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Objective Nursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements. Method Using a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services. Results Respondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n = 63/74), then annually (88% n = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n = 41), patient/resident falls (52% n = 34), and patient/resident inactivity (69% n = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n = 67/73), despite a belief that this may reduce staff injuries (93% n = 68/73), patient/resident falls (81% n = 59/73) and inactivity (92% n = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health. Conclusion Most Australian health and aged care services provide clinical staff with regular manual handling training for staff‐assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in‐the‐moment risk assessment during staff‐assisted patient/resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs.

The Cambrian transgression across the Great Unconformity produced one of the largest expansions of shallow marine habitats and associated diversification of marine invertebrate faunas in Earth history. However, identification of the underlying controls on the pattern of transgression of Cambrian seas has been hampered by imprecise or inaccurate age assignments for many formations. Recovery of an Ehmaniella Zone trilobite fauna from the Lodore Formation in northwestern Colorado (United States) revises the age of this unit to be significantly older, specifically middle Miaolingian (upper Wuliuan). This expands the established distribution of thick Miaolingian deposits of the northern Rocky Mountains to within 90 km of a broad region of central Colorado where Miaolingian strata are missing and Furongian successions rest directly on basement. The boundary between these two regions marks the position of an ~200 km east-west offset within the generally north-south–trending Cambrian paleoshoreline of western North America. The offset is co-located with a Precambrian continental suture zone (Cheyenne belt) at the northern Yavapai terrane margin and is directly east of an offset of similar magnitude and latitude in the early to middle Paleozoic shelf edge in Nevada. We thus posit that Precambrian deep-seated crustal-scale features controlled the Cambrian paleotopography of western Laurentia, strongly influencing the patterns of Cambrian transgression and structure of the shallow marine ecosystem established during continental submergence. These continental-scale structural elements remained a major control on marine paleogeography for >200 m.y. into the late Paleozoic.

The aim of this systematic review was to compare the benefits and harms of nasogastric and oral-based refeeding on the quality of care, including effectiveness, safety, and patient experience, for patients hospitalised with an eating disorder.A systematic search for studies measuring comparative data between nasogastric and oral refeeding methods was conducted in August 2021. Title and abstracts and remaining full texts were screened by both authors. Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation narrative synthesis.Seven studies (one randomised controlled trial, five non-randomised studies of interventions, and one qualitative study) with 917 participants were included. There was low certainty evidence that nasogastric refeeding resulted in no difference or a small increase in weekly weight gain, and moderate certainty of greater total weight gain, and very low certainty of increased length of stay compared to oral refeeding. There was no difference or a small increase in discharge weight and body mass index with nasogastric refeeding compared to oral refeeding. No serious adverse events were reported.Patients selected for nasogastric refeeding have a longer duration of illness and lower admission weight, making it difficult to determine which refeeding approach is superior. However, the lack of clear difference in weekly weight gain and the lack of reported harms suggests that other factors such as the normalisation of eating behaviour may be taken into account when choosing the most appropriate refeeding method.

BackgroundSerious car seat installation errors occur at high rates in infants and children. These errors significantly increase the risk of child injury in a motor vehicle crash, and few interventions have addressed the challenge longitudinally.MethodsThis was a pilot randomised controlled feasibility trial of virtual car seat safety checks for caregivers of newborns recruited from an urban newborn nursery. The control (enhanced usual care (EUC)) group received an in-person car seat check as a newborn and virtual check at 9 months. The intervention group received two additional virtual checks at 3 and 6 months. Installation and infant positioning errors were documented and corrected by a child passenger safety technician (CPST). We measured feasibility and acceptability by tracking caregiver and CPST challenges, and caregiver retention. Group differences were tested for statistical significance using χ2or Fisher’s exact test for categorical variables, and two sample t-tests for continuous variables.Results33 caregivers were randomised to the EUC and 28 to the intervention group. Virtual checks were feasible, with variable participation levels at each quarter. Wi-Fi and app challenges noted in 30%. There was satisfaction with the virtual car seat checks. At baseline, car seat installation and infant positioning errors occurred at equal frequency, and at 9 months the intervention group had a significantly lower mean proportion than the EUC group in all categories of errors. In summary, virtual seat checks are feasible and the optimal timing of repeat checks requires additional study. A larger study is needed to further evaluate the effect of longitudinal virtual checks on errors.

