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Background/AimsInpatient admissions can increase carer stress rather than provide respite. The aim of this study was to gain carers' perspectives about how their needs can be met during an inpatient admission.MethodsSemi-structured interviews were conducted with 12 carers whose relatives had been admitted to inpatient care at least once. Interviews were analysed thematically.ResultsCarers described a fear of relinquishing responsibility for care, which was exacerbated by concerns about the quality of care provided by staff. Better experiences were possible when carers were given information, ranging from generic information about symptoms or how the mental health system works, information about patients' needs and carer support systems.ConclusionsCommunication is key and needs to be a two-way process, with carers and staff learning from each other to support patients.Implications for practiceInpatient staff need training in carer involvement, including ways of engaging carers when patients do not give consent to information sharing.

Voluntary Safety Reporting Programs (VSRPs) create an opportunity for actively identifying potential safety issues within aviation operations. However, manually reading and analyzing these reports can be labor-intensive and heavily relies on subject-matter experts. The full potential of VSRP data is difficult to achieve due to limited resources available to extract meaningful human factors (HF) data from reports. New machine learning (ML) techniques involving natural language processing (NLP) offer opportunities to label factors of interest within safety reports more efficiently and effectively. A novel ML model was developed to identify HF issues within aviation safety reports. The AVIAN-S model was trained on over 50,000 rows of manually classified VSRPs. The model uses ML and NLP to automate the process of labeling aviation safety reporting data and coding reporter narratives according to an established HF taxonomy. Preliminary results and implications for using the AVIAN-S model for analyzing aviation safety event reports are described.

Photoaging is a complex process of skin changes associated with chronic ultraviolet exposure. Prevention with photoprotection and treatment with topical retinoids are the core components of a topical antiaging regimen. Other topicals such as hydroquinone, vitamin C, niacinamide, and alpha hydroxyl acid can be added based on specific concerns. However, caution must be used with some of these products as the stability and absorption are major considerations. A simple topical regimen will reduce irritability and enhance compliance.

RNA-binding proteins play important roles in bacterial gene regulation through interactions with both coding and noncoding RNAs. ProQ is a FinO-domain protein that binds a large set of RNAs in Escherichia coli, though the details of how ProQ binds these RNAs remain unclear. In this study, we used a combination of in vivo and in vitro binding assays to confirm key structural features of E. coliProQ’s FinO domain and explore its mechanism of RNA interactions. Using a bacterial three-hybrid assay, we performed forward genetic screens to confirm the importance of the concave face of ProQ in RNA binding. Using gel shift assays, we directly probed the contributions of ten amino acids on ProQ binding to seven RNA targets. Certain residues (R58, Y70, and R80) were found to be essential for binding of all seven RNAs, while substitutions of other residues (K54 and R62) caused more moderate binding defects. Interestingly, substitutions of two amino acids (K35, R69), which are evolutionarily variable but adjacent to conserved residues, showed varied effects on the binding of different RNAs; these may arise from the differing sequence context around each RNA’s terminator hairpin. Together, this work confirms many of the essential RNA-binding residues in ProQ initially identified in vivo and supports a model in which residues on the conserved concave face of the FinO domain such as R58, Y70, and R80 form the main RNA-binding site of E. coliProQ, while additional contacts contribute to the binding of certain RNAs.

Photoaging is a complex process of skin changes associated with chronic ultraviolet exposure. Prevention with photoprotection and treatment with topical retinoids are the core components of a topical antiaging regimen. Other topicals such as hydroquinone, vitamin C, niacinamide, and alpha hydroxyl acid can be added based on specific concerns. However, caution must be used with some of these products as the stability and absorption are major considerations. A simple topical regimen will reduce irritability and enhance compliance.

This protocol describes a bacterial three-hybrid (B3H) assay, an in vivo system that reports on RNA–protein interactions and can be implemented in both forward and reverse genetic experiments. The B3H assay connects the strength of an RNA–protein interaction inside of living Escherichia colicells to the transcription of a reporter gene (here, lacZ). We present protocols to (1) insert RNA and protein sequences into appropriate vectors for B3H experiments, (2) detect putative RNA–protein interactions with both qualitative and quantitative readouts and (3) carry out forward genetic mutagenesis screens. The B3H assay builds on a well-established bacterial two-hybrid system for genetic analyses. As a result, protein–protein interactions can be assessed in tandem with RNA interactions with a bacterial two-hybrid assay to ensure that protein variants maintain their functionality. The B3H system is a powerful complement to traditional biochemical methods for dissecting RNA–protein interaction mechanisms: RNAs and proteins of interest do not need to be purified, and their interactions can be assessed under native conditions inside of a living bacterial cell. Once cloning has been completed, an assay can be completed in under a week and a screen in 1–2 weeks.

In mathematics, the expectation to set up and solve word problems emerges as early as kindergarten; however, many students who experience mathematics difficulty (MD) and dual-language learners often present with specific challenges in this area. To investigate why these populations experience word-problem difficulty, we examined the word, problem solving and oral explanations of third-grade dual-language learners (DLLs; n= 40) and non-DLLs (n= 40), all of whom were identified as experiencing MD. Students solved five additive word problems and provided oral explanations of their work, which were transcribed and coded for the number of words in each explanation, type of mathematics vocabulary terms used, inclusion of correct numbers in explanations, and descriptions of addition or subtraction. We identified no significant differences in word-problem scores between DLLs and non-DLLs with MD. For both DLLs and non-DLLs, students who answered problems correctly used more words in each explanation and used more mathematics vocabulary terms within their explanations. For incorrectly answered problems, the most common mistake for both DLLs and non-DLLs involved using the incorrect operation to solve the problem.

Background/aimsImprovement in social functioning is an important aspect of recovery from severe mental health problems. Nurses on acute mental health wards play an important role in facilitating this recovery. Therefore, it is important to explore potential predictors of social functioning and the quality of nurse–patient relationships. The aim of this study was to explore associations between patient social functioning, nurse–patient therapeutic alliances, emotional regulation, attachment style and nurse distress in acute mental health settings.Methods:A questionnaire-based, cross-sectional approach with correlational and regression analyses was used for this study. A total of 50 nurse–patient dyads in acute mental health inpatient wards across four NHS trusts in the north-west of England took part. Patients and nurses completed questionnaires regarding demographic information, emotional regulation, attachment style and alliance. Nurses also rated patient social functioning and their own distress.ResultsThe patient anxious attachment style was associated with difficulties in regulating emotions. Patient emotional regulation, patient insecure attachment and the patient-rated alliance predicted nurse-rated patient social functioning. Nurse emotion regulation, nurse insecure attachment style and nurse-rated alliance did not significantly predict nurse-rated patient social functioning and correlations were non-significant. Nurse distress was associated with nurse emotion regulation, nurse anxious attachment and nurse-rated alliance. These factors significantly predicted nurse distress.Conclusions:Patient social functioning is predicted by emotion regulation, attachment and alliance. Similarly, nurse distress is predicted by nurse emotion regulation, attachment style and alliance. Interventions targeting emotion regulation or attachment-informed wards would be beneficial.

Background/AimsInpatient wards provide an opportunity to intervene with medical, psychological and social care to contain distress and prevent future relapse. However, they have been criticised for an over-reliance on medication and risk management with limited psychosocial interventions. The aim of this study was to investigate clinical trials of psychosocial interventions for inpatients to identify interventions that are effective at improving quality of life, symptoms or patient functioning.MethodsAn electronic search of six databases was conducted for papers published from 1806 up until February 2017. A total of 18 randomised controlled trials was identified in which outcomes for symptoms, quality of life or functioning were reported.ResultsOverall, 15 trials showed a statistically significant result for at least one outcome. Seven categories were identified from the 18 studies, at least one in each category was found to be effective for symptoms, quality of life or functioning. The majority were effective (15 out of 18).ConclusionsGiven that the methodological quality was generally low and number of randomised controlled trials were small, it is difficult to draw definitive conclusions. Recommendations include more and repeated trials using rigorous methods of testing and reporting.

BackgroundAlthough studies continue to demonstrate lower complications in neurointerventions using transradial access (TRA) compared with transfemoral approaches, anatomic radial variants can be difficult to navigate and remain one of the frequent causes of access site conversion.ObjectiveTo evaluate predictors of TRA failure in neuroendovascular patients with radial loops and suggest a protocol for managing these anomalies.MethodsA prospective collection of patients undergoing TRA at participating institutions from July 2018 to September 2020 was reviewed. Patients with a radial loop were identified. Patient demographics and procedural characteristics were evaluated to determine predictors of both TRA failure and successful reduction of the radial loop.ResultsWe identified 32 transradial neurointerventions in which patients had radial loops. Twenty-two (68.8%) were identified by diagnostic angiography, and the majority were performed for evaluation or treatment of an aneurysm (56.3%). TRA failure occurred in 13 (40.6%) of the cohort and happened more frequently in patients over 60 years of age (p=0.01) and those with recurrent radial artery diameters ≤2 mm (p=0.02). Of the 19 patients who had successful TRA, 12 (63.2%) procedures were performed through the recurrent radial artery.ConclusionAlthough radial loops are associated with high transradial failure rates, our results suggest that the presence of a loop is not an absolute contraindication to TRA. Therefore, we recommend attempting loop navigation using our protocol. Patient age, vascular tortuosity, and recurrent radial artery size should help dictate when to convert to an alternative access site.

BackgroundMany neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm (RAS) remains one of the most commonly cited reasons for access site conversions. We discuss the benefits, techniques, and indications for using the long radial sheath in RAS and present our experience after implementing a protocol for routine use.MethodsA retrospective review of all patients undergoing neurointerventions via TRA at our institution from July 2018 to April 2020 was performed. In November 2019, we implemented a long radial sheath protocol to address RAS. Patient demographics, RAS rates, radial artery diameter, and access site conversions were compared before and after the introduction of the protocol.Results747 diagnostic cerebral angiograms and neurointerventional procedures in which TRA was attempted as the primary access site were identified; 247 were performed after the introduction of the long radial sheath protocol. No significant differences in age, gender, procedure type, sheath sizes, and radial artery diameter were seen between the two cohorts. Radial anomalies and small radial diameters were more frequently seen in patients with RAS. Patients with clinically significant RAS more often required access site conversion (p<0.0001), and in our multivariable model use of the long sheath was the only covariate protective against radial failure (OR 0.061, 95% CI 0.007 to 0.517; p=0.0103).ConclusionIn our experience, we have found that the use of long radial sheaths significantly reduces the need for access site conversions in patients with RAS during cerebral angiography and neurointerventions.

Noncoding RNAs regulate gene expression in every domain of life. In bacteria, small RNAs (sRNAs) regulate gene expression in response to stress and are often assisted by RNA–chaperone proteins, such as Hfq. We have recently developed a bacterial three-hybrid (B3H) assay that detects the strong binding interactions of certain E. colisRNAs with proteins Hfq and ProQ. Despite the promise of this system, the signal-to-noise has made it challenging to detect weaker interactions. In this work, we use Hfq–sRNA interactions as a model system to optimize the B3H assay, so that weaker RNA–protein interactions can be more reliably detected. We find that the concentration of the RNA–DNA adapter is an important parameter in determining the signal in the system and have modified the plasmid expressing this component to tune its concentration to optimal levels. In addition, we have systematically perturbed the binding affinity of Hfq–RNA interactions to define, for the first time, the relationship between B3H signal and in vitro binding energetics. The new pAdapter construct presented here substantially expands the range of detectable interactions in the B3H assay, broadening its utility. This improved assay will increase the likelihood of identifying novel protein–RNA interactions with the B3H system and will facilitate exploration of the binding mechanisms of these interactions.

Laser interstitial thermal therapy is a minimally invasive surgical alternative to craniotomy that uses laser light through a fiber optic probe placed within a target lesion to create thermal tissue damage, resulting in cellular death. It is used in neuro-oncology to treat inaccessible lesions and obviate morbidity in high-risk patients. Overall complication rates and outcome measures are comparable with those seen in radiation and/or craniotomy. Laser interstitial thermal therapy can be an effective option for recurrent brain metastases. Prospective, randomized trials must be performed to evaluate the efficacy of laser interstitial thermal therapy as a primary treatment for brain metastases.

Acne is the most common skin condition observed in adolescent and preadolescent patients. Pediatric providers are on the forefront of managing the disease, often as a secondary concern in a busy practice. Therefore, every provider needs to have an acne treatment plan that is effective, easy to communicate, and simple to follow. This article provides treatment rationale and guidelines-based recommendations for the initial treatment of acne, tips for troubleshooting any side effects, and a plan for subsequent follow-up to maintain good control. Acne is the most common skin condition observed in adolescent and preadolescent patients. Pediatric providers are on the forefront of managing the disease, often as a secondary concern in a busy practice. Therefore, every provider needs to have an acne treatment plan that is effective, easy to communicate, and simple to follow. This article provides treatment rationale and guidelines-based recommendations for the initial treatment of acne, tips for troubleshooting any side effects, and a plan for subsequent follow-up to maintain good control. [[Pediatr Ann. 2020;49(3):e109–e115.]

Introduction:

IMPORTANCE: Actinic keratosis (AK) is a skin growth induced by UV light exposure that requires long-term management because a small proportion of the disease can progress to squamous cell carcinoma. The influence of how clinicians frame or present information to patients may affect decision making about AK. OBJECTIVE: To evaluate the differences in patients’ decisions on whether to receive treatment for AK related to information presentation or choice framing. DESIGN, SETTING, AND PARTICIPANTS: A prospective survey study was performed from June 1 to July 31, 2016, in participants who were able to read English. Participants were recruited through the Penn State Milton S. Hershey Dermatology Clinic and an online survey site. The survey was conducted through an online portal. A total of 571 individuals were recruited. Regression analysis, correlation coefficient analysis, and test-retest validation were conducted. MAIN OUTCOMES AND MEASURES: The proportions of patients choosing to receive treatment for AK. Analyses were performed to adjust for age, sex, educational level, history of skin cancer, and history of AK. RESULTS: Of the 571 recruited participants, 539 (94.4%) returned completed surveys. The mean (SD) age of respondents was 42.9 (17.8) years; 306 (56.8%) were women. The decision to receive treatment for AK varied from 57.7% (n = 311) to 92.2% (n = 497) for the 5 scenarios presented in the questions (P &lt; .001). The question that presented AK as a “precancer” had the highest proportion of participants who preferred treatment (497 [92.2%]). Two questions that presented the risk of AK as not progressing to cancer had the lowest proportion of individuals who chose treatment (311 [57.7%] and 328 [60.9%]). Participants from the clinic and from the online portal were significantly different in age (mean [SD] age, 56.1 [17.6] vs 33.3 [10.0] years), sex (145 [63.6%] vs 161 [51.8%] were females), educational level (40 [17.5%] vs 80 [25.7%] had completed some graduate school), history of AK (46 [20.2%] vs 19 [6.1%] answered yes), and history of skin cancer (76 [33.3%] vs 15 [4.8%] answered yes) (all P ≤ .001). Based on a regression analysis, age, sex, and previous diagnosis of skin cancer were not significantly associated with the participants’ responses. CONCLUSIONS AND RELEVANCE: This study found that patients’ decisions on whether to receive treatment for AK is significantly affected by physician wording, especially with alterations in the presentation of risk of malignant transformation.

Sporadic inclusion body myositis, a variant of inflammatory myopathy, has features distinct from polymyositis/dermatomyositis. The disease affects men more than women, most commonly after age 50. Clinical features include weakness of the quadriceps, finger flexors, ankle dorsiflexors, and dysphagia. The distribution of weakness is similar to Becker muscular dystrophy, where we previously reported improvement following intramuscular injection of an isoform of follistatin (FS344) by AAV1. For this clinical trial, rAAV1.CMV.huFS344, 6 × 1011vg/kg, was delivered to the quadriceps muscles of both legs of six sporadic inclusion body myositis subjects. The primary outcome for this trial was distance traveled for the 6-min walk test. The protocol included an exercise regimen for each participant. Performance, annualized to a median 1-year change, improved +56.0 m/year for treated subjects compared to a decline of −25.8 m/year (p = 0.01) in untreated subjects (n = 8), matched for age, gender, and baseline measures. Four of the six treated subjects showed increases ranging from 58–153 m, whereas two were minimally improved (5–23 m). Treatment effects included decreased fibrosis and improved regeneration. These findings show promise for follistatin gene therapy for mild to moderately affected, ambulatory sporadic inclusion body myositis patients. More advanced disease with discernible muscle loss poses challenges.

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Separation Management capabilities aim to provide controllers with tools and procedures to more efficiently manage air traffic in a mixed equipage environment. This paper presents the results of an integrated human performance safety assessment of Separation Management concepts planned for implementation between 2016 and 2020. The assessment utilized the Human and Organizational Safety Technique (HOST) to provide a structured method for identifying potential human error modes and estimating their contribution to the human performance risk profile. The HOST assessment resulted in multiple potential human error modes across the individual Separation Management changes. As no concept will be implemented in isolation, key interactions among error modes were assessed utilizing an integrated Human-System Interaction Model. The findings from this research provide a proactive view of potential human-system integration challenges that can be used by stakeholders to proactively develop human factors mitigation strategies that will reduce implementation time and costs associated with each concept.

One of the General Surgery milestones focuses on effective handoffs between residents as they change shifts. Although the content of handoffs is crucial, we recognized that the culture of handoffs was equally important. After the reorganization of the trauma service at our institution, there were difficulties in maintaining the standardized handoff culture. We analyzed the culture of handoffs on the trauma service to create an environment more conducive to effective handoffs.

The FAA intends to considerably increase the usage of area navigation (RNAV) approach and departure procedures in order to achieve the proposed NextGen goals for improved efficiency and capacity. RNAV procedures enable aircraft to have better access and flexibility for point-to-point operations. In an effort to better understand the potential impact of increased RNAV usage, a human factors safety assessment was conducted to identify the key human factors issues present in current RNAV operations. An analysis of 100 RNAV narrative-based safety reports from the Air Traffic Safety Action Program (ATSAP) and 68 narrative-based safety reports from the Aviation Safety Reporting System (ASRS) was conducted to identify key causal factors. The analysis found several key causal factors related to RNAV procedure design, controller-pilot communication, automation systems, and track deviations. Specific human performance concerns and mitigation strategies for each causal factor were developed. These results should drive future requirements associated with the implementation of future RNAV procedures.

In an effort to modernize the National Airspace System (NAS), the Federal Aviation Administration (FAA) has introduced the Next Generation Air Transportation System (NextGen). The introduction of new capabilities and operational improvements (OI) offers the potential for changes to the roles and responsibilities of the traffic management unit (TMU). Each change presents the opportunity to positively or adversely impact the overall safety of the NAS. This paper applies a proactive approach to identifying potential human performance hazards associated with NextGen TMU operations. The TMU performance hazards identified were primarily related to the potential for selecting inadequate airspace and airport configurations. The potential effects of these hazards will directly affect the NextGen controller and thus represent rich opportunities for researchers to mitigate potential issues in the early stages of system design.

In an effort to modernize the National Airspace System (NAS) the Federal Aviation Administration (FAA) has introduced the Next Generation Air Transportation System (NextGen). The introduction of new systems and procedures as described in NextGen offers the potential for significant changes to the daily activities of air traffic controllers. Along with the many proposed NextGen capabilities and improvements comes the need for new controller alerts and notifications. This research presents fourteen potential new alerts directly or indirectly proposed by literature describing NextGen midterm operations. Each new alert along with the potential positive and negative implications of providing the controller with the alert is discussed. This high-level survey of alerts should serve to inform researchers and system designers as they develop research and design requirements.

The operation and safety of the National Airspace System (NAS) is reliant on a multitude of actors and systems, which includes the members of the Airline Operation Center (AOC), whose primary job is to ensure flight safety (Sheremeta & Weitzel, 2005). The FAA’s NextGen will constitute many changes within the NAS, and the effects of these changes need to be examined in respect to the AOC. However, before these changes can be examined in detail, it is necessary to have a baseline understanding of the current operations and actors of an AOC. In this study, AOC actors that are critical to the day-to-day operation of an AOC were identified and a functional allocation was performed. Using this research as a baseline, further research should be conducted to examine how those AOC actors and their functions will change with the implementation of NextGen.

In an effort to modernize the National Airspace System, the Federal Aviation Administration has introduced the Next Generation Air Transportation System (NextGen). The introduction of new systems and procedures as described in NextGen offers the potential for significant changes to the daily activities of air traffic controllers. Each change presents the opportunity for both positive and negative effects on the overall safety of the NAS and the role of the air traffic manager. This paper presents a methodology for prospectively identifying hazards to the performance of air traffic controllers as well as a summary of the categorization of the hazards by task. Scenarios describing NextGen airport departure operations and operations with varying levels of equipage presented the most significant human performance hazards. These identified hazards represent rich opportunities for future human factors research.

Hepatitis C virus (HCV) is a considerable global health problem for which new classes of therapeutics are needed. The authors developed a high-throughput assay to identify compounds that selectively block translation initiation from the HCV internal ribosome entry site (HCV IRES). Rabbit reticulocyte lysate conditions were optimized to faithfully report on authentic HCV IRES-dependent translation relative to a 5′ capped mRNA control. The authors screened a library of ~430,000 small molecules for IRES inhibition, leading to ~1700 initial hits. After secondary counterscreening, the vast majority of hits proved to be luciferase and general translation inhibitors. Despite well-optimized in vitro translation conditions, in the end, the authors found no selective HCV IRES inhibitors but did discover a new scaffold of general translation inhibitor. The analysis of these molecules, as well we the finding that a large fraction of false positives resulted from off-target effects, highlights the challenges inherent in screens for RNA-specific inhibitors.

There is a high incidence of trauma and posttraumatic stress disorder (PTSD) in people with a diagnosis of psychosis. Sequelae of trauma may affect the ability to engage in both attachment and therapeutic relationships. This study investigated associations between trauma histories, PTSD, attachment styles, and working alliance in a sample of 110 individuals with psychosis and substance misuse. Anxious attachment was associated with number of interpersonal traumas and PTSD reported, but there were no associations between trauma and alliance. There were discrepancies in number of traumatic events reported by care coordinators and patients. The findings of this study highlight the potential use of attachment theory in working with trauma and PTSD in psychosis.

This study investigated human error in non-aviation industries utilizing the Human Factors Classification and Analysis System (HFACS). The purpose of this study was to identify associations between active errors and latent conditions beyond the aviation industry using a taxonomy that systemically identifies both active errors and latent conditions at all levels of an organization. Doing so could potentially allow for the shifting of intervention target areas from active errors to latent conditions. Seven data sources representing five different non-aviation industry types were analyzed using HFACS methodology and causal category associations were identified. Among the various significant causal factor associations, violations were determined be associated with certain causal categories at the unsafe supervision tier. Additionally, crew resource management causal factors were found to be associated with both skill-based and decision errors. Associations among the HFACS causal categories yield useful information when determining targeted interventions.

This study aimed to explore clients' attachments to psychiatric rehabilitation services and associations with adult attachment style and severity of symptoms. Potential correlates of attachments to services were investigated using a cross-sectional design. A total of 78 participants from inpatient rehabilitation units completed measures of attachment to mental health services, adult attachment style, depression, and psychosis. Clients with a more insecure attachment style and greater severity of depression indicated lower levels of attachment to services, although no effects were found for severity of psychotic symptoms. Patients with insecure adult attachment styles and higher levels of depression may experience particular difficulties in developing secure attachments to services.

The hepatitis C virus (HCV) genomic RNA contains an internal ribosome entry site (IRES) in its 5' untranslated region, the structure of which is essential for viral protein translation. The IRES includes a predicted pseudoknot interaction near the AUG start codon, but the results of previous studies of its structure have been conflicting. Using mutational analysis coupled with activity and functional assays, we verified the importance of pseudoknot base pairings for IRES-mediated translation and, using 35 mutants, conducted a comprehensive study of the structural tolerance and functional contributions of the pseudoknot. Ribosomal toeprinting experiments show that the entirety of the pseudoknot element positions the initiation codon in the mRNA binding cleft of the 40S ribosomal subunit. Optimal spacing between the pseudoknot and the start site AUG resembles that between the Shine–Dalgarno sequence and the initiation codon in bacterial mRNAs. Finally, we validated the HCV IRES pseudoknot as a potential drug target using antisense 2'-OMe oligonucleotides.

This article highlights the relevance of attachment theory for psychiatric rehabilitation services and discusses practice implications derived from the theory. Attachment theory can guide the development of interpersonal relationships during recovery and this aspect of rehabilitation is emphasised here. Attachment theory can also be used to help staff predict and understand problematic behaviours such as violence and aggression, and different styles of recovery. The theory can help promote positive staff–service-user relationships by highlighting the qualities of effective caregivers and the way in which people with different attachment styles might benefit from different approaches. We conclude by suggesting ways of teaching rehabilitation staff to become more effective attachment figures.

This study investigated human error across a variety of industry types utilizing the Human Factors Classification and Analysis System (HFACS). One of the goals of the present study was to determine any similarities or disparities across industry type in regards to HFACS causal categories. Seven data sources represented five different industry types were collected and analyzed for percentage of cases associated with a causal factor at each HFACS causal category. Skill-based errors were found to dominate the unsafe acts tier regardless of industry type. Different statistical methods for determining population differences yielded conflicting results. Significant differences were found among certain data source pairings when the traditional two-proportion z-test was applied; however, the differences were found to be non-significant when the false discovery rate method was applied.

The purpose of this study was to develop and establish content validity of an instrument designed to measure the organizational climate for research integrity in academic health centers. Twenty-seven research integrity scholars and administrators evaluated 64 survey items for relevance and clarity, as well as overall comprehensiveness of the constructs that are measured (organizational inputs, structures, processes and outcomes). Both quantitative and qualitative methods were used, particularly content validity indices (CVI) and analyses of respondents' comments. The content validity index for the overall survey was initially high (CVI = .83) and improved (CVI = .90) when 17 marginal-to-poor items were removed. This study resulted in the Organizational Climate for Research Integrity (OCRI) survey, a 43-item fixed-response survey with established content validity.

Charcot‐Marie‐Tooth disease (CMT) is a genetically heterogeneous disorder that has been associated with alterations of several proteins: peripheral myelin protein 22, myelin protein zero, connexin 32, early growth response factor 2, periaxin, myotubularin related protein 2, N‐mycdownstream regulated gene 1 product, neurofilament light chain, and kinesin 1B. To determine the frequency of mutations in these genes among patients with CMT or a related peripheral neuropathy, we identified 153 unrelated patients who enrolled prior to the availability of clinical testing, 79 had a 17p12 duplication (CMT1A duplication), 11 a connexin 32 mutation, 5 a myelin protein zero mutation, 5 a peripheral myelin protein 22 mutation, 1 an early growth response factor 2 mutation, 1 a periaxin mutation, 0 a myotubularin related protein 2 mutation, 1 a neurofilament light chain mutation, and 50 had no identifiable mutation; the N‐mycdownstream regulated gene 1 and the kinesin 1B gene were not screened for mutations. In the process of screening the above cohort of patients as well as other patients for CMT‐causative mutations, we identified several previously unreported mutant alleles: two for connexin 32, three for myelin protein zero, and two for peripheral myelin protein 22. The peripheral myelin protein 22 mutation W28R was associated with CMT1 and profound deafness. One patient with a CMT2 clinical phenotype had three myelin protein zero mutations (I89N+V92M+I162M). Because one‐third of the mutations we report arose de novo and thereby caused chronic sporadic neuropathy, we conclude that molecular diagnosis is a necessary adjunct for clinical diagnosis and management of inherited and sporadic neuropathy.

The paper describes the implementation of outcome measures in routine clinical practice in a psychiatric rehabilitation unit in the UK. Informant-rated outcome measures assessing functional skills and community integration were successfully completed by nursing staff for all 10 patients over a period of 6 months. The results of outcome measures for individual patients were used to inform discussions of patient functioning at multidisciplinary review and support planning meetings. Outcome measures were also compared at two time points to provide a preliminary evaluation of the service. Data suggest that patients showed improvements in all variables assessed, lending support to the effectiveness of the programme. These findings were positively received by key stakeholders. Recommendations are made for the future implementation of outcome evaluation in psychiatric rehabilitation services.