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This review article addresses the role of safety professionals in the diffusion strategies for predictive analytics for safety performance. The article explores the models, definitions, roles, and relationships of safety professionals in knowledge application, access, management, and leadership in safety analytics. The article addresses challenges safety professionals face when integrating safety analytics in organizational settings in four operations areas: application, technology, management, and strategy. A review of existing conventional safety data sources (safety data, internal data, external data, and context data) is briefly summarized as a baseline. For each of these data sources, the article points out how emerging analytic data sources (such as Industry 4.0 and the Internet of Things) broaden and challenge the scope of work and operational roles throughout an organization. In doing so, the article defines four perspectives on the integration of predictive analytics into organizational safety practice: the programmatic perspective, the technological perspective, the sociocultural perspective, and knowledge-organization perspective. The article posits a four-level, organizational knowledge-skills-abilities matrix for analytics integration, indicating key organizational capacities needed for each area. The work shows the benefits of organizational alignment, clear stakeholder categorization, and the ability to predict future safety performance.

A 75-year-old man presents to his general practitioner (GP) with dyspnoea, and dysphagia to liquids and solids, with regurgitation causing recurrent episodes of dyspnoea. He had a background of osteoarthritis, was an ex heavy smoker and had undergone coronary artery bypass graft five years previously. After several emergency admissions, initial investigation by the GP, and referral to ear, nose and throat specialists with no cause for dysphagia found, he underwent computed tomography imaging of the neck and thorax which demonstrated large cervical osteophytes at the level of C3–C4. He was referred to spinal orthopaedics and after multidisciplinary team discussion the cervical osteophytes were removed via an anterior approach, resulting in complete resolution of his symptoms.

Background New technologies for clinical staff are typically introduced via an “in-service” that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption. Methods The new technology proposed for adoption was a telehealth cart that provided direct video communication with electronic intensive care unit (eICU) staff for a rural Emergency Department (ED). A novel 3-Act-3-Debrief in situ simulation structure was created to target predictive constructs from the CFIR and connect debriefing to specific workflows. The structure and content of the simulation in relation to the framework is described. Participants completed surveys pre-simulation/post-simulation to measure change in their readiness to adopt the new technology. Results The scenario was designed and pilot tested before implementation at two rural EDs. There were 60 interprofessional participants across the 2 sites, with 58 pre-simulation and 59 post-simulation surveys completed. The post-simulation mean ratings for each readiness measure (feasibility, quality, resource availability, role clarity, staff receptiveness, and tech usability) increased significantly as a result of the simulation experience. Conclusions A novel 3-stage simulation-debriefing structure positively targets factors influencing the adoption of new healthcare technologies.

Background Papers on COVID-19 are being published at a high rate and concern many different topics. Innovative tools are needed to aid researchers to find patterns in this vast amount of literature to identify subsets of interest in an automated fashion. Objective We present a new online software resource with a friendly user interface that allows users to query and interact with visual representations of relationships between publications. Methods We publicly released an application called PLATIPUS (Publication Literature Analysis and Text Interaction Platform for User Studies) that allows researchers to interact with literature supplied by COVIDScholar via a visual analytics platform. This tool contains standard filtering capabilities based on authors, journals, high-level categories, and various research-specific details via natural language processing and dozens of customizable visualizations that dynamically update from a researcher’s query. Results PLATIPUS is available online and currently links to over 100,000 publications and is still growing. This application has the potential to transform how COVID-19 researchers use public literature to enable their research. Conclusions The PLATIPUS application provides the end user with a variety of ways to search, filter, and visualize over 100,00 COVID-19 publications.

MFEM is an open-source, lightweight, flexible and scalable C++ library for modular finite element methods that features arbitrary high-order finite element meshes and spaces, support for a wide variety of discretization approaches and emphasis on usability, portability, and high-performance computing efficiency. MFEM's goal is to provide application scientists with access to cutting-edge algorithms for high-order finite element meshing, discretizations and linear solvers, while enabling researchers to quickly and easily develop and test new algorithms in very general, fully unstructured, high-order, parallel and GPU-accelerated settings. In this paper we describe the underlying algorithms and finite element abstractions provided by MFEM, discuss the software implementation, and illustrate various applications of the library., Comment: 36 pages, 21 figures

Chronic primary mitral regurgitation (MR) exposes the left ventricle (LV) to volume overload and is associated with evidence of fibrosis on non-invasive imaging. It is not known whether fibrosis predicts outcome from surgery. This study aimed to 1) quantify myocardial fibrosis on histology and non-invasive imaging, 2) investigate any association between fibrosis and LV size and function, 3) determine the impact of fibrosis on post-operative outcome. Methods In a prospective observational multicentre study, 105 patients with severe MR (N=65/32/8 NYHA Class I/II/III respectively; mean age 63.1±13.4 years; male 73%; VO2max 91.2±22.4%) had multiparametric cardiac magnetic resonance (CMR), symptom assessment (Minnesota Living with Heart Failure Questionnaire (MLHFQ)) and cardiopulmonary exercise testing before and at 9 months following repair. Patients consented for up to 3 intraoperative LV biopsies for histological collagen volume fraction (CVF) quantification. Results 234 LV biopsies were feasible from 86 patients with median CVF of 14.6% [IQR 7.4–20.3]. Fibrosis was present even in NYHA Class I patients (13.6% [6.3–18.8]), and was significantly higher than the 3.3% [2.6–6.1] obtained from 8 autopsy controls without cardiac disease (P Pre-operatively, there was no relationship between CVF and LV size, systolic function, ECV, late gadolinium enhancement, although it did correlate with MLHFQ (R=0.23, P=0.034). Conversely, ECV (27.4±3.3%) correlated with systolic (LVEF Rho=−0.22, P=0.029; LVESVi Rho=0.22, P=0.025, GCS Rho=0.31, P=0.002) and diastolic function (E/e' R=0.25, P=0.022), exercise capacity (%VO2max R=−0.22, P=0.030), with borderline correlation to MLHFQ (R=0.19, P=0.058). Post-operatively, although LVEF remained normal (defined as >50%) in all but 6 patients (LVEF pre 69.1±8.0 vs post 63.3±8.3%, P Conclusions Myocardial fibrosis is present in primary MR, before the onset of symptoms. Due to its patchy nature, ECV but not fibrosis on histology is a better marker of pre-operative myocardial function and symptom status. Despite ECV reduction following successful MR surgery, symptomatic patients fail to regain exercise fitness and symptom-free status – providing further support for the benefits of early surgery. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Background/objectives Older people living in residential aged care facilities (RACFs) experience acute deterioration requiring assessment and decision making. We evaluated the impact of a large-scale regional Aged Care Emergency (ACE) program in reducing hospital admissions and emergency department (ED) transfers. Design A stepped wedge nonrandomized cluster trial with 11 steps, implemented from May 2013 to August 2016. Setting A large regional and rural area of northern and western New South Wales, Australia. Participants Nine hospital EDs and 81 RACFs participated in the evaluation. Intervention The ACE program is an integrated nurse-led intervention underpinned by a community of practice designed to improve the capability of RACFs managing acutely unwell residents. It includes telephone support, evidence-based algorithms, defining goals of care for ED transfer, case management in the ED, and an education program. Measurements ED transfers and subsequent hospital admissions were collected from administrative data including 13 months baseline and 9 months follow-up. Results A total of 18,837 eligible ED visits were analyzed. After accounting for clustering by RACFs and adjusting for time of the year as well as RACF characteristics, a statistically significant reduction in hospital admissions (adjusted incident rate ratio = .79; 95% confidence interval [CI] = .68-.92); P = .0025) was seen (i.e., residents were 21% less likely to be admitted to the hospital). This was also observed in ED visit rates (adjusted incidence rate ratio = .80; 95% CI = .69-.92; P = .0023) (i.e., residents were 20% less likely to be transferred to the ED). Seven-day ED re-presentation fell from 5.7% to 4.9%, and 30-day hospital readmissions fell from 12% to 10%. Conclusion The stepped wedge design allowed rigorous evaluation of a real-world large-scale intervention. These results confirm that the ACE program can be scaled up to a large geographic area and can reduce ED visits and hospitalization of older people with complex healthcare needs living in RACFs.

To measure the psychometric properties of a reduced, 27-statement version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT).We administered the GTCAT to 183 participants who were using a single bottle of an ocular hypotensive agent, and objectively measured adherence with Medication Event Monitoring System devices over 60 days. Adherence was the number of days with correctly timed bottle openings divided by the total number of study days. Using the 47-statement GTCAT, we created a reduced GTCAT by removing statements that: (1) did not load using Principal Components Analysis (PCA); (2) did not have a univariable association with adherence; or (3) were highly correlated (.75 or higher) with another statement. We assessed the construct validity of the remaining statements using PCA and assessed the predictive validity using multiple logistic regression analysis.We removed 20 statements because they did not appear in the PCA analysis; were not predictive of adherence; and/or had high correlation. PCA of the reduced GTCAT (27 statements) extracted 5 components of the Health Belief Model (knowledge, susceptibility, cues-to-action, self-efficacy, and barriers). Multiple regression showed that the 27 statements predicted adherence (Rsq = .11, p = .03).The reduced version of the GTCAT is associated with adherence, which suggests that after external validation, future glaucoma medication adherence studies could use the reduced version to efficiently measure health behaviors and determine the benefit of the GTCAT to develop personalized interventions in glaucoma adherence.

Purpose To determine the psychometric properties of a reduced version of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), which was translated to Brazilian Portuguese. Patients and methods We translated into Portuguese the GTCAT using validated techniques and administered it to a group of glaucoma patients using at least 1 ocular hypotensive eye drop medication. We used principal components analysis to determine construct validity, Rasch analysis, and Cronbach α for internal consistency reliability, frequency analysis for floor and ceiling effects, and Spearman ρ for test-retest reliability. Results We included 76 glaucoma patients. Principal component analysis loaded 14 questions into 7 components that were consistent with the Health Belief Model. The components were related to "barriers due to lack of drops," "self-efficacy," "experience of negative effects of the disease," "well-being," "general glaucoma knowledge," "glaucoma symptoms," and "cues-to-action." No statements had floor or ceiling effects, and all statements had acceptable test-retest reliability. Components had internal consistency Cronbach α reliability between 0.125 and 0.794. and average Spearman ρ reliability was 0.73, ranging from 0.44 to 1.00. According to Rasch analysis, the mean (±SD) of the person measures was 0.24±0.15 logits, person separation index was 0.58, and person reliability 0.25. Conclusions The Portuguese-translated version of the GTCAT showed acceptable psychometric properties. With further refinement, clinicians and researchers could use it to better investigate glaucoma adherence issues in the Brazilian population.

We examined how positive and negative affect covary within individuals over time and how patterns of association between affective traits and states relate to academic success across 4 years of university. Participants were 187 full-time first-year students at a large Canadian university who completed questionnaires about recent affective experiences in 6 waves across 4 years. Grade point average for each year of study was provided by the registrar's office. Our analysis identified an adaptive pattern characterized by the maintenance of high positive affect ("chronic happiness") and the cooccurrence of time-limited bouts of negative affect. Our results are consistent with findings showing productive consequences of experiencing positive and negative affect in tandem and the development of emotion regulation capacity across the transition to adulthood. (PsycINFO Database Record

Infections caused by multi-drug resistant (MDR) bacteria, particularly Gram-negative bacteria, are an escalating global health threat. Often clinicians are forced to administer the last resort antibiotic colistin, however colistin resistance is becoming increasingly prevalent, giving rise to the potential for a situation in which there are no treatment options for MDR Gram-negative infections. The development of adjuvants that circumvent bacterial resistance mechanisms is a promising orthogonal approach to the development of new antibiotics. We recently disclosed that the known IKK-β inhibitor IMD-0354 potently suppresses colistin resistance in several Gram-negative strains. In this report, we explore the structure-activity relationship (SAR) between the IMD-0354 scaffold and colistin resistance suppression, and identify several compounds with more potent activity than the parent against highly colistin resistant strains of Acinetobacter baumannii and Klebsiella pneumoniae.

Objective To determine whether theta burst repetitive transcranial magnetic stimulation is an effective treatment for chronic tinnitus compared with a control stimulus. Study design A two-arm, single-blind, randomized controlled trial comparing an active treatment group to a placebo control group. Setting Neurotology department of a tertiary referral center. Patients Forty new and existing patients with chronic unilateral or bilateral tinnitus were recruited from specialist hearing and balance clinics. Interventions The subjects were randomized into two groups representing the treatment and sham subcategories. Two 40 second trains, 15 minutes apart of transcranial stimulation was provided using a super rapid stimulator (2.2. Tesla, Magstim Inc., Wales, UK) using a circular delivery coil. Treatment was provided over 5 consecutive days. Main outcome measure Tinnitus functional index (TFI) scores were recorded before treatment, immediately after treatment, 2 weeks, and at 4 weeks following treatment and compared. Results TFI scores were analyzed using the Shapiro-Wilk test and found to be normally distributed. A paired Student t test was then performed. Both the active treatment group and control group had a significant improvement in their TFI scores following treatment; however, there was no significant difference between active treatment and sham treatment groups. Conclusion This study demonstrated a significant placebo effect following treatment with sham therapy and may suggest that repetitive transcranial magnetic stimulation does not have a therapeutic use in treating chronic tinnitus.

[Image: see text] Antibiotic resistance has significantly increased since the beginning of the 21st century. Currently, the polymyxin colistin is typically viewed as the antibiotic of last resort for the treatment of multidrug resistant Gram-negative bacterial infections. However, increased colistin usage has resulted in colistin-resistant bacterial isolates becoming more common. The recent dissemination of plasmid-borne colistin resistance genes (mcr 1–8) into the human pathogen pool is further threatening to render colistin therapy ineffective. New methods to combat antibiotic resistant pathogens are needed. Herein, the utilization of a colistin-adjuvant combination that is effective against colistin-resistant bacteria is described. At 5 μM, the lead adjuvant, which is nontoxic to the bacteria alone, increases colistin efficacy 32-fold against bacteria containing the mcr-1 gene and effects a 1024-fold increase in colistin efficacy against bacteria harboring chromosomally encoded colistin resistance determinants; these combinations lower the colistin minimum inhibitory concentration (MIC) to or below clinical breakpoint levels (≤2 μg/mL).

The purpose of this study was to assess the reliability of a pre-loaded 1 500-m treadmill time trial, conducted in moderate normobaric hypoxia. 8 trained runners/triathletes (24±3 years, 73.2±8.1 kg, 182.5±6.5 cm, altitude specific V˙O 2max : 52.9±5.5 ml·kg −1 ·min −1 ) completed 3 trials (the first as a familiarisation), involving 2, 15-min running bouts at 45% and 65% V˙O 2max , respectively, and a 1 500-m time trial in moderate normobaric hypoxia equivalent to a simulated altitude of 2 500 m (F i O 2 ~15%). Heart rate, arterial oxygen saturation, skeletal muscle and cerebral tissue oxygenation (StO 2 ), expired gas ( V˙O 2 and V˙CO 2 ), and ratings of perceived exertion were monitored. Running performance (Trial 1: 352.7±40; Trial 2: 353.9±38.2 s) demonstrated a low CV (0.9%) and high ICC (1). All physiological variables demonstrated a global CV≤4.2%, and ICC≥0.87, with the exception of muscle (CV 10.4%; ICC 0.70) and cerebral (CV 4.1%; ICC 0.82) StO 2 . These data demonstrate good reliability of the majority of physiological variables and indicate that a pre-loaded 1 500-m time trial conducted in moderate normobaric hypoxia is a highly reliable test of performance.

This exploratory study investigated the effect of visiting therapy dogs on college-student perceived and physiological stress the week prior to final exams. Students (n = 78) were randomly assigned to order of a therapydog intervention and attention-control condition, each 15 minutes long. Students completed the Perceived Stress Scale (PSS), a stress visual analog scale (SVAS), and provided saliva for measuring nerve growth factor (sNGF) and alpha amylase (sAA), prior to randomization. Saliva samples and SVAS were again collected after each condition. There was no effect of group order on demographics, PSS, or initial SVAS. Repeated measures models were used to analyze the complete data sets of 57 students. There were no significant differences in sAA between or within students completing the intervention and control conditions. sNGF was not subjected to analysis as most levels were undetectable. Significant differences in SVAS scores were found between the intervention and control condition, with...

We reviewed the literature on transcutaneous electrical nerve stimulation (TENS) used as a therapy for overactive bladder (OAB) symptoms, with a particular focus on: stimulation site, stimuli parameters, neural structures thought to be targeted, and the clinical and urodynamic outcomes achieved. The majority of studies used sacral or tibial nerve stimulation. The literature suggests that, whilst TENS therapy may have neuromodulation effects, patient are unlikely to benefit to a significant extent from a single application of TENS and indeed clear benefits from acute studies have not been reported. In long-term studies there were differences in the descriptions of stimulation intensity, strategy of the therapy, and positioning of the electrodes, as well as in the various symptoms and pathology of the patients. Additionally, most studies were uncontrolled and hence did not evaluate the placebo effect. Little is known about the underlying mechanism by which these therapies work and therefore exactly which structures need to be stimulated, and with what parameters. There is promising evidence for the efficacy of a transcutaneous stimulation approach, but adequate standardisation of stimulation criteria and outcome measures will be necessary to define the best way to administer this therapy and document its efficacy.

Functional electrical stimulation has been shown to be a safe and effective means of correcting drop foot of central neurological origin. However, despite recent technological advances, the set-up of surface stimulators remains a challenge for many users with drop foot. The automation of the setup process through the use of electrode arrays has been proposed as a way to address this problem. This paper describes a series of research and clinical studies which have led to the first demonstration of unsupervised automated setup of an electrode-array based drop foot stimulator. Finally, future research plans are discussed.

Objective: Gradiometers have the advantage of increasing measuring sensitivity, which is particularly useful in magnetic induction spectroscopy (MIS) for bio-impedance measurements. Traditional gradiometers use a pair of field sensing coils equally distant and on opposite sides of a drive coil, which provides high immunity to interference. In this paper, a ferrite-cored coaxial gradiometer probe of 29 mm diameter has been developed for measuring the impedance spectra of cervical tissues in vivo. Approach: It consists of a ferrite rod with outer ferrite confinement screening in order to eliminate the signals from surrounding tissue. The magnetic screening efficiency was compared with an air-cored gradiometer probe. For both gradiometer probes, a drive coil and two sensing coils were wound on a borosilicate glass former aligned coaxially with two sensing coils equidistant from the drive coil. The signal sensitivity of those two MIS gradiometers has been measured using saline samples with a conductivity range between 0.1 and 1.1 S m−1. Finite element methods using COMSOL Multiphysics have been used to simulate the distribution of sensitivity to conductivity over the face of each probe and with depth. Main Results: The ferrite-cored probe has a sensitivity confined to the volume defined by the gap between the ferrite core and outer tube of ferrite while the air-cored probe without any magnetic shielding had a wide sensitivity over the face and the side of the probe. Four saline samples and one of distilled water with conductivities from 0.1 to 1.1 S m−1 have been used to make conductivity measurements at frequencies of 50 kHz, 100 kHz, and 300 kHz. The measurement accuracy of the air-cored MIS probe was 0.09 S m−1 at 50 kHz, improving to 0.05 S m−1 at 300 kHz. For the ferrite-cored MIS probe, the measurement accuracy was 0.28 S m−1 at 50 kHz, improving to 0.04 S m−1 at 300 kHz. Significance: In vivo measurements on human hand have been performed using both types of gradiometers and the conductivity is consistent with reported data.

Functional electrical stimulation has been shown to be a safe and effective means of correcting foot 12 drop of central neurological origin. Current surface-based devices typically consist of a single channel stimulator, 13 a sensor for determining gait phase and a cuff, within which is housed the anode and cathode. The cuff-mounted 14 electrode design reduces the likelihood of large errors in electrode placement, but the user is still fully responsible 15 for selecting the correct stimulation level each time the system is donned. Researchers have investigated different 16 approaches to automating aspects of setup and/or use, including recent promising work based on iterative learning 17 techniques. This paper reports on the design and clinical evaluation of an electrode array-based FES system for 18 the correction of drop foot, ShefStim. The paper reviews the design process from proof of concept lab-based study, 19 through modelling of the array geometry and interface layer to array search algorithm development. Finally, the 20 paper summarises two clinical studies involving patients with drop foot. The results suggest that the ShefStim 21 system with automated setup produces results which are comparable with clinician setup of conventional systems. 22 Further, the final study demonstrated that patients can use the system without clinical supervision. When used 23 unsupervised, setup time was 14 minutes (9 minutes for automated search plus 5 minutes for donning the 24 equipment), although this figure could be reduced significantly with relatively minor changes to the design.

Transdermal amplitude modulated signal (TAMS) is a novel electrical stimulus which has been recently introduced for the treatment of overactive bladder (OAB) syndrome. It has been suggested that it has advantages over conventional waveforms by providing more effective penetration of the skin to enhance the efficacy of therapy. As there is no literature which supports this, we performed this study to evaluate potential advantages of the TAMS signal for electrical stimulation of subcutaneous nerves as compared to conventional stimuli. The stimuli were applied on forearms of ten healthy volunteers and electrical parameters of stimuli and sensation measurements were recorded. None of the recorded electrical parameters showed significant differences (paired t-test p ≥ 0.250) between the TAMS and conventional waveforms. Similarly, the mean sensation recorded at motor threshold level and at 50% of maximal motor response level showed no differences (paired t-test p = 0.242 and p = 0.687 respectively). It is unlikely, based on the results of this study, that TAMS provides any enhancement of the efficacy of conventional stimuli. We would recommend that further studies are carried out to clearly demonstrate in man what, if any, advantages the TAMS waveform has over conventional stimulation before it is widely deployed into clinical practice.

Gravitational forces may lead to local changes in subarachnoid cerebrospinal fluid (CSF) layer thickness, which has important implications for neurophysiological modulation and recording techniques. This study examines the effect of gravitational pull associated with different head positions on the distribution of subarachnoid CSF using structural magnetic resonance imaging. Images of seven subjects in three different positions (supine, left lateral and prone) were statistically compared. Results suggest that subarachnoid CSF volume decreases on the side of the head closest to the ground, due to downward brain movement with gravity. These findings warrant future research into currently unexplored gravitation-induced changes in regional subarachnoid CSF thickness.

Importance Ophthalmologists rely on accurate concentrations of mitomycin C (MMC) to prevent scarring with trabeculectomy surgery. To our knowledge, the concentration accuracy and variability of compounded MMC are unknown. Objective To determine whether the measured concentration differs from the expected concentration of 0.4 mg/mL of MMC used in ophthalmic surgery. Design, Setting, and Participants Laboratory experimental investigation conducted in July 2013. We acquired 60 samples of 0.4 mg/mL of MMC from a spectrum of common compounding and storage techniques (refrigeration, freezing, and immediately compounded dry powder) and a variety of pharmacies (an academic hospital, a community hospital, and an independent Pharmacy Compounding Accreditation Board–accredited pharmacy). We used C18 reversed-phase high-performance liquid chromatography to measure the MMC concentration of all samples. We used pure MMC (Medisca Inc) to generate calibration curves and sulfanilamide as an internal standard. Main Outcomes and Measures We calculated MMC concentration using a calibration curve (range, 0.3-0.5 mg/mL) generated by dividing MMC peak area by internal standard peak area and plotting the area ratio against the calibrant concentrations. We compared the measured concentration against the expected 0.4 mg/mL concentration for all samples. Results Measurement of MMC using the high-performance liquid chromatography method demonstrated acceptable accuracy (92%-100%), precision (2%-6% coefficient of variation), and linearity (mean correlation coefficient of r 2 = 0.99). The measured MMC concentration determined using the high-performance liquid chromatography method for all samples was 12.5% lower than the expected 0.4 mg/mL value (mean [SD], 0.35 [0.04] mg/mL; 95% CI, 0.34-0.36; P Conclusions and Relevance Common compounding and storage techniques for MMC resulted in a lower accuracy and wider range of concentration than expected. These differences in concentration may result from compounding techniques and/or MMC degradation. Variability in MMC concentration could cause inconsistency in glaucoma surgical results, but the clinical relevance of such findings on glaucoma surgery outcomes remains unknown.

This article explores the uses of coaching and mentoring as they apply to organizational communication professors. The authors contend that these professors already are proficient at coaching and mentoring and the coaching and mentoring processes are routinely undertaken as part of their standard university teaching responsibilities. As coaches, these faculty members assist their students in improving student communication abilities through observation, discussion, and follow-up. As mentors, these faculty members enter into a developmental relationship with students that extend beyond the classroom. A greater knowledge of coaching and mentoring will enhance instructional efforts and benefit students in multiple ways.

Internal and external workplace diversity and the technology-induced time constraints of multinational competition make the challenge of improving organizational communication bigger than ever. Nar...

Axial osseous sarcoidosis: rare clinical presentation and radiological findings S. Yanny *, A.P. Toms , D. MacIver , T. Barker , A. Wilson c Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK Department of Pathology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, UK

Metal-on-metal hip replacements are the subject of much current debate. There is some evidence that there may be a hypersensitivity reaction, specific to metal-on-metal total hip replacements (THRs), which is associated with early failure of these prostheses. It has to date only been described in total replacements and not in metal-on-metal hip resurfacing. We present the case of a 68-year-old man who underwent bilateral metal-on-metal hip resurfacing for osteoarthrosis. The patient presented 6 months after surgery with pain and lateral thigh swelling. Pre-operative ultrasound and MRI demonstrated findings similar to those described in early failing metal-on-metal THRs, as well as evidence of lymphoreticular spread of metal debris. The operative findings included extensive aseptic soft-tissue necrosis. Histology revealed necrosis and a dense perivascular lymphocytic infiltrate along with metal debris within sinus histiocytes. The surgical, radiological and histological findings are similar to soft-tissue reactions described in metal-on-metal THRs.

To perform a retrospective review of all the conventional radiographic and magnetic resonance imaging (MRI) studies performed in patients with early postoperative pain following cobalt-chrome metal-on-metal total hip arthroplasty.A retrospective review of the radiology, surgical findings and histology in nineteen patients who had undergone a total of 20 hip arthroplasties using a cobalt-chromium on cobalt-chromium alloy prosthesis was undertaken.Measures of implant placement on the immediate postoperative radiographs were all within the normal ranges (n=20). Where more than one postoperative radiograph was available statistical analysis revealed no evidence of progressive change before the MRI examination (14). The median postoperative time to MRI was 35 months (range 11-63 months). Abnormalities were demonstrated using MRI in all symptomatic hips (n=20). These comprised: periprosthetic fluid collections (20), which were isointense to muscle on T1-weighted images in 19 cases and hyperintense on T2-weighted images in 18 cases, periprosthetic bone marrow oedema (n=6), muscle oedema (n=4), avulsion of the gluteus minimus and medius tendons (n=5), atrophy of piriformis (n=15) and obturator internus (n=17), and fracture of the medial calcar (n=1). Operative findings in patients who had undergone revision surgery (n=15) included: fluid-filled cavities (n=11), soft tissue necrosis (n=8), gluteal tendon avulsion (n=5), proximal femoral diaphyseal necrosis (n=4), and pitting and corrosion of the femoral stems (n=8), which were, in all cases, firmly fixed to the cement mantle. Histology revealed viable tissue in six hips with necrosis (n=12) and fibrin deposition (n=15) being the predominate findings. Other findings included a perivascular lymphocytic infiltrate (n=5), features of active inflammation (n=4), and metallosis (n=1).A significant number of patients with metal-on-metal hip replacements presented with early postoperative pain because of an abnormal soft-tissue reaction. MRI can demonstrate characteristic soft-tissue disease in these patients where conventional radiographs are frequently normal.