Myasthenia gravis (MG) is a rare, debilitating, chronic disorder caused by the production of pathogenic immunoglobulin G autoantibodies against the neuromuscular junction. A lack of real-world studies in rare diseases reflects a relatively limited understanding of the significant unmet needs and burden of disease for patients. We aimed to provide comprehensive real-world insights into the management and burden of MG from treating physicians in the United States (US).Data were collected using the Adelphi Real World MG Disease Specific Programme™, a point-in-time survey of physicians and their patients with MG, in the US between March and July 2020. Physician-reported clinical data, including demographics, comorbidities, symptoms, disease history, treatments, and healthcare resource utilization, were collected.In total, 456 patient record forms were completed by 78 physicians based in the US. At time of survey completion, patient mean age was 54.5 years. Mean time from symptom onset to diagnosis was 9.0 months (n = 357). Ocular symptoms were reported in 71.7% of patients. General fatigue affected 47.1% of patients and over half of those reported the severity as moderate or severe (59.5%, n = 128). Acetylcholinesterase inhibitors and/or steroids were the most frequently prescribed first-line treatment type among patients receiving treatment at time of survey completion and with moderate-to-severe symptoms (77.9%, n = 159/204). High-dose steroids (n = 14) and intravenous immunoglobulin (n = 13) were the most prescribed acute treatments among those receiving an acute treatment at time of survey completion (n = 36), with symptom exacerbations or myasthenic crises being the most common reasons for acute treatment. On average, 2.5 healthcare professionals were involved in patient management and 5.0 consultations were made per patient over the last 12 months.Our findings indicated that, despite treatment, there is a proportion of patients with MG in the US who had a significant need for improved disease management.

In recent years, understanding functional brain connectivity has become increasingly important as a scientific tool with potential clinical implications. Statistical methods, such as graphical models and network analysis, have been adopted to construct functional connectivity networks for single subjects. Here we focus on studying the association between functional connectivity networks and clinical characteristics such as psychiatric symptoms and diagnoses. Utilizing machine learning algorithms, we propose a method to examine predictability of functional connectivity networks from clinical characteristics. Our methods can identify salient clinical characteristics predictive of the whole brain network or specific subnetworks. We illustrate our methods on the analysis of fMRI data in the Philadelphia Neurodevelopmental Cohort study, demonstrating clinically meaningful results.

While much research has highlighted phenotypic heterogeneity in obsessive compulsive disorder (OCD), less work has focused on heterogeneity in neural activity. Conventional neuroimaging approaches rely on group averages that assume homogenous patient populations. If subgroups are present, these approaches can increase variability and can lead to discrepancies in the literature. They can also obscure differences between various subgroups. To address this issue, we used unsupervised machine learning to identify subgroup clusters of patients with OCD who were assessed by task-based fMRI. We predominantly focused on activation of cognitive control and performance monitoring neurocircuits, including three large-scale brain networks that have been implicated in OCD (the frontoparietal network, cingulo-opercular network, and default mode network). Participants were patients with OCD (n = 128) that included both adults (ages 24-45) and adolescents (ages 12-17), as well as unaffected controls (n = 64). Neural assessments included tests of cognitive interference and error processing. We found three patient clusters, reflecting a "normative" cluster that shared a brain activation pattern with unaffected controls (65.9% of clinical participants), as well as an "interference hyperactivity" cluster (15.2% of clinical participants) and an "error hyperactivity" cluster (18.9% of clinical participants). We also related these clusters to demographic and clinical correlates. After post-hoc correction for false discovery rates, the interference hyperactivity cluster showed significantly longer reaction times than the other patient clusters, but no other between-cluster differences in covariates were detected. These findings increase precision in patient characterization, reframe prior neurobehavioral research in OCD, and provide a starting point for neuroimaging-guided treatment selection.

Background. Patients with schizophrenia show abnormal gaze processing, which is associated with social dysfunction. These abnormalities are associated with aberrant connectivity among brain regions associated with visual processing, social cognition, and cognitive control. In this study, we investigated 1) how effective connectivity during gaze processing is disrupted in schizophrenia, and 2) how this might contribute to social dysfunction and clinical symptoms.Methods. Thirty-nine patients with schizophrenia/schizoaffective disorder (SZ) and 33 healthy controls (HC) completed an eye gaze processing task during fMRI. Participants viewed faces with different gaze angles and performed explicit and implicit gaze processing. Four brain regions—the secondary visual cortex (Vis), posterior superior temporal sulcus (pSTS), inferior parietal lobule (IPL), and posterior medial frontal cortex (pMFC)—were identified as nodes for dynamic causal modeling analysis. Results. SZ and HC showed similar model structures for general gaze processing. Explicit gaze discrimination led to changes in effective connectivity, including stronger excitatory, bottom-up connections from Vis to pSTS and IPL and inhibitory, top-down connections from pMFC to Vis. Group differences in top-down modulation from pMFC to pSTS and IPL were noted, such that these inhibitory connections were attenuated in HC while further strengthened in SZ. Connectivity was associated with social dysfunction and symptom severity.Discussion. SZ showed notably stronger top-down inhibition during explicit gaze discrimination, which was associated with more social dysfunction but less severe symptoms among patients. Findings help pinpoint neural mechanisms of aberrant gaze processing and may serve as future targets for interventions that combine neuromodulation with social-cognitive training.

Background The Risk Assessment for moving Individuals SafEly (RAISE) program is a hospital-based manual handling nursing training program. RAISE involves upskilling on continual risk assessment during patient-assisted movements. RAISE aims to optimise staff and patient safety while providing the patient with movement and rehabilitation opportunities. Implementation of RAISE in the hospital setting has been established. The aim of this study was to explore the feasibility of implementing RAISE in the long-term care setting. Methods We examined three feasibility domains: acceptability, practicality, and limited efficacy (observed nursing behaviour change which has the potential to reduce nursing injuries), using a prospective pilot pre-post design in the long-term care setting. Staff completed a 4-hour training session on RAISE delivered by two physiotherapists, followed by 8 h of supported behaviour change in the workplace. Staff acceptability and practicality of incorporating risk assessment strategies into manual handling approaches were explored through pre- and post-training staff surveys and a semi-structured interview. Resident acceptability of manual handling practices was explored via survey data collected after the RAISE training. Pre to post-training changes in staff knowledge and behaviour were examined through the pre- and post-training staff survey, and observation of staff assisting resident movement. Results Two enrolled nurses and five residents participated. Staff reported the RAISE program was acceptable and practical to implement in the long-term care setting. There were no adverse events or safety concerns. Staff reported the RAISE program provided guidance and enhanced staff empowerment to make decisions during assisted resident movement. There were 26 observed resident-staff manual handling interactions recorded, with 13 pre-training and 13 post-training. Post-training, RAISE skills had improved and were completed 100% of the time, except for completing a physical risk assessment which improved from 46 to 85%, demonstrating limited efficacy. Residents reported it’s important for staff to be trained on how to assist them to mobilise and they found the concept of the RAISE program acceptable. Conclusions This pilot study supports the feasibility of long-term care facilities participating in future studies testing the effectiveness and cost-effectiveness of the Risk Assessment for moving Individuals SafEly (RAISE) patient and resident manual handling program.

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PDF file, 123K, Copy number (CN), mutation status (MS), loss of heterozygosity analysis (LOH) and immunohistochemistry (IHC) data for all tumors (n=160).

Purpose: The phosphatidylinositol 3-kinase (PI3K) pathway can be activated by alterations affecting several pathway components. For rational application of targeted therapies, detailed understanding of tumor biology and approaches to predict efficacy in individual tumors are required. Our aim was to assess the frequency and distribution of pathway alterations in bladder cancer.Experimental Design: We examined the pathway components (PIK3CA, PTEN, TSC1, RHEB, and LKB1) and putative upstream regulators (FGFR3 and RAS genes) for mutation, allelic loss, copy number alteration, and expression in bladder tumors and cell lines.Results: No mutations were found in RHEB and only a single mutation in LKB1. PIK3CA mutations were detected in 25% of tumors and 26% of cell lines with a significant excess of helical domain mutations (E542K and E545K). There was over-representation but not amplification of the gene. Loss of heterozygosity of the PTEN region and homozygous deletion were found in 12% and 1.4% of tumors, and reduced expression in 49%. Forty-six percent of cell lines showed alterations that implicated PTEN. Sixteen percent of tumors and 11% of cell lines showed TSC1 mutation, and 9q loss of heterozygosity was common (57%). Pathway alterations were independently distributed, suggesting that the mutation of two pathway members may have additive or synergistic effects through noncanonical functions.Conclusions: PI3K pathway alterations are common in bladder cancer. The lack of redundancy of alterations suggests that single-agent PI3K-targeted therapy may not be successful in these cancers. This study provides a well-characterized series of cell lines for use in preclinical studies of targeted agents. (Clin Cancer Res 2009;15(19):6008–17)

PDF file, 59K, Relationship between copy number gains and losses and individual Ta, T1G3 and ≥T2 clusters.

Purpose: There is a need for improved subclassification of urothelial carcinoma (UC) at diagnosis. A major aim of this study was to search for novel genomic subgroups.Experimental design: We assessed 160 tumors for genome-wide copy number alterations and mutation in genes implicated in UC. These comprised all tumor grades and stages and included 49 high-grade stage T1 (T1G3) tumors.Results: Our findings point to the existence of genomic subclasses of the “gold-standard” grade/stage groups. The T1G3 tumors separated into 3 major subgroups that differed with respect to the type and number of copy number events and to FGFR3 and TP53 mutation status. We also identified novel regions of copy number alteration, uncovered relationships between molecular events, and elucidated relationships between molecular events and clinico-pathologic features. FGFR3 mutant tumors were more chromosomally stable than their wild-type counterparts and a mutually exclusive relationship between FGFR3 mutation and overrepresentation of 8q was observed in non-muscle-invasive tumors. In muscle-invasive (MI) tumors, metastasis was positively associated with losses of regions on 10q (including PTEN), 16q and 22q, and gains on 10p, 11q, 12p, 19p, and 19q. Concomitant copy number alterations positively associated with TP53 mutation in MI tumors were losses on 16p, 2q, 4q, 11p, 10q, 13q, 14q, 16q, and 19p, and gains on 1p, 8q, 10q, and 12q. Significant complexity was revealed in events affecting chromosome 9.Conclusions: These findings may lead to improved biologic understanding and the development of prognostic biomarkers. Novel regions of copy number alteration may reveal potential therapeutic targets. Clin Cancer Res; 18(21); 5865–77. ©2012 AACR.

PDF file, 507K, Relationship between PTEN loss, RB1 loss and TP53 mutation status and time to metastasis.

PDF file, 3635K, Unsupervised hierarchical cluster analysis of aCGH data from all tumor samples and genome-wide frequency plots of copy number alterations in individual ≥T2 clusters.

PDF file, 902K, Loss and gain in tumors from individual Ta, T1 and ≥T2 clusters.

PDF file, 44K, TP53 and FGFR3 mutation in all Ta tumors, and tumors from individual T1G3 and ≥T2 clusters.

PDF file, 86K, Clinico-pathological characteristics, mutation status and FGA in 160 UC.

PDF file, 1713K, Fraction of genome altered (FGA%).

Supplementary Data from Spectrum of Phosphatidylinositol 3-Kinase Pathway Gene Alterations in Bladder Cancer

Supplementary Figures 1-2 from MRE11 Expression Is Predictive of Cause-Specific Survival following Radical Radiotherapy for Muscle-Invasive Bladder Cancer

Radical radiotherapy and surgery achieve similar cure rates in muscle-invasive bladder cancer, but the choice of which treatment would be most beneficial cannot currently be predicted for individual patients. The primary aim of this study was to assess whether expression of any of a panel of DNA damage signaling proteins in tumor samples taken before irradiation could be used as a predictive marker of radiotherapy response, or rather was prognostic. Protein expression of MRE11, RAD50, NBS1, ATM, and H2AX was studied by immunohistochemistry in pretreatment tumor specimens from two cohorts of bladder cancer patients (validation cohort prospectively acquired) treated with radical radiotherapy and one cohort of cystectomy patients. In the radiotherapy test cohort (n = 86), low tumor MRE11 expression was associated with worse cancer-specific survival compared with high expression [43.1% versus 68.7% 3-year cause-specific survival (CSS), P = 0.012] by Kaplan-Meier analysis. This was confirmed in the radiotherapy validation cohort (n = 93; 43.0% versus 71.2%, P = 0.020). However, in the cystectomy cohort (n = 88), MRE11 expression was not associated with cancer-specific survival, commensurate with MRE11 being a predictive marker. High MRE11 expression in the combined radiotherapy cohort had a significantly better cancer-specific survival compared with the high-expression cystectomy cohort (69.9% versus 53.8% 3-year CSS, P = 0.021). In this validated immunohistochemistry study, MRE11 protein expression was shown and confirmed as a predictive factor associated with survival following bladder cancer radiotherapy, justifying its inclusion in subsequent trial designs. MRE11 expression may ultimately allow patient selection for radiotherapy or cystectomy, thus improving overall cure rates. Cancer Res; 70(18); 7017–26. ©2010 AACR.

Purpose: To quantify a perceived barrier to physical activity participation (proximity to exercise facilities) by investigating the distance a population-based cohort of young people with cerebral palsy aged 13–30 years lived from community gyms. Method: We developed a web-based application using open-access software that could be used to complete a geospatial analysis by simultaneously visualising, describing, and estimating the location of young people with cerebral palsy, using deidentified data from a cerebral palsy register, in terms of distance and travel time to all available community gyms in one metropolitan city. The suitability of facilities for individuals was not investigated. Distance to the closest gym for participants was measured using the “as the crow flies” and “street network” methods. The proportion of the cohort living 5, 7, and 9 km from a community gym was calculated using the “as the crow flies” method. Distances and travel times to the closest gym for each person were calculated using the “street network” method. Data analysis used one-dimensional (median, quartiles) and two-dimensional (spatial median, bagplot) dispersion measures. Results: Of 568 young people with cerebral palsy, 97% lived within 7 km of a community gym, with a median absolute distance to their closest gym of 3.6 km (1st and 3rd quartiles 2.4, 5.1) and median travel time of 6.6 minutes (1st and 3rd quartiles 4.4, 8.8) by car. For the two-dimensional analysis, the spatial medians were 3.7 km and 6.5 minutes. Conclusions: The open-access, web-based application that was developed can be used by physiotherapists and others to study proximity of clinical and community infrastructure for other populations in other cities and regions. In this study, most young people with cerebral palsy living in one metropolitan city had reasonable access by car to a community gym.

Multiple myeloma (MM) shows constitutive activation of canonical and non-canonical nuclear factor-ĸB (NF-ĸB) signaling through genetic mutations or stimuli from the tumour microenvironment (TME). A subset of MM cell lines showed dependency for cell growth and survival on the canonical NF-ĸB transcription factor RELA alone, suggesting a critical role for a RELA-mediated biological program in MM pathogenesis. Here, we determined the RELA-dependent transcriptional program in MM cell lines and found the expression of the cell surface molecules IL-27 receptor-α (IL-27Rα) and the adhesion molecule JAM2 to be responsive to RELA at the mRNA and protein levels. IL-27Rα and JAM2 were expressed on primary MM cells at higher levels than on normal long-lived plasma cells (PCs) in the bone marrow. IL-27 activated STAT1, and to a lesser extent STAT3, in MM cell lines and in PCs generated from memory B-cells in an IL-21-dependent in vitro PC-differentiation assay. Concomitant activity of IL-21 and IL-27 enhanced differentiation into PCs and increased cell-surface expression of the known STAT target gene CD38. In accordance, a subset of MM cell lines and primary MM cells cultured with IL-27 upregulated CD38 cell-surface expression, a finding with potential implications for enhancing the efficacy of CD38-directed monoclonal antibody (mAb) therapies by increasing CD38-expression on tumour cells. The elevated expression of IL-27Rα and JAM2 on MM cells compared to normal PCs may be exploited for the development of targeted therapeutic strategies that modulate the interaction of MM cells with the TME.

PurposeTo investigate the association between implementation of clinical governance and patient safety.Design/methodology/approachA pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.FindingsThere was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.Practical implicationsGiven that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.Originality/valueThe findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

Patients with long-standing carpal tunnel symptoms may develop transient and, paradoxically, worsened neuropathic pain immediately following release. The authors have termed this "reawakening phenomenon." The purpose of this study was to compare the characteristics of patients with this phenomenon to those with a standard postoperative course.A retrospective chart review was performed on all patients who underwent carpal tunnel release at a single institution between January of 2012 to December of 2017. Patients demonstrating increased neuropathic pain in the median nerve distribution postoperatively without evidence of complex regional pain syndrome were included. A comparison cohort was composed of the remaining patients identified. Demographic data, medical history, carpal tunnel history, and electromyogram and nerve conduction study findings were recorded.A total of 640 patients were identified; 440 met criteria. Seventeen patients were found to have symptoms consistent with median nerve reawakening phenomenon. The reawakening cohort was older (71.1 versus 56.8 years), more likely to have evidence of thenar muscle atrophy (58.8 percent versus 13.48 percent), and more likely to have fibrillations and sharp waves on electrodiagnostic studies. Although not statistically significant, they also had a longer duration of symptoms (4.9 versus 2.9 years). Of those patients with reawakening phenomenon, 14 had resolution of their symptoms at an average period of 4.4 months. Three remaining patients who were subjectively symptomatic had normal or improved postoperative electromyogram and nerve conduction studies.Reawakening of the median nerve has not been previously described but occurs in 3.9 percent of hands following routine carpal tunnel release. Preoperative counseling of patients at high risk for reawakening phenomenon is recommended.Risk, III.

Objective The purpose of this study was to examine the impact of increasing allied health staffing levels on patient and health service outcomes across 1) all Geriatric Evaluation and Management patients, and 2) Geriatric Evaluation and Management patients discharged to home in the community. Design Quasi-experimental, pre-post intervention study. Setting Two sub-acute hospital units in an Australian, tertiary health service. Subjects Data related to patients admitted to the study units, who were classified as Geriatric Evaluation and Management patients. Interventions Comparison of therapy time across two units with a differential in staffing allocation over a six-month trial period. Main measures Primary outcomes: length of stay, readmission rate, and improvement on the Functional Independence Measure. Secondary outcomes: total cost of admission per patient and number of allied health sessions. Results Data were analysed for 214 patients (mean age = 79.9, standard deviation (SD) = 9.4 years, mean Functional Independence Measure (FIM = 64.9, SD = 21.2) admitted to the intervention unit, and 199 patients (mean age = 81.3, SD = 8.5, mean FIM = 64.2, SD = 24.0) admitted to the control unit. The overall difference in staffing allocation between the control and intervention units for the trial period was 21%. There was no statistically significant difference between units in subacute length of stay (Adj Coef = -0.10 days, 95%CI = -0.39 to 0.19), rate of readmission (OR = 1.0, 95%CI = 0.5 to 2.0) or change in function (Coef = 1.42 FIM change score, 95%CI = -2.4 to 5.3). Conclusions Increasing allied health staffing allocation to a unit over six-months did not impact change in function or length of stay for patients admitted for Geriatric Evaluation and Management.

PurposeThe social media (SM) engagement framework consists of dimensions of employee privacy expectations and organizations' social media orientation. Further, the social media privacy orientation model provides better understanding of complexities of selection and retention created by the social media landscape.Design/methodology/approachOrganizations are increasingly seeking talent to support burgeoning social media strategies. Qualified employees may be expected to have related professional experience and an active personal social media presence. In contrast to this evolving demand, prevailing guidelines suggest applicants minimize their social media activity altogether. These restrictive guidelines may be better suited for organizations that prefer or require high levels of discretion on social media given the differing engagement expectations across firms and among individuals.FindingsHow the congruence between an employee's expectations of privacy on SM and the organization's expectation of employees' SM usage affects applicant attraction to organizations and employee retention is outlined. Propositions are offered to foster research in this area.Practical implicationsSocial media congruence is an important consideration for human resource (HR) policies and associated training.Social implicationsPublic policies toward the use of social media in recruitment and privacy should consider social media congruence.Originality/valueThe model advanced in the paper provides organizations and applicants with a stronger understanding of the complexities surrounding the use of SM in selection and retention decisions.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-05-2021-0260

Objective The study aimed to explore patient perceptions of and motivations for physical activity after total knee joint replacement. Methods Participants were purposively sampled after completing a public outpatient rehabilitation exercise group. Semi-structured interviews were completed with 22 participants (mean age 70 years, 45% women) 6 to 12 months after total knee joint replacement. Interviews were audiotaped and transcribed verbatim. Themes were identified by an inductive and iterative process of data analysis. Results The main theme to emerge was participants were in the dark about physical activity. Participants were typically not familiar with physical activity guidelines and had difficulty distinguishing between low and moderate-intensity physical activity. Three subthemes were identified: (1) people prioritise participation in meaningful life situations after total knee joint replacement; (2) rehabilitation was perceived to not explicitly address moderate-intensity physical activity levels; and (3) other health and social reasons replaced knee osteoarthritis as barriers to physical activity. Conclusion Limited understanding of physical activity recommendations, prioritisation of participation in meaningful life situations, rehabilitation that was impairment focused and other health and social reasons appeared to contribute to low levels of moderate-intensity physical activity for adults after knee joint replacement. Addressing being in the dark about physical activity may be an important first step to increase the effectiveness of behavioural interventions designed to promote physical activity after total knee joint replacement.

To explore older persons' perceptions of the impact of COVID-19 restrictions on participating in community activities after discharge from inpatient rehabilitation.Mixed-methods study design. Participants were older adults who were discharged home following inpatient rehabilitation. Interviews were conducted with 70 participants, with a variety of diagnoses, 8 weeks after discharge from inpatient rehabilitation. Frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Qualitative analysis was completed using qualitative content analysis and triangulated with FAI scores.In all, 70 older adults (mean age: 73.0 years, SD: 9.9; 59% female) participated in the study. The overarching theme was that participants felt socially isolated following discharge from rehabilitation, with COVID-19 restrictions increasing perceptions of social isolation and complicating their return to participating in community activities. The four categories informing the overarching theme were as follows: physical health was the primary limitation to participation in community activities; COVID-19 restrictions limited participation in social activities and centre-based physical rehabilitation; low uptake of videoconferencing to facilitate socialisation and rehabilitation; and reduced incidental physical activity. Mean FAI score was 21.2 (SD 7.8), indicating that participants were moderately active. Participants most commonly performed domestic activities (mean: 10.0, SD: 4.1), followed by outdoor activities (mean: 6.6, SD: 3.5) and leisure/work activities (mean: 4.5, SD: 2.5).COVID-19 restrictions exacerbated perceptions of social isolation and the limitations already imposed by poor physical health after discharge from rehabilitation. The findings highlight the need for rehabilitation that addresses the psychological and social dimensions of community reintegration.

Mercury (Hg) deposition was reconstructed in sediment cores from lakes in two coastal U.S. National Parks: Acadia National Park (ANP) and Cape Cod National Seashore (CCNS), to fill an important spatial gap in Hg deposition records and to explore changing sources of Hg and processes affecting Hg accumulation in these coastal sites. Recent Hg deposition chronology was assessed using (1) a newly developed lead-210 (

Bovine herpesvirus 1 (BoHV-1), is associated with several clinical syndromes in cattle, among which bovine respiratory disease (BRD) is of particular significance. Despite the importance of the disease, there is a lack of information on the molecular response to infection via experimental challenge with BoHV-1. The objective of this study was to investigate the whole-blood transcriptome of dairy calves experimentally challenged with BoHV-1. A secondary objective was to compare the gene expression results between two separate BRD pathogens using data from a similar challenge study with BRSV. Holstein-Friesian calves (mean age (SD) = 149.2 (23.8) days; mean weight (SD) = 174.6 (21.3) kg) were either administered BoHV-1 inoculate (1 × 107/mL × 8.5 mL) (n = 12) or were mock challenged with sterile phosphate buffered saline (n = 6). Clinical signs were recorded daily from day (d) −1 to d 6 (post-challenge), and whole blood was collected in Tempus RNA tubes on d six post-challenge for RNA-sequencing. There were 488 differentially expressed (DE) genes (p < 0.05, False Discovery rate (FDR) < 0.10, fold change ≥2) between the two treatments. Enriched KEGG pathways (p < 0.05, FDR p < 0.05, FDR

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Communication is an essential asset enabling humankind to forge an advanced civilization. Using approximately 31,000 languages from the Stone Age to our present digital information society, humans have connected and collaborated to accomplish remarkable feats. As the newly dawned Space Age progresses, we are attempting to communicate with intelligent species beyond our world, on distant planets and in Earth’s far future. Absent mutually understood signs, symbols, and semiotic conventions, this study, the “Message in a Bottle”, uses scientific methods to assess and design a means of communication encapsulating the story of humanity, conveying our thoughts, emotions, ingenuity, and aspirations. The message will be structured to provide a universal yet contextual understanding of modern human society, evolution of life on Earth, and challenges for the future. In assembling this space and time capsule, we aim to energize and unite current generations to celebrate and preserve humanity.

There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations’ adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery.