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Abstract Using the case of traumatic brain injury, this paper explores 1) challenges to academic and ethical integrity when in the role of clinician-researcher, and 2) potential strategies to enhance ethical qualitative research involving people with possible physical and/or emotional trauma and temporary or permanent cognitive disruption. When undertaking qualitative research with patients, families, and/ or health professionals, a researcher’s clinical background may stimulate insightful and relevant research questions, interviews, and/or field observations of care to inform meaningful and translatable practice improvements. However, there may be tension between clinician versus researcher values, and these priorities affect what the clinician sees and interprets in the field. A clinician’s ingrained values and professional socialisation can make it difficult to hold their professional assumptions about various phenomena at bay. The principles of human research merit and integrity, justice, beneficence, and respect, along with methodological clarity, can provide a rigorous foundation for discussion of ethical research in traumatic brain injury. This paper discusses challenges and strategies through: 1) examining clinical assumptions; 2) determining capacity for consent; 3) considering dependent or unequal power relationships; 4) determining the scope for field observations; 5) responding to unprofessional practice; 6) discriminating between research interviews and clinical conversations; and 7) critically reflecting on research data. Implications for clinical research are evident: seeing past one’s own construct of understanding is challenging for clinician-researchers aiming to illuminate both patient and family experiences of care, and nuanced clinical skills. Careful ethical and methodological planning can protect participants while illuminating elements of specialist practice.

Explosive ordnance disposal (EOD) operators wear fully encapsulating suits to protect them from potential fragments and blast while disarming or destroying threats; however, these suits impose excess heat and cardiovascular strain. This work provides a practical method for planning safe working durations of these extremely hazardous and unique activities that previously did not exist. Biophysical measures were obtained for the EOD9 suit (Med-Eng EOD9 suit, Allen Vanguard; Ottawa, Canada) using a sweating thermal manikin. An EOD9-specific mathematical model of heat transfer was developed and compared to human data from eight healthy males (age, 25.3 ± 6.4 y; height, 180.4 ± 6.6 cm; weight, 79.4 ± 8.7 kg; VO2max, 57.0 ± 5.7 ml.kg.min−1). Activities included three walking speeds (0.69, 1.11, and 1.53 m/s), within three environmental conditions warm-humid (WH) (ambient temperature (Ta), 32 °C; relative humidity (RH), 60%; mean radiant temperature, 32 °C), hot-dry (HD) (48 °C; 20%; 48 °C), and temperate (T) (24 °C; 50%; 24 °C). Comparisons were assessed using bias, limits of agreement (LoA), mean absolute error (MAE), and root mean square error (RMSE). Biophysical measures show EOD9 suit to be completely vapor impermeable, allowing for a simplified modeling method where evaporative cooling is completely restricted creating a strictly dry heat exchange. Averaged predicted core body temperatures possessed an acceptable bias (−0.05 °C), but possessed a MAE of 0.33 °C, RMSE of 0.42 °C, and LoA was −0.88 to 0.79 compared to observed data. Observed endurance times were combined with thermal modeling to provide a simple method for estimating safe working times. Simplified method can be used as a guidance for determining EOD operation planning.

Background: It is unclear whether energy intake can impact the incidence of upper respiratory symptoms (URS). The purpose of this study was to examine if there are differences in energy intake between symptomatic (SYM) and asymptomatic (ASYM) groups of URS in Ironman-triathletes. Methods: Thirty-three subjects competing in the Lake Placid Ironman-triathlon (mean±SD; age,37±8y; height,178±8cm; mass,76.3±10.4kg; body fat,10.8±3.8%) were randomized into either the control (CON) or intervention (INT). INT consumed 4-commercial recovery drinks, two immediately post-race and two 3-hours post-race. Calorie and macronutrient intake were recorded pre-, during, and post-race. Subjects completed the Wisconsin URS Survey to assess URS over the next two weeks. Two analyses were done by comparing results between CON and INT, and when subjects were classified as either asymptomatic (ASYM=20) or symptomatic (SYM=13). Results: There were no differences in energy intake (p>0.05) and URS (INT,32±38; CON,16±23; p=0.155). However, on the race day, SYM (9,044±2,598kcal) consumed less energy intake than ASYM (10,991±2497kcal) (p=0.044). Also, SYM consumed less energy the day before the race (p=0.031) and post-race (p=0.008). ASYM consumed greater carbohydrate the day before the race (p=0.032), fat the day of the race (p=0.006), carbohydrate post-race (p=0.08) and fat post-race (p=0.002). Conclusions: Overall energy intake was similar between CON and INT. However, when subjects were differentiated by URS, SYM consumed less calories the day before and day of the race versus ASYM.

Background: It is unclear whether energy intake can impact the incidence of upper respiratory symptoms (URS). The purpose of this study was to examine if there are differences in energy intake between symptomatic (SYM) and asymptomatic (ASYM) groups of URS in Ironman-triathletes. Methods: Thirty-three subjects competing in the Lake Placid Ironman-triathlon (mean±SD; age,37±8y; height,178±8cm; mass,76.3±10.4kg; body fat,10.8±3.8%) were randomized into either the control (CON) or intervention (INT). INT consumed 4-commercial recovery drinks, two immediately post-race and two 3-hours post-race. Calorie and macronutrient intake were recorded pre-, during, and post-race. Subjects completed the Wisconsin URS Survey to assess URS over the next two weeks. Two analyses were done by comparing results between CON and INT, and when subjects were classified as either asymptomatic (ASYM=20) or symptomatic (SYM=13). Results: There were no differences in energy intake (p>0.05) and URS (INT,32±38; CON,16±23; p=0.155). However, on the race day, SYM (9,044±2,598kcal) consumed less energy intake than ASYM (10,991±2497kcal) (p=0.044). Also, SYM consumed less energy the day before the race (p=0.031) and post-race (p=0.008). ASYM consumed greater carbohydrate the day before the race (p=0.032), fat the day of the race (p=0.006), carbohydrate post-race (p=0.08) and fat post-race (p=0.002). Conclusions: Overall energy intake was similar between CON and INT. However, when subjects were differentiated by URS, SYM consumed less calories the day before and day of the race versus ASYM.

It has been estimated that there are more than 60 million Hepatitis C virus (HCV) carriers in the World Health Organisation's Western Pacific region (WHO-WPR), where liver cancer is among the top three causes of cancer death. WHO and the US Centres for Disease Control and Prevention report the prevalence of HCV in the South Pacific islands (countries within the WHO-WPR) to be high (5-10% and >2% respectively). However, since HCV is not tested for in many of these countries, there is sparse data available to support this assertion. We screened ∼2000 apparently healthy individuals from Papua New Guinea, Fiji and Kiribati and found a sero-prevalence of 2.0%, 0.1% and 0%, respectively. All sero-positive samples tested negative for HCV RNA. Curious as to why all the sero-positive individuals were negative for HCV-RNA, we also screened them for the HCV protective IL28B SNP markers rs12979860 and rs8099917. All antibody-positive participants bar one had HCV protective haplotypes. Our results suggest that HCV is present in these Pacific island countries, albeit at a prevalence lower than previous estimates. As none of our participants had undergone antiviral treatment, and therefore must have cleared infection naturally, we hypothesise that genotypes 1 and/or 4 are circulating in South Pacific Island people and that these peoples are genetically predisposed to be more likely to spontaneous resolve HCV infection than to become chronic carriers.

Aims and objectives. To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation. Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation. Design. Qualitative. Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice. Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect. Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation. Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery. © 2008 Blackwell Publishing Ltd.

Aims and objectives. To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation. Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation. Design. Qualitative. Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice. Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect. Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation. Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery. © 2008 Blackwell Publishing Ltd.

BACKGROUND: To evaluate the immunological impact of the 23-valent pneumococcal polysaccharide vaccine (23vPPS) at 12 months, for children who have received zero to three infant doses of seven-valent pneumococcal conjugate vaccine (PCV), on responses to a subsequent exposure to a small dose of 23vPPS (mPPS). METHODS: Five hundred and fifty-two Fijian infants were stratified by ethnicity and randomized into eight groups to receive zero, one, two, or three PCV doses at 14 weeks, six and 14 weeks, or six, ten, and 14 weeks. Within each group, half received 23vPPS at 12 months and all received mPPS at 17 months. Sera were taken prior and one month post-mPPS. FINDINGS: By 17 months, geometric mean antibody concentrations (GMC) to all 23 serotypes in 23vPPS were significantly higher in children who had received 23vPPS at 12 months compared to those who had not. Post-mPPS, children who had not received the 12 month 23vPPS had a significantly higher GMC for all PCV serotypes compared with those who had (each p<0.02). For the non-PCV serotypes, children who had not received the 12 month 23vPPS had significantly higher GMC for six of 16 non-PCV serotypes (7F, 9N, 12F, 19A, 22F, 33F) than those who did (each p<0.02). After adjusting for the pre-mPPS level, exposure to 23vPPS was associated with a lower response to mPPS for all serotypes (each p<0.001). INTERPRETATION: Despite higher antibody concentrations at 17 months in children who had received 23vPPS at 12 months, the response to a re-challenge was poor for all 23 serotypes compared to children who had not received the 12 month 23vPPS.

Invasive pneumococcal disease (IPD) epidemiology and the potential impact of the pneumococcal conjugate vaccine in Fiji are documented. The annual incidence was 26.5 and 10.9 in those aged <5 and > or =55 years per 100,000, respectively. The case fatality rate was 9.4% and 67% in <5 and >65 year olds, respectively. One pneumococcal death and case would be prevented in <5 years olds for every 1930 and 128 infants vaccinated with 7vPCV, respectively.

The aim was to identify an appropriate infant pneumococcal vaccination strategy for resource poor countries. Fijian infants received zero, one, two, or three doses of 7-valent pneumococcal conjugate vaccine (PCV) in early infancy. Following three PCV doses, geometric mean concentration (GMC) to all seven serotypes were ≥1.0 μg/mL, and >85% of children achieved antibody levels ≥0.35 μg/mL at 18 weeks. Following two doses, GMC were lower for 6B, 14, and 23F, but higher for 19F compared with three doses. Following a single dose, significant responses were seen for all serotypes post-primary series compared with the unvaccinated. By 12 months, differences between two and three doses persisted for serotype 14 only. Although GMC following three doses are higher than after two doses, the differences were small. A single dose may offer some protection for most serotypes.

The aim was to identify an appropriate infant pneumococcal vaccination strategy for resource poor countries. Fijian infants received zero, one, two, or three doses of 7-valent pneumococcal conjugate vaccine (PCV) in early infancy. Following three PCV doses, geometric mean concentration (GMC) to all seven serotypes were > or = 1.0 microg/mL, and >85% of children achieved antibody levels > or = 0.35 microg/mL at 18 weeks. Following two doses, GMC were lower for 6B, 14, and 23F, but higher for 19F compared with three doses. Following a single dose, significant responses were seen for all serotypes post-primary series compared with the unvaccinated. By 12 months, differences between two and three doses persisted for serotype 14 only. Although GMC following three doses are higher than after two doses, the differences were small. A single dose may offer some protection for most serotypes.

When the World Trade Centre was destroyed in New York on 11 September 2001, I felt devastation for all the victims of this atrocity. This included the terrorist themselves as well as the families of the dead and injured and of the perpetrators. When America used this atrocity as a reason to attack Iraq I was very disturbed by the transposition of lines of blame to a country that had no direct link to this attack on the USA.

OBJECTIVE: To calculate the incidence and document the clinical features of chest X-ray- (CXR-) confirmed pneumonia in children aged between 1 month and 5 years living in Greater Suva, Fiji. METHODS: A retrospective review was undertaken of children aged between 1 month and 5 years with a discharge diagnosis suggesting a lower respiratory tract infection (LRTI) admitted to the Colonial War Memorial Hospital in Suva, Fiji, in the first 10 days of each month from 1 January 2001 to 31 December 2002. Clinical data were collected and CXRs were reread and classified according to WHO standardized criteria for CXR-confirmed pneumonia. FINDINGS: Two hundred and forty-eight children with LRTI met the inclusion criteria. CXRs were obtained for 174 (70%) of these cases, of which 59 (34%) had CXR-confirmed pneumonia. The annual incidence of CXR-confirmed pneumonia was 428 cases per 100,000 children aged between 1 month and 5 years living in Greater Suva. If a similar proportion of the children for whom CXRs were unavailable were assumed to have CXR-confirmed pneumonia, the incidence was 607 per 100,000. The incidence appeared to be higher in Melanesian Fijian than Indo-Fijian children. The case-fatality rate was 2.8% in all children with LRTI, and 6.8% in those with CXR-confirmed pneumonia. CONCLUSION: This is the first study to document the incidence of CXR-confirmed pneumonia in a Pacific Island country, and demonstrates a high incidence. A significant proportion of hospital admissions of children with LRTI are likely to be preventable by the introduction of pneumococcal conjugate vaccine.

OBJECTIVE: To calculate the incidence and document the clinical features of chest X-ray- (CXR-) confirmed pneumonia in children aged between 1 month and 5 years living in Greater Suva, Fiji. METHODS: A retrospective review was undertaken of children aged between 1 month and 5 years with a discharge diagnosis suggesting a lower respiratory tract infection (LRTI) admitted to the Colonial War Memorial Hospital in Suva, Fiji, in the first 10 days of each month from 1 January 2001 to 31 December 2002. Clinical data were collected and CXRs were reread and classified according to WHO standardized criteria for CXR-confirmed pneumonia. FINDINGS: Two hundred and forty-eight children with LRTI met the inclusion criteria. CXRs were obtained for 174 (70%) of these cases, of which 59 (34%) had CXR-confirmed pneumonia. The annual incidence of CXR-confirmed pneumonia was 428 cases per 100,000 children aged between 1 month and 5 years living in Greater Suva. If a similar proportion of the children for whom CXRs were unavailable were assumed to have CXR-confirmed pneumonia, the incidence was 607 per 100,000. The incidence appeared to be higher in Melanesian Fijian than Indo-Fijian children. The case-fatality rate was 2.8% in all children with LRTI, and 6.8% in those with CXR-confirmed pneumonia. CONCLUSION: This is the first study to document the incidence of CXR-confirmed pneumonia in a Pacific Island country, and demonstrates a high incidence. A significant proportion of hospital admissions of children with LRTI are likely to be preventable by the introduction of pneumococcal conjugate vaccine.

The following question is addressed. How do multiple, simultaneously present cognitive structures influence the representation and recall of social information? In an empirical study examining both free and cued recall, we found that variable information redundancy to influence both the organization and accuracy of subjects' recollections of trait-related behaviors. Redundancy was defined in terms of the degree of person/trait overlap in a social information ensemble. Some evidence indicated that this effect is attributable to an increase in the discriminability of the organizational structures during encoding. The implications of these findings for understanding the formation of integrated cognitive representations of individuals are discussed., Prepared in cooperation with Notre Dame Univ., IN.

xv p., 1 L., [17]-704 p. incl. front. illus., ports., maps (part fold.) 22 cm., Making of America (MOA), (dlps) ABJ6714.0001.001, (lccallno) E467.1.F72 J82, http://quod.lib.umich.edu/t/text/accesspolicy.html

xv p., 1 L., [17]-704 p. incl. front. illus., ports., maps (part fold.) 22 cm., Making of America (MOA), (dlps) ABJ6714.0001.001, (lccallno) E467.1.F72 J82, http://quod.lib.umich.edu/t/text/accesspolicy.html