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Workplace violence is a common safety concern for hospital staff. The Behaviour Safety Risk Communication and Care Planning program identifies, manages and cares for patients at risk of exhibiting unsafe behaviours. This paper reports on a mixed-methods evaluation consisting of staff surveys, focus groups and open forums, screening audits, patient interviews and assessment of effectiveness measures at five hospital sites. Staff perceptions about safety risk imposed by a patient's behaviour significantly improved after this program was implemented. Opportunities exist to improve staff adherence to screening processes and communication with patients. This study provides insight for teams implementing similar interventions.

Phyllodes tumor (PT) is a rare benign tumor with malignant potential. There have been few case reports that have described this condition. We report the case of a 61-year-old woman with a “giant” borderline PT who underwent a modified radical left breast mastectomy with left axillary lymph node dissection, followed by chest wall reconstruction using serratus anterior and pectoralis major muscle flap coverage. A breast tissue measuring 22.5 × 18.5 × 12.5 cm and weighing a total of 5.2 lbs was resected. A case report like this can provide further information on surgical management of the tumor and the importance of an early diagnosis. In addition, PTs are rare to find in patients and this case will further contribute to the literature regarding PT. J Curr Surg. 2021;11(3):69-72 doi: https://doi.org/10.14740/jcs445

Workplace violence prevention of patient behaviours is a primary safety focus in hospital settings. In response to provincial mandates, a multi-site tertiary care hospital system developed the Behaviour Safety Risk Communication and Care Planning Program. Components include patient risk screening, communication tools and care plans that outline mitigation strategies. The program has been implemented at six sites using the following strategies: educational and planning meetings, formation of steering committees, identification of champions, educational materials/training, facilitation and consultation, and audit and feedback. Our paper can guide program development and implementation in similar contexts.

Background: In October 2016 the American Joint Committee on Cancer published the early eighth edition breast cancer prognostic staging system, incorporating biomarkers into previously accepted staging. The updated and current eighth edition became effective nationwide in January 2018 after a large update to its staging guidelines. This study’s aim was to compare patients’ anatomic seventh edition (anatomic), early eighth (pre-update, prognostic), and current eighth (post-update, prognostic) pathological stages and to assess the utility of recent inclusions to staging criteria. Additionally, we observed how the aforementioned stage changes aligned with breast cancer histologic subtypes. Methods: An Institutional Review Board (IRB)-approved retrospective chart review was performed. Inclusion criteria included female patients between the ages of 35 to 95 years with a diagnosis of invasive ductal or lobular carcinoma of the breast (n = 100) at three Hackensack Meridian Health hospitals. The study evaluated any trends in patients’ stage changes between the seventh edition, early eighth edition, and current eighth edition breast cancer staging guidelines. Breast cancer restaging was performed using a novel staging tool on Microsoft Excel. Results: Only 26% of patients’ stages changed when comparing the seventh edition stage vs. current eighth edition prognostic staging, most of which were downstaged. When comparing the seventh with early eighth edition prognostic staging, 38% of the patients’ stages changed, with a majority of them being upstaged. Lastly, 95% of total stage changes were downstages between the early eighth and current eighth edition staging guidelines. Conclusions: When comparing the seventh edition vs. current eighth edition staging, few patients (especially those with early stage cancer) underwent a stage change. However, there were significant changes in stage when comparing early eighth vs. current eighth stages. Considering these changes were mostly downstages and many patients reverted to their original seventh edition stage, the current eighth edition is based on a personalized, less radical staging approach, one that is more synonymous with original seventh edition staging. J Clin Med Res. 2019;11(6):407-414 doi: https://doi.org/10.14740/jocmr3803

Background Despite evidence that high-sensitivity cardiac troponin (hs-cTn) levels in women are lower than in men, a single threshold based on the 99th percentile upper reference limit of the overall reference population is commonly used to diagnose myocardial infarction in clinical practice. This trial aims to determine whether the use of a lower female-specific hs-cTn threshold would improve the diagnosis, treatment, and outcomes of women presenting to the emergency department with symptoms suggestive of myocardial ischemia. Methods/Design CODE-MI (hs-cTn—Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women) is a multicenter, stepped-wedge, cluster-randomized trial of 30 secondary and tertiary care hospitals across 8 Canadian provinces, with the unit of randomization being the hospital. All adults (≥20 years of age) presenting to the emergency department with symptoms suggestive of myocardial ischemia and at least 1 hs-cTn test are eligible for inclusion. Over five, 5-month intervals, hospitals will be randomized to implement lower female hs-cTn thresholds according to the assay being used at each site. Men will continue to be assessed using the overall thresholds throughout. Women with a peak hs-cTn value between the female-specific and the overall thresholds will form our primary cohort. The primary outcome, a 1-year composite of all-cause mortality or readmission for nonfatal myocardial infarction, incident heart failure, or emergent/urgent coronary revascularization, will be compared before and after the implementation of female thresholds using mixed-effects logistic regression models. The cohort and outcomes will be obtained from routinely collected administrative data. The trial is designed to detect a 20% relative risk difference in the primary outcome, or a 2.2% absolute difference, with 82% power. Conclusions This pragmatic trial will assess whether adopting lower female hs-cTn thresholds leads to appropriate assessment of women with symptoms suggestive of myocardial infarction, thereby improving treatment and outcomes.

BACKGROUND The Chedoke Arm and Hand Activity Inventory (CAHAI) is an assessment of upper limb function designed for use in the stroke population. The CAHAI has strong reliability and validity in this population; however, it is unknown whether this measure can be used with other clinical populations such as acquired brain injury (ABI). PURPOSE The purpose of this study was to estimate the inter-rater reliability of the CAHAI when used with persons with ABI. METHODS The research design was an observational parameter estimation study. The administration of the CAHAI was videotaped for 6 persons with ABI. To estimate inter-rater reliability each video was assessed independently by 6 clinicians yielding a total of 36 assessments. A Latin square design was used to balance the order raters evaluated the videos. Shrout and Fleiss Type 2,1 intra class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to estimate inter-rater reliability of the CAHAI. RESULTS Inter-rater reliability was high ICC = 0.96 (95% CL: 0.88, 0.99) and the SEM was 3.35 (95% CL: 2.63, 4.63) CAHAI points. CONCLUSIONS These results suggest that the CAHAI, although designed for use in the stroke population, can be used reliably in the ABI population.

Summary Background Acute Graft Versus Host Disease (GVHD) affects about 20%–80% of the patients after the hematopoietic stem cell transplant (HSCT) and it is amongst the main causes of morbidity and mortality both in children and adults. The intestine is one of the most affected organs by GVHD causing important alterations in the nutritional status and quality of life, considering that the dysfunctional intestine could decrease food intake as well as an inappropriate dietary plan could worsen the clinical condition. In addition to GVHD, chemotherapy conditioning regimen suppresses the immune system, promotes mucositis and increases the risk of infectious complications. Taking the above into consideration, when per oral diet is possible; the food choices should be carefully planned and monitored to promote nutritional support and avoid worsening the intestinal function and clinical condition. Objective This work was aimed to present a practice guideline proposal, to be validated, based on literature review, regarding to oral dietary recommendations for acute intestinal GVHD after HTSC. Methods Two research phases were defined: Phase one: evidence-based literature review; Phase 2: Practice Guideline Proposal. 1: Evidence based literature review Search methods A literature review (1997–2019) was performed including PubMed, in English, and Lilacs, in Portuguese electronic database to address the subject of dietary intervention for intestinal GVHD related to the HSCT, with children and adults, whose receiving oral or tube feeding nutrition therapy. Selection criteria The study selection was based on the PRISMA method. Controlled clinical trials were searched. Randomization was not possible considering the rare condition. Data collection and analysis Two independent authors assessed the abstracts of the selected studies to determine the articles feasible to compose the review as the base to elaborate the practice guideline proposal protocol, object of the present study. To determine the level of evidence of the selected article, GRADE criteria were used. Main results One controlled clinical trial study was included. The study was developed in Japan with a total of 35 patients. The dietary plan was characterized by gradual increasing food consistency/density. They found better nutritional parameters in the treated group, however, following GRADE criteria, we rated the quality of evidence as very low. Authors' conclusions We could not demonstrate confidence in the effect estimate based on the selected study. However, considering the lack of literature information and the relevance of the topic, we decided to proceed and propose a practice guideline for an oral diet protocol for acute intestinal GVHD as a reference to be a starting point to validate protocols in future clinical trials. 2: Practice Guideline Proposal The criteria to elaborate the protocol were based on the RIGHT Statement. In addition to the literate information about diet and intestinal health, recommendations already adopted in the Service of Bone Marrow Transplant in the Complex Hospital of Clinics of Curitiba, in the state of Parana, Brazil, were also considered.

We review and discuss a number of questions and conjectures about multiplicity lists occurring among real symmetric matrices whose graph is a tree. Our investigation is aided by a new electronic database containing all multiplicity lists for trees on fewer than 12 vertices. Some questions and conjectures are familiar and some are new, and new information is given about several.

e14146 Background: Breast cancer (BC) is the most common invasive cancer in adult females.The role of preoperative MRI in assessing the extent of primary breast cancer remains controversial. This study’s objective is to determine if MRIs performed after the diagnosis of invasive/non-invasive-breast cancer will identify additional breast cancers. We hypothesize that preoperative MRIs will result in the discovery of additional significant lesions, leading to changes in surgical treatment. Methods: A retrospective study of 389 BC patient charts were reviewed, dated from January 2000- July 2019. Files were collected from an office in the Breast Cancer Surgery Department. Information on each patient’s imaging studies, treatment, demographics, surgery, and pathology were collected and stored in anonline cloud system. Summary statistics, including proportions, percentages, and difference of proportion hypothesis tests were utilized to interpret the data. All statistical tests were conducted at a 95% confidence interval. Results: We reviewed the charts of 335 patients that met eligibility criteria. In 221 newly diagnosed cancers, a preoperative MRI was taken before treatment. 127 cancers (57.5%)showed additional finding.In BC patients with additional preoperative MRI findings, we observed 61.4%true positive and 38.6%false positive results. These values are comparable to prior studies.We determined that the treatment plan was altered in 17.6%of all patients who received an MRI and in 30.7%of patients with a true positive MRI finding, which is also consistent with previous literature.A majority of the treatment changes were from Lumpectomy to Mastectomy. Conclusions: Literature on MRI use in BC diagnosis exists; our study differs by focusing on newly diagnosed breast cancers.We discovered 35.3% of preoperative MRIs identified a true additional finding in known breast cancer. In addition, our true positive rate (61.4%) and false positive rate (22.2%) of MRI findings is comparable to those of previous studies. Plans were changed in 30.7% of additional findings supporting the idea that preoperative MRI studies are useful when organizing surgical treatment. Further studies to demonstrate the impact on local recurrence rates and overall survival, may clarify the true role of pre-operative MRI in these cases.

Purpose: The purpose of this study was to estimate the interrater reliability of three shortened versions of the Chedoke Arm and Hand Activity Inventory (CAHAI-7, CAHAI-8, CAHAI-9) when used with persons with acquired brain injury (ABI). The CAHAI is an assessment of upper limb function with high reliability in the stroke and ABI populations. In the stroke population, three shortened versions of the measure have established reliability. Clinicians report time constraints as a barrier to using standardized assessments; thus, establishing the reliability of the shortened versions of the CAHAI in the ABI population may increase the use of this measure. Method: This was an observational, parameter estimation study. The participants were recruited from an in-patient ABI rehabilitation programme. The administration of the CAHAI to six persons with ABI was video recorded, and the video recordings were assessed by six clinicians to estimate interrater reliability. A Latin square design was used to balance the order in which the raters evaluated the videos. A repeated-measures analysis of variance was performed, and the variance components were used to calculate an intra-class correlation coefficient (ICC) and standard error of measurement (SEM) with 95% confidence limits (CLs) for each of the shortened versions. Results: Interrater reliability was high for all three versions: CAHAI-7, ICC=0.96 (95% CL: 0.89, 0.99; SEM 2.65); CAHAI-8, ICC=0.96 (95% CL: 0.90, 0.99; SEM 2.72); and CAHAI-9, ICC=0.95 (95% CL: 0.85, 0.99; SEM 3.49). Conclusions: These results suggest that the three shortened versions of the CAHAI demonstrate high reliability in the ABI population. These versions may be particularly useful when time constraints or patient tolerance are an issue.

Using the method of seeds and branch duplication, it is shown that for every tree of diameter , there is an Hermitian matrix with as few as distinct eigenvalues (a known lower bound). For diameter 7, some trees require 8 distinct eigenvalues, but no more; the seeds for which 7 and 8 are the worst case are classified. For trees of diameter , it is shown that, in general, the minimum number of distinct eigenvalues is bounded by a function of . Many trees of high diameter permit as few of distinct eigenvalues as the diameter and a conjecture is made that all linear trees are of this type. Several other specific, related observations are made.

Spasticity is a common impairment following an upper motor neuron lesion in conditions such as stroke and brain injury. A clinical issue is how to best quantify and measure spasticity. Recently, research has been performed to develop new methods of spasticity quantification using various systems. This paper follows up on previous work taking a closer look at the role of transversal forces obtained via rehabilitation robot for motions in the para-sagittal plane. Results from 45 healthy individuals and 40 individuals with acquired brain injury demonstrate that although the passive upper motions are vertical, horizontal forces into and away from the individual's body demonstrate a relationship with the Modified Ashworth Scale. This finding leads the way to new avenues of spasticity quantification and monitoring.

Introduction Assessment of velocity dependent resistance (VDR) can provide insights into spasticity in individuals with upper motor neuron syndrome. This study investigates the relationship between Modified Ashworth scores and a biomechanical based representation of VDR using a rehabilitation robot. Comparisons in VDR are made for the upper limb (UL) between individuals with acquired brain injury and healthy controls for the para-sagittal plane. Methods The system manipulates the individual’s limb through five flexion and extension motions at increasing speeds to obtain force profiles at different velocities. An approximation of VDR is calculated and analyzed statistically against clinical scales and tested for interactions. Results All individuals (aged 18–65), including healthy controls exhibited VDR greater than 0 (P Conclusion The robot can detect and quantify VDR that captures information relevant to UL spasticity. Results suggests a better categorization of VDR is possible and supports further development of rehabilitation robotics for assisting spasticity assessment.

The purpose of this exploratory study was to determine the feasibility and effectiveness of using guided interactions with horses as a nonpharmaceutical intervention to improve the physiological and behavioral states of persons with dementia. A convenience sample of persons with dementia was recruited from an adult day health center (n = 16). A multi-component intervention was implemented comprised of opportunities for grooming, painting, and leading horses. Using a randomized pretest-posttest crossover design, researchers compared participants receiving the equine-assisted intervention with participants receiving treatment as usual. Older persons with Alzheimer's disease and related dementias engaged positively in animal-assisted therapy with horses. A reduction in behavioral problems was found post intervention in contrast to the comparison group. Pre-intervention measures showed that participants exhibited lower levels of disruptive behaviors compared with the control group on the days they wer...

Psychological science offers a variety of methods to both understand and intervene when acts of potential racial or ethnic racism, bias or prejudice occur. The Trayvon Martin killing is a reminder of how vulnerable African American men and boys, especially young African American men, are to becoming victims of social inequities in our society. We examine several historical events of racial bias (the Los Angeles civil disturbance after the Rodney King verdict, the federal government’s launch of a “War on Drugs” and the killing of Trayvon Martin) to illustrate the ways in which behaviors of racism and race-based discrimination can be viewed from a psychological science lens in the hopes of eliminating and preventing these behaviors. If society is to help end the genocide of African American men and boys then we must broaden our focus from simply understanding instances of victimization to a larger concern with determining how policies, laws, and societal norms serve as the foundation for maintaining implicit biases that are at the root of race-based discrimination, prejudice, bias and inequity. In our call to action, we highlight the contributions that psychologists, particularly racial and ethnic minority professionals, can make to reduce the negative impact of racial and ethnic bias through their volunteer/pro bono clinical efforts.

This study explored the antecedents of self-efficacy beliefs for literacy instruction and the relationship of these beliefs to self-efficacy for teaching in general. Factor analysis demonstrated construct validity of the measure of TSELI developed. Moderate correlations between TSELI and the more general TSES suggest that while there is some overlap, they are not the same thing. In a regression analysis, the quality of university preparation, highest level of education, participation in a book club, school level, resources available for classroom books, teachers’ sense of efficacy for instructional strategies and for student engagement all explain variance in TSELI.

The purpose of this article is to explore the motivation for and content of young adult literature author's blogs and the potential use of these blogs for teaching and learning the English language arts and 21st-century literacy skills.

Empowerment has been advanced as a strategy for eliminating remaining health disparities. Popular education promotes community empowerment by increasing individuals’ and communities’ awareness of their capacity and providing a framework and strategies through which participants can identify and resolve problems. Poder es Salud/Power for Health, a community-based participatory research project, sought to improve health and decrease disparities in African American and Latino communities in Multnomah County, Oregon, through the intervention of Community Health Workers (CHWs) who used popular education. In-depth interviews were conducted with five CHWs involved in the project to explore their perceptions of the effects of the use of popular education on the CHWs and their communities. Results suggested that CHWs possessed a shared understanding of popular education. Effects on the CHWs included increases in community participation and identification, desire to advocate for the community, and sense of personal...

Aberrant lymphatic drainage is believed to contribute to the high recurrence rate of head and neck melanomas. The purpose of this study was to identify the clinical significance of unexpected lymphatic drainage patterns.A single institution retrospective analysis was performed of middle-aged and older men (mean age, 66.2 years; range, 41-87 years) who underwent successful lymphoscintigraphy with sentinel lymph node biopsy (SLNB) from 1997 through 2012. Node status, distribution, and recurrence were assessed comparing patients with expected and unexpected drainage patterns.Sixty-six patients were identified with 55.8 months median follow-up (range, 5.6-206.1 months). Unexpected sentinel lymph node drainage was associated with multiple basin drainage (p .01) and greater recurrence after negative SLNB (p = .03). Both groups had similar anatomic distribution, sentinel lymph node sampling, histopathologic characteristics, follow-up, and survival.Lymphatic drainage differing from expected patterns is associated with greater recurrence after negative SLNB in middle-aged and older men. © 2015 Wiley Periodicals, Inc. Head Neck 38: E754-E760, 2016.

The concept of site selection has received extensive attention throughout history. Although plant location decision issues have always been important to US manufacturing firms, the impact of global competition has increased recognition of their importance. To successfully compete globally, manufacturers must have an effective global supply chain infrastructure, which requires effective communications. However, plant location strategies change over time, because of the dynamic nature of the variables that determine a location decision. This study was conducted to extend the location decision taxonomy by including telecommunications. The research included a specification of telecommunications attributes that impact site selection, the importance of telecommunications as a location decision criterion and the differences in location decision criteria between domestic (US) and foreign sites. The telecommunications-specific attributes determined in this study include: telecommunications infrastructure, cost, reliability, bandwidth, personnel, local and US government restrictions, and local and US government regulations on exporting and importing data. The conclusions of this study not only present evidence that telecommunications is influencing decision-makers in site selection, but also provides a list of criteria that are critical to site selection.

Following the 1993 bombing of the World Trade Center (WTC), terrorism and security experts agreed that the U.S. financial services industry was a prime target for future terrorist attacks. Experts warned that the industry's disaster recovery plans were out-of-date, designed primarily to withstand natural disasters, and no match for the destructive power of an intentional terrorist attack. While the tragic events of September 11, 2001 confirmed experts' foreboding predictions of future attacks on the U.S. financial system, was the financial services industry inadequately prepared to recover from such an attack?

Like the fingerprints that show on the edge of my door frame, all of us are different—our families are different; our kids and young adults are different. Our tastes differ; our reading needs diffe...

Modern organizations face increasing pressure to find new ways to compete effectively in a dynamic global market. Many firms are turning to E-commerce and virtual structures, such as virtual organizations and virtual teams, to improve organizational agility and to expand globally. These solutions elevate the importance of information flow within the firm and among firm partners. New technologies are emerging at a rapid pace to support this increased flow of information. As organizations grow to depend upon these new technologies, their opportunities to expand into new geographic regions might be limited by the ability of the remote information infrastructure to support the organization's modernized requirements. Thus, firms seeking to improve their ability to compete globally might actually impede future expansion.

The success of an organization depends on rapid, reliable, and direct communications within the organization and with the outside world. To determine if electronic mail (e-mail) provides a competitive benefit, a sample of 99 management-level participants in 41 companies responded to a survey that assessed their intraorganizational (internal) and interorganizational (external) uses of e-mail. Through the use of factor analysis and regression methodologies, the researchers investigated whether a significant relationship exists between the internal and external uses and benefits of e-mail. The intraorganizational uses of e-mail indicated a significant and positive relationship with the organizational benefits of e-mail, thus, supporting the electronic exchange of information within organizations.However, the results indicated that interorganizational uses of e-mail did not promote corporate communication outside the company. Thus, managers need to know which communication technology is appropriate for intraorganizational and interorganizational uses.

This paper describes initial testing of a spasticity assessment system for passive elbow flexion/extension motions using a robotic manipulator. Quantitative force data was collected from healthy individuals. As repetition and speed were increased, significant differences in measured force were found in a study with a high speeds (n=48), but were not found in a study with a lower speeds (n=52). This result assists clinicians who now possess a baseline of healthy data to which quantitative patient data can be compared. Future developments include contrasting healthy baseline values to clinical trial data from individuals with stroke or acquired brain injury.

This study compared the effects of 2 interventions often used to enhance social relationships in preschool classrooms. Social Integration Activities involves a teacher structured play activity along with teacher provided roles, suggestions, and feedback. Group Friendship Activities involves adapting songs and games so that opportunities occur for peers to demonstrate positive, affectionate, friendship behaviors to targeted students. One preschooler with a developmental disability and one at risk for delay participated. Results indicated differential benefits across the 2 approaches, suggesting a need to tailor the selection of interventions to the individual child's characteristics, skills, and interests. Findings stress the importance of closely monitoring children's social behaviors to determine if interventions are achieving desired outcomes.

Pneumonia is the third most frequent admission diagnosis at Macomb Hospital Center. The average length of stay for this diagnosis (DRGs 89 and 90) was 9.07 days. After the initiation of a critical pathway that begins in the emergency department, the average length of stay decreased to 7.11 days. Quality of care also improved in two areas: the time elapsed before delivery of antibiotics and availability of X-ray reports. This article reviews the implementation and results of the critical pathway for pneumonia.