SUMMARY Mentalhealthquestionnaires oftenask respondentstoreporthowfrequently theyexperiencedifferent emotions. We report two experiments designed to assess the accuracy of these reports and the strategies used to generate them. Each day for 2 weeks, participants in Experiment 1 filled out a webbased emotions-and-activities checklist. Then, they estimated the diary-period frequency of these emotionsandactivitiesandindicatedhowtheygeneratedeachestimate.InExperiment2,participants provided frequency estimates and strategy reports, but did not fill out the checklist. We found that (a) the frequency estimates were quite accurate for emotions and activities, (b) participants relied on memory-based strategies (enumeration and direct retrieval) when estimating activity frequencies, but (c) used self-knowledge strategies (personality beliefs and schematic inferences) somewhat more than memory strategies for emotions and (d) the relationship between strategy use and question type was unaffected by diary keeping. We conclude by considering practical and theoretical implications. Copyright # 2007 John Wiley & Sons, Ltd.

Implantable cardiac pacemakers are medical devices that can monitor and correct abnormal heart rhythms. To provide the necessary safety assurance for pacemaker software, both testing and verification of the code, as well as testing the entire pacemaker hardware in the loop, is necessary. In this paper, we present a hardware testbed that enables detailed hardware-in-the-loop simulation and energy optimisation of pacemaker algorithms with respect to a heart model. Both the heart and the pacemaker models are encoded in Simulink/Stateflow™ and translated into executable code, with the pacemaker executed directly on the microcontroller. We evaluate the usefulness of the testbed by developing a parameter synthesis algorithm which optimises the timing parameters based on power measurements acquired in real-time. The experiments performed on real measurements successfully demonstrate that the testbed is capable of energy minimisation in real-time and obtains safe pacemaker timing parameters.

Introduction Damage control laparotomy for trauma (DCL) entails immediate control of haemorrhage and contamination, temporary abdominal closure (TAC), a period of physiological stabilisation, then definitive repair of injuries. Although immediate primary fascial closure is desired, fascial retraction and visceral oedema may dictate an alternate approach. Our objectives were to systematically identify and compare methods for restoration of fascial continuity when primary closure is not possible following DCL for trauma, to simplify these into a standardised map, and describe the ideal measures of process and outcome for future studies. Methods Cochrane, OVID (Medline, AMED, Embase, HMIC) and PubMed databases were accessed using terms: (traum*, damage control, abbreviated laparotomy, component separation, fascial traction, mesh closure, planned ventral hernia (PVH), and topical negative pressure (TNP)). Randomised Controlled Trials, Case Series and Cohort Studies reporting TAC and early definitive closure methods in trauma patients undergoing DCL were included. Outcomes were mortality, days to fascial closure, hospital length of stay, abdominal complications and delayed ventral herniation. Results 26 studies described and compared early definitive closure methods; delayed primary closure (DPC), component separation (CS) and mesh repair (MR), among patients with an open abdomen after DCL for trauma. A three phase map was developed to describe the temporal and sequential attributes of each technique. Significant heterogeneity in nomenclature, terminology, and reporting of outcomes was identified. Estimates for abdominal complications in DPC, MR and CS groups were 17%, 41% and 17% respectively, while estimates for mortality in DPC and MR groups were 6% and 0.5% (data heterogeneity and requirement of fixed and random effects models prevented significance assessment). Estimates for abdominal closure in the MR and DPC groups differed; 6.30 (95% CI = 5.10–7.51), and 15.90 (95% CI = 9.22–22.58) days respectively. Reporting poverty prevented subgroup estimate generation for ventral hernia and hospital length of stay. Conclusion Component separation or mesh repair may be valid alternatives to delayed primary closure following a trauma DCL. Comparisons were hampered by the lack of uniform reporting and bias. We propose a new system of standardised nomenclature and reporting for further investigation and management of the post-DCL open abdomen.

OBJECTIVE To assess the feasibility of using a novel form of multichannel electrical stimulation, termed Sensory Barrage Stimulation (SBS) for the treatment of spasticity affecting the elbow flexor muscles and to compare this with conventional single-channel TENS stimulation. MATERIALS AND METHODS Altogether ten participants with spasticity of the flexor muscles of the elbow of Grade 2 or above on the Modified Ashworth Scale (MAS) were recruited to this crossover double blind randomized trial. The participants received two intervention sessions (SBS and TENS), one week apart in a randomized order. Both interventions were applied over the triceps brachii on the affected arm for a duration of 60 minutes. Spasticity was measured using the MAS. Secondary outcome measures were self-reported change in spasticity, measured on a visual analog scale (VAS, 0-100), and therapist-rated strength of elbow extension and strength of elbow flexion. Measurements were taken immediately before each intervention was applied, immediately after the intervention, and one hour after the intervention. RESULTS Immediately after stimulation spasticity showed a significant reduction for both TENS and SBS groups assessed by MAS -0.9 ± 0.2 vs. -1.1 ± 0.2 and by VAS -15 ± 3 vs. -31 ± 8. For SBS this improvement in MAS was still present at one hour after the stimulation, but not for TENS. Altogether seven SBS responders and four TENS responders were identified. CONCLUSIONS This study demonstrates the feasibility and practicality of applying the new concept of SBS. Promising results indicate it causes a reduction in spasticity.

To compare the effects of common pharmacy preparation and storage conditions on the stability of mitomycin C (MMC) in solution.We used C18 reversed-phase high-performance liquid chromatography to determine the stability of 0.4 mg/mL MMC solutions, and liquid chromatography-electrospray ionization-mass spectrometry to identify degradation products. Conditions compared were: compounding and storage by refrigeration (1 and 2 wk), freezing (23 d), shipment "on-ice" (1 mo frozen followed by 1-wk refrigeration), and immediately compounding dry powder (Mitosol; Mobius Therapeutics LLC). We tested 3 samples for each storage method when samples reached room temperature (time 0), and then 1, 4, and 24 hours later. We used MMC peak area as a percentage of total (MMC plus degradants) area detected with high-performance liquid chromatography as a measure of stability.We assessed MMC stability for 5 preparation and storage methods at 4 timepoints (with n=3 per timepoint). At time 0, we found similar stabilities for MMC (F=0.72, P=0.599) between all 5 storage methods: 1-week refrigerated (97.9±0.2%), dry powder (97.5±0.3%), 2-week refrigerated (96.9±0.2%), 23-day frozen (96.7±3.1%), and shipment on-ice (96.0±1.2%). However, MMC demonstrated significant degradation over a 24-hour period with 2-week refrigeration (95.7±0.3%, β=-0.1%/h, P0.001) and shipment on-ice (93.1±1.8%, β=-0.1%/h, P=0.013). We identified small amounts (3.2%) of 2 degradants, cis-hydroxymitosene and trans-hydroxymitosene, across all samples.The different preparation and storage methods of MMC showed similar stability when used immediately upon reaching room temperature. However, degradation of MMC occurred with further storage at room temperature. The clinical implication of small amounts of MMC degradants is unclear.

To appraise the application of accepted good practice guidance on public involvement in assistive technology research and to identify its impact on the research team, the public, device and trial design.Critical reflection and within-project evaluation were undertaken in a case study of the development of a functional electrical stimulation device. Individual and group interviews were undertaken with lay members of a 10 strong study user advisory group and also research team members.Public involvement was seen positively by research team members, who reported a positive impact on device and study designs. The public identified positive impact on confidence, skills, self-esteem, enjoyment, contribution to improving the care of others and opportunities for further involvement in research. A negative impact concerned the challenge of engaging the public in dissemination after the study end.The public were able to impact significantly on the design of an assistive technology device which was made more fit for purpose. Research team attitudes to public involvement were more positive after having witnessed its potential first hand. Within-project evaluation underpins this case study which presents a much needed detailed account of public involvement in assistive technology design research to add to the existing weak evidence base.The evidence base for impact of public involvement in rehabilitation technology design is in need of development. Public involvement in co-design of rehabilitation devices can lead to technologies that are fit for purpose. Rehabilitation researchers need to consider the merits of active public involvement in research.

Purpose To assess the psychometric properties of a new version of the Glaucoma Treatment Compliance Assessment Tool, a survey evaluating health behavior and glaucoma adherence using constructs from the Health Belief Model. Design Psychometric analysis. Methods We administered the 47-statement Glaucoma Treatment Compliance Assessment Tool to 201 participants who were using a single bottle of an ocular hypotensive agent, and objectively measured adherence with medication event monitoring system devices over 60 days. Adherence was the percentage of days with correctly timed bottle openings. We used principal components analysis to determine construct validity, Cronbach's alpha for internal consistency reliability, frequency analysis for floor and ceiling effects, and Spearman rho for test-retest reliability. We determined predictive validity using univariate and multiple regression. Results The mean (±SD, range) adherence percentage was 79.9% (±18.5%, 20.3%–100.0%). Principal component analysis loaded 24 questions into 6 components that were consistent with the Health Belief Model. All 6 components had Cronbach's alpha reliability between 0.601 and 0.797. No statements had floor or ceiling effects, and all statements had acceptable test-retest reliability. Multiple regression analysis showed 4 Health Belief Model statements, white race, older age, and married marital status to be associated with higher adherence (adjusted R 2 = 0.27, P Conclusions The newest version of the Glaucoma Treatment Compliance Assessment Tool showed acceptable psychometric properties. With further refinement, clinicians and researchers could use it to examine factors related to adherence and measure improvement in adherence with a change in health behavior attitudes.

Regional migratory osteoporosis is an uncommon self-limiting disease characterized by an arthralgia which migrates between the weight-bearing joints of the lower limb. The radiological features of the disease obtained by conventional radiography, CT, MRI and radionuclide scintigraphy are illustrated by means of five case reports. These range from the most common presentation of sequential, proximal to distal spread in the lower limb to the rare intra-articular form, and disease involving the axial skeleton is also recognized. Clinical and radiographical features often overlap with those of diseases such as transient osteoporosis of the hip and transient bone marrow oedema syndrome, which is reflected in confusing terminology. Histological sampling is usually unnecessary; the radiological features are characteristic and the histological findings are not specific. Regional migratory osteoporosis is associated with systemic osteoporosis. This association is probably under-recognized, and has implications for the pathophysiology of the disease and for treatment.

OBJECTIVE To evaluate the effect of magnetic stimulation of the pelvic floor (MSPF) on involuntary detrusor activity observed during natural filling, and on the overactive bladder symptom complex. PATIENTS AND METHODS Eighteen women with detrusor overactivity on conventional cystometry underwent ambulatory urodynamic monitoring over two filling cycles. Fluid intake was standardized, provocative manoeuvres applied at regular intervals and symptoms documented contemporaneously. During the second filling cycle MSPF was delivered whenever the detrusor pressure increased by> 5 cmH2O. The women were subsequently treated with MSPF for 6 weeks; their lower urinary tract symptoms were assessed before and after treatment. RESULTS Comparing the second (stimulated) cycle with the first (unstimulated) cycle, cystometric capacity was higher (373 vs 224 mL, P

This article explores approaches to crisis communication and the application of those approaches by organizations responding to a disaster. The authors conducted a survey of 107 state government agencies to learn about government efforts in situations requiring crisis communication. Generally, the survey results suggest that although state agencies enjoy a positive relationship with the media, they have little proactive communication with the media, and less than half have a written crisis communication plan. Significant associations were found between the variables under study, including size of the organization, roles in crisis situations, media relationships, and preparation of a crisis communication plan. Case studies and additional evaluations of communication resources are needed to help determine the ability of the public sector to respond effectively to crises. This article considers the needs of state agencies and proposes a conceptual approach that synthesizes a crisis communication process designed for the public sector.

A Crawford transverse electro-magnetic (TEM) cell, used for RF exposure of in vitrocell cultures to examine any pathological effects, is modelled using an original high resolution finite-difference time-domain (FDTD) code at cellular handset frequencies. The standard scalar specific absorption rate (SAR) dosimetry parameter is augmented by new vector parameters of field polarization type and phase, and an easily comprehensible way of displaying these data as polar plots is used. It is shown that whilst the incident field in the empty TEM cell has plane wave properties, the exposure field in a blood sample is not a TEM plane wave, nor is it representative of the near field produced by a mobile handset. It is suggested that the exposure field vector properties need to be quantified and controlled in the TEM cell, and experimentation performed to assess whether there is a differential cellular stress response to these parameters in addition to SAR level. Copyright © 2002 John Wiley & Sons, Ltd.

This article identifies and assesses the effectiveness of communicating expectations, listening, delegating, and providing feedback in relation to the Hersey-Blanchard Situational Leadership model. It reviews the correlation between task versus relationship behavior that forms the basis of the Situational Leadership model. Then the article summarizes information found in literature on effective techniques for the four skills stated above. As these techniques are identified, they are discussed in relation to their effective use in the Situational Leadership model. To understand the application of the model in businesses and its impact on managers' communication effectiveness, we conducted a study of an operational department of a Fortune 500 financial services company. The results and content analysis of a survey we administered by random selection of the managers in this department indicate that successful use of the Situational Leadership model relies on effectiveness in four communication components: communicating expectations, listening, delegating, and providing feedback. Finally, we recommend areas of future research such as comparison analysis of surveys, interviews, and focus groups with subordinates of managers who have been trained on the Situational Leadership model and those who have not.

Aims: This study presents a series of five cases in whichmetaplastic carcinoma, predominantly low-gradeadenosquamous carcinoma, of the breast is seen arisingwithin a background of a complex sclerosing lesion.This association has been recognized previously but hasnot been documented in detail. This study describes thecharacteristics of the components present in each caseand discusses the existing literature. This observationadds further evidence to support an association betweensome types of invasive breast carcinoma and sclerosinglesions of the breast.Methods and results: Four of these cases were received asreferral cases for opinion. The fifth was received as partof the routine surgical workload within our owninstitution. Two patients presented following mammo-graphic screening and three symptomatically; theirmean age was 62 years (range 49–68). The meanlesion size was 16 mm (range 7–24). All five lesionsshowed features of a complex sclerosing lesion/radialscar in the form of central sclerosis with elastosis andradiating benign entrapped tubules. One had associatedbenign papillary structures and two had focal benignsquamous mletaplasia. Four cases showed coexistingbut distinct areas of low-grade adenosquamous carcin-oma with glandular and squamous epithelial differen-tiation in a spindle cell background. One case hadassociated undifferentiated spindle cell carcinoma.Detailed immunophenotypic characteristics of twocases are presented.Conclusions: This series illustrates a postulated butpreviously unconfirmed association between an unusualform of metaplastic breast carcinoma (adenosquamouscarcinoma) and complex sclerosing lesions. Themechanisms of induction of breast carcinoma arepoorly understood but these observations furtheremphasize the potential for sclerosing lesion of thebreast to be associated with, and possibly give rise to,invasive carcinoma of different types. The precise natureof the interaction between the pathological processesremains unclear.Keywords: breast carcinoma, metaplastic carcinoma, sclerosing lesion, radial scar

This article presents an analysis of an image advertisement using techniques developed from Narrative Paradigm Theory. It is suggested that the nature of postmodern culture makes image advertising an appropriate external communication strategy for generating stakeholder loyalty. A content analysis of Exxon’s “Driver Human” campaign’s introductory television advertisement was performed to explore potential sources of rational and value-laden audience conflicts. Two random samples, one advertising professionals and one upper-division undergraduate business students, participated in this study. Analysis suggests that, used in advance of traditional audience testing, Narrative Paradigm Theory can identify potential sources of audience conflict by illuminating sources of disbelief arising from both values and life experiences that contradict the corporate message.