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Machines have achieved a broad and growing set of linguistic competencies, thanks to recent progress in Natural Language Processing (NLP). Psychologists have shown increasing interest in such models, comparing their output to psychological judgments such as similarity, association, priming, and comprehension, raising the question of whether the models could serve as psychological theories. In this article, we compare how humans and machines represent the meaning of words. We argue that contemporary NLP systems are fairly successful models of human word similarity, but they fall short in many other respects. Current models are too strongly linked to the text-based patterns in large corpora, and too weakly linked to the desires, goals, and beliefs that people express through words. Word meanings must also be grounded in perception and action and be capable of flexible combinations in ways that current systems are not. We discuss more promising approaches to grounding NLP systems and argue that they will be more successful with a more human-like, conceptual basis for word meaning., Comment: In press at Psychological Review

ObjectiveTo determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury.MethodsAdult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score.ResultsThere were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001).ConclusionIn PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.

BACKGROUND: Peer-facilitated interventions have been successfully used in chronic disease management. Less is known about their application in vocational rehabilitation. OBJECTIVE: To pilot-test an online peer discussion forum to improve exploration of employment options in job-seekers with long-term multiple sclerosis (MS). METHODS: Twenty-nine persons with relapsing/progressive MS (4–27 years since diagnosis) were recruited online and randomly assigned to an 8-week discussion forum led by peers and a moderator, MS JobSeek (n = 14), or an active control group (n = 15). Forum engagement and user satisfaction were examined, as were pre-post self-evaluations of job search behaviour, efficacy, and quality of life. RESULTS: A high (43%) attrition rate was noted, although intervention completers acknowledged and valued online mentors’ guidance and expertise. Group and time effects were not significant (p

BackgroundPelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. There is mixed evidence supporting early endoscopic urethral realignment (EUR) over suprapubic tube (SPT) placement and delayed urethroplasty. Some studies show decreased urethral obstruction with EUR, while others show few differences. We hypothesized that EUR would reduce the rate of urethral obstruction after PFUI.MethodsTwenty-six US medical centers contributed patients following either an EUR or SPT protocol from 2015 to 2020. If retrograde cystoscopic catheter placement failed, patients were included and underwent either EUR or SPT placement based on their institution's assigned treatment arm. Endoscopic urethral realignment involved simultaneous antegrade/retrograde cystoscopy to place a catheter across the urethral injury. The primary endpoint was development of urethral obstruction. Fisher's exact test was used to analyze the relationship between PFUI management and development of urethral obstruction.ResultsThere were 106 patients with PFUI; 69 (65%) had complete urethral disruption and failure of catheter placement with retrograde cystoscopy. Of the 69 patients, there were 37 (54%) and 32 (46%) in the EUR and SPT arms, respectively. Mean age was 37.0 years (SD, 16.3 years) years, and mean follow-up was 463 days (SD, 280 days) from injury. In the EUR arm, 36 patients (97%) developed urethral obstruction compared with 30 patients (94%) in the SPT arm ( p = 0.471). Urethroplasty was performed in 31 (87%) and 29 patients (91%) in the EUR and SPT arms, respectively ( p = 0.784).ConclusionIn this prospective multi-institutional study of PFUI, EUR was not associated with a lower rate of urethral obstruction or need for urethroplasty when compared with SPT placement. Given the potential risk of EUR worsening injuries, clinicians should consider SPT placement as initial treatment for PFUI when simple retrograde cystoscopy is not successful in placement of a urethral catheter.Level of evidenceTherapeutic/Care Management; Level III.

This paper reports the results from a qualitative study aimed at identifying the factors influencing the rehabilitation experience of people living with an amputation in a rural setting. Following the conduct of an initial focus group, 24 rural-based individuals responded to an invitation to participate in the study's in-depth interviews. Fourteen of those interviewed lived in a ‘regional’ setting (the regional group) and the other ten lived in more remote locations (the ‘distant’ group). Consistent with this population's demography, the sample was comprised mainly of older people (mean age of 66.8 years) who had suffered their amputation as a result of vascular disease. While the groups differed with respect to two aspects of their rehabilitation experience (with the distant group reporting more problems with accommodation and access to health services), many common themes emerged from the interviews, including an overall positive acceptance of the surgical intervention, the call for increased post-operative counselling services, and an endorsement of the usefulness of peer-support (and more generally of social support) services. Results are discussed in terms of their implications for service delivery and endorsement is made of the suggestion that rural health planning be more community-focussed.

Introduction Early intervention is among the factors frequently associated with more positive vocational rehabilitation outcomes; however, vocational rehabilitation is not generally a core component of inpatient rehabilitation following spinal cord injury. Objective This qualitative study explored the opinions and perceptions of health professionals regarding InVoc, an early vocational rehabilitation intervention provided to spinal cord injury unit inpatients. The aim of this evaluation was to determine the critical elements of the InVoc programme, and whether it was perceived as successfully implemented in the hospital setting. Methods Twenty-five medical and allied health staff working in the 3 Spinal Cord Injury Units in New South Wales, Australia, participated in the qualitative study. Three staff focus-group discussions were conducted and data analysed thematically. Results Four themes emerged: timeliness of the intervention, support and advocacy, value of early intervention, and conflicting messages to patients. Three critical programme elements were identified: flexibility, coordinators working on the ward, and good communication between all staff. Conclusion Early vocational rehabilitation was perceived as appropriate and successfully implemented in the spinal injury unit in-patient setting, addressing an existing gap in patient care. The InVoc programme was seen to assist patients identify the possibility of returning to work and/or education. The importance of programme flexibility was highlighted.

Objective To evaluate if decreasing postop abx prophylaxis affects UTI and wound infection rates in patients following urethroplasty. Methods A retrospective review of patients who underwent urethroplasty from 9/2017 - 3/2020 by a single surgeon was performed. All patients received urine culture specific perioperative IV abx prior to urethroplasty and kept a urethral catheter for 3 weeks postop. Patients undergoing a urethroplasty from 9/2017 to 12/2018 received extended postop abx prophylaxis for 3 weeks until catheter removal (Group 1). Patients from 12/2018 to 3/2020 received abx for 3 days around catheter removal (Group 2). UTIs, abx complications, and wound infections between groups were evaluated. UTIs were defined as a positive urine culture or reported lower urinary tract symptoms/fevers treated with empiric abx. Results 120 patients underwent urethroplasty. Group 1 consisted of 60 patients with mean age of 51.9 years and mean stricture length of 3.6 cm. Group 2 had 60 patients with mean age of 53.1 years and mean stricture length of 3.8 cm. 10 patients had UTIs after urethroplasty. There was no significant difference in UTI (6.7% vs 11.7%; P = 0.529) or wound infection rates (3.3% vs 1.7%;’ P = 1.000) between the two groups. Conclusion Extended postoperative antibiotic prophylaxis does not appear to significantly affect UTI or wound infection rates following urethroplasty. The retrospective nature of the study has limitations, however, this is the first comparison of two different antibiotic administration protocols to our knowledge.

Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. There is mixed evidence supporting early endoscopic urethral realignment (EUR) over suprapubic tube (SPT) placement and delayed urethroplasty. Some studies show decreased urethral obstruction with EUR, while others show few differences. We hypothesized that EUR would reduce the rate of urethral obstruction after PFUI.Twenty-six US medical centers contributed patients following either an EUR or SPT protocol from 2015-2020. If retrograde cystoscopic catheter placement failed, patients were included and underwent either EUR or SPT placement based on their institution's assigned treatment arm. EUR involved simultaneous antegrade/retrograde cystoscopy to place a catheter across the urethral injury. The primary endpoint was development of urethral obstruction. Fisher's exact test was used to analyze the relationship between PFUI management and development of urethral obstruction.There were 106 patients with PFUI; 69(65%) had complete urethral disruption and failure of catheter placement with retrograde cystoscopy. Of the 69 patients, there were 37(54%) and 32(46%) in the EUR and SPT arms, respectively. Mean age was 37.0 (SD = 16.3) years and mean follow-up was 463(SD = 280) days from injury. In the EUR arm, 36(97%) patients developed urethral obstruction compared to 30(94%) patients in the SPT arm (p = 0.471). Urethroplasty was performed in 31(87%) and 29(91%) patients in the EUR and SPT arms, respectively (p = 0.784).In this prospective multi-institutional study of PFUI, EUR was not associated with a lower rate of urethral obstruction or need for urethroplasty when compared to SPT placement. Given the potential risk of EUR worsening injuries, clinicians should consider SPT placement as initial treatment for PFUI when simple retrograde cystoscopy is not successful in placement of a urethral catheter.Level II, This is a Care Management Study.

CONTEXT/OBJECTIVE: Prolonged unemployment is common for people living with a spinal cord injury or disorder (SCI/D) and can impact negatively on quality of life. The present study examines stakeholder perspectives and experiences with the job search process in order to identify service gaps and return-to-work solutions. DESIGN: In-depth semi-structured interviews were thematically analysed, with questions focused on factors that can help or hinder efforts to gain employment. Generated themes were then applied to the Person-Environment-Occupation (PEO) systems model of participation. SETTING: Community-based disability service provider in South Australia. PARTICIPANTS: Purposive sample of persons with SCI/D (n = 8) and rehabilitation professionals (n = 4). RESULTS: Person-centred themes were strongly endorsed by both groups and focused on incentives of, and motivation for, employment. Equally important to the job search process were individual expectations and attitudes, particularly job readiness. Environmental facilitators included employers’ positive attitude, although workplace discrimination remained a concern. Occupation-based barriers, rather than opportunities, were identified – namely, difficulties in SCI/D self-management, the need for timely functional assessments, and more opportunities for education, upskilling and retraining. CONCLUSIONS: The PEO model provides a broad framework to better understand the complex return-to-work process for people with a SCI/D and, potentially, uncover tangible solutions. The suggestion is that vocational rehabilitation should go beyond skills training and include motivational support to enhance job readiness. This must be done on a case-by-case basis. There is also a need for active and covert discrimination to be addressed through employment policies. The findings will be used to develop intervention targets for a newly established vocational rehabilitation service.

A novel inpatient vocational counseling service (named “In-Voc”) was developed and evaluated in three Australian spinal cord injury (SCI) rehabilitation hospitals, aiming to improve vocational outcomes after SCI. The program provided a trained Vocational Counseling Coordinator who worked alongside the allied health team, medical, and nursing staff at each hospital. The Coordinators were interviewed to examine the role expectations and role behaviors associated with the introduction of their novel, vocationally focused, occupational role. The Coordinators’ descriptions of their role behavior were very similar to those defined by rehabilitation counselors in North America. They reported the novel role to be a productive and satisfying one. Encouragingly, the In-Voc program was associated with significantly higher post-injury employment outcomes.

Anecdotally, there are frequent reports that peer-facilitated initiatives can be successfully used in employment services. However, in Australia, there is little information about how to effectively deliver peer support. In this paper, we discuss how peer-based interventions might be used to supplement formal return-to-work services and contribute to positive job-seeking outcomes. We illustrate the potential of vocational peer support using a real situation involving a young adult who successfully returned to work soon after sustaining a traumatic injury. Future research should explore the inclusion of various peer support structures and formats as a component of other employment services, to help people with long-term conditions and disabilities achieve a range of vocational outcomes and to guide practice in this area.

BACKGROUND: As the field of retinal prostheses advances, volunteers are required for device trials, and optimal participant recruitment is vital for intervention success. The aims of this study were: (i) to select tests that assess the psychosocial aspects of visual impairment and develop a psychosocial assessment protocol for persons who may be eligible for participation in retinal prostheses trials; (ii) to investigate correlations between these tests; and (iii) to determine associations between psychosocial factors and a person's interest in participating in a retinal prosthesis (bionic eye) trial. METHODS: Cross-sectional study of 72 adults with advanced retinal degeneration. Questionnaire assessments included personality, cognitive ability, social-support, self-efficacy, coping, optimism, depression, and quality of life (Impact of Vision Impairment Profile ([IVI], and Vision and Quality of Life Index [VisQoL]). Level of interest in a retinal prosthesis was also evaluated. RESULTS: All questionnaires were completed without floor or ceiling effects and with minimal respondent burden. Depression correlated with decreased quality of life (rho = -0.37 and 0.40, p < 0.001 for IVI and VisQoL, respectively). Together, depression, gender and vision-specific coping explained 35.2 per cent of variance in IVI quality of life (p < 0.001). Forty-nine per cent of participants were interested in a retinal prosthesis now and 77 per cent in the future. Although the personality trait of 'openness' was somewhat predictive of interest in retinal prostheses (odds ratio 0.78, 95% CI 0.62-0.97), neither severity of vision impairment nor any of the psychosocial measures were strong predictors. CONCLUSIONS: Several existing psychosocial questionnaires can be used for patients with advanced retinal degeneration and may be useful in exploring suitability for a retinal prosthesis or evaluating outcomes. However, the questionnaires used in this study were not good predictors of whether or not a person might be interested in a retinal prosthesis.

Two experiments investigated whether listeners mandatorily apply the Gricean maxim of quantity. In conversation, it is infelicitous to use a label that does not distinguish the referent (“the car” when there are two cars) or to use an unnecessarily specific label (“the convertible” when only one car is present). Subjects verified labels that picked out one of two objects, which was visually cued. Labels were at the basic or subordinate level, and the objects were related (two cars) or not (car and boat). Presuppositions were manipulated by varying determiners (“the/a car”). Responses were slower and less accurate when the basic-level name was used in the context of two related objects, suggesting that listeners prefer more distinguishable names even when the referent is unambiguous. Overly specific names did not incur a cost. Manipulating determiners had little effect. These results argue against a general use of Gricean maxims or presuppositions when identifying referents.

This paper utilises the national Survey of Disability Ageing and Carers to summarise the educational disadvantages and vocational inequalities for those with disabilities in Australia. Amongst pers...

Web-based physician ratings are increasingly popular but imperfect proxies for clinical competence. Yet they provide valuable information to patients and providers when taken in proper context. Providers need to embrace the reviews and use them to enact positive change in order to improve the quality of our patients' experience. Patients need to realize the limitations of online ratings, particularly with smaller sample size and be discerning about the reasons behind the review.

Background Antenatal and parenting programmes are a way of supporting and empowering parents. However, not all informational needs are being met, and nor are programmes equipping women with skills and confidence to meet the challenges of parenthood. Aims To explore women's experiences of participating in a group psycho-educational programme across their pregnancy and early postnatal period. Methods A qualitative descriptive design was applied, incorporating thematic analysis to identify themes in the data. Findings The programme demonstrated practical benefits such as dissemination of timely information, continuity of care and professional support. It enabled opportunities for mastering new tasks and increased a woman's social support network. Conclusion Focusing on the entire perinatal period can promote better perinatal health and psychosocial outcomes.

Professional anxiety existed early in the coronavirus disease 2019 (COVID-19) pandemic with challenging infection prevention and control support. The aims of this study were to compare epidemiological features of healthcare workers (HCWs) within primary and secondary care with their serological evidence of infection. A prospective observational cohort of 1,916 HCWs completed a questionnaire, and their sera were assayed for detectable antibody to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein in the first wave of the pandemic. Datasets were compared between the two sub-cohorts in primary and secondary care and between the combined seropositive and seronegative cohorts. Curiosity of antibody status was high. Detectable antibody was 7% in the primary care and 5% in the secondary care workers at a time of 1.7% in the general community. Inappropriate personal protective equipment (PPE) was more common in primary care, and detectable antibody was twice as prevalent in HCWs who felt they did not have appropriate PPE. Contact tracing was perceived to be inadequate although it was more commonly performed in the seropositive cohort suggesting appropriate prioritisation. Both temperature and symptom checking alerts and work exclusion were significantly more prevalent in the seropositive cohort. The seroprevalence data support increased risk for HCWs, the importance of appropriate PPE and the usefulness of the daily temperature and symptom checks, particularly in primary care.

Children’s concepts differ systematically from those of adults, posing a conundrum in how to compare the ‘same’ concepts across ages. It also creates a problem in making psychological generalizations across ages, such as people’s preference for basic-level categories. For example, if children acquire the concept of chair before that of furniture, this seems to be an example of learning a basic-level concept before its superordinate. However, given that children’s concepts are not the same as adults and change throughout childhood, can we in fact draw conclusions about levels of categorization and other properties defined in terms of adult concepts? This chapter addresses levels of categorization as a case study in how to deal with the problem of individual differences in concepts, suggesting a focus on similar psychological principles and constraints rather than on conceptual content.

To evaluate flexible pediatric cystoscopy (FPC) as an adjunctive procedure to retrograde urethrography (RUG) and voiding cystourethrography (VCUG) in the preoperative setting for male urethral strictures. Since imaging interpretation of stricture length and caliber can be difficult at times, we sought to evaluate diagnostic utility of FPC to predict reconstructive surgery.Reconstructive urology databases at Washington University and Columbia University were queried from 2010-2017. A total of 185 anterior urethroplasty patients met inclusion criteria. All surgeries were performed by a single surgeon. There were 102 patients that underwent preoperative FPC (7.5 Fr in diameter). Surgical urethroplasty techniques employed were: ventral or dorsal onlay buccal mucosa graft, fasciocutaneous penile skin flap, excision and primary anastomosis or augmented anastomotic. We analyzed the RUG, VCUG, FPC, and intraoperative details of the urethral strictures by univariate and multivariate statistics.Mean patient age was 47.2 (+/-16.5) years. Of the patients who underwent FPC, 42.2% were narrower than the FPC, and 57.8% were wider. Intraoperative stricture length better correlated with FPC findings compared to RUG/ VCUG (r = 0.834 versus r = 0.766) (p0.001). Moreover, inability to pass the FPC through the stricture correlated with the need to perform urethral stricture excision or complete reconstruction of the urethral plate (p = 0.005), rather than onlay urethroplasty.Preoperative FPC is a useful adjunctive tool in the evaluation of urethral strictures. FPC facilitates stricture assessment by accurately correlating with intraoperative stricture length and predicting the need to excise or graft during reconstruction.

Background/Aims: Early intervention is among the factors frequently associated with positive vocational rehabilitation outcomes. However, vocational rehabilitation is not generally a core component of inpatient rehabilitation for individuals with spinal cord injury, who traditionally have poor vocational outcomes. This study explored the perceptions of vocational coordinators providing early and integrated vocational rehabilitation services in the inpatient hospital settings and their opinions regarding the structures and processes of the interventions. Methods: All the four vocational coordinators involved in providing early integrated vocational services at the three spinal units in New South Wales, Australia were interviewed (in-depth) as key informants using a semi-structured approach. Transcripts of the interviews were created via audio recordings, transcribed verbatim, and the contents were analysed thematically. Findings: Many benefits were seen for vocational coordinators working within a multidisciplinary team in the hospital settings chiefly providing and promoting vocationally oriented therapy. Timing of service provision was not the overarching issue given the optional and voluntary nature of the intervention. The counselling role was seen as eminent given the challenging and (occasionally confronting) nature of working with newly injured individuals. Conclusions: The key nature of service provision being patient-centred and paced, within the context of a supportive spinal cord injury rehabilitation team, seemed to engender much hope and optimism, which are salient for newly injured individuals with spinal cord injury in the hospital setting.

A prospective, parallel randomized controlled trial (RCT). To test the preliminary effects of an online resource targeted to job-seekers with spinal cord injury or disorder (SCI/D), and to determine the feasibility of proceeding to a full-scale RCT. A community cohort in Australia. Forty-eight adults (M = 42 years, SD = 10.95, 27 males) were randomized to receive 4-weeks access to the Work and SCI resource (n = 25) or to a wait-list control group (n = 23). The Work and SCI intervention involved six stand-alone learning modules which provided job-searching and career-planning information through text, videos, and interactive activities. Self-report measures were administered at baseline and after 4 weeks: Job Procurement Self-Efficacy Scale (JSES), Life Orientation Test-Revised (LOT-R), and Patient Health Questionnaire-9 (PHQ-9). Online usage data identified high uptake of the Work and SCI resource, although study attrition was problematic. Intention-to-treat analyses failed to reach statistical significance, whereas complete data revealed a significant interaction effect for optimism (LOT-R). Further research to develop and enhance Work and SCI is indicated. Remediable strategies to optimize recruitment and statistical power in a future definitive RCT are discussed. This project was funded by the auDA Foundation (project 16019).

The role of the clinical prosthetist in healthcare has evolved substantially, and it is likely that expectations of the role have changed in recent times. Organisational Role Theory provides a framework for considering the expectations and behaviours of health professionals regarding their functions and roles.The main objective of this study is to explore stakeholder consensus in role expectations of the clinical prosthetist in an Australian healthcare setting.Cross-sectional survey.The Prosthetist Role Expectations Scale was used to measure expectations and views of the roles of clinical prosthetists. The Prosthetist Role Expectations Scale has 72 items that form 11 subscales that describe prosthetist behaviour. It was distributed to six key stakeholder groups which included: prosthetists, prosthetic technicians, physiotherapists, medical rehabilitation specialists, orthotists and clients with limb loss.Of the 1064 surveys distributed, 275 were returned. An additional 35 electronic responses were received, resulting in 299 complete data sets. A high level of consensus across the different stakeholder groups was found for 10 of the 11 subscales. In contrast, there were significant differences between groups for the 'Independent Prescription' subscale (There was broad agreement in expectations from stakeholders regarding the role of prosthetists in interdisciplinary functioning, research and communication related to prosthetic device provision and function. There were more varied expectations regarding prescription decisions, referral practices and clinician-client communication regarding emotional issues.It is important to understand the expectations that stakeholder groups have regarding the clinical prosthetist role in healthcare settings. Such information can guide health professional education and interprofessional practice and may reduce interpersonal and interprofessional conflict.

Global health is an ever-expanding area of interest for many healthcare workers around the world. In recent years, it has become apparent that much of the global disease burden is surgical. Urologic disease is no exception—many international organizations send volunteers around the world to support Urologic services in countries that lack capacity and resources. Urethral stricture represents a unique opportunity for specialized surgical management that vastly improves long term morbidity. Here we review the prevalence, etiology, and management of urethral stricture from a global perspective while highlighting impact of international urologic volunteer efforts.

Background Many Western countries have a strong record of obstetric safety; however, there are disparities in other indicators (such as morbidity) and best-practice outcomes, including breastfeeding rates and perinatal depression. Aims To pilot a multifaceted psycho-educational group programme for first-time parents. Methods This alternate-allocation study compared an intervention programme (n=10) and a comparison group (n=8) who received routine care with the addition of a weekly telephone call. Findings There were distinct differences between groups at follow-up, with the intervention group reporting lower depression scores and exclusive breastfeeding. Trends included positive adjustment to parenthood, perceived parenting competence and increased mother-infant attachment. Conclusion The intervention demonstrated benefits including learning opportunities, skills training and increased social capital.

The role of the prosthetist has changed substantially over the past century. In the transition from 'limb-maker' to 'clinician', the expectations of prosthetics professionals have also changed.To develop and test a new scale capable of assessing and comparing current expectations of the roles of the prosthetist.Scale development and validation.A new scale was constructed in accordance with Organizational Role Theory. It comprised 72 items that subdivide into 11 subscales. Face, content and construct validity, along with test-retest and inter-rater reliability were evaluated.The Prosthetist Role Expectations Scale was found to be psychometrically sound, reliable for use in a range of settings and clinically feasible in a sample of 17 Australian therapists.The Prosthetist Role Expectations Scale demonstrated robust psychometric properties and appears well suited to monitoring current expectations of the role of the prosthetist in health service delivery. Clinical relevance The Prosthetist Role Expectations Scale can identify current expectations of the role of the prosthetist, showing areas of consensus and conflict between key professional and client groups. Wider use of the instrument will contribute to increased understanding of professional roles. This may help to reduce role conflict and improve communication within healthcare teams.

BACKGROUND Vocational potential in people with spinal cord injury (SCI) are unrealised with rates of employment substantially lower than in the labour force participation of the general population and the pre-injury employment rates. OBJECTIVES To understand the experience and pathway of people achieving employment outcome after traumatic spinal cord injury by; classifying participants into employment outcome groups of stable, unstable and without employment; identifying pre and post-injury pathways for participants in each group and, exploring the experiences of people of seeking, gaining and maintaining employment. METHODS Thirty-one participants were interviewed. Mixed methods approach including interpretive phenomenological analysis and vocational pathway mapping of quantitative data. RESULTS The most common pathway identified was from study and work pre-injury to stable employment post-injury. Four super-ordinate themes were identified from the interpretive phenomenological analysis; expectations of work, system impacts, worker identity and social supports. Implications for clinical practice include fostering cultural change, strategies for system navigation, promotion of worker identity and optimal use of social supports. CONCLUSIONS The findings increase insight and understanding of the complex experience of employment after spinal cord injury. There is opportunity to guide experimental research, policy development and education concerning the complexity of the return to work experience and factors that influence pathways.

© 2017 American Congress of Rehabilitation Medicine Objective: To provide a preliminary evaluation of the effectiveness of an online resource for job seekers with multiple sclerosis (MS). Design: Randomized controlled design. Setting: Community-dwelling cohort. Participants: Adults (N = 95) with relapsing-remitting or progressive MS were randomly assigned to one of two groups. Forty-five accessed an email delivered, 7 module resource, Work and MS, over a 4 week period. Waitlist control participants (n=50) were offered the opportunity to access Work and MS 4 weeks postenrollment. Main Outcome Measures: Primary outcomes focused on vocational interests (My Vocational Situation Scale) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire [MSWDQ]), optimism (Life Orientation Test – Revised), and mood (Patient Health Questionnaire-9). Results: Intention-to-treat analyses revealed pre-post gains: participants who accessed Work and MS reported improved confidence in their career goals (My Vocational Situation Scale g=.55; 95% confidence interval [CI],.14–.96; P=.008) and positively reappraised potential workplace difficulties (MSWDQ g range,.42–.47; P range,.023–.042). The effect on job self-efficacy was not significant, but changed in the expected direction (g=.17; 95% CI, –.23 to.57; P=.409). Completer data revealed larger, significant effect estimates (g range,.52–.64; P range,.009–.035). Conclusions: Findings provide preliminary support for the utility of a job information resource, Work and MS, to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of online peer support to increase intervention compliance.

Two decades of research finds that embeddedness consistently predicts employee retention and performance. Although colleges of business are very interested in student retention and performance, the...

Urinary diversion (UD) remains the last option for improving quality of life in patients with treatment-refractory urinary incontinence (UI) or voiding dysfunction after cancer treatment. We aim to critically review the utility of UD for UI and voiding dysfunction in patients previously treated for malignancy. UD patients are at high risk given their oncologic treatment and multiple procedures prior to UD. The severe impact of UI and voiding dysfunction on quality of life is significant. Despite the risk of complications after UD, men reported significant improvement of their urinary symptoms and were confident that they would have sought UD sooner. UD remains a last option for some men dealing with severe urinary symptoms after treatment of pelvic malignancy in both men and women. Further investigation is needed to better characterize the burden of disease and potential gains surrounding management of these men.

The association between employment and psychological health in adults with multiple sclerosis was examined ( N = 33 studies). Standardised mean differences (Hedges’ g) between those employed and those not in the workforce were calculated. Employed peers reported significantly greater quality of life and mood, cited fewer work and multiple sclerosis–related difficulties and were more likely to adopt problem-focused coping strategies, considered to be more effective in managing specific stressors. These data are consistent with the positive by-products of maintaining work with multiple sclerosis. Further research is needed to determine the longitudinal course of coping for those who remain employed.

This study investigated the effectiveness of support groups for people living with chronic ill-health conditions. Searches of the published literature were undertaken for the period 1993–2013. Papers were included if participants were between 18 and 65 years old, and study designs were either pre-test post-test one group descriptive, non-randomised group comparison, or randomised controlled trial, with reported data appropriate for meta-analysis and sufficient for estimating effect size(s). Total 19 studies were eligible in the meta-analysis, and 2,986 participants were examined. Six general outcome categories emerged from the data: (1) psychosocial functioning, (2) self-efficacy, (3) quality of life, (4) health status, (5) health behaviours and (6) health care use. In total, 155 effect sizes were calculated from the outcome measures with 15.5% resulting in a large effect size, 6% moderate effects, 39% small effects, and 39.5% producing trivial effects. The majority of the effect sizes (92%) were in the hypothesised direction. Overall, results demonstrate that self-help and support group interventions can positively influence management of chronic ill-health conditions and contribute to the desired outcome of successful adaptation.

PURPOSE: Guidelines call for routine reimaging of Grade 4–5 renal injuries at 48–72 h. The aim of the current study is to evaluate the clinical utility of computed tomography (CT) reimaging in high-grade renal injuries. MATERIALS AND METHODS: We assembled data on 216 trauma patients with high-grade renal trauma at three level 1 trauma centers over a 19-year span between 1999 and 2017 in retrospectively collected trauma database. Demographic, radiographic, and clinical characteristics of patients were retrospectively reviewed. RESULTS: In total, 151 cases were Grade 4 renal injuries, and 65 were Grade 5 renal injuries. 53.6% (81) Grade 4 and 15.4% (10) Grade 5 renal injuries were initially managed conservatively. Of the 6 asymptomatic cases where repeat imaging resulted in intervention, 100% had collecting system injuries at initial imaging. Collecting system injuries were only present in 42.9% of cases where routine repeat imaging did not trigger surgical intervention. Collecting system injury at the time of initial imaging was a statistically significant predictor of routine repeat imaging triggering surgical intervention (p = 0.022). Trauma grade and the presence of vascular injury were not significant predictors of intervention after repeat imaging in asymptomatic patients. CONCLUSION: In asymptomatic patients with high-grade renal trauma, the number needed to image is approximately one in eight (12.5%) to identify need for surgical intervention. There is potentially room to improve criteria for routine renal imaging in high-grade renal trauma based on the more predictive imaging finding of collecting system injury.

PurposePerineal urethrostomy is a viable option for many complex urethral strictures. However, to our knowledge no comparison with anterior urethroplasty regarding patient reported outcome measures has been published. We compared these groups using a large multi-institution database.Materials and methodsWe performed a retrospective study of anterior urethroplasty in the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database. The anterior urethroplasty cohort was defined by long strictures greater than 6 cm. We compared demographic, clinical, urinary and sexual characteristics using validated patient reported outcome measures between patients treated with long stricture anterior urethroplasty and those who underwent perineal urethrostomy.ResultsOf the 131 patients 92 treated with long stricture anterior urethroplasty and 39 treated with perineal urethrostomy met study inclusion criteria. The cumulative incidence of failure at 2 years was 30.2% (95% CI 18.3-47.3) for long stricture anterior urethroplasty and 14.5% (95% CI 4.8-39.1) for perineal urethrostomy (p = 0.09). Compared to baseline metrics, patients who underwent long stricture anterior urethroplasty and perineal urethrostomy had similar improvements in urinary function and stable sexual function after surgery.ConclusionsPatients reported improvement in urinary function after perineal urethrostomy with no deleterious effect on sexual function. These patient reported outcome measures were comparable to those of long stricture anterior urethroplasty. Perineal urethrostomy failure rates were similar to those of long stricture anterior urethroplasty.

© 2019, © The Academy of Spinal Cord Injury Professionals, Inc. 2019. Objective: To pilot a novel email-based information package (Work and SCI) for job-seekers with an acquired spinal cord injury (SCI) or spinal cord dysfunction (SCI/D). Study design: Prospective, non-randomized, repeated measures trial. Setting: Community dwelling cohort in Australia. Participants: Five people with SCI (mean age 46.4 years, SD = 10.2; 4 female) initially reviewed Work and SCI. Twenty-four with SCI/D subsequently enrolled, of whom 16 (mean age 46.4 years, SD = 11.1; 7 female), completed the intervention. Intervention: Intervention participants accessed Work and SCI over a 4-week period. Outcome measures: Individual changes in pre-post scores for the My Vocational Situation Scale, Job Procurement Self-Efficacy Scale, Patient Health Questionnaire-9 and Life Orientation Test-Revised were examined. Results: Reliable change in pre-post scores across outcomes were reported by 38% (n = 6) of participants. Favorable comments on the Work and SCI resource were provided in addition to suggestions for improvement. Conclusions: Preliminary data suggest that Work and SCI may help to establish vocational interests among job-seekers with a SCI/D, however further work is needed to enhance participant compliance. This might include moderator support to promote and maintain participation. A controlled design will also help to identify factors that influence engagement with the Work and SCI resource.

Category information is used to predict properties of new category members. When categorization is uncertain, people often rely on only one, most likely category to make predictions. Yet studies of perception and action often conclude that people combine multiple sources of information near-optimally. We present a perception-action analog of category-based induction using eye movements as a measure of prediction. The categories were objects of different shapes that moved in various directions. Experiment 1 found that people integrated information across categories in predicting object motion. The results of Experiment 2 suggest that the integration of information found in Experiment 1 were not a result of explicit strategies. Experiment 3 tested the role of explicit categorization, finding that making a categorization judgment, even an uncertain one, stopped people from using multiple categories in our eye-movement task. Experiment 4 found that induction was indeed based on category-level predictions rather than associations between object properties and directions. (PsycINFO Database Record

Background: A pilot early-intervention vocational rehabilitation program was conducted in Sydney, Australia, over a 2-year period. It was postulated that the early provision of integrated vocational rehabilitation services in the hospital settings for newly injured individuals would be well received and result in better employment and psychosocial health outcomes. Objective: The objective of this qualitative inquiry was to examine the perspectives of program participants who had completed the intervention about the timeliness, perceived value, and critical elements of the early intervention. Methods: A convenience sample of participants was selected by accessibility; participants were interviewed individually after discharge using a semi-structured approach. Transcripts of the interviews were created via audio recordings; interviews were transcribed verbatim, and the contents were analyzed thematically. Results: Thirteen participants aged from 19 to 60 years with varying levels of impairment and vocational backgrounds were interviewed from 7 to 21 months post injury. Overall, the early introduction of vocational rehabilitation services was well received and viewed positively. Emerging themes include sense of direction and distraction, advocacy, and support, with “hope” (early after injury) emerging as the overarching theme. Criticisms voiced about the program were that it was offered too early in the intensive care unit and there were competing interests and information overload in the early recovery phase. Conclusions: Vocational rehabilitation provided during inpatient rehabilitation appears appropriate, important, and valuable from patients' perspective. Early engagement results in feelings of hope and encourages patients to see the possibility of returning to work or education very early after injury, and it allows rehabilitation to be directed accordingly.