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Introduction The COVID-19 pandemic caused significant disruption in clinical placements of medical students in the United Kingdom (UK), including trauma and orthopaedic surgery (TO) rotations. Based on the British Orthopaedic Association (BOA) undergraduate syllabus, a 12-week online teaching program was designed to supplement TO teaching for medical students across the UK while lockdown and social-distancing restrictions were in place. This study aims to describe the process of designing an online teaching program, evaluate the effectiveness of online education, explore medical student perceptions of the virtual learning environment, and report the lessons learned from this 12-week online program. Methods The "Crash Course in Orthopaedics" consisted of 12 webinars, with topics covering a range of acute and chronic TO conditions, and was delivered through the online platform Zoom. Attendees were invited to complete a post-course questionnaire retrospectively and the results were used in this study. Qualitative data was assessed using thematic analysis. Quantitative data were presented as descriptive statistics. Results The webinar series was attended by approximately 5150 participants, with the largest demographic group being clinical medical students (49%). Results from the survey revealed three broad themes which were: 1). Interactivity: question + answer (Q+A), multiple choice questions (MCQs), online tools 2). Content: case examples, orthopaedic examinations, objective structure clinical examination (OSCE) tips 3). Accessibility: slides, recordings, duration of the session. Our study found that the online teaching program improved students' clinical knowledge of TO and they found learning through interactive methods such as polls, the chat function on zoom, and case-based discussions to be most useful. Also, from the results of this study, a guide on "How to Run a Successful Webinar Series for Medical Students" was developed. Conclusion Online webinars effectively supplement TO teaching and experience for medical students whose TO placements were disrupted during the COVID-19 pandemic. The results will be a helpful guide to those planning medical education webinars in the future.

Objective:Dissemination of pre-Exposure Prophylaxis (PrEP) is a priority for reducing new HIV infections, especially among vulnerable populations. However, there are limited data available on PrEP discontinuation following initiation, an important component of the PrEP cascade.Design:Patients receiv

Social skill is the foundation upon which other skills are built. Without a social presence, visually impaired students may encounter isolation, difficulty with inter personal relationships, difficulty with employment and independent living as adults. Over the past years in which children with visual impairment have been included in public schools and most especially private special schools with increasing numbers, the practicalities and legalities of ensuring access to the curriculum have often taken precedence to, and sometimes obscured the issue of social inclusion. The UK, Scottish Government and Nigeria through adoption recognises that ensuring all children develop good levels of social competency in their school years has the potential to be a very powerful strategy for promoting lifelong social inclusion. Providing equal access to education in an inclusive setting to all individuals with disabilities is the key element of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1992 making it the role of the school in promoting, developing and supporting the social skills of all pupils as documented in the legislation and guidelines. So, bringing the social world at a very early age to a child who is blind is an essential skill or task in the developmental process of a child with visual impairment. This paper therefore is an attempt at discussing social inclusion as a task in the developmental process of persons with visual impairment and its implication to special needs counselling. To this end, this work uses two facets of social inclusion which is education through interacting with society and education through fulfilling social roles. Special Needs Counselling guidelines and management of children with visual impairment for social, academic, physical and spiritual adjustment are also highlighted. Article visualizations

Column description. The Future Voices in Public Services column is a forum for graduate students in library and information science programs to discuss key issues in academic library public service...

Introduction : Transmission in serodiscordant couples (SDCs) accounts for approximately half of all new HIV infections, both in Kenya and the wider sub-Saharan region [1]. With evidence to suggest inconsistent condom use within this population [2], the World Health Organization has recommended two new methods of HIV prevention for SDCs: Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP). However, there has been little research about the attitudes of SDCs towards these strategies [3,4]; knowledge that is paramount for successfully predicting the acceptability and efficacy of each method, as well as for informing decisions regarding HIV policy changes in Kenya. Methods : An exploratory, qualitative study was conducted in the Muhoroni constituency of Nyando district, Kenya from January to March 2013. Purposive sampling was predominately used to recruit 21 HIV-positive and 17 HIV-negative individuals in a serodiscordant relationship from four hospitals and health centres. During face-to-face semi-structured interviews, topic guides were used to elicit information about participants’ attitudes and preferences towards TasP and PrEP. Collected data underwent framework analysis, allowing the development of overarching categories, sub-themes and inductive interpretation. Results : The majority of participants, irrespective of gender and HIV status, found TasP more acceptable than PrEP. A key factor influencing this decision was HIV-negative participants’ limited motivation to take and adhere to antiretrovirals (ARVs), primarily due to a predominantly external health locus of control, a lack of cultural acceptance of prophylactic medication and concerns about side effects. In addition to this, the likely health improvements TasP offers HIV-positive partners, as well as the attitude that the sick individual should be the first to receive HIV medication, also contributed to this conclusion. Issues of risk compensation were raised, with some HIV-negative partners indicating a desire to stop using condoms if ARV-based prevention methods were available. Conclusions : Findings from the study indicate that TasP may represent a more viable approach to HIV prevention in Kenya than PrEP. Couples’ preferences, however, may differ depending on local attitudes towards prophylaxis and health locus of control. (Published: 2 November 2014) Citation : Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Fowler N et al. Journal of the International AIDS Society 2014, 17(Suppl 3): 19563 http://www.jiasociety.org/index.php/jias/article/view/19563 | http://dx.doi.org/10.7448/IAS.17.4.19563

The global incidence of spinal cord injuries varies with the developed world having improved survival and 1 year mortality in a poly-trauma setting. This improved survival has been estimated at 20 % in a recent Cochrane review of Advanced Trauma Life Support (ATLS).The aim of this audit is to evaluate the management of patients with suspected spinal cord injury by the trauma and orthopaedic team in three centres in South Wales. A retrospective case note review of the secondary survey was performed. Inclusion criteria were patients 18 years and above, with poly-trauma and presenting to Accident and Emergency department at the treating hospital. We used ATLS guidelines as an audit tool and reviewed the documentation of key components of the secondary assessment. Forty-nine patients were included (29 males, 20 females) with an average age of 53.7 years (19–92 years). We found that completion of all components of the secondary survey for spinal injury was poor, 29 % receiving a digital per rectal examination despite suspected spinal injury. Paralysis level was not documented in 20.4 % of patients. Medical Research Council grade was only documented in 24.5 % although was assessed in 73.5 %. The secondary survey took place after 2 h in 54.6 % of patients. We found that the documentation of the performance of a secondary survey was poor. We found that most patients included in this study are not currently meeting the minimal standard suggested by the ATLS guidelines.

The spread of electronic health records systems (EHRs) poses challenges for both patient and provider care experience. Limited research suggests that scribes offer potential benefits to productivity and clinician satisfaction in emergency health and specialty settings. We conducted this evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR 2011-2014. The scribe programme trained and managed scribes for 51 providers (25% participation) from 5 of 12 San Francisco Health Network primary care clinics. We evaluated the programme using four measures. Providers reported spending less time out of clinic completing notes after sessions with scribes versus sessions without scribes (14.0 min vs 30.2 min, p

Patients' rights such as the need for dignity and respect are essential in the provision of quality care. This exploratory clinical study explored patient dignity within the acute hospital environment through observation of staff-patient interactions and interviews with patients. Dignity can be influenced through two major mediums-maintenance of the physical environment and the communication style of the nurse. The findings identified deviations to ideal practice in the maintenance of the physical environment and communication styles of the nursing staff. Maintenance of dignity and privacy were not identified by patients during the interviews as being under threat despite deviations to ideal practice being observed. Patients possibly accept that 'ideal practice' is not always provided to them because nurses are 'busy', or other factors take precedence in this environment. It is possible that a prevailing culture influences patients' perceptions of whether dignity is maintained.

This research provides a profile of nurse executives' roles, career opportunities and professional development needs across metropolitan, provincial, rural and remote settings in Queensland. A cross-sectional survey was posted to all Directors/Assistant Directors of Nursing in the Queensland Public Health Sector (n = 281), with a response rate of 52.3% (n = 147). Findings indicated that the role of nursing executives has expanded and diversified, with multiple role responsibilities increasing with distance from the metropolitan area. Nurse executives in remote areas were less satisfied with the quality of supervision and mentorship they received, and least likely to participate in career enhancing activities. Metropolitan nursing executives utilised more of the career enhancing opportunities provided by the Queensland Public Health Sector than did provincial, rural or remote nursing executives. Provincial nurse executives were the group most likely to network, attend conferences and participate in informal educational activities. Professional development needs, although generally common to all groups, were more practice specific for those in rural and remote areas. Many nurse executives begin their careers in rural or remote areas where limited opportunities for career development may be detrimental to their future development.

Title. ‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them Aim. This paper is a report of a study to explore what constitutes nurse–patient interactions and to ascertain patients’ perceptions of these interactions. Background. Nurses maintain patient integrity through caring practices. When patients feel disempowered or that their integrity is threatened they are more likely to make a complaint. When nurses develop a meaningful relationship with patients they recognize and address their concerns. It is increasingly identified in the literature that bureaucratic demands, including increased workloads and reduced staffing levels, result in situations where the development of a ‘close’ relationship is limited. Method. Data collection took two forms: twelve 4-hour observation periods of nurse–patient interactions in one cubicle (of four patients) in a medical and a surgical ward concurrently over a 4-week period; and questionnaires from inpatients of the two wards who were discharged during the 4-week data collection period in 2005. Findings. Observation data showed that nurse–patient interactions were mostly friendly and informative. Opportunities to develop closeness were limited. Patients were mostly satisfied with interactions. The major source of dissatisfaction was when patients perceived that nurses were not readily available to respond to specific requests. Comparison of the observation and survey data indicated that patients still felt ‘cared for’ even when practices did not culminate in a ‘connected’ relationship. Conclusion. The findings suggest that patients believe that caring is demonstrated when nurses respond to specific requests. Patient satisfaction with the service is more likely to be improved if nurses can readily adapt their work to accommodate patients’ requests or, alternatively, communicate why these requests cannot be immediately addressed.

Issue addressed: This paper provides an overview of current and recently completed population health programs/projects in the Australian general practice setting.

Barrett’s enlightening article on gender dysphoria1 provided our department with much food for thought—in particular, highlighting that, as more than one in 200 patients identifies as transgender, we probably serve at least one such patient a day in our local district general hospital. The article touches on management including surgery but states that the NHS does not fund ear, nose, and throat or facial surgeries. Our understanding is that such procedures—including voice surgery, nasal surgery, and facial …

PURPOSE: In vivo confocal microscopy (IVCM) demonstrates reduction in corneal sub-basal nerve density in herpes simplex keratitis (HSK). Image J is an open source image-analysis platform that can be combined with a nerve tracer, Neuron J. We sought to compare the reliability and speed of corneal nerve density quantification between these modalities and their relation to clinical damage. METHODS: A total of 16 eyes (14 patients) with chronic HSK was assessed clinically and by IVCM. Randomly ordered triplicate, representative images from the central cornea were presented to two masked observers and corneal sub-basal nerve density was measured using Image J/Neuron J. Agreement was quantified using intraclass correlation coefficients (ICC), Bland-Altman plots together with mean difference, and level of agreement (LoA). RESULTS: The median nerve density was measured at 7.1 mm/mm(2) (quartiles, 3.3-11.2), with Neuron-J demonstrating good intra-/interobserver agreement (ICC, 0.96-0.99; P < 0.001; mean difference, 0.1-1.4; LoA

Preterm birth is the most important determinant of adverse infant outcomes including survival, quality of life, psychosocial effect on the family, and health-care costs.1 Prioritising research is a pathway to potential solutions for the global problem of preterm birth.2,3 The Preterm Birth Priority Setting Partnership aimed to identify and prioritise research areas in preterm birth that are most important to service users and health-care practitioners in the UK, using methods established by the James Lind Alliance.

Immunophenotyping by flow cytometry has not been widely applied to cerebrospinal fluid (CSF) analysis. We attempted to optimize flow cytometric detection of malignant lymphoma in CSF samples by the routine use of 3- and 4-color flow cytometry, with specific selection of lymphoid cells by fluorescence vs 90 degrees light scatter gating. Thirty-six consecutive CSF samples were immunophenotyped by flow cytometry, and the results were compared with those of standard microscopic examination. Lymphoid events were adequate for analysis in 27 of the 36 samples. Each of the 9 unsuccessful samples was more than 24 hours old at analysis or contained fewer than 1 x 10(4) total cells (< or =1 cell/microL). Lymphoma was detected in 10 of the remaining 27 cases. Six lymphomas were detected by morphology and flow cytometry, 1 only by morphologic examination, and 3 only by flow cytometry. Therefore, the combination of flow cytometry and morphologic examination enhanced the detection by 43% over morphologic examination alone. Flow cytometry permitted the detection of lymphoid clones totaling less than 1% of total cells. Multicolor flow cytometry is a rapid and sensitive technique that enhances detection of lymphoma in paucicellular CSF samples. Given the great sensitivity of flow cytometry, future studies will be necessary to assess the significance of detecting small lymphoid clones in this setting.

Amine conjugates of the semi-synthetic 1,3-β-(D)-glucan synthesis inhibitors L-731,373 (3) and L-733,560 (4) were prepared and evaluated for in vitro and in vivo antifungal activity. Tricationic analogs were more potent than the dicationic which were more potent than the monocationic. The L-ornithine conjugate of 4 possessed excellent pharmacokinetic parameters but lacked sufficient antifungal spectrum for development.

Selective methanolysis or dehydration followed by reduction of the 3-hydroxyglutamine residue of pneumocandin B0 (1) or its dideoxy analog 5 (L-692,289) gave the methyl 3-hydroxyglutamate and 3-hydroxyornithine analogs 6 and 9, respectively. Further derivatization of these analogs allowed a study of the SAR at this position. In general, carboxylic acid-containing derivatives were poorer antifungal agents than neutral derivatives while amine-bearing analogs displayed the greatest potency.

As pan of a larger cross-cultural study of the chemoreceptive abilities and preferences of Australiansand Japanese, this study investigated the differential taste sensitivity of subjects from both cultures. Theresults indicate that there are no significant differences between the abilities of subjects from the two culturesto discriminate small increments (just noticeable differences) in the intensities of the four common tastants-sucrose, sodium chloride, citric acid and caffeine. Furthermore, the Weber ratios found with each tastantwere within the range of those reported in the literature. These findings represent further evidence for theview that differences in responses of subjects from different cultures to chemosensory stimuli are restrictedto preference behaviour arising from experience rather than from genetically-based influences. IntroductionAnecdotal information from food companies and travellers suggest that the Japaneseconsumer may be more sensitive to subtle variations in flavour and other attributesof foods than their Western counterparts. It is conceivable, therefore, that communitieswhich have had a stable culture for several thousands of years, such as that found inJapan, may have developed chemosensory abilities and preferences attuned to the dietprovided by their geographic circumstance and culture.From the relatively few cross-cultural studies that have compared Asian and Westernchemosensory responses, no differences in taste thresholds have been found betweensubjects from the US and Japan for sucrose, sodium chloride, monosodium glutamate(MSG) and inosine monophosphate (IMP) (Yamaguchi et al., 1988), between subjectsfrom Nigeria, Korea and the US for sucrose, sodium chloride, citric acid and caffeine(Druz and Baldwin, 1982), or between the ratings of aroma intensity and firmness oforange flavoured pectin gels by Japanese and subjects from nine Western nations(Lundgren et al., 1986). However, there appear to be very few comparative studiesinvolving Asian and Western subjects other than those measuring detection/recognitionthresholds. For example, there is only one reported study of the ability of Asian andWestern subjects to discriminate between different intensities of a tastant (Lundgrenet al., 1978). This latter study found no differences between the abilities of subjectsfrom Sweden, Poland, US and Japan to discriminate between different levels of sucrose.Thus, although there is growing evidence to indicate that little difference exists161

Management of patients on long-term opioids (LTOs) with acute or postoperative pain presents a number of problems. Such patients will need higher doses of opioids postoperatively than the general population; they are also more likely to need surgery. Managing the challenge of acute pain control in this group requires being able to identify which patients are at risk, and understanding the physiological basis for the problems that may arise from LTO dependence.

Scholars and practitioners working with protracted conflicts in polarized communities have long recognized the complex dynamics between intragroup disputes and intergroup relations in these settings. In fact, the multitude of factors interacting within and between groups in these conflicts, and their tendency to change over time, largely contributes to their intractable natures. Unfortunately, the ability of scholars to conduct research on such dynamic phenomena has been largely constrained by the atomistic, linear approach of traditional research models and methods. However, recent advances in dynamical systems theory have provided a new set of tools for developing computer simulations that allow us to model the dynamic patterns emerging from complex interactions of multiple variables over time. This paper presents one such model: a dynamical model of protracted intergroup conflict. Using data collected from Israeli and Palestinian communities during the current Intifada, we modeled the dynamic relations between conflict escalation and international intervention on intragroup subgroup attitude clustering and patterns of intergroup interactions. Next steps and refinements for the model are discussed.

In a time of health care reform and rapid change, nurse executives need effective leadership skills to be able to respond to a challenging environment, provide quality cost-effective care and promote the professional development of nursing. This research aimed to provide an understanding of nursing executives' roles and professional development needs and obtain concise information for the development of strategies and professional development programs to enhance the effectiveness of the present and future roles of nursing executives. A descriptive cross-sectional postal survey was sent to all public sector Level 4 and 5 nursing executives in Queensland (n = 281), with a response rate of 52.3% (n = 147). Financial management, human resource management and information technologies were identified as the areas where professional development was most needed. Structured educational activities such as short courses or seminars covering information technology, financial and budget management and general business management were identified as the type of activities best suited to nurse executives' needs. The most frequently reported barriers to professional development were difficulties obtaining relief staff, inadequate time, financial cost and inadequate district manager and regional support to enable access to professional development programs.

During the past decade, economic and political forces have caused radical transformations in health caresystems resulting in changed circumstances within which nursing executives must function. This paper providesan understanding of nursing executives' roles and responsibilities and the impact changes in the health industryhave had on their careers.One hundred and forty-seven (52%) of the 281 nursing executives employed in the Queensland Public HealthSector completed a postal self-administered survey. The findings of this study demonstrate their role hasexpanded to include not only nursing administration, but also responsibility for financial, human resources,strategic and resource management, staff development and quality improvement. The impact of these rolechanges has affected the health and well-being of nursing executives, with nearly half reporting increased stress,frustration and irritation. Their workload has increased and some reported deterioration in their health,specifically, exhaustion, fatigue and insomnia. Respondents reported they now have less time to spend withfamilies and friends, which has had a negative impact on family relationships. Overall, nursing executives weresatisfied with their current position, the work itself and their relationships with their co-workers, but dissatisfiedwith organisational aspects, especially the quality of mentorship and opportunities for promotion.