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Archaeologists have not recognized the importance of increasing complexity as a social evolutionary tendency. An argument is made for an interdisciplinary study of complex adaptive systems.

Findings from observational studies investigating the association between Dietary Inflammatory Index (DII®) scores and depression symptoms (DepS) are inconsistent. This study aims to assess the association between energy-adjusted DII (E-DII™) and DepS using the North West Adelaide Health Study (NWAHS) cohort as well as update a previous meta-analysis. A total of 1743 (mean ± SD age: 56.6 ± 13.6 years, 51% female) study participants from NWAHS were included in the cross-sectional study and 859 (mean ± SD age: 58.4 ± 12.1 years, 52.6% female) in the longitudinal analyses. The Center for Epidemiological Studies Depression Scale (CES-D) was used for the measurement of DepS. E-DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Data from two stages [Stage 3 (2008–10) and North West 15 (NW15) (2015)] were used. Log- and negative binomial regression were used to assess the association between quartiles of E-DII and DepS. A recent meta-analysis was updated by including 12 publications (six cross-sectional and six cohort studies) on the association between DII and DepS. In the cross-sectional analysis, a higher E-DII score (i.e., more pro-inflammatory diet) was associated with a 79% increase in odds of reporting DepS [OR Quartile4vs1 : 1.79; 95% CI: 1.14–2.81; p = 0.01; p for trend (p trend) = 0.03]. Males with higher E-DII had a more than two-fold higher odds of DepS (OR Quartile4vs1 : 2.27; 95% CI: 1.02–5.06; p = 0.045; p trend = 0.09). Females with higher E-DII had an 81% increase in odds of DepS (OR Quartile4vs1 : 1.81; 95% CI: 1.01–3.26; p = 0.046; p trend = 0.07). These associations were consistent in the longitudinal analysis. Comparing highest to lowest quintiles of E-DII, the updated meta-analysis showed that a pro-inflammatory diet is associated with a 45% increase in odds of having DepS (OR: 1.45; 95% CI: 1.20–1.74; p < 0.01) with higher odds in females (OR: 1.53; 95% CI: 1.16–2.01; p = 0.01) compared to their male counterparts (OR: 1.29; 95% CI: 0.98–1.69; p = 0.15). The data from the NWAHS and the updated meta-analysis of observational studies provide further evidence that a pro-inflammatory diet is positively associated with increased risk of DepS. These findings support the current recommendation on consuming a less inflammatory diet to improve DepS. [ABSTRACT FROM AUTHOR]

Our purpose was to assess the effect of a combined intervention – simulation-based training supported by neurofeedback sessions – on radiation technologists' (RTs') workload, situation awareness, and performance during routine quality assurance and treatment delivery tasks. As part of a prospective institutional review board approved study, 32 RTs previously randomized to receive versus not receive simulation-based training focused on patient safety were again randomized to receive versus not receive a 3-week neurofeedback intervention (8 sessions of alpha-theta protocol) focused on stress reduction as well as conscious precision, strong focus, and ability to solve arising problems. Perceived workload was quantified using the NASA Task Load Index. Situation awareness was quantified using the situation awareness rating technique. Performance score was calculated using procedural compliance with time-out components and error detection. RTs randomized to simulation-based training followed by neurofeedback sessions demonstrated no significant changes in perceived workload or situation awareness scores, but did have better performance compared with other study groups (P <.01). This finding is encouraging and provides basis for using neurofeedback as means to possibly augment performance improvements gained during simulation-based training. [ABSTRACT FROM AUTHOR]

Our purpose was to assess the effect of workspace configuration on radiation therapists' (RTs) physical stressors, mental workload (WL), situational awareness (SA), and performance during routine treatment delivery tasks in a simulated environment. Fourteen RTs were randomized to 2 workspace configurations while performing 4 simulated scenarios: current (not ergonomically optimized; n = 7) and enhanced (ergonomically optimized, n = 7). Physical stressors were objectively assessed using a rapid upper limb assessment tool. Mental WL was measured at the end of each simulated scenario subjectively using the NASA Task-Load Index and objectively throughout the scenario using eye-tracking metrics (pupil diameter and blink rate). SA was measured at the end of each simulated scenario subjectively using the situation awareness and review technique. Performance was measured objectively via assessment of time-out compliance, error detection, and procedural compliance. Analysis of variance was used to test the effect of workspace configuration on physical stressors, mental WL, SA, and performance. The enhanced configuration significantly reduced physical stressors (rapid upper limb assessment; P <.01) and resulted in a higher rate of time-out compliance (P =.01) compared with current workspace configuration. No significant effect on other metrics was measured. Our results suggest that an ergonomically designed workspace may minimize physical stressors and improve the performance of RTs. [ABSTRACT FROM AUTHOR]

• Studies using strict definitions to investigate the association between metabolic phenotypes (MP) and diabetes are scarce. • Participants with obesity/healthy MP were not at increased diabetes risk compared to the ones with normal weight/healthy MP. • Reduced grip strength was associated with a higher risk of diabetes incidence in the long-term. • High grip strength attenuated the risk associated with metabolically unhealthy phenotypes. The association of diabetes risk in the long-term, metabolic phenotypes (MP) and muscle strength is unclear. We aimed to investigate the association between strictly defined MP, grip strength (GS) and diabetes. MP were defined according to BMI and presence of any individual metabolic abnormality for ≥18 years, in participants of the North West Adelaide Health Study (Australia) free of diabetes at baseline. The association of MP and dominant hand GS with incident diabetes over 15-years follow-up and the moderation effect of GS on the association between diabetes and MP were investigated by logistic regression models. Of 3039 participants followed over 13.3 years (SD 2.6), 236 (7.8%) developed diabetes. Compared to the metabolically healthy (MH) normal weight phenotype, the metabolically unhealthy (MU) overweight (OR 6.15, 95%CI 2.43–15.59) and obese (OR 12.32, 95%CI 4.97–30.52) phenotypes were associated with a high risk of diabetes, but not the MU normal weight (OR 1.73, 95%CI 0.57–5.25), MH overweight (OR 1.15, 95%CI 0.31–4.31) or MH obese phenotypes (OR 0.77, 0.07–8.89). GS was inversely associated with diabetes (OR 0.97, 95% CI 0.95–0.99) and attenuated the risk associated with MU overweight (beta = −0.296, p = 0.039) and MU normal weight (beta = −0.773; p for interaction = 0.009). Strictly defined MP (rather than based on metabolic syndrome criteria) and GS, a proxy of muscle strength, might be useful for stratifying the risk of diabetes in the long-term. Improving muscle strength might be an important strategy to reduce diabetes risk. [ABSTRACT FROM AUTHOR]

Objective: Describe the use of an emergency department (ED) pharmacist-driven microbiology follow-up collaborative practice agreement (CPA) at a community hospital ED.Setting: A 297-bed community hospital that serves several counties in south-central Indiana.Practice Description: The 40-bed ED had 48,550 visits in 2018. The clinical staff consists of 14 physicians, 14 advanced practice providers, and 2 ED pharmacists.Practice Innovation: A CPA exists between the ED medical director and the ED clinical pharmacists. The pharmacist reviews the patient's case, culture result(s), and medications administered in or prescribed at the ED. If supported by the CPA, the pharmacist will intervene independently. If the intervention is not supported by the CPA, the pharmacist will discuss treatment options with an ED provider.Evaluation: The primary end point was the number of cases reviewed and acted upon independently by the ED pharmacists using the CPA. The secondary end points included the average number of culture cases reviewed per day, average time spent daily reviewing culture data, number of cases not requiring further action under the CPA because the treatment is appropriate, type of intervention used under the CPA, number of culture cases unable to be executed under the CPA, reason for CPA exclusion, and ED provider satisfaction with the CPA. Descriptive statistics were used for data analysis.Results: The CPA covered 1094 microbiology follow-up cases. Of these, 36% (n = 394) required further intervention under the CPA. The CPA was unable to be used in 31% (n = 493) of the cases. Typically, a pharmacist reviewed 5.5 new cases daily over an estimated 2 hours. The ED providers strongly support the ED clinical pharmacists' current use of the CPA and also its expansion.Conclusion: The CPA has several avenues for potential expansion that are being explored in response to the information gathered in this study. [ABSTRACT FROM AUTHOR]

Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multi-night sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials. [ABSTRACT FROM AUTHOR]

Introduction and Goal: Stroke is a serious health condition that disproportionally affects African-Americans relative to non-Hispanic whites. In the absence of clearly defined reasons for racial disparities in stroke recovery and subsequent stroke outcomes, a critical first step in mitigating poor stroke outcomes is to explore potential barriers and facilitators of poststroke recovery in African-American adults with stroke. The purpose of this study was to qualitatively explore poststroke recovery across the care continuum from the perspective of African-American adults with stroke, caregivers of African-American adults with stroke, and health care professionals with expertise in stroke care.Materials and Methods: This qualitative descriptive study included in-depth key informant interviews with health care providers (n = 10) and focus groups with persons with stroke (n = 20 persons) and their family members or caregivers (n = 19 persons). Data were analyzed using thematic analysis according to the Social Ecological Model, using both inductive and deductive approaches.Findings: Persons with stroke and their caregivers identified social support, resources, and knowledge as the most salient factors associated with stroke recovery. Perceived barriers to recovery included: (1) physical and cognitive deficits, mood; (2) medication issues; (3) lack of support and resources; (4) stigma, culture, and faith. Health care providers identified knowledge/information, care coordination, and resources in the community as key to facilitating stroke recovery outcomes.Conclusions: Key findings from this study can be incorporated into interventions designed to improve poststroke recovery outcomes and potentially reduce the current racial-ethnic disparity gap. [ABSTRACT FROM AUTHOR]

Abstract The mechanical behaviour of two elastomeric fuel tank sealants was investigated. Laboratory tests were conducted on two sealants, an epoxy cured polythioether and a manganese cured polysulfide. Tensile, planar tension and torsion tests were performed to characterize and understand the response of the sealants under quasi-static loading. Single lap joint tests in tension were also carried out using four different sealant layer thicknesses and two types of adherend (aluminium and steel). The adherends were either primed with an epoxy primer or otherwise conventionally treated (e.g. grit blasted). Experimental results showed a decrease in joint strength with increasing sealant layer thickness. Emphasis was given to the understanding of the failure and the prediction of the strength of the single lap joints. Predicted failure loads were derived by analytical calculations and finite element simulation of the joints. [ABSTRACT FROM AUTHOR]

Abstract Compact Deuterium-Deuterium fast neutron generators are generally limited to a low neutron yield due to outgassing of implanted deuterium in case of ion beam target overheating. This is even more pronounced for a generator with a small emitting spot tailored to transmission-based imaging applications, resulting in long exposure times. In this work a novel water-cooled rotating copper target rod with a 5 µm thin titanium coating as a deuteron beam target was developed. Using extensive computational fluid dynamics and heat transfer analysis, an optimized target configuration was chosen. The details of the target rod design, construction and loading with deuterium are outlined. The first results after loading showed a peak total neutron output of 4.8 × 107 n/s for −107 kV target high voltage and 0.9 mA average target current at 220 rpm target rotational velocity. The comparison between actual and theoretical ideal neutron yield suggested that no loss of deuterium density in the target due to outgassing occurred. Highlights • Computational fluid dynamics and heat transfer analysis of a water-cooled rotating deuteron beam target. • Mechanical design of the high voltage rotating target rod and support structure. • Novel target design achieving a neutron output of 4.8 × 107 n/s at −107 kV target voltage and 0.9 mA beam current. • Experiments indicated that the titanium deuteride surface successfully remained below the degassing temperature. [ABSTRACT FROM AUTHOR]

Non-fertile accessions of vetiver grass ( Chrysopogon zizanioides (L.) Roberty) have been utilized in many parts of the world for environmental remediation and erosion control, but fertile plants can become noxious weeds. Due to the global interest in the environmental benefits of sterile vetiver, unique polymorphisms are needed to distinguish non-fertile from fertile plants. In this research, the chloroplast (cp) genomes of three non-fertile and two fertile vetivers were sequenced. The size, structure, and content of the vetiver cp genomes were typical of other grasses within the Andropogoneae. However, the total cp polymorphism rate of 0.02% was 5- to 7-fold lower, suggesting a recent divergence or slower rate of evolution in non-fertile and fertile vetivers relative to other grasses. In total, 28 polymorphisms––including 14 single nucleotide polymorphisms (SNPs), 11 microsatellites, two small indels, and one microinversion––were identified that distinguished the sterile Sunshine from fertile accessions. In a broader survey of Poaceae cp genomes, one of the SNPs was used to develop a cleaved amplified polymorphic sequence (CAPS) assay to uniquely identify Sunshine genomes. In a panel of 26 fertile and sterile vetivers, the four Sunshine and six additional non-fertile vetivers were distinguished from all other accessions. Two other sterile accessions were not detected by the assay, suggesting that sterility has originated more than once in vetiver. These variations in cp genome sequence can be used to assess sterility in other accessions through sequencing or by the newly developed CAPS assay. [ABSTRACT FROM AUTHOR]

Gamma imaging using a relatively low strength 5.8 mCi laboratory Co-60 source and a CsI(Tl) scintillator screen read out by a CCD camera was investigated. A simple model was used to estimate the effective count rate, which was verified with experiments. Radiography and tomography of phantoms were used to determine the test setup spatial resolution of about 1.3–2.5 mm. Exposure times were on the order of a couple minutes per radiograph. These tests demonstrate the value of the count rate model and the feasibility of the setup as a simple and low-cost solution for gamma imaging cases where acquisition time is flexible and resolution requirements are moderate. The approach can be applied with higher activity sources for short exposure times and with thinner scintillator screens for better resolution. This work was performed with non-destructive testing applications in mind, particularly for the study of multi-phase flows. [ABSTRACT FROM AUTHOR]

Summary Background & aims There is limited data relating to the effect of the combination of nutrients on inflammation and the interactions with lifestyle factors and chronic conditions. We examined the association between nutrient patterns and inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6) in community dwelling middle-aged and elderly Australian men. Methods Participants (mean age 59.7 y) with complete data relating to diet and fasting serum inflammatory markers in the Men Androgen Inflammation Lifestyle Environment and Stress cohort were analysed (n = 1577 for CRP, n = 1557 for IL-6). Food intake was assessed using a food frequency questionnaire, and nutrient patterns were identified by factor analysis. Biomedical examinations were conducted in The Queen Elizabeth Hospital and Lyell McEwin Health Service. CRP and IL-6 were log transformed due to the skewed distribution. Linear regression models were used to assess the association between nutrient patterns and inflammation. Results We generated three nutrient patterns by factor analysis. An animal-sourced pattern (animal protein, cobalamin, cholesterol and omega-6) was positively associated with CRP (p for trend across quartiles 0.057). A plant-sourced pattern (beta-carotene, vitamin A, lutein and zeaxanthin) was inversely associated with CRP (p for trend across quartiles 0.005). The association between plant-sourced pattern and CRP was stronger in participants with severe sleep apnoea, smoking (p for interaction 0.019), and participants without diabetes (p for interaction 0.238) and/or with normal triglycerides (p for interaction 0.005) and high density lipoprotein (p for interaction 0.120) compared with their counterparts. No interactions were found between the animal-sourced pattern and lifestyle factors and chronic conditions. No independent associations were found between the animal/plant-sourced pattern and IL-6. No associations were found between the vitamin B and folate pattern (total folate, thiamine, riboflavin and niacin) and inflammatory markers. Conclusions While an animal-sourced pattern may enhance inflammation level, a plant-sourced pattern may reduce inflammation particularly in people with less healthy lifestyles and severe obstructive apnoea. [ABSTRACT FROM AUTHOR]

Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs. [ABSTRACT FROM AUTHOR]

Objectives To determine the longitudinal relationship of muscle mass and strength with incident type 2 diabetes, and previously unstudied mediating effects of testosterone and inflammation. Methods Community-dwelling male participants (aged ≥ 35 years) of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study underwent biomedical assessment in 2002–2006 and 2007–2010, including hand grip strength (dynamometer), testosterone and inflammatory markers. Body composition (dual-energy X-ray absorptiometry) was assessed at baseline only. Incident type 2 diabetes was defined as a self-reported doctor diagnosis, diabetes medication use, fasting plasma glucose ≥ 7.0 mmol/L, or glycated haemoglobin ≥ 6.5% (48 mmol/mol) at follow-up, that was not present at baseline. Results Of n = 1632 men, incident type 2 diabetes occurred in 146 (8.9%). Muscle mass was not associated with incident type 2 diabetes. Grip strength was inversely associated with incident type 2 diabetes [unadjusted odds ratio (OR) per 5 kg: 0.87, 95% confidence interval (CI): 0.80–0.95; adjusted OR, 95% CI: 0.87, 0.78–0.97]. Arm muscle quality (grip strength divided by arm lean mass) was similarly associated with incident type 2 diabetes. Testosterone, IL-6 and TNF-α did not significantly mediate the associations. The population attributable fraction of type 2 diabetes from low grip strength was 27% (13–40%), assuming intervention could increase strength by 25%. Conclusions Reduced muscle strength, but not reduced muscle mass, is a risk factor for incident type 2 diabetes in men. This is not mediated by testosterone or inflammation. Intervention could prevent a substantial proportion of disease. [ABSTRACT FROM AUTHOR]

Very few experimental imaging studies using a compact neutron generator have been published, and to the knowledge of the authors none have included tomography results using multiple projection angles. Radiography results with a neutron generator, scintillator screen, and camera can be seen in Bogolubov et al. (2005) , Cremer et al. (2012) , and Li et al. (2014) . Comparable results with a position-sensitive photomultiplier tube can be seen in Popov et al. (2011) . One study using an array of individual fast neutron detectors in the context of cargo scanning for security purposes is detailed in Eberhardt et al. (2005) . In that case, however, the emphasis was on very large objects with a resolution on the order of 1 cm, whereas this study focuses on less massive objects and a finer spatial resolution. In Andersson et al. (2014) three fast neutron counters and a D–T generator were used to perform attenuation measurements of test phantoms. Based on the axisymmetry of the test phantoms, the single-projection information was used to calculate radial attenuation distributions of the object, which was compared with the known geometry. In this paper a fast-neutron tomography system based on an array of individual detectors and a purpose-designed compact D–D neutron generator is presented. Each of the 88 detectors consists of a plastic scintillator read out by two Silicon photomultipliers and a dedicated pulse-processing board. Data acquisition for all channels was handled by four single-board microcontrollers. Details of the individual detector design and testing are elaborated upon. Using the complete array, several fast-neutron images of test phantoms were reconstructed, one of which was compared with results using a Co-60 gamma source. The system was shown to be capable of 2 mm resolution, with exposure times on the order of several hours per reconstructed tomogram. Details about these measurements and the analysis of the reconstructed images are given, along with a discussion of the capabilities of the system and its outlook. [ABSTRACT FROM AUTHOR]

Background and purpose Transcranial direct current stimulation (tDCS) has shown mixed results in post-stroke motor recovery, possibly because of tDCS dose differences. The purpose of this meta-analysis was to explore whether the outcome has a dose–response relationship with various dose-related parameters. Methods The literature was searched for double-blind, randomized, sham-controlled clinical trials investigating the role of tDCS (≥5 sessions) in post-stroke motor recovery as measured by the Fugl-Meyer Upper Extremity (FM-UE) scale. Improvements in FM-UE scores were compared between active and sham groups by calculating standardized mean differences (Hedge's g ) to derive a summary effect size. Inverse-variance-weighted linear meta-regression across individual studies was performed between various tDCS parameters and Hedge's g to test for dose–response relationships. Results Eight studies with total of 213 stroke subjects were included. Summary Hedge's g was statistically significant in favor of the active group (Hedge's g  = 0.61, p = 0.02) suggesting moderate effect. Specifically, studies that used bihemispheric tDCS montage (Hedge's g  = 1.30, p = 0.08) or that recruited chronic stroke patients (Hedge's g  = 1.23, p = 0.02) showed large improvements in the active group. A positive dose–response relationship was found with current density (p = 0.017) and charge density (p = 0.004), but not with current amplitude. Moreover, a negative dose–response relationship was found with electrode size (p < 0.001, smaller electrodes were more effective). Conclusions Our meta-analysis and meta-regression results suggest superior motor recovery in the active group when compared to the sham group and dose–response relationships relating to electrode size, charge density and current density. These results need to be confirmed in future dedicated studies. [ABSTRACT FROM AUTHOR]

Recombinant (r) and native butyrylcholinesterse (BChE) are potent bioscavengers of organophosphates (OPs) such as nerve agents and pesticides and are undergoing development as antidotal treatments for OP-induced toxicity. Because of the lethal properties of such agents, regulatory approval will require extensive testing under the Animal Rule. However, human (Hu) glycoprotein biologicals, such as BChE, present a challenge for assessing immunogenicity and efficacy in heterologous animal models since any immune responses to the small species differences in amino acids or glycans between the host and biologic may alter pharmacodynamics and preclude accurate efficacy testing; possibly underestimating their potential protective value in humans. To establish accurate pharmacokinetic and efficacy data, an homologous animal model has been developed in which native and PEGylated forms of CHO-derived rMaBChE were multiply injected into homologous macaques with no induction of antibody. These now serve as controls for assessing the pharmacokinetics and immunogenicity in macaques of multiple administrations of PEGylated and unmodified human rBChE (rHuBChE) by both intravenous (IV) and pulmonary routes. The results indicate that, except for maximal concentration (Cmax), the pharmacokinetic parameters following IV injection with heterologous PEG-rHuBChE were greatly reduced even after the first injection compared with homologous PEG-rMaBChE. Anti-HuBChE antibody responses were induced in all monkeys after the second and third administrations regardless of the route of delivery; impacting rates of clearance and usually resulting in reduced endogenous MaBChE activity. These data highlight the difficulties inherent in assessing pharmacokinetics and immunogenicity in animal models, but bode well for the efficacy and safety of rHuBChE pretreatments in homologous humans. [ABSTRACT FROM AUTHOR]

Purpose To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. Methods and materials We created an event learning system (termed a “good catch” program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Results Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions ( p < .05). Conclusions Results suggest that event learning and continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety. [ABSTRACT FROM AUTHOR]

The world of health care delivery is becoming increasingly complex. The purpose of this manuscript is to analyze current metrics and analytically predict future practices and principles of medical dosimetry. The results indicate five potential areas precipitating change factors: a) evolutionary and revolutionary thinking processes, b) social factors, c) economic factors, d) political factors, and e) technological factors. Outcomes indicate that significant changes will occur in the job structure and content of being a practicing medical dosimetrist. Discussion indicates potential variables that can occur within each process and change factor and how the predicted outcomes can deviate from normative values. Finally, based on predicted outcomes, future opportunities for medical dosimetrists are given. [ABSTRACT FROM AUTHOR]

Background Telestroke extends stroke expertise to underserved hospitals and facilitates treatment with tissue plasminogen activator (tPA). We investigated the variability in tPA treatment rates across 2 large telestroke networks—consisting of hubs at Georgia Regents Medical Center (GRMC) and Medical University of South Carolina (MUSC) and their affiliated spoke hospitals—to identify spoke-related factors predictive of greater tPA use. Methods Observational study of tPA treatment rate at 32 spoke hospitals within the GRMC and MUSC telestroke networks. Spokes were characterized by primary stroke center status, local stroke nurse coordinator, local neurology support, hospital size, post-tPA management strategy, whether the spoke hospitals paid to participate in the network, and whether the hub or the spoke hospital initially proposed the telemedicine linkage for consultations with a remote stroke specialist. Primary outcome was tPA treatment rate adjusted for emergency department (ED) volume. Results There was substantial variation in the adjusted tPA rate across spokes (range, .85-8.74 administrations/10 4 ED visits/year). Only spokes with a stroke nurse coordinator (4.75/10 4 ED visits/year versus 2.84/10 4 ED visits/year, P = .03) were associated with higher tPA use. Conclusions The application of telestroke has variable results on tPA delivery in spoke hospitals. However, the presence of a stroke nurse coordinator at the spoke facilitated treatment of ischemic stroke cases with tPA. [ABSTRACT FROM AUTHOR]

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Purpose To assess the applicability of the human factors analysis and classification system (HFACS) model for analyzing events in a radiation oncology environment by comparing the HFACS analysis results between novices and experts. Methods and materials Four novices (resident physicians, 2-4 postgraduate years) volunteered to participate and were asked to independently perform the HFACS analysis on the selected 30 events. The events were divided into the following 2 sets: (1) the description of events was given in detail (eg, the conditions under which the events occurred including information about root causes of error); (2) the description of events was given without detailed information. Each novice’s categorization of events into 4 main and 12 sublevels were compared with expert categorization (“gold standard”) and used for statistical analysis. Analysis of variance was performed to test the difference in mean agreement with the expert-defined gold standard between the novices across the 4 main levels; and across the 12 sublevels independently. Results There were no significant differences in mean agreement with the expert-defined gold standard among the 4 novices (novice versus novice; P > .05) across the 4 main and 12 sublevels, respectively. There was a significant difference in mean agreement with the expert-defined gold standard among the 4 main levels and 12 sublevels ( P < .05) across the 4 novices. For the 4 main levels, there was a significant difference in agreement with the expert-defined gold standard for events with detailed information versus events without detailed information provided across the 4 novices. The additional information did not improve mean agreement on the 12 sublevels. Conclusions Novices learned to use the HFACS model for higher level analysis (4 main levels) with 1 hour training. Regardless of the amount of detail provided in the event description, the study results indicate a need of formal training for novices to better understand the definition and their interpretation at the 12 sublevel analyses. [ABSTRACT FROM AUTHOR]

The experimental characterization of a pulsed D–D fast neutron generator designed for fan-beam tomography applications is presented. Using Monte Carlo simulations the response of an LB6411 neutron probe was related to the neutron generator output. The yield was measured to be up to ∼ 10 7 neutrons / s . An aluminum block was moved stepwise between the source and a BC400 plastic scintillator detector in order to measure an edge response. This edge response was related to the neutron emitting spot size using Monte Carlo simulations and a simplified geometry-based model. The experimentally determined spot size of 2.2 mm agreed well with the simulated value of 1.5 mm. The time-dependence of pulsed output for various operating conditions was also measured. The neutron generator was found to satisfy design requirements for a planned fast neutron tomography arrangement based on a plastic scintillator detector array which is expected to be capable of producing 2D tomograms with a resolution of ∼1.5 mm. [ABSTRACT FROM AUTHOR]

In automotive construction, adhesive bonding can be used for joining metals, plastics or combinations of the two, and it offers the further advantage that, because the joints are continuous, an overall increase in body stiffness is achieved, thus enabling thinner material to be used. Because of their ability to absorb energy adhesive joints can also contribute to the impacted system. The objective of this work is to investigate the behavior of a flexible adhesive under impact loading using the single lap joint configuration. This adhesive showed a high strain to failure with good strength. These features of the adhesive under impact loading improve structural crashworthiness. Results showed that the lap joint strength increases considerably under impact loading compared with those under quasi-static loading and that there is a relationship between the joint performance and the loading speeds. [ABSTRACT FROM AUTHOR]

Background: The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnostic codes can identify racial disparities in ischemic stroke hospitalizations; however, inclusion of revascularization procedure codes as acute stroke events may affect the magnitude of the risk difference. This study assesses the impact of excluding revascularization procedure codes in the ICD-9 definition of ischemic stroke, compared with the traditional inclusive definition, on racial disparity estimates for stroke incidence and recurrence.Methods: Patients discharged with a diagnosis of ischemic stroke (ICD-9 codes 433.00-434.91 and 436) were identified from a statewide inpatient discharge database from 2010 to 2012. Race-age specific disparity estimates of stroke incidence and recurrence and 1-year cumulative recurrent stroke rates were compared between the routinely used traditional classification and a modified classification of stroke that excluded primary ICD-9 cerebral revascularization procedures codes (38.12, 00.61, and 00.63).Results: The traditional classification identified 7878 stroke hospitalizations, whereas the modified classification resulted in 18% fewer hospitalizations (n = 6444). The age-specific black to white rate ratios were significantly higher in the modified than in the traditional classification for stroke incidence (rate ratio, 1.50; 95% confidence interval [CI], 1.43-1.58 vs. rate ratio, 1.24; 95% CI, 1.18-1.30, respectively). In whites, the 1-year cumulative recurrence rate was significantly reduced by 46% (45-64 years) and 49% (≥ 65 years) in the modified classification, largely explained by a higher rate of cerebral revascularization procedures among whites. There were nonsignificant reductions of 14% (45-64 years) and 19% (≥ 65 years) among blacks.Conclusions: Including cerebral revascularization procedure codes overestimates hospitalization rates for ischemic stroke and significantly underestimates the racial disparity estimates in stroke incidence and recurrence. [ABSTRACT FROM AUTHOR]

[Display omitted] • Single and multiphase CFD of a small-scale crystallizer with two stirrer types. • Indications when each stirrer is preferably used based on hydrodynamics. • X-ray CT applied in mixing studies used for the validation of the CFD simulations. Although small-scale crystallizers have gained increasing importance in recent years, their hydrodynamic properties have not yet been thoroughly studied. The purpose of this work is to characterize an intensively stirred small-scale crystallizer and to analyze whether its fluid mechanics behavior deviates from being homogeneously well-mixed. To this aim, single and multiphase computational fluid dynamics (CFD) simulations have been conducted. Two types of stirrers, including one overhead stirrer (OS) and one magnetic stirrer (MS), were compared. The single-phase CFD simulations showed that the mixing characteristics of the two stirrers differ significantly, thereby leading to variations in the distribution of solids. The MS is an axial flow type impeller, which is better at handling solid suspensions than the OS. The simulations were complemented by X-ray computed tomography measurements, which confirmed that spatial variations in solid distribution occur and that assuming a homogeneous suspension might lead to errors when modeling crystallization processes. [ABSTRACT FROM AUTHOR]