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PubMed1997

Biologically active, alternatively processed interleukin-1 beta in psoriatic scales.

The aims of the present work were to elucidate the biochemical properties of interleukin-1 beta (IL-1 beta) in psoriatic scales to get information on the processing of epidermal IL-1 beta in psoriasis, and to elucidate whether the IL-1 beta in psoriatic scales possesses biological activity. By means of ion exchange chromatography, IL-1 beta in extracts of psoriatic scales was purified to a stage where it could be analyzed with electrophoretic methods and immunoblotting. Compared to mature recombinant human IL-1 beta (Ala 117 IL-1 beta), IL-1 beta in psoriatic scales had a slightly higher apparent molecular mass and a more acidic isoelectric point, as revealed by two-dimensional electrophoresis under denaturing conditions. Isoelectric focusing under non-denaturing conditions of IL-1 beta partially purified from psoriatic scales, or from non-inflamed plantar stratum corneum (Nylander Lundqvist, E., Bäck, O. and Egelrud, T., J. Immunol. 1996. 157: 1699), and of mature IL-1 beta, followed by immunoblotting with IL-1 beta-specific antibodies, showed that psoriatic scales contained two components with IL-1 beta-like immunoreactivity which were isoelectric at pH 6.1 and 6.3, respectively. These components could also be detected in extracts of plantar stratum corneum, which also contained small amounts of an IL-1 beta-like component isoelectric at pH 6.9. Mature IL-1 beta was isoelectric at pH 6.9. No IL-1 beta-like biological activity could be detected in crude extracts of psoriatic scales. These extracts also contained high amounts of IL-1 receptor antagonist. Partially purified preparations of IL-1 beta from psoriatic scales, in which an apparently total separation of IL-1 beta and IL-1 receptor antagonist had been achieved, could induce expression of E-selectin in human umbilical vein endothelial cells. This activity was inhibited by antibodies specific for IL-1 beta, but not by antibodies specific for IL-1 alpha. It is concluded that psoriatic scales contain biologically active IL-1 beta, which has been processed by a mechanism which may be similar to that present in non-inflamed plantar stratum corneum, and which does not involve IL-1 beta converting enzyme.

Biological Assay↗
PubMed1994

A controversy in scaling of subjective states: magnitude estimation versus category rating methods.

Measurement issues surrounding the quantification of subjective states such as sensations and attitudes have received increasing attention in nursing in recent years. It has sometimes been argued that magnitude estimation (ME) procedures are superior to category rating (CR) methods for scaling of subjective states which require judgments of intensity or strength of perception. A critique of the two scaling methods is presented. In contrast to arguments first proposed by Stevens and others for the superiority of ME procedures and the ability to attain "direct" ratio level measurement with ME scaling, there is evidence to suggest that ME procedures do not in fact produce ratio level scales. The "characteristic" exponents associated with ME scaling are not necessarily intrinsic to particular subjective states. CR scales neither necessarily constrain nor lack the requisite sensitivity needed to produce valid responses. It is concluded that ME is not necessarily superior to the commonly used CR method for scaling of subjective states in nursing research. Implications of the controversy for selection of scaling methods for nursing research are discussed. Greater attention to the ordinal or rank-order properties of data is encouraged. A small set of data is used to illustrate the importance of rank order properties in scaling subjective states in nursing.

Attitude↗
PubMed2004

A multi-scale study of industrial fermentation processes and their optimization.

In this article problems in multi-scale industrial fermentation processes are discussed. The problems are generated virtually, by using computer simulation on three different scales--the molecular scale (genetics), the cellular scale (metabolic regulation), and the reactor engineering scale. Inter-scale observation and operation are deemed to be crucial in the optimization of bioprocesses. Bioreaction engineering based on metabolic flux analysis and control is further elucidated. Optimization methodology for study of multi-scale problems in a fermentation process, based on correlation of data, and the scale-up technique for regulation of several bioprocess parameters are generalized by investigation of two typical fermentation processes. A novel bioreactor system was designed to monitor mass flux (for example substrates and (by-)products) in a fermentation process. It was successfully applied to the optimization and scale-up of an industrial fermentation process for penicillin, erythromycin, chlortetracyclin, inosine, and guanosine, and for production of recombinant human serum albumin and a malaria vaccine by use of the Pichia expression system. Substantial improvement of industrial fermentation productivity was achieved.

Bioreactors↗
PubMed1995

Physiological and technological aspects of large-scale heterologous-protein production with yeasts.

Commercial production of heterologous proteins by yeasts has gained considerable interest. Expression systems have been developed for Saccharomyces cerevisiae and a number of other yeasts. Generally, much attention is paid to the molecular aspects of heterologous-gene expression. The success of this approach is indicated by the high expression levels that have been obtained in shake-flask cultures. For large-scale production however, possibilities and restrictions related to host-strain physiology and fermentation technology also have to be considered. In this review, these physiological and technological aspects have been evaluated with the aid of numerical simulations. Factors that affect the choice of a carbon substrate for large-scale production involve price, purity and solubility. Since oxygen demand and heat production (which are closely linked) limit the attainable growth rate in large-scale processes, the biomass yield on oxygen is also a key parameter. Large-scale processes impose restrictions on the expression system. Many promoter systems that work well in small-scale systems cannot be implemented in industrial environments. Furthermore, large-scale fed-batch fermentations involve a substantial number of generations. Therefore, even low expression-cassette instability has a profound effect on the overall productivity of the system. Multicopy-integration systems may provide highly stable expression systems for industrial processes. Large-scale fed-batch processes are typically performed at a low growth rate. Therefore, effects of a low growth rate on the physiology and product formation rates of yeasts are of key importance. Due to the low growth rates in the industrial process, a substantial part of the substrate carbon is expended to meet maintenance-energy requirements. Factors that reduce maintenance-energy requirements will therefore have a positive effect on product yield. The relationship between specific growth rate and specific product formation rate (kg product.[kg biomass]-1.h-1) is the main factor influencing production levels in large-scale production processes. Expression systems characterized by a high specific rate of product formation at low specific growth rates are highly favourable for large-scale heterologous-protein production.

Biotechnology↗
PubMed2003

Motor learning processes in a movement-scaling task in olivopontocerebellar atrophy and Parkinson's disease.

Nine Parkinson's disease (PD), seven olivopontocerebellar atrophy (OPCA) patients and two age-matched control groups learned a linear arm movement-scaling task over 2 days, requiring movements proportional in length to visually presented target-bars. Scaling was acquired through knowledge of results (KR concerning the direction and magnitude of errors) following every second acquisition trial. Initial acquisition of both groups was significantly worse than their respective controls (poorer movement scaling), but rapidly improved to nearly identical levels. Retention for the PD group's movement scaling was as good as controls initially, but markedly poorer after 24 h. The OPCA group did not show this deficit. Both patient groups extrapolated accurately to longer, previously unpracticed target distances (no KR provided), suggesting an unimpaired capacity to generate and use an internal representation of the movement scaling. They also rapidly learned a new scaling relationship when the gain was changed. Overall, the learning of this movement-scaling task was not adversely affected in OPCA, and the impairment was restricted primarily to longer-term retention in PD. The study suggests that: (1) the ability to acquire movement scaling in a task that requires conscious use of error feedback and no new coordination may depend little on the cerebellum, and (2) the basal ganglia may participate in longer-term storage of scaling information.

Adult↗
PubMed2005

Using animal movement paths to measure response to spatial scale.

Animals live in an environment that is patchy and hierarchical. I present a method of detecting the scales at which animals perceive their world. The hierarchical nature of habitat causes movement path structure to vary with spatial scale, and the patchy nature of habitat causes movement path structure to vary throughout space. These responses can be measured by a combination of path tortuousity (measured with fractal dimension) versus spatial scale, the variation in tortuousity of small path segments along the movement path, and the correlation between tortuousities of adjacent path segments. These statistics were tested using simulated animal movements. When movement paths contained no spatial heterogeneity, then fractal D and variance continuously increased with scale, and correlation was zero at all scales. When movement paths contained spatial heterogeneity, then fractal D sometimes showed a discontinuity at transitions between domains of scale, variation showed peaks at transitions, and correlations showed a statistically significant positive value at scales smaller than patch size, decreasing to below zero at scales greater than patch size. I illustrated these techniques with movement paths from deer mice and red-backed voles. These new analyses should help understand how animals perceive and react to their landscape structure at various spatial scales, and to answer questions about how habitat structure affects animal movement patterns.

Animals↗
PubMed1991

Avian scale development. XIII. Epidermal germinative cells are committed to appendage-specific differentiation and respond to patterned cues in the dermis.

The ability of the germinative cell population of scutate scale epidermis to continue to generate cells that undergo their appendage-specific differentiation (beta stratum formation), when associated with foreign dermis, was examined. Tissue recombination experiments were carried out which placed anterior metatarsal epidermis (scutate scale forming region) from normal 15-day chick embryos with either the anterior metatarsal dermis from 15-day scaleless (sc/sc) embryos or the dermis from the metatarsal footpad (reticulate scale forming region) of 15-day normal embryos. Neither of these dermal tissues are able to induce beta stratum formation in the simple ectodermal epithelium of the chorion, however, the footpad dermis develops an appendage-specific pattern during morphogenesis of the reticulate scales, while the sc/sc dermis does not. Morphological and immunohistological criteria were used to assess appendage-specific epidermal differentiation in these recombinants. The results show that the germinative cell population of the 15-day scutate scale epidermis is committed to generating suprabasal cells that follow their appendage-specific pathways of histogenesis and terminal differentiation. Of significance is the observation that the expression of this determined state occurred only when the epidermis differentiated in association with the footpad dermis, not when it was associated with the sc/sc dermis. The consistent positioning of the newly generated beta strata to the apical regions of individual reticulate-like appendages demonstrates that the dermal cues necessary for terminal epidermal differentiation are present in a reticulate scale pattern. The observation that beta stratum formation is completely missing in the determined scutate scale epidermis when associated with the sc/sc dermis adds to our understanding of the sc/sc defect. The present data support the conclusion of earlier studies that the anterior metatarsal dermis from 15-day sc/sc embryos lacks the ability to induce beta stratum formation in a foreign epithelium. In addition, these observations evoke the hypothesis that the sc/sc dermis either lacks the cues (generated during scutate and reticulate scale morphogenesis) necessary for terminal differentiation of the determined scutate scale epidermis or inhibits the generation of a beta stratum.

Animals↗
PubMed1987

Hydrophobicity scales and computational techniques for detecting amphipathic structures in proteins.

Protein segments that form amphipathic alpha-helices in their native state have periodic variation in the hydrophobicity values of the residues along the segment, with a 3.6 residue per cycle period characteristic of the alpha-helix. The assignment of hydrophobicity values to amino acids (hydrophobicity scale) affects the display of periodicity. Thirty-eight published hydrophobicity scales are compared for their ability to identify the characteristic period of alpha-helices, and an optimum scale for this purpose is computed using a new eigenvector method. Two of the published scales are also characterized by eigenvectors. We compare the usual method for detecting periodicity based on the discrete Fourier transform with a method based on a least-squares fit of a harmonic sequence to a sequence of hydrophobicity values. The two become equivalent for very long sequences, but, for shorter sequences with lengths commonly found in alpha-helices, the least-squares procedure gives a more reliable estimate of the period. The analog to the usual Fourier transform power spectrum is the "least-squares power spectrum", the sum of squares accounted for in fitting a sinusoid of given frequency to a sequence of hydrophobicity values. The sum of the spectra of the alpha-helices in our data base peaks at 97.5 degrees, and approximately 50% of the helices can account for this peak. Thus, approximately 50% of the alpha-helices appear to be amphipathic, and, of those that are, the dominant frequency at 97.5 degrees rather than 100 degrees indicates that the helix is slightly more open than previously thought, with the number of residues per turn closer to 3.7 than 3.6. The extra openness is examined in crystallographic data, and is shown to be associated with the C terminus of the helix. The alpha amphipathic index, the key quantity in our analysis, measures the fraction of the total spectral area that is under the 97.5 degrees peak, and is a characteristic of hydrophobicity scales that is consistent for different sets of helices. Our optimized scale maximizes the amphipathic index and has a correlation of 0.85 or higher with nine previously published scales. The most surprising feature of the optimized scale is that arginine tends to behave as if it were hydrophobic; i.e. in the crystallographic data base it has a tendency to be on the hydrophobic face of teh amphipathic helix. Although the scale is optimal only for predicting alpha-amphipathicity, it also ranks high in identifying beta-amphipathicity and in distinguishing interior from exterior residues in a protein.(ABSTRACT TRUNCATED AT 400 WORDS)

Algorithms↗
PubMed1978

Ratio scales of sensory and affective verbal pain descriptors.

The results of two experiments show that ratio scales of sensory and affective verbal pain descriptors are valid, reliable and objective. In the first experiment, 16 subjects rated 15 sensory and 15 affective verbal pain descriptors by numerical magnitude estimation and by cross-modality matching to handgrip force. Ratio scales of sensory and affective verbal pain descriptors computed for two separate groups were highly correlated between the groups (sensory, r = 0.97; affective, r = 0.98), as well as over session (r = 0.99, 0.98). Scales based on an individual's data correlated equally with either another set of scales from the same individual (r = 0.96, 0.98) or a mean scale from a similar group (r = 0.96, 0.89). Sensory and affective verbal descriptor scales from the first experiment correlated highly (r = 0.99, 0.99) with those from the second experiment in which 40 subjects rated verbal pain descriptors by cross-modality matching to time duration and to handgrip force. The ratio responses to the verbal descriptors in both experiments demonstrated specific functional relationships found for measurable psychophysical stimuli. This result supports the validity of cross-modality matched ratio scales of verbal stimuli. The reliability of these scales is shown by the high between-session, between-group and between-experiment correlations. The objectivity is shown by the similarity of within-subject and between-subject correlations for both group and individual descriptor scales.

Adolescent↗
PubMed1987

Reliability and validity of verbal descriptor scales of painfulness.

Previous studies have provided information about the reliability and validity of verbal descriptor scales of sensory intensity and unpleasantness and have shown that these two dimensions can be differentially affected by pharmacological manipulations. Since the relation between these dimensions and the general term 'pain' is not known, two experiments developed a verbal descriptor scale of painfulness and compared the sensitivity of this scale to pharmacological manipulations used previously with scales of sensory intensity and unpleasantness. In exp. I, 20 subjects used cross-modality matching to both handgrip force and tone duration to quantify the amount of pain implied by verbal descriptor phrases such as 'slightly painful,' 'somewhat painful' and 'very painful.' Ratio scales of relative magnitude for each individual were highly correlated within subjects (mean r = 0.92) and between a scale from each individual and a combined scale from others in the group (mean r = 0.93). These correlations indicate agreement between individual scales; an individual's scale values were predicted equally well by that individual or by a group of similar persons. In exp. II, 4 groups of 10 subjects rated the magnitude of painful tooth pulp sensations by choosing pain descriptors from randomized lists. Seven electrical stimuli spaced between individually determined pain threshold and tolerance values were delivered in random sequence 6 times before and after double-blind intravenous infusions of placebo, 0.11 mg/kg diazepam, 0.66 microgram/kg fentanyl or a combination of the diazepam and fentanyl doses. Mean responses were reduced significantly after all active drugs but not after placebo. These results suggest that the term pain does not represent a simple combination of sensory intensity and/or unpleasantness and shows that the sensitivity to an inert placebo, an active placebo, and an analgesic can vary with the type of pain assessment procedure.

Adolescent↗
PubMed2006

Validation of a beta-agonist long-term asthma control scale derived from computerized pharmacy data.

BACKGROUND: Asthma control has been defined clinically by using validated tools, but an asthma control scale using administrative data has not been reported. OBJECTIVE: We sought to validate a beta-agonist asthma control scale derived from administrative data. METHODS: Surveys that included validated asthma symptom and control tools were completed by a random sample of 2250 health maintenance organization members aged 18 to 56 years with persistent asthma. Linked computerized pharmacy data provided beta-agonist canister and oral corticosteroid dispensings. The proposed 4-level asthma control scale was based on the number of short-acting beta-agonist canisters dispensed in 12 months. Construct validity and predictive validity were assessed. RESULTS: For construct validity, factor analysis showed significant loading of the beta-agonist scale on the symptom control factor, and the beta-agonist scale was significantly related to the validated asthma control and symptom scales (r = 0.31, P < .0001). For predictive validity, each progressive level of the proposed beta-agonist control scale was associated with an increased risk of subsequent asthma hospitalizations or emergency department visits and oral corticosteroid use, independent of prior use. CONCLUSION: A scale based on the number of beta-agonists dispensed in a 1-year period and derived from administrative data reflects asthma symptom control over that period of time. This scale can help identify patients who are at risk for future acute asthma health care use. CLINICAL IMPLICATIONS: This information can be used in population management and by clinicians to assess long-term asthma control and identify patients who need intervention to prevent future morbidity.

Adolescent↗
PubMed2005

Scoring based on item response theory did not alter the measurement ability of EORTC QLQ-C30 scales.

BACKGROUND AND OBJECTIVES: Most health-related quality-of-life questionnaires include multi-item scales. Scale scores are usually estimated as simple sums of the item scores. However, scoring procedures utilizing more information from the items might improve measurement abilities, and thereby reduce the needed sample sizes. We investigated whether item response theory (IRT)-based scoring improved the measurement abilities of the EORTC QLQ-C30 physical functioning, emotional functioning, and fatigue scales. METHODS: Using a database of 13,010 subjects we estimated the relative validities of IRT scoring compared to sum scoring of the scales. RESULTS: The mean relative validities were 1.04 (physical), 1.03 (emotional), and 0.97 (fatigue). None of these were significantly larger than 1. Thus, no gain in measurement abilities using IRT scoring was found for these scales. Possible explanations include that the items in the scales are not constructed for IRT scoring and that the scales are relatively short. CONCLUSION: IRT scoring of the three longest EORTC QLQ-C30 scales did not improve measurement abilities compared to the traditional sum scoring of the scales.

Adult↗
PubMed2006

Scaling of spontaneous imbibition data with wettability included.

Wettability is a dominant parameter governing spontaneous imbibition. However less attention has been paid to the effect of wettability on the scaling of spontaneous imbibition data. Actually few models can include wettability in scaling of spontaneous imbibition data. To this end, a scaling model has been developed for NAPL (oil)-saturated porous media with different wettability based on the fluid flow mechanisms in porous media. Relative permeability, capillary pressure, initial water saturation, and wettability are considered in the scaling model. Theoretically this scaling model is suitable for both cocurrent and countercurrent spontaneous imbibition. The experimental data of countercurrent spontaneous water imbibition at different wettability cannot be scaled using the frequently used scaling model but can be scaled satisfactorily using the scaling model developed in this study. An analytical solution to the relationship between recovery and imbibition time for linear spontaneous imbibition has also been derived in the case in which gravity is ignored. The analytical solution predicts a linear correlation between the recovery by spontaneous water imbibition and the square root of imbibition time, which has been verified against experimental data.

Models, Theoretical↗
PubMed2004

Multi-scale analysis of a household level agent-based model of landcover change.

Scale issues have significant implications for the analysis of social and biophysical processes in complex systems. These same scale implications are likewise considerations for the design and application of models of landcover change. Scale issues have wide-ranging effects from the representativeness of data used to validate models to aggregation errors introduced in the model structure. This paper presents an analysis of how scale issues affect an agent-based model (ABM) of landcover change developed for a research area in the Midwest, USA. The research presented here explores how scale factors affect the design and application of agent-based landcover change models. The ABM is composed of a series of heterogeneous agents who make landuse decisions on a portfolio of cells in a raster-based programming environment. The model is calibrated using measures of fit derived from both spatial composition and spatial pattern metrics from multi-temporal landcover data interpreted from historical aerial photography. A model calibration process is used to find a best-fit set of parameter weights assigned to agents' preferences for different landuses (agriculture, pasture, timber production, and non-harvested forest). Previous research using this model has shown how a heterogeneous set of agents with differing preferences for a portfolio of landuses produces the best fit to landcover changes observed in the study area. The scale dependence of the model is explored by varying the resolution of the input data used to calibrate the model (observed landcover), ancillary datasets that affect land suitability (topography), and the resolution of the model landscape on which agents make decisions. To explore the impact of these scale relationships the model is run with input datasets constructed at the following spatial resolutions: 60, 90, 120, 150, 240, 300 and 480 m. The results show that the distribution of landuse-preference weights differs as a function of scale. In addition, with the gradient descent model fitting method used in this analysis the model was not able to converge to an acceptable fit at the 300 and 480 m spatial resolutions. This is a product of the ratio of the input cell resolution to the average parcel size in the landscape. This paper uses these findings to identify scale considerations in the design, development, validation and application of ABMs of landcover change.

Agriculture↗
PubMed2004

A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment.

The aim of the study was to compare five different pain assessment scales for use with people with different levels of cognitive impairment who resided in nursing homes. The verbal rating scale, horizontal numeric rating scale, Faces pictorial scale, color analogue scale and mechanical visual analogue scale were presented in random order to 113 residents. Cognitive impairment was assessed using the Mini-Mental State Examination. The use of the verbal rating scale was the most successful with this group, completed by 80.5% overall, and 36% of those with severe cognitive impairment. Repeated explanation improved completion rates for all the scales. Consistency between scores on the five scales was good for those with none to moderate cognitive impairment and poor for those severely impaired. This study showed no difference in pain scores according to cognitive status.

Aged↗
PubMed2004

Environmental consequence analyses of fish farm emissions related to different scales and exemplified by data from the Baltic--a review.

The aim of this work is to review studies to evaluate how emissions from fish cage farms cause eutrophication effects in marine environments. The focus is on four different scales: (i) the conditions at the site of the farm, (ii) the local scale related to the coastal area where the farm is situated, (iii) the regional scale encompassing many coastal areas and (iv) the international scale including several regional coastal areas. The aim is to evaluate the role of nutrient emissions from fish farms in a general way, but all selected examples come from the Baltic Sea. An important part of this evaluation concerns the method to define the boundaries of a given coastal area. If this is done arbitrarily, one would obtain arbitrary results in the environmental consequence analysis. In this work, the boundary lines between the coast and the sea are drawn using GIS methods (geographical information systems) according to the topographical bottleneck method, which opens a way to determine many fundamental characteristics in the context of mass balance calculations. In mass balance modelling, the fluxes from the fish farm should be compared to other fluxes to, within and from coastal areas. Results collected in this study show that: (1) at the smallest scale (<1 ha), the "footprint" expressing the impact areas of fish cage farm often corresponds to the size of a "football field" (50-100 m) if the annual fish production is about 50 ton, (2) at the local scale (1 ha to 100 km2), there exists a simple load diagram (effect-load-sensitivity) to relate the environmental response and effects from a specific load from a fish cage farm. This makes it possible to obtain a first estimate of the maximum allowable fish production in a specific coastal area, (3) at the regional scale (100-10,000 km2), it is possible to create negative nutrient fluxes, i.e., use fish farming as a method to reduce the nutrient loading to the sea. The breaking point is to use more than about 1.1 g wet weight regionally caught wild fish per gram feed for the cultivated fish, and (4) at the international scale (>10,000 km2) related to the Baltic Proper, the contribution from fish farms to the overall nutrient fluxes are very small. We have also given two case-studies at the local scale where the impact of the fish farm emissions are greatest and the idea is to identify coastal areas unsuitable and suitable for fish cage farms and the reasons why. It should also be stressed that the results presented here are exemplified using emissions from fish farms, but that the underlying principles to evaluate the ecosystem effects of nutrient discharges from point source emissions are valid in a wider and more general perspective.

Animals↗
PubMed2006

A novel scale including strabismus and 'cuspidal ear' for distinguishing schizophrenia patients from controls using minor physical anomalies.

The present study explored minor physical anomaly items relevant to schizophrenia in order to establish a scale that can distinguish schizophrenia from controls using newly identified items along with items from the refined Waldrop scale. Seven items were significantly more frequent among schizophrenia patients (N=218) than controls (N=226). Among these seven items, two novel features, strabismus and 'cuspidal ear' showed markedly different prevalence rates between schizophrenia and control groups. A six-item scale, including the newly identified strabismus and cuspidal ear, was selected for most accurately discriminating patients with schizophrenia from controls. This scale correctly classified 59.6% of patients and 78.9% of control subjects. This new scale is procedurally more exacting and quantitative, and more relevant to schizophrenia than the original Waldrop scale. The validity of this scale should be sound since it was tested on a larger number of cohorts than used in previous research. Our scale can be used as a biomarker for predicting risk for future development of schizophrenia. The scale may also facilitate the identification of schizophrenia susceptibility genetic/environmental factors by stratifying etiologically heterogeneous patients according to physical abnormalities.

Abnormalities, Multiple↗
PubMed2006

Development and validation of a scale to assess attitudes of health care administrators toward the use of e-mail communication between patients and physicians.

BACKGROUND: The medical profession has been slow in embracing the e-mail as a means of improving patient communications. Today, most physicians work in group practices where administrators seek to develop standard procedures for care delivery. To understand the slow adoption of e-mail technology among physicians when communicating with their patients, it is important to understand these administrators' attitudes. OBJECTIVE: The purpose of this study was to develop and purify a scale to measure health care administrators' attitudes toward the use of e-mail communication and identify associations between e-mail communication attitudes and administrators' demographic and practice-related characteristics. METHODS: A preliminary list of features for e-mail communication was generated by reviewing the literature and Rogers' diffusion theory. The features were grouped initially into 5 hypothesized dimensions: relative advantage, norms (established rules of the social system), complexity, compatibility, and infrastructure. Following pilot testing, the main survey instrument was mailed to a total of 1500 health care administrators. Attitudes toward features of e-mail communication scale were analyzed using exploratory factor analysis with promax rotation. Internal consistency of the scale and its subscales was determined using Cronbach's alpha and item-total correlations. RESULTS: The overall response rate was 8.7%. Scale purification procedures reduced the preliminary scale of 22 items to a final scale of 20 items. The reliability of the scale measured by Cronbach's alpha was 0.81. Norms was considered the major barrier to e-mail communication, whereas infrastructure was considered a facilitator, and other features like relative advantage, complexity, and compatibility issues were perceived more as a barrier than a facilitator. The item related to and usage of e-mail by staff was statistically significant with the overall scale score (P=0.0095), complexity subscale score (P=0.0168), and infrastructure subscale score (P=0.0480). The relationship between number of years of experience of the administrator and infrastructure subscale score was statistically significant (P=0.0480). CONCLUSION: A scale developed to determine the attitudes of health care administrators regarding e-mail communication between patients and physicians demonstrated adequate content validity and reliability.

Adolescent↗