BACKGROUND & AIMS: :Achieving 'universal access' to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: 'labyrinthine bureaucracy' governing access to ART; a 'system Catch 22' created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and 'system verticalization', where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform.

背景与目标： : 在低收入和过渡环境中实现抗逆转录病毒艾滋病毒治疗的 “普遍获得” 是一个全球目标。然而，获得艺术的途径是受当地社会条件的影响，绝不是普遍的。定性研究非常适合描述获得艺术的社会地位。我们探讨了在俄罗斯城市 (叶卡捷琳堡) 中注射毒品 (PWID) 的人获得ART的系统性障碍，该城市的HIV治疗需求负担很大。我们对目前或最近有注射吸毒经验的艾滋病毒感染者进行了42次深入的定性访谈。对帐户进行了主题分析，并在此处进行了说明性案例研究。确定了三个核心主题: “迷宫式官僚” 管理获得ART的机会; 由于期望在有限的药物治疗机会中获得ART的条件下以治疗药物的使用为条件而创建的 “系统Catch 22”; 和 “系统垂直化”，其中缺乏艾滋病毒之间的融合，结核病 (TB) 和药物治疗损害了获得ART的机会。总之，我们发现系统性因素在塑造获得ART的途径中起着关键作用，其潜在的不利影响是再现治疗开始延迟和脱离治疗。我们认为，影响PWID获得ART的中观系统因素与更广泛的宏观结构力量相互作用，包括与药物治疗政策和PWID的社会边缘化有关的力量。我们注意到，在这种情况下，迫切需要进行系统性和结构性改革，以改善PWID获得抗逆转录病毒疗法的机会，包括简化官僚程序，促进艾滋病毒，结核病和药物治疗综合服务，并倡导药物治疗政策改革。

BACKGROUND & AIMS: :Cervical screening attendance among women aged 25-29 years in England is lower than at older ages. There is some evidence that pre-notification leaflets motivate women who have not yet considered their response to a health intervention. We aimed to identify key information to motivate young women at their first cervical screening invitation. Six focus groups were conducted, five with young women aged 17-25 registered with a General Practice in Manchester, UK, and one with Practice nurses. Some women took part in two further groups to discuss leaflet design. There was low awareness of the purpose or procedures of cervical screening, and most women were de-motivated by reports of bad experiences. Some intended to be screened, but not immediately after invitation. Screening was viewed as a test for a cancer that affected older women. Since none of the participants believed that they had cervical cancer, screening seemed unnecessary. We conclude that the perception that screening is unimportant when you are young needs to be challenged. Women also need to be better informed of screening procedures. A pre-notification leaflet incorporating key information was designed and will be tested in a randomized trial of complex interventions within the routine cervical screening programme.

背景与目标： : 英格兰25-29岁女性的子宫颈筛查出勤率低于老年人。有证据表明，预先通知的传单会激励尚未考虑对健康干预措施做出反应的妇女。我们的目标是确定关键信息，以激励年轻女性首次接受子宫颈筛查邀请。进行了六个重点小组，其中五个是在英国曼彻斯特注册的17-25岁的年轻女性，其中一个是执业护士。一些妇女参加了另外两个小组，讨论传单设计。人们对宫颈筛查的目的或程序的认识不足，大多数妇女因不良经历的报道而缺乏动力。有些人打算放映，但不是在邀请后立即放映。筛查被视为对影响老年妇女的癌症的测试。由于没有参与者相信自己患有宫颈癌，因此筛查似乎没有必要。我们得出的结论是，年轻时筛查不重要的看法需要受到挑战。妇女还需要更好地了解筛查程序。设计了包含关键信息的预通知传单，并将在常规子宫颈筛查计划中进行复杂干预的随机试验中进行测试。

BACKGROUND & AIMS: :Patients taking tricyclic antidepressants (TCA) can experience toxicity or severe side effects. As a rapid and less technically demanding alternative to quantitative serum analysis, most laboratories offer qualitative immunoassays to assist in the evaluation of a suspected TCA overdose. However, the relationship between quantitative serum and qualitative urine levels of TCA-related compounds and their metabolites has not been comprehensively studied. Serum high-performance liquid chromatography results were compared to the qualitative urine results using the Syva Rapid Test and the Biosite Triage. Serum concentrations of amitriptyline, desipramine, doxepin, imipramine, and nortriptyline ranging from subtherapeutic to toxic triggered a positive response on both urine immunoassay devices. On the other hand, neither immunoassay uniformly detected clomipramine, even at serum levels greater than the therapeutic range. False positives due to cyclobenzaprine were more common with the Biosite assay. For virtually all positive urine TCA findings, it was not possible to determine whether the positive results corresponded to subtherapeutic, therapeutic, supratherapeutic, or toxic serum concentrations. Because urine immunoassays are the only option for many laboratories analyzing specimens for TCAs (especially in an emergency setting), clinicians must understand the limitations and interpret results in conjunction with clinical findings and/or quantitation of serum levels.

背景与目标： : 服用三环类抗抑郁药 (TCA) 的患者会出现毒性或严重的副作用。作为定量血清分析的快速且技术要求较低的替代方法，大多数实验室提供定性免疫测定，以帮助评估可疑的TCA过量。然而，尚未全面研究TCA相关化合物及其代谢产物的定量血清和定性尿液水平之间的关系。使用Syva快速测试和Biosite分诊将血清高效液相色谱结果与定性尿液结果进行比较。阿米替林，地昔帕明，多塞平，丙咪嗪和去甲替林的血清浓度从亚治疗性到毒性，在两种尿液免疫测定设备上都产生了阳性反应。另一方面，即使在血清水平大于治疗范围的情况下，也没有免疫测定方法能均匀检测到氯米帕明。由于环苯扎林引起的假阳性在生物矿测定中更为常见。对于几乎所有尿液TCA阳性结果，无法确定阳性结果是否对应于亚治疗，治疗，超治疗或毒性血清浓度。由于尿液免疫测定是许多实验室分析TCAs标本的唯一选择 (尤其是在紧急情况下)，因此临床医生必须了解局限性并结合临床发现和/或血清水平定量来解释结果。

BACKGROUND & AIMS: :The lack of substantial research in the area of clinical teaching would suggest that this 'heart' of the nursing student's professional education has long been neglected. Employing a qualitative descriptive methodology, this study explored the teaching activities that nine clinical instructors said they implemented during the direct client care period and the teaching activities that these nine clinical instructors said they would implement in response to a specific scenario of a clinical teaching event. The unstructured interviews revealed that clinical instructors: (a) noted role modelling the greatest number of times as a teaching activity but implemented it less frequently; (b) used verbalizations in the form of telling, asking, saying, discussing or talking as the primary teaching activity in the clinical area and in response to the specific scenario; (c) do not have opportunities to see other clinical instructors teaching in the clinical area; (d) have difficulty separating teaching activities and evaluation activities; (e) are eclectic in their use of learning theories; and (f) find articulating teaching activities that they implement during the direct client care period to be a complex task.

背景与目标： : 在临床教学领域缺乏实质性的研究表明，长期以来一直忽略了护生专业教育的 “心脏”。本研究采用定性描述性方法，探讨了九名临床讲师表示他们在直接客户护理期间实施的教学活动，以及这九名临床讲师表示他们将针对临床教学事件的特定场景实施的教学活动。非结构化访谈显示，临床讲师 :( a) 注意到角色建模作为教学活动的次数最多，但实施频率较低; (b) 以讲述，询问，说，讨论或谈话作为临床领域的主要教学活动，并针对具体情况; (c) 没有机会看到临床领域的其他临床讲师教学; (d) 难以分离教学活动和评估活动; (e) 在学习理论的使用上不拘一格; (f) 发现他们在直接服务客户期间实施的明确教学活动是一项复杂的任务。

BACKGROUND & AIMS: BACKGROUND:Preservation of a dying person's dignity in the emergency department (ED) is fundamental for the patient, his/her relatives and healthcare professionals. The aim of this study was to explore and interpret physicians' and nurses' experiences regarding conservation of dignity in end-of-life care in dying patients in the ED. METHODS:A qualitative study based on the hermeneutic phenomenological approach, was carried out in the emergency department of two general hospitals. A total of 16 nurses and 10 physicians participated in the study. Data collection included 12 individual in-depth interviews and 2 focus groups. RESULTS:The findings revealed that two themes represent the practices and proposals for the conservation of dignity in the emergency department: dignified care in hostile surroundings and the design of a system focused on the person's dignity. CONCLUSION:Dignifying treatment, redesigning environmental conditions, and reorienting the healthcare system can contribute to maintaining dignity in end-of-life care in the ED.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:High-risk human papillomaviruses (HPVs) cause all cervical cancer and the majority of vulvar, vaginal, anal, penile and oropharyngeal cancers. Although HPV is the most common sexually transmitted infection, public awareness of this is poor. In addition, many clinicians lack adequate knowledge or confidence to discuss sexual transmission and related sensitive issues. Complex science needs to be communicated in a clear, digestible, honest and salient way. Therefore, the aim of this study was to coproduce with patients who have cancer appropriate resources to guide these highly sensitive and difficult consultations. METHODS:A matrix of evidence developed from a variety of sources, including a systematic review and telephone interviews with clinicians, supported the production of a draft list of approximately 100 potential educational messages. These were refined in face-to-face patient interviews using card-sorting techniques, and tested in cognitive debrief interviews to produce a ‘fast and frugal’ knowledge tool. RESULTS:We developed three versions of a consultation guide, each comprising a clinician guidance sheet and patient information leaflet for gynaecological (cervical, vaginal, vulvar), anal or oropharyngeal cancers. That cancer could be caused by a sexually transmitted virus acquired many years previously was surprising to many and shocking to a few patients. However, they found the information clear, helpful and reassuring. Clinicians acknowledged a lack of confidence in explaining HPV, welcomed the clinician guidance sheets and considered printed information for patients particularly useful. CONCLUSION:Because of the ‘shock factor’, clinicians will need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account, but we provide a novel, rigorously developed and tested resource which should have broad applicability in the UK National Health Service and other health systems.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:General practitioners' (GPs) negative beliefs about smoking cessation services may act as barriers to them recommending such services to smokers motivated to stop smoking. METHODS:In Study 1, 25 GPs from 16 practices across London were interviewed in this qualitative study. Framework analysis was used to identify key themes in GPs' beliefs about smoking cessation services. In Study 2, a convenience sample of 367 GPs completed an internet-based survey. Path-analysis was used to examine relationships between beliefs identified in Study 1 and intentions to recommend smoking cessation services. RESULTS:In Study 1, GPs felt that smoking cessation assistance was best provided by others. GPs favoured local services (i.e. practice nurses offering stop smoking support) over central services (i.e. offered through the Primary Care Trust), mainly because these were seen as more personalised and accessible for patients. These beliefs appeared to influence GPs' beliefs about the effectiveness of services. In Study 2, GPs' beliefs had a large effect on their intentions to recommend both central services, (f2 = .79) and local services, (f2 = 1.04). GPs' beliefs about effectiveness and cost-effectiveness were key predictors their intentions to recommend central services and local services. Beliefs about the level of personalisation offered and smokers' likelihood of attending services had indirect effects on intentions to recommend services operating via beliefs about effectiveness. CONCLUSION:GPs vary in their perceptions of the effectiveness of smoking cessation services and their intentions to recommend these services vary in line with these beliefs. Interventions aimed at increasing the likelihood with which GPs recommend these services may therefore be more effective if they addressed these beliefs.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In the UK, 8-15% of women suffer from postnatal depression, with long-term consequences for maternal mood and child development. Previous literature suggests that health visitors struggle with their conflicting roles with respect to mother and infant. Current policy is redirecting the emphasis and organisation of health visitor work, but guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression. AIM:To explore the views of GPs and health visitors on the diagnosis and management of postnatal depression. DESIGN OF STUDY:A qualitative study nested within a multicentre randomised controlled trial. SETTING:Nine primary care trusts in Bristol, Manchester, and London. METHOD:In-depth interviews with GPs and health visitors from primary care trusts participating in a randomised controlled trial of antidepressants versus health visitor-delivered non-directive counselling. Interviews were audiotaped and fully transcribed. Thematic analysis with an iterative approach was used to develop conceptual categories from the transcripts. RESULTS:Nineteen GPs and 14 health visitors were interviewed. GPs and health visitors described their work in making and negotiating the diagnosis of postnatal depression, the value of a long-term relationship with the woman, and how labelling affects management of women with postnatal depression. Responders described how they viewed others' roles in the management of postnatal depression, and how national policy and local organisational changes had an impact on patient care, so that no one health professional was assuming overall responsibility for the care of women with postnatal depression. CONCLUSION:Ongoing organisational changes within primary care, such as the implementation of corporate working by health visitors, affect care provided to women after birth, which in turn has an impact on the diagnosis and management of postnatal depression.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Hypoglycemia is a frequent phenomenon in people being treated for diabetes mellitus, which can acutely disrupt driving performance. For the benefit of personal and public traffic safety, we decided to identify successful diabetes-related (SDR) behaviors to support safe driving for people with diabetes, from the perspective of experiential experts with diabetes mellitus. Experiential experts are people who can manage their own illness and conditions by developing expertise relevant to maintaining health and countering illness, and who are able to use this expertise to the benefit of peers. OBJECTIVE:The aim of our study was to objectify and systematize experiential expertise in terms of SDR behaviors, based on reports by experiential experts, to support safe driving for people with type 1 and type 2 diabetes mellitus. The emphasis was on preventing hypoglycemia as a short-term complication during driving. METHODS:We performed a mixed-methods study involving (i) semi-structured in-depth interviews with 33 experiential experts with diabetes mellitus from the Dutch Diabetes Association (DVN; Diabetesvereniging Nederland), in order to identify SDR behaviors regarding safe driving, and (ii) a validation study by means of a survey among a panel of 98 experiential experts (peers) from the DVN, to determine the extent to which they agreed with the communicability, importance, and feasibility of these behaviors for drivers with diabetes mellitus. RESULTS:We identified a comprehensive set of 11 SDR behaviors, differentiated into seven general and four specific behaviors, to support safe driving. The general behaviors concern the following topics: (i) acquiring knowledge and information; (ii) acquiring and using self-measuring of blood glucose (SMBG) equipment; (iii) knowing one's physical response pattern; (iv) obtaining knowledge about the medication used; (v) preventing long-term eye complications; (vi) influencing factors that can affect blood glucose; and (vii) renewal procedure for driving license. The four specific behaviors refer to the following topics: (i) measures to be taken before driving; (ii) responding effectively to hypoglycemia while driving; (iii) informing and instructing passengers; and (iv) preventing hypoglycemia in drivers with type 2 diabetes mellitus not using SMBG equipment. Key factors for safe driving proved to be the ability of drivers to anticipate and respond effectively to hypoglycemia while driving and to inform and instruct fellow passengers. Participants of the validation survey agreed to a considerable degree with the communicability, importance, and feasibility of these behaviors to support safe driving for people with diabetes mellitus. CONCLUSIONS:This study resulted in the identification and description of SDR behaviors to support safe driving. It proved possible to operationalize experiential expertise in terms of such behaviors. The next step is to have these behaviors validated by professional care providers in the field of diabetes, followed by translation into recommendations in self-management programs.

背景与目标：

BACKGROUND & AIMS: :Given the increasing vehicle numbers and expanding road construction in developing countries, the importance of safe road user behaviour is critical. Road traffic crashes (RTCs) are a significant problem in Pakistan; however, the factors that contribute to RTCs in Pakistan are not well researched. Fatalistic beliefs are a potential barrier to the enhancement of road safety, especially participation in health-promoting and injury prevention behaviours, and also contribute to risk taking. Fatalistic beliefs relating to road safety have been found in some developing countries, although research is scarce and indicates that the nature and extent of fatalism differs in each country. Qualitative research was undertaken with a range of drivers, religious orators, police and policy makers to explore associations between fatalism, risky road use and associated issues. Findings indicate that fatalistic beliefs are pervasive in Pakistan, are strongly linked with religion, present a likely barrier to road safety messages and contribute to risky road use. Fatalism appears to be a default attribution of RTC and the intensity of belief in fate surpasses the kinds of fatalism noted in the limited existing literature. These findings have importance to developing road safety countermeasures in countries where fatalistic beliefs are strong.

背景与目标： : 鉴于发展中国家车辆数量的增加和道路建设的扩大，安全道路使用者行为的重要性至关重要。道路交通事故 (rtc) 是巴基斯坦的一个重要问题; 但是，尚未对导致巴基斯坦区域贸易中心的因素进行很好的研究。宿命论信念是加强道路安全，特别是参与促进健康和预防伤害行为的潜在障碍，也有助于冒险。在一些发展中国家发现了与道路安全有关的宿命论信念，尽管研究很少，并表明每个国家的宿命论性质和程度都不同。对一系列司机、宗教演说家、警察和决策者进行了定性研究，以探索宿命论、危险道路使用和相关问题之间的联系。调查结果表明，宿命论信仰在巴基斯坦普遍存在，与宗教息息相关，可能成为道路安全信息的障碍，并助长了危险的道路使用。宿命论似乎是RTC的默认归因，对命运的信念强度超过了有限的现有文献中提到的宿命论。这些发现对于在宿命论观念强烈的国家制定道路安全对策具有重要意义。

BACKGROUND & AIMS: OBJECTIVES:The National Health Service (NHS) in England recently introduced general practice pharmacists (GPPs) to provide medication-focused support to both patients and the general practice team. This healthcare model may benefit people with asthma, who currently receive suboptimal care and demonstrate low medication adherence. This study aimed to explore the perspectives of adults with asthma on the potential for pharmacist-led adherence support delivered in general practice, with a focus on how these perspectives are formed. DESIGN AND SETTING:The study was conducted in the United Kingdom (UK) utilising a qualitative interview methodology. Participants were invited to partake in a telephone-based semistructured interview, followed by an online questionnaire for demographic details and asthma history. Qualitative data were analysed using thematic analysis. PARTICIPANTS:Participants (n=17) were adults with asthma in the UK with a prescription for an inhaled corticosteroid. Participants did not have previous experience with GPPs and were asked to provide their views on a proposed GPP-led service. RESULTS:Participant perspectives of GPPs were determined by trust in pharmacists, perceived gaps in asthma care and the perceived strain on the NHS. Trust was based on pharmacists' perceived clinical competency, established over time, and gauged through a 'benchmarking' process. GPP's fit in current asthma care was assessed based on potential role overlap with other healthcare professionals, continuity of care and medication-related support needs. Participants navigated the NHS based on a perceived hierarchy of healthcare professionals (general practitioners on top, nurses, then pharmacists), and this influenced their perspectives of GPPs. CONCLUSION:While the GPP scheme shows promise based on the perspectives of people with asthma, the identified barriers to optimal patient engagement and service implementation will need to be addressed for the service to be effective.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units (HASUs). DESIGN:Interview and observation study to explain patterns of variation in delivery and outcomes of care described in a quantitative partner paper (Melnychuk et al). SETTING:Eight HASUs in London. PARTICIPANTS:We interviewed HASU staff (n=76), including doctors, nurses, therapists and administrators. We also conducted non-participant observations of delivery of care at different times of the day and week (n=45; ~102 hours). We analysed the data for thematic content relating to the ability of staff to provide evidence-based interventions consistently at different times of the day and week. RESULTS:Staff were able to deliver 'front door' interventions consistently by taking on additional responsibilities out of hours (eg, deciding eligibility for thrombolysis); creating continuities between day and night (through, eg, governance processes and staggering rotas); building trusting relationships with, eg, Radiology and Emergency Departments and staff prioritisation of 'front door' interventions. Variations by time of day resulted from reduced staffing in HASUs and elsewhere in hospitals in the evenings and at the weekend. Variations by day of week (eg, weekend effect) resulted from lack of therapy input and difficulties repatriating patients at weekends, and associated increases in pressure on Fridays and Mondays. CONCLUSIONS:Evidence-based service standards can facilitate 7-day working in acute stroke services. Standards should ensure that the capacity and capabilities required for 'front door' interventions are available 24/7, while other services, for example, therapies are available every day of the week. The impact of standards is influenced by interdependencies between HASUs, other hospital services and social services.

背景与目标：

BACKGROUND & AIMS: :In this paper we consider a time-delayed mathematical model describing tumor growth with angiogenesis and Gibbs-Thomson relation. In the model there are two unknown functions: One is $\sigma(r,t)$ which is the nutrient concentration at time $t$ and radius $r$, and the other one is $R(t)$ which is the outer tumor radius at time $t$. Since $R(t)$ is unknown and varies with time, this problem has a free boundary. Assume $\alpha(t)$ is the rate at which the tumor attracts blood vessels and the Gibbs-Thomson relation is considered for the concentration of nutrient at outer boundary of the tumor, so that on the outer boundary, the condition $$\dfrac{\partial \sigma}{\partial r}+\alpha(t)\left(\sigma-N(t)\right)=0,~~r=R(t)$$ holds, where $N(t)=\bar{\sigma}\left(1-\dfrac{\gamma}{R(t)}\right)H(R(t))$ is derived from Gibbs-Thomson relation. $H(\cdot)$ is smooth on $(0,\infty)$ satisfying $H(x)=0$ if $x\leq \gamma$, $H(x)=1$ if $x\geq 2\gamma$ and $0\leq H'(x)\leq 2/\gamma$ for all $x\geq 0$. In the case where $\alpha$ is a constant, the existence of steady-state solutions is discussed and the stability of the steady-state solutions is proved. In another case where $\alpha$ depends on time, we show that $R(t)$ will be also bounded if $\alpha(t)$ is bounded and some sufficient conditions for the disappearance of tumors are given.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Frailty is the leading prognosticator for poor outcomes and palliative care among older adults. Delivery of negative prognostic information entails potentially difficult conversations about decline and death. OBJECTIVE:The study aims were to: 1) examine hospitalized older adults' and family caregivers' receptivity to general (vs. individualized) prognostic information about frailty, injury, and one-year outcomes; and 2) determine information needs based on prognostic information. DESIGN:Provision of general prognostic information followed by semi-structured interview questions. We deductively analyzed qualitative data within the context of problematic integration theory. SETTING:An academic medical center in the Southeast region of the U.S. PARTICIPANTS:Purposive sampling was utilized to obtain a distribution of patients across the frailty continuum (non-frail [N=10], pre-frail [N=9], frail [9=6]). Twenty-five older adults (≥ age 65) hospitalized for a primary injury (e.g. fall) and 15 family caregivers of hospitalized patients were enrolled. METHODS:Hospitalized older patients and family caregivers were shown prognostic information about one-year outcomes of injured older adults in the form of simple pictographs. Semi-structured interview questions were administered immediately afterwards. The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis. Demographic and medical information data were used to contextualize the responses during analysis. RESULTS:Overall, participants (patients [56%], caregivers [73%]) were open to receiving prognostic information. A small number of family caregivers (N=3) expressed reservations about the frankness of the information and suggested delivery through a softer approach or not at all. Qualitative data was coded using categories and constructs of problematic integration theory. Four codes (personalizing the evidence, vivid understanding, downhill spiral, realities of aging) reflected probabilistic and evaluative orientation categories of problematic integration theory. One code (fatalism vs. hope) represented manifestations of ambivalence and ambiguity in the theory; and another code (exceptionalism) represented divergence and impossibility. Two codes (role of thought processes, importance of faith) reflected forms of resolutions as described in problematic integration theory. Information needs based on prognostic information revealed four additional codes: give it to me straight, what can I do? what can I expect? and how can I prevent decline? A consistently reported desire of both patients and caregivers was for honesty and hope from providers. CONCLUSION:This study supports the use of general prognostic information in conversations about aging, injury, frailty and patient outcomes. Incorporating prognostic information into communication aids can facilitate shared decision making before end-of-life is imminent.

背景与目标：

BACKGROUND & AIMS: A qualitative and quantitative analysis of the conformation of Langmuir-Blodgett (LB) dried films of cytochrome C on silicon wafers was performed by Fourier transform ir (FTIR) spectroscopy. A deconvolution procedure was applied to the amide I band analysis, in order to determine the percentage of the different secondary structures. Qualitative analysis was performed by examining difference spectra. Films obtained by spreading protein solutions at pH 7.4 and 1, dried at 25 and 100 degrees C, on silicon wafers were also examined in order to detect spectral components associated with denatured protein domains, and to compare them with cytochrome C LB films. FTIR spectroscopy showed that the following important changes characterise LB film spectra(a) the alpha-helix component is higher (its percentage is 57 and 54%) than the one estimated in dried film obtained by spreading the solutions at pH 7.4 on a silicon substrate (43%), (b) there is an increase in the intensity of bands attributed to protonated carboxy group bands, involved and not involved in the formation of hydrogen bonds, and a decrease in those attributed to deprotonated carboxy groups, (c) the intensity of several bands attributed to aromatic amino acids and aliphatic chains increases, and (d) bands due to O-H stretching vibrations of crystallization water are present. These conformational changes could be induced by protein-protein interaction caused by the close packing of molecules that occurs during LB film formation; it cannot be excluded that they may be accompanied by partial changes in the tertiary structure of the protein. A preferential orientation of protein molecules in LB films is also a possibility.

背景与目标： 通过傅立叶变换红外光谱 (FTIR) 对硅晶片上细胞色素C的Langmuir-Blodgett (LB) 干膜的构象进行了定性和定量分析。将反卷积程序应用于酰胺I带分析，以确定不同二级结构的百分比。通过检查差异光谱进行定性分析。还检查通过在25和100 ℃ 下将pH 7.4和1下的蛋白质溶液在硅晶片上扩散而获得的膜，以便检测与变性蛋白质结构域相关的光谱组分，并将它们与细胞色素C LB膜进行比较。FTIR光谱表明，下列重要变化表征了LB薄膜光谱 (a) α-螺旋组分比在硅衬底上通过在pH 7.4下扩散溶液而获得的干膜中估计的 α-螺旋组分更高 (其百分比为57和54%) (43%)，(b) 归因于质子化羧基带的带强度增加，参与和不参与氢键的形成，归因于去质子化羧基的带强度降低，(c) 归因于芳香族氨基酸和脂肪族链的几个带强度增加，并且 (d) 存在由于结晶水的o-h拉伸振动引起的带。这些构象变化可能是由LB膜形成过程中发生的分子紧密堆积引起的蛋白质-蛋白质相互作用引起的; 不能排除它们可能伴随着蛋白质三级结构的部分变化。LB膜中蛋白质分子的优先取向也是可能的。