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Past studies by the authors have demonstrated the feasibility of utilizing municipal solid waste (MSW) incineration bottom ash (IBA) as an aerating agent to produce autoclaved aerated concrete (AAC). However, the gas generation potential of as-received IBA (General IBA) is significantly poorer than conventional aerating agents such as pure aluminum powder. The classification of IBA showed that coarse non-ferrous IBA fraction with particle size greater than 1.18 mm (CNF-IBA) contains a higher concentration of metallic aluminum. This study proposes specifically utilizing CNF- IBA fraction as an aerating agent to produce AAC. Two other AACs with pure Al powder and General IBA as aerating agents were investigated for systematic comparison. The aeration kinetics, fresh, and hardened properties were experimentally investigated. A novel approach is presented to study the influence of coordination between aeration extent and yield stress development on volume expansion capacity. The developed AAC with CNF-IBA exhibited the highest specific compressive strength. The leaching analysis showed that the usage of IBA as an aerating agent in AAC production is safe during the service life of AAC, and its demolished samples at the end of service time can be landfilled as inert material. National Environmental Agency (NEA) National Research Foundation (NRF) The authors would like to acknowledge financial support from the Environment Technology Research Program (ETRP), National Environment Agency (NEA), Singapore (ETRP 1301 104), and from the SinBerBEST program, National Research Foundation (NRF), Singapore.

PurposeThe authors examine psychologically informed coaching approaches for evidence-based work-applied management through a meta-analysis. This analysis synthesized previous empirical coaching research evidence on cognitive behavioral and positive psychology frameworks regarding a range of workplace outcomes, including learning, performance and psychological well-being.Design/methodology/approachThe authors undertook a systematic literature search to identify primary studies (k = 20, n = 957), then conducted a meta-analysis with robust variance estimates (RVEs) to test the overall effect size and the effects of each moderator.FindingsThe results confirm that psychologically informed coaching approaches facilitated effective work-related outcomes, particularly on goal attainment (g = 1.29) and self-efficacy (g = 0.59). Besides, these identified coaching frameworks generated a greater impact on objective work performance rated by others (e.g. 360 feedback) than on coachees' self-reported performance. Moreover, a cognitive behavioral-oriented coaching process stimulated individuals' internal self-regulation and awareness to promote work satisfaction and facilitated sustainable changes. Yet, there was no statistically significant difference between popular and commonly used coaching approaches. Instead, an integrative coaching approach that combines different frameworks facilitated better outcomes (g = 0.71), including coachees' psychological well-being.Practical implicationsEffective coaching activities should integrate cognitive coping (e.g. combining cognitive behavioral and solution-focused technique), positive individual traits (i.e. strength-based approach) and contextual factors for an integrative approach to address the full range of coachees' values, motivators and organizational resources for yielding positive outcomes.Originality/valueBuilding on previous meta-analyses and reviews of coaching, this synthesis offers a new insight into effective mechanisms to facilitate desired coaching results. Frameworks grounded in psychotherapy and positive appear most prominent in the literature, yet an integrative approach appears most effective.

Laparoscopic surgery for rectal cancer is technically challenging. Robotic and transanal TME (TaTME) are both novel approaches developed to provide better visualization and dissection. We aim to combine both approaches in a hybrid procedure and evaluate the feasibility as well as patient and oncological outcomes in this study. A review of a prospectively maintained database of patients who underwent a hybrid abdominal robotic approach with TaTME for rectal cancer between January 2016 and October 2018 was undertaken. Patient demographics, tumor characteristics and surgical outcomes were recorded and analyzed. A total of 69 patients (43 males, 26 females) received this hybrid approach. Their median age was 58 years (range 35–87) with a mean BMI of 24.3 kg/m2 (range 16.4–44.2). Median distance from anal verge was 5 cm (range 2–9). The patients had a median hospital length of stay of 7 days (range 5–28). Complication rate was 17.4% (12 patients) with 3 patients (4.3%) requiring a reoperation. TME quality was optimal with all of them either complete (81.2%) or almost complete (18.8%). 65 patients (94.2%) had an R0 resection with 4 patients (5.8%) with involved circumferential resection margins (≤ 1 mm). The median number of lymph nodes harvested was 20 (range 6–37). After a median follow-up of 27.7 months (range 7–42), local recurrence was identified in 2 patients (4%). Three patients (5.2%) had distant recurrence at the 3-year mark. Hybrid robotic abdominal dissection with transanal TME for rectal cancer appears to be feasible with comparable surgical outcomes to other traditional approaches.

PurposeThis study aims to investigate resistance to change and change management through a micro-level interpersonal perspective. Specifically, this paper addresses in what way external change experts, such as coaches, identify distinctive emotional and behavioural indicators of resistance and facilitate individuals to develop positive strengths and motivation to change.Design/methodology/approachThe authors drew upon critical realism and abductive research methodology to understand connections between coaching intervention and individual change resistance through 21 in-depth interviews with independent coaches listed in coaching associations in Germany.FindingsThis study first re-evaluates the implications of resistance and extends its meaning from negative obstacles into natural emotional responses of individuals and constructive resources for change. In addition, the study results indicate resistance can be distinguished through both explicit behaviours, body language along with implicit emotional reactions, like being tired or making small jokes. Moreover, several micro-level interpersonal approaches for coaches to apply in dealing with resistance, including understanding coachees' cognitive status and working environment, adapting varied communication styles as well as drawing upon coachees' strengths.Practical implicationsThe research results offer organisations (e.g. managers and human resource professionals) essential guidelines in micro-level change management strategy by considering external coaching as a valuable option to deal with varied individual, social and contextual factors (e.g. organisational power and politics). From the organisational investment perspective, indicators of resistance and approaches to facilitate coachees' emotional reactions can be served as a preliminary protocol for stakeholders to evaluate the effectiveness of their change management schemes. Moreover, the framework outlined in this research can be considered in the future coaching education and professional development programmes.Originality/valueOverall, this study demonstrates that external coaching is one of the valuable approaches in responding to individual resistance in organisational change management. The research findings widen existing bipolar paradigms of resistance (either change obstacles or positive resource) into a neutral spectrum that holds an impartial view on emotional reactions to change. Furthermore, individual differences and contextual factors play essential roles in the change process, e.g. coachees' personality, personal experiences, knowledge, interpretations to change process and topics as well as organisational context (e.g. power, hierarchy and culture) need to be considered into change management strategy.

Technique Awake tracheostomy for devastating airway obstruction have applied this simple, safe, efficient and low-cost procedure as a management strategy for malignant or benign tracheal obstruction that would frequently require Extracorporeal Membrane Oxygenation (ECMO) for circulatory support in other centers. Results We present a 52-year-old male with a rapidly growing neck mass, complicated by worsening orthopnea over the span of one week. A computed tomography (CT) scan revealed a huge, irregular neck mass extending from the upper mediastinum, causing severe airway compression. The patient initially had gone through an awake tracheostomy to secure tracheal obstruction, followed by a T-tube insertion under general anesthesia for both stabilization of the airway and voice preservation. Patent lumen after T-tube insertion allowed for a smooth procedure including a Magnetic Resonance Imaging (MRI) of the thorax and a Positron Emission Tomography with Computed Tomography (PET-CT) scan. An upper G-I endoscopy with a biopsy confirmed an esophageal tumor over 27–30 cm from the incisor. Following the diagnosis of squamous cell carcinoma of the esophagus with critical tracheal invasion, chemoradiotherapy was then given for definite treatment. We implemented this simple method in order to secure the devastated airway, sparing the need for a demanding rigid bronchoscopy, or use of a costly ECMO expedient. Conclusions We implemented this simple method in order to secure the devastated airway, sparing the need for a demanding rigid bronchoscopy, or use of a costly ECMO expedient.

Background Ceftazidime-avibactam has in vitro activity against some carbapenem-resistant gram-negative infections (GNIs), and therefore may be a useful alternative to more toxic antibiotics such as colistin. Understanding ceftazidime-avibactam uptake and usage patterns would inform hospital formularies, stewardship, and antibiotic development. Methods A retrospective cohort study assessed inpatient encounters in the Vizient database. Ceftazidime-avibactam and colistin administrations were categorized into presumed empiric (3 consecutive days of therapy or less with qualifying exclusions) versus targeted therapy (≥4 consecutive days of therapy) for presumed carbapenem-resistant GNIs. Quarterly percentage change (QPC) using modified Poisson regression and relative change in frequency of targeted ceftazidime-avibactam to colistin encounters was calculated. Factors associated with preferentially receiving targeted ceftazidime-avibactam versus colistin were identified using generalized estimating equations. Results Between 2015 quarter (q) 1 and 2017q4, ceftazidime-avibactam was administered 21 215 times across 1901 encounters. Inpatient prescriptions for ceftazidime-avibactam increased from 0.44/10 000 hospitalizations in 2015q1 to 7.7/10 000 in 2017q4 (QPC, +11%; 95% CI, 10–13%; P < .01), while conversely colistin prescriptions decreased quarterly by 5% (95% CI, 4–6%; P < .01). Ceftazidime-avibactam therapy was categorized as empiric 25% of the time, targeted 65% of the time, and indeterminate 10% of the time. Patients with chronic kidney disease were twice as likely to receive targeted ceftazidime-avibactam versus colistin (RR, 2.02; 95% CI, 1.82–2.25), whereas those on dialysis were less likely to receive ceftazidime-avibactam than colistin (RR, 0.71; 95% CI, .61–.83). Conclusions Since approval in 2015, ceftazidime-avibactam use has grown for presumed carbapenem-resistant GNIs, while colistin has correspondingly declined. Renal function drove the choice between ceftazidime-avibactam and colistin as targeted therapy.

Background: The Taiwanese government implemented a stay-at-home order that restricted all community-based health promotion activities for the elderly by shutting down all community care centers from May 2021 to August 2021 to control the spread of COVID-19. Community-based dementia care centers were barely able to provide dementia care services during that period. Methods: The data used in this study were collected from a community-based dementia care center that was able to continue their dementia care services through a Tele-Health intervention program. The difference-in-differences methodology was applied to evaluate the effects of the Tele-Health intervention program on home-dwelling persons with dementia or mild cognitive impairment and on their primary caregivers during the COVID-19 pandemic. Results: The Tele-Health intervention program significantly increased the well-being of the participants and their primary caregivers, but the negative correlations between the Tele-Health intervention program and family functioning were also found to be significant. Conclusions: The significant substitution (negative) effects between the Tele-Health intervention program and family functioning raises the concern that promotion of the Tele-Health intervention program comes at the potential cost of a loss of family functioning. Policymakers should be cautious when considering the Tele-Health intervention program in response to pandemics and demographic transitions.

Background Trimethoprim-sulfamethoxazole (TMP-SMX) is considered first-line therapy for Stenotrophomonas maltophilia infections based on observational data from small studies. Levofloxacin has emerged as a popular alternative due to tolerability concerns related to TMP-SMX. Data comparing levofloxacin to TMP-SMX as targeted therapy are lacking. Methods Adult inpatient encounters January 2005 through December 2017 with growth of S maltophilia in blood and/or lower respiratory cultures were identified in the Cerner Healthfacts database. Patients included received targeted therapy with either levofloxacin or TMP-SMX. Overlap weighting was used followed by downstream weighted regression. The primary outcome was adjusted odds ratio (aOR) for in-hospital mortality or discharge to hospice. The secondary outcome was number of days from index S maltophilia culture to hospital discharge. Results Among 1581 patients with S maltophilia infections, levofloxacin (n = 823) displayed statistically similar mortality risk (aOR, 0.76 [95% confidence interval {CI}, .58–1.01]; P = .06) compared to TMP-SMX (n = 758). Levofloxacin (vs TMP-SMX) use was associated with a lower aOR of death in patients with lower respiratory tract infection (n = 1452) (aOR, 0.73 [95% CI, .54–.98]; P = .03) and if initiated empirically (n = 89) (aOR, 0.16 [95% CI, .03–.95]; P = .04). The levofloxacin cohort had fewer hospital days between index culture collection and discharge (weighted median [interquartile range], 7 [4–13] vs 9 [6–16] days; P, Our findings suggest that mortality outcomes are similar comparing levofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) treatment of Stenotrophomonas maltophilialower respiratory tract and bloodstream infections. Until trial data are available, levofloxacin appears to be a reasonable alternative to TMP-SMX for these infections.

Summary Technique Uncovered metallic stents have the potential to cause granulation tissue ingrowth, leading to re-occlusion and difficult or impossible retrievability. This can cause severe dyspnea or even life threatening respiratory distress. Critical tracheal stenosis which manifests itself into stridor and wheezing, while also exhibiting aggravated symptoms of orthopnea, will indicate that there is near total airway obstruction. Here, we present an awaked tracheostomy aid to initially treat the patient while under spontaneous ventilation to secure the airway readily. Results A 45-year-old female with tracheal stenosis due to tracheal trauma, underwent a tracheostomy followed by T-tube treatment. A recurrence of tracheal stenosis was noted two years later after decannulation, so the patient was employed an uncovered ultraflex stent for cosmetic reasons. Severe stenosis with orthopnea, due to fulminating granulomatosis with a variously cobble-stone shaped adherence over the proximal stent, was detected six months later. An awaked tracheostomy performed under local anesthesia following a laser ablation and removal of the stent while under general anesthesia, before an adequated T-tube stent was alternatively inserted. Conclusions The patient had maintained a hallmark of breathing ability and sound sleep after the operation, which was observed during a one-year follow-up examination.

Background The condition of mediastinal chondrosarcoma causing severe airway compression has never been reported before, and its complexity makes its surgical management challenging. We implemented two new techniques to overcome this problem. Creative mockup analogy of a distorted trachea and tumor lesion using a 3-D printing module, with reprogramming by computed tomography, streamlined the panorama with intricate correlation. Case presentation Our patient was a previously healthy 52-year-old slender yellow man who had no obvious medical history. In the last 3 years, upper respiratory tract infection and productive cough were noted frequently, and the patient’s symptoms were aggravated with shortness of breath when his head was positioned below 90 degrees during squatting and hunching of the body. The patient manifested prone sleep with ashen complexion, and he had lost 3–4 kg of body weight over the 3 weeks before admission to our hospital. Virtual bronchoscopy with computed tomography revealed an 8.3 × 7.5 × 4-cm lobulated right upper mediastinal mass with amorphous calcification and severe, intricate airway compression. A creative mockup analogy module of the distorted trachea and tumor was generated by 3-D printing and reprogrammed by computed tomography to streamline the sophisticated correlation. The patient underwent a two-stage operation comprising stabilization of the airway for innovative T-tube insertion preceded by thoracoscopy-assisted radical removal of the tumor. Postoperative adjuvant radiotherapy was administered. The patient recovered uneventfully and stayed healthy for 2 solid years in follow-up. Conclusions An advanced 3-D printing model provides affirmative information related to treatment strategy and is also a prospective tool for better doctor–patient communication regarding the disease.

This chapter aims to introduce and summarise key research topics and areas underpinning the development of coaching psychology. With the steady increase in the application of psychological theories, models, and techniques in coaching practice, coaching scholars and organisational stakeholders have examined evidence to see if psychologically-informed approaches have positive effects on coaching outcomes. To provide a comprehensive profile of coaching psychology research and future research trends, this chapter focuses on four major contemporary coaching psychology research themes (between 1995 and 2018): effectiveness of psychological coaching approaches, the role coaching relationship plays in the coaching process, the application of psychometrics in coaching and coach training, and development-related issues (e.g., training programme design, ethics, and coaching supervision). Both the evolution of each research theme and summaries of research results are discussed in this chapter. This chapter offers a range of learning aims by outlining: the overview of contemporary coaching psychology research; the effectiveness of psychological coaching approaches; the association of coaching relationship and coaching outcomes; directions and suggestions for future coaching psychology research; and the application of these research results.

The increasing move to remote work has raised new questions in the field of workplace wellbeing and engagement with the individual’s emotional health and the quality of working relationships as essential concerns. In particular, loneliness, as a specific form of low-quality connections at work, has also become a key area of concern and research, given it is a discreet disrupter to wellbeing and engagement, not just to the individual but across the broader workplace. Hence there is a pressing need for workplaces and in particular coaches to assist their coachees to create high quality connections at work. Relationships are at the heart of the human experience, with Self-Determination theory having identified “relatedness” as one of three core psychological needs. A fundamental ingredient to fostering quality relationships are emotions, yet within the workplace, emotions have historically been avoided and viewed as the remit of therapists rather than coaches. Hence, specific knowledge and skill development has been lacking in coach training and practice. This chapter explores how the coaching relationship can facilitate the creation of positive relationships, work with emotions and loneliness (as a socio-emotional construct) in the workplace with coaching examples and a case study to illustrate coaching in practice.

Background: There remains a scarcity of both autografts and allografts for tracheal transplantation after long-segmental resection. Subsequently, tissue engineering has become a promising alternative for tracheal transplantation, which requires successful in vitro chondrogenesis. Methods: To optimize the protocol for in situ chondrogenesis using the pig-derived whole Umbilical Cord (UC) as the starting material, it must be performed without using the UC-multipotent stromal cell (MSCs) isolation procedure. Nevertheless, chondrogenic induction is performed under a variety of conditions; with or without TGF-β1 at different concentrations, and also in combination with either a rotatory or hollow organ bioreactor. The engineered explant sections were analyzed using various histochemical and immunohistochemical stains to assess the expression of chondrocyte markers. Cell viability was determined through use of the APO-BrdU TUNEL assay kit. Results: The results showed that culture conditions induced heterogeneous chondrogenesis in various compartments of the UC. Moreover, explants cultured with 10 ng/ml TGF-β1 under hypoxic (1% O(2)) in combination with a bioreactor, significantly enhanced the expression of aggrecan and type II collagen, but were lacking in the production of Glycosaminoglycans (GAGs), as evidenced by alcian blue staining. We speculated that whole segment UCs allowed for the differentiation into premature chondrocytes in our tissue-engineered environments. Conclusion: This study has provided exciting preliminary evidence showing that a stem cell-rich UC wrapped around an anatomical tracheal scaffold and implanted in vivo can induce nodes of new cartilage growth into a structurally functional tissue for the repairing of long-segmental tracheal stenosis.

A 62‐year‐old man was referred to our medical centre with productive cough and high fever over the span of one week, as well as the affiliated symptoms of chronic cough and dizziness for more than six months. Computed tomography (CT) of the thorax was performed and analysed revealing lobulated empyema with thick pleura and two foreign body (FB) retentions in the right lower lobe bronchus. The patient proceeded to thoracoscopic decortications and finalized through retrieval of two dark black stained bonelets with ignored aspiration. After surgery, the patient recovered uneventfully and was discharged in stable condition., We describe the successful treatment of an adult patient who presented to our hospital with the serious condition of empyema complicated by anaemia due to occult bonelet aspiration.

Background Invasive candidiasis (IC) is a growing concern among US healthcare facilities. A large-scale study evaluating incidence and trends of IC in the United States by species and body site is needed to understand the distribution of infection. Methods An electronic medical record database was used to calculate incidence and trends of IC in the United States by species and infection site from 2009 through 2017. Hospital incidence was calculated using total unique inpatient hospitalizations in hospitals reporting at least 1 Candida case as the denominator. IC incidence trends were assessed using generalized estimating equations with exchangeable correlation structure to fit Poisson regression models, controlling for changes in hospital characteristics and case mix over time. Results Candida albicans remains the leading cause of IC in the United States, followed by Candida glabrata. The overall incidence of IC was 90/100 000 patients, which did not change significantly over time. There were no changes in incidence among C. albicans, C. glabrata, C. parapsilosis, or C. tropicalis; the incidence of other Candida spp. as a whole increased 7.2% annually. While there was no change in candidemia 2009–2017, abdominal and nonabdominal sterile site IC increased significantly. Conclusions Nonbloodstream IC is increasing in the United States. Understanding the epidemiology of IC should facilitate improved management of infected patients.

Within the literature on coaching supervision, most studies relate to supervision for full-time coaching practitioners. This paper presents the results of an integrated literature review into coaching supervision for internal coaches who have coaching in addition to their technical role. As well as answering specific research questions, emergent data showed internal coaches using group supervision for competence, relatedness and whether they have autonomy; purposes synonymous with the psychological needs within Self-determination theory (SDT). This paper proposes SDT as an evidence-based theoretical framework for supervisors to understand these areas in group supervision with internal coaches, whilst also making suggestions for further research.

A 40‐year‐old man had considered himself to be robust, with the exception of an earlier diagnosis of hepatitis C. He underwent a wedge resection of the lung, at the left upper lobe (LUL), mimicking an anterior mediastinal tumor. A pathology report showed a 5 × 5 × 2.5 cm grey‐brown and yellowish lesion in a resected 9 × 6 × 3 cm of the lung, with a subsequent diagnosis of organizing pneumonia. The patient recovered uneventfully and was discharged while in a stable condition. One month later, he was admitted and given empiric antibiotic treatment for a lung abscess due to a compound symptom for three weeks after discharge. Although his symptom improved readily, a computed tomography (CT) of the chest disclosed a steady consolidation over the LUL. The fluctuation with haemoptysis and a productive cough spanned 11 months, until a bout of aggravated symptoms including foul and blood‐tinged sputum which mingled with an intermittent high fever became evident. The patient then underwent a bronchoscopy, which surprisingly revealed a metal material impacted over the orifice of the LUL bronchus, requiring biopsy forceps removal. The patient readily recovered with his symptoms thoroughly subsiding thereafter.

Background Neoadjuvant chemoradiotherapy is currently the gold standard treatment for esophageal cancer prior to surgery. This radiation therapy will sometimes lead to liver damage parallel to esophageal lesions, which mimics liver metastasis visualized by 18F-fluorodeoxyglucose positron emission tomography with computed tomography. In this report, we publish virtual radiation-induced liver damage images obtained during surgery, along with the coherent pathology, in order to confirm the false-positive result through an optimally decisive radiological examination. Case presentation We report a case of a Asian male patient with distal esophageal cancer who had undergone neoadjuvant chemoradiotherapy (5000 cGy). Subsequently, a new lesion was discovered during a positron emission tomography with computed tomography scan 6 weeks later, near the left caudate lobe of the liver during tumor restaging. To exclude the possibility of liver metastasis, serial imaging was conducted, which included liver sonography, computed tomography, and magnetic resonance imaging for a more intimate probe. The patient’s condition was verified as being liver inflammation change, as seen by the liver magnetic resonance imaging presentation. Thoracoscopic esophagectomy was performed with cervical esophagogastrostomy via the retrosternal route, along with a feeding jejunostomy. The procedure was performed smoothly, with an intraoperative liver biopsy also being conducted 2 weeks later, after positron emission tomography with computed tomography restaging. The pathology report revealed esophageal cancer in the form of poorly differentiated squamous cell carcinoma, pT3N1M0. The liver biopsy revealed obvious inflammation change after radiation therapy, which elucidated sinusoidal congestion with the attenuated hepatic cords and filled with erythrocytes. There was no evidence of liver metastasis. The patient recovered uneventfully and was discharged with his oral intake performing smoothly, and a stable condition was observed during 12 months of outpatient department follow-up. Conclusions New foci of increased 18F-fluorodeoxyglucose avidity are commonly seen in the caudate and left hepatic lobes of the liver during neoadjuvant chemoradiation for distal esophageal cancer, and these findings generally reflect radiation-induced liver disease rather than metastatic disease. Awareness of the pitfalls of a high 18F-fluorodeoxyglucose uptake in radiation-induced liver injury is crucial in order to avoid misinterpretation and overstaging. Except for the location of 18F-fluorodeoxyglucose uptake, the shape of the lesion, and an maximum standardized uptake value (> 10/h), a convincing liver magnetic resonance imaging scan or even a liver biopsy can provide accurate information for distinguishing radiotherapy-induced liver injury from liver metastasis.

This case study offers a new insight into application of multiple-criteria decision-making methods (MCDM) to social identity issues in the context of talent management. This study used MCDM to help a high-tech company to identify potential talents in its sale and marketing team (n = 54). MCDM adjusted subjective information consisted of intangible organisational political issues into a transparent, objective benchmark. The transparency and consistency of this evaluation process reduced potential social identity disruption between individuals or groups. Furthermore, the involvement of multiple decision-makers (both managers and employees) in the talent identification procedure enhanced employees' motivation for further development.

Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. Conservative treatment is full‐fledged for uncomplicated cases. We presented here an 18‐year‐old young adult with chest trauma caused by a fall. Chest computed tomography disclosed a cavitary lesion 10.5 × 8.5 × 6.4 cm3 over right upper lobe (RUL) with bilateral lower lung contusion and a mild haemopneumothorax but without rib fractures. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X‐ray were recorded for the analysis of natural healing processes., Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. To the best of our knowledge, we present here a case of the largest TP without rib fracture. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X‐ray were recorded for the analysis of natural healing processes.

Background: Experiments were conducted on the assumption that vivid chondrogenesis would be boosted in vivo following previously preliminary chondrogenesis in a mesenchymal stem cell (MSC)-rich entire umbilical cord (UC) in vitro. Methods: Virtual 3-D tracheal grafts were generated by using a profile obtained by scanning the native trachea of the listed porcine. Although the ultimate goal was the acquisition of a living specimen beyond a 3-week survival period, the empirical results did not meet our criteria until the 10(th) experiment, ending with the sacrifice of the animal. The categories retrospectively evolved from post-transplant modification due to porcine death using 4 different methods of implantation in chronological order. For each group, we collected details on graft construction, clinical outcomes, and results from both gross and histology examinations. Results: Three animals died due to tracheal complications: one died from graft crush, and two died secondary to erosion of the larger graft into the great vessels. It appeared that the remaining 7 died of tracheal stenosis from granulation tissue. Ectopic de novo growth of neocartilage was found in three porcine subjects. In the nearby tissues, we detected neocartilage near the anastomosis containing interim vesicles of the vascular canals (VCs), perichondrial papillae (PPs) and preresorptive layers (PRLs), which were investigated during the infancy of cartilage development and were first unveiled in the tracheal cartilage. Conclusions: 3-D-printed anatomically precise grafts could not provide successful transplantation with stent-sparing anastomosis; nonetheless, de novo cartilage regeneration in situ appears to be promising for tracheal graft adaptability. Further graft refinement and strategies for managing granulated tissues are still needed to improve graft outcomes.

Background: Delayed or in vitro inactive empiric antibiotic therapy may be detrimental to survival in patients with bloodstream infections (BSIs). Understanding the landscape of delayed or discordant empiric antibiotic therapy (DDEAT) across different patient, pathogen, and hospital types, as well as by their baseline resistance milieu, may enable providers, antimicrobial stewardship programs, and policy makers to optimize empiric prescribing. Methods: Inpatients with clinically suspected serious infection (based on sampling of blood cultures and receiving systemic antibiotic therapy on the same or next day) found to have BSI were identified in the Cerner Healthfacts EHR database. Patients were considered to have received DDEAT when, on culture sampling day, they received either no antibiotic(s) or none that displayed in vitro activity against the pathogenic bloodstream isolate. Antibiotic-resistant phenotypes were defined by in vitro resistance to taxon-specific prototype antibiotics (eg, methicillin/oxacillin resistance in S. aureus) and were used to estimate baseline resistance prevalence encountered by the hospital. The probability of DDEAT was examined by bacterial taxon, by time of BSI onset, and by presence versus absence of antibiotic-resistance phenotypes, sepsis or septic shock, hospital type, and baseline resistance. Results: Of 26,036 assessable patients with a BSI at 131 US hospitals between 2005 and 2014, 14,658 (56%) had sepsis, 3,623 (14%) had septic shock, 5,084 (20%) had antibiotic-resistant phenotypes, and 8,593 (33%) received DDEAT. Also, 4,428 (52%) recipients of DDEAT received no antibiotics on culture sampling day, whereas the remaining 4,165 (48%) received in vitro discordant therapy. DDEAT occurred most often in S. maltophilia (87%) and E. faecium (80%) BSIs; however, 75% of DDEAT cases and 76% of deaths among recipients of DDEAT collectively occurred among patients with S. aureus and Enterobacteriales BSIs. For every 8 bacteremic patients presenting with septic shock, 1 patient did not receive any antibiotics on culture day (Fig. 1A). Patients with BSIs of hospital (vs community) onset were twice as likely to receive no antibiotics on culture day, whereas those with bloodstream pathogens displaying antibiotic-resistant (vs susceptible) phenotypes were 3 times as likely to receive in vitro discordant therapy (Fig. 1B). The median proportion of DDEAT ranged between 25% (14, 37%) in eight Conclusions: Delayed or in vitro discordant empiric antibiotic therapy is common among patients with BSI in US hospitals regardless of hospital size, teaching status, or local resistance patterns. Prompt empiric antibiotic therapy in septic shock and hospital-onset BSI needs more support. Reliable detection of S. aureus and Enterobacteriales bloodstream pathogens and their resistance patterns earlier with rapid point-of-care diagnostics may mitigate the population-level impact of DDEAT in BSI.Funding: This study was funded in part by the National Institutes of Health Clinical Center, National Institutes of Allergy and Infectious Diseases, National Cancer Institute (NCI contract no. HHSN261200800001E) and the Agency for Healthcare Research and Quality.Disclosures: None

The prevalence and effects of inappropriate empirical antibiotic therapy for bloodstream infections are unclear. We aimed to establish the population-level burden, predictors, and mortality risk of in-vitro susceptibility-discordant empirical antibiotic therapy among patients with bloodstream infections.Our retrospective cohort analysis of electronic health record data from 131 hospitals in the USA included patients with suspected-and subsequently confirmed-bloodstream infections who were treated empirically with systemic antibiotics between Jan 1, 2005, and Dec 31, 2014. We included all patients with monomicrobial bacteraemia caused by common bloodstream pathogens who received at least one systemic antibiotic either on the day blood cultures were drawn or the day after, and for whom susceptibility data were available. We calculated the prevalence of discordant empirical antibiotic therapy-which was defined as receiving antibiotics on the day blood culture samples were drawn to which the cultured isolate was not susceptible in vitro-overall and by hospital type by using regression tree analysis. We used generalised estimating equations to identify predictors of receiving discordant empirical antibiotic therapy, and used logistic regression to calculate adjusted odds ratios for the relationship between in-hospital mortality and discordant empirical antibiotic therapy.21 608 patients with bloodstream infections received empirical antibiotic therapy on the day of first blood culture collection. Of these patients, 4165 (19%) received discordant empirical antibiotic therapy. Discordant empirical antibiotic therapy was independently associated with increased risk of mortality (adjusted odds ratio 1·46 [95% CI, 1·28-1·66]; p0·0001), a relationship that was unaffected by the presence or absence of resistance or sepsis or septic shock. Infection with antibiotic-resistant species strongly predicted receiving discordant empirical therapy (adjusted odds ratio 9·09 [95% CI 7·68-10·76]; p0·0001). Most incidences of discordant empirical antibiotic therapy and associated deaths occurred among patients with bloodstream infections caused by Staphylococcus aureus or Enterobacterales.Approximately one in five patients with bloodstream infections in US hospitals received discordant empirical antibiotic therapy, receipt of which was closely associated with infection with antibiotic-resistant pathogens. Receiving discordant empirical antibiotic therapy was associated with increased odds of mortality overall, even in patients without sepsis. Early identification of bloodstream pathogens and resistance will probably improve population-level outcomes.US National Institutes of Health, US Centers for Disease Control and Prevention, and US Agency for Healthcare Research and Quality.

Summary Background Clindamycin is strongly recommended as an adjunctive treatment to β-lactam antibiotics in patients with severe invasive group A β-haemolytic streptococcal (iGAS) infections. However, there is little evidence of a benefit in the use of clindamycin in humans, and its role, if any, in treating patients with invasive non-group A/B β-haemolytic streptococcal (iNABS) infections is unclear. Methods For this retrospective multicentre cohort study, we used a dataset from patients in the Cerner Health Facts database, which contains electronic health-based data from 233 US hospitals. We queried the Cerner Health Facts database for inpatients (no age restriction) admitted to hospital in 2000–15, with any clinical cultures positive for β-haemolytic streptococcal taxa of interest, and who had received β-lactam antibiotics within 3 days either side of culture sampling. This group of patients was then queried for those who had also received intravenous or oral clindamycin within 3 days either side of culture sampling. Patients were excluded if they had polymicrobial growth or clindamycin non-susceptible isolates, received linezolid, or had missing variable data needed for analysis. Patients were categorised by Lancefield group (iGAS or iNABS); β-lactam antibiotic-treated patients who had received clindamycin were propensity-matched (1:2) to those who did not receive clindamycin separately for iGAS and iNABS cohorts, and logistic regression was then used to account for residual confounding factors. The primary outcome was the adjusted odds ratio (aOR) of in-hospital mortality in propensity-matched patients treated with adjunctive clindamycin versus those not treated with clindamycin in the iGAS and iNABS infection cohorts. Findings We identified 1956 inpatients with invasive β-haemolytic streptococcal infection who had been treated with β-lactam antibiotics across 118 hospitals (1079 with iGAS infections and 877 with iNABS infections). 459 (23·4%) of these patients had received adjunctive clindamycin treatment (343 [31·7%] patients with iGAS infections and 116 [13·2%] patients with iNABS infections). The effect of adjunctive clindamycin therapy on in-hospital mortality differed significantly and showed the opposite trend in iGAS and iNABS infection cohorts (p=0·013 for an interaction). In the iGAS cohort, in-hospital mortality in propensity-matched patients who received adjunctive clindamycin (18 [6·5%] of 277 patients) was significantly lower than in those who did not (55 [11·0%] of 500 patients; aOR 0·44 [95% CI 0·23–0·81]). This survival benefit was maintained even in patients without shock or necrotising fasciitis (six [2·6%] of 239 patients treated with adjunctive clindamycin vs 27 [6·1%] of 422 patients not treated with adjunctive clindamycin; aOR 0·40 [0·15–0·91]). By contrast, in the iNABS infection cohort, in-hospital mortality in propensity-matched patients who received adjunctive clindamycin (ten [9·8%] of 102) was higher than in those who did not (nine [4·6%] of 193), but this difference was not significant (aOR 2·60 [0·94–7·52]). Several subset analyses found qualitatively similar results. Interpretation Real-world data suggest that increased use of adjunctive clindamycin for invasive iGAS infections, but not iNABS infections, could improve outcomes, even in patients without shock or necrotising fasciitis. Funding Intramural Research Program of the National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Disease.

Rectal cancer has always posed surgical challenges to the colorectal surgeon. The quality of the total mesorectal excision (TME) performed is key in determining local disease control. Unlike the great success in adoption of laparoscopic surgery in colon cancer treatment, studies comparing laparoscopy to open rectal surgery all revealed noninferiority was not achieved. Transanal TME (taTME) is the latest advanced technique pioneered to tackle difficult pelvic dissections. The evolution of taTME surgery in recent years was explored in this review. The outcomes to date on the latest literatures are reviewed, included complications, functional outcomes, oncological results and future clinical researches. taTME, while definitely still in its early stages of development, has steadily accumulated safety and feasibility data. It not only provides a better solution to an old problem that colorectal surgeons have been attempting to tackle for quite some time, but also appears to be quite promising in terms of outcomes on numerous fronts. With structured training models, and proctored clinical application, alongside design and implementation of international-scale large multicenter randomized clinical trials, one can only hope that taTME and its innovations will not only open a new era for colorectal surgery, but also for even more surgical disease pathologies.

This study builds upon the previous research that recognised coaching as a triangular political space generating power relationships. We integrate social identity theory into this power negotiation process and consider that the ultimate purpose of coaching is to facilitate a shared coaching identity among all related collaborators. To gain in-depth understanding of factors that promote a three-way joint coaching identity; we conducted 25 critical incident interviews and two levels of Q-sorting (n = 10) with coaches, coachees and organisational stakeholders. The research results indicated that a workplace coaching identity is a flexible space underpinned by coaches’ attitude, all collaborators’ positions and the contracting process. Coaches’ accommodated communication techniques determine the relationship climate (instrumental or influential). Coaches’ position in the coaching space regulates their self-interests and motivation to change. Moreover, a transparent contracting process encourages communication flows and psychological exchanges among all collaborators that may gain more support from stakeholders.

Summary Background Evidence-based needs assessments for novel antibiotics against highly-resistant Gram-negative infections (GNIs) are scarce. We aimed to use real-world data from an electronic health record repository to identify treatment opportunities in US hospitals for GNIs resistant to all first-line drugs. Methods For this retrospective cohort study, population estimates with an unmet need for novel Gram-negative antibiotics were quantified using the Cerner Health Facts database (2009–15), aggregating episodes of infection in US hospitals with pathogens displaying difficult-to-treat resistance (DTR; resistance to carbapenems, other β-lactams, and fluoroquinolones) and episodes involving empirical coverage with reserve drugs (colistin or polymyxin B and aