: Williams R. Ian , Fraser Alan G. , West Robert R.
Published: July 2005

Background  Guidelines for the management of patients with acute myocardial infarction are available, but implementation may be difficult when resources are limited.

Objective  The aim of this study was to investigate whether resources, manpower or access to specialist facilities affect care following myocardial infarction.

Patients and methods  A representative sample of 1595 patients in all 19 district general hospitals in Wales was analysed for differences in use of investigations and prescription of secondary prevention and how these factors were related to provision of cardiologists and coronary care beds and distance from specialist cardiac services.

Results  Inpatient investigation rates were low and there were wide interhospital variations for exercise testing [mean 42%; interquartile range (IQR) 27–59%] and echocardiography (mean 46%; IQR 33–66%). In comparison, prescription of secondary prevention was similar to European standards and showed less interhospital variation (beta blockers mean 48%; IQR 44–54%; angiotensin‐converting enzyme inhibitors mean 59%; IQR 43–63%). There was little association between investigation or secondary prevention rates and cardiac services, but overall rates and provision were low.

Conclusion  Delivery of care after acute myocardial infarction for stratifying risk and preventing recurrence was unrelated to relative provision or distance from specialist centres. Low use of investigations and high interhospital variability could imply limited access to resources such as echocardiography. Higher rates of prescription of drugs, with less variation between hospitals, argues against low utilization because of insufficient evidence.
The seduction of general practice and illegitimate birth of an expanded role in population health care
Authors: Buetow Stephen , Docherty Barbara
Published: July 2005

To reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. They appear to disregard implications of the policy for redefining the nature and scope of their discipline (and of public health), including their own role as providers of personal care. This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The ex‐ample of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.
Organizational assessment in general practice: a systematic review and implications for quality improvement
Authors: Rhydderch Melody , Edwards Adrian , Elwyn Glyn , Marshall Martin , Engels Yvonne , Van den Hombergh Pieter , Grol Richard
Published: July 2005

Background  Quality improvement of organizational aspects in general practice is receiving increasing attention. In particular, the impact of effective organization on preventative care has been recognized. Organizational assessments are typically used as part of professionally led accreditation schemes where there is a tension between externally led quality assurance and internally led quality improvement. The aim of this article is to inform the debate by reviewing the international‐peer‐reviewed literature on organizational assessments used in  general  practice  settings.  

Design  Systematic literature review.

Methods  The literature was searched for articles relating to organizational assessment. Titles and abstracts were examined by two independent reviewers and relevant articles obtained. Bibliographies were examined for follow‐up references. Data were extracted on the development and use of assessment methods.

Results  Thirteen papers describing five organizational assessment instruments were included for detailed appraisal.

Conclusion  This review discovered a developing field containing different approaches to the measurement of organizational aspects of general practice. Whilst professionally led accreditation is well‐developed and dependent on externally led quality assurance, approaches to internally led quality improvement are less well‐developed. There is a need for organizational assessment tools designed for the purpose of stimulating internal development.
Factors that influence prescribing within a therapeutic drug class
Authors: Nutescu Edith A. , Park Hayley Y. , Walton Surrey M. , Blackburn Juan C. , Finley Jamie M. , Lewis Richard K. , Schumock Glen T.
Published: July 2005

Rationale, aims and objectives  The decision to prescribe one drug instead of another within the same therapeutic class may be influenced by a variety of drug‐related, direct, or indirect factors; but little is known about which considerations are most important in such choices. The low‐molecular‐weight heparins (LMWHs) represent a class of drugs that are commonly used and for which therapeutic equivalence has been debated in the literature. The purpose of this study was to identify and compare factors perceived by doctors and clinical pharmacists to be influential in prescribing decisions among LMWHs.

Methods  Doctors and clinical pharmacists were interviewed to elicit information and to rank factors that influence the prescribing and use of LMWHs in community hospitals in the United States. For each factor, the mean and median of the rating were determined along with the frequency distribution across ratings. The non‐parametric Mann–Whitney U‐test was used to examine differences between doctors and clinical pharmacists.

Results  Both groups considered efficacy, formulary status, and policies restricting drug use to be highly influential in the decision to use one LMWH instead of another. Compared to clinical pharmacists, doctors rated personal experience as more influential, whereas they rated drug cost and prescribing guidelines lower.

Conclusions  These findings suggest that doctors and clinical pharmacists differentiate between LMWHs based on differences between products and because of hospital administrative programs (such as drug formularies). This information may be of value in designing programs to alter medication use.
The impact of practice guidelines and funding policies on the use of new drugs in advanced non‐small cell lung cancer*
Authors: Dranitsaris George , Evans William K. , Milliken Debbie , Zanke Brent
Published: July 2005

Background  Cancer Care Ontario's (CCO) Program in Evidence‐based Care has provided a credible basis for policy development and the funding of new and expensive anticancer drugs in the province of Ontario. In November 1997, vinorelbine was approved for the first‐line treatment of advanced non‐small cell lung cancer (NSCLC) on the basis of evidence‐based practice guidelines generated by the Provincial Lung Disease Site Group. In June 1998, gemcitabine was approved as an alternative to vinorelbine for use in selected patients (e.g. significant venous access problems, peripheral neuropathy, severe toxicity to vinorelbine). A provincial drug database was used to determine the impact that these new policies had on the rate of vinorelbine and gemcitabine uptake within the CCO new drug funding programme.

Methods  Drug utilization data for vinorelbine and gemcitabine from October 1997 to June 1999 were obtained from the CCO drug database. Individual patient data consisted of age, gender, first‐line agent used, number of treatments, duration of therapy, treatment location (regional cancer centre vs. other) and total cost. Demographic and drug utilization data were analysed descriptively as means, medians, or proportions. Multivariable logistic regression analysis was then used to identify factors associated with the selection of gemcitabine over vinorelbine, as a first‐line therapy.

Results  Following the approval of the first policy in November 1997, there was a rapid adoption of vinorelbine use in new NSCLC patients. When the gemcitabine policy was approved in June 1998, there was a rapid uptake in its use reaching a stable plateau of approximately 15% of all NSCLC patients within 9 months. The logistic regression analysis identified patient age greater than 65 years [odds ratio (OR) = 1.90, P = 0.001] and treatment in a non‐regional cancer setting (OR = 1.71, P = 0.008) as significant predictors of gemcitabine utilization. Overall, the mean drug cost per patient treated with first‐line gemcitabine was significantly higher than vinorelbine ($Can2590 vs. $Can1030, P < 0.001).

Conclusions  The new funding policies were associated with a rapid increase in drug utilization reaching a stable plateau within 9 months. Factors contributing to the usage of these new drugs for NSCLC included patient characteristics, such as age and treatment location.
Kisspeptins: Regulators of Metastasis and the Hypothalamic‐Pituitary‐Gonadal Axis
Authors: Murphy K. G.
Published: July 2005

The kisspeptins are the peptide products of the KiSS‐1 gene and the endogenous agonists for the GPR54 receptor. Although KiSS‐1 was initially discovered as a metastasis suppressor gene, recent evidence suggests the kisspeptin/GPR54 system is a key regulator of the reproductive system. Disrupted GPR54 signalling causes hypogonadotrophic hypogonadism in rodents and man. Central or peripheral administration of kisspeptin potently stimulates the hypothalamic‐pituitary‐gonadal axis, increasing circulating gonadotrophin concentrations in a number of animal models. These effects appear likely to be mediated via the hypothalamic gonadotrophin‐releasing hormone system, although kisspeptins may have direct effects on the anterior pituitary gland. Hypothalamic KiSS‐1 expression is regulated by circulating sex steroids. The precise physiological role of the kisspeptin system in the regulation of reproductive function remains to be elucidated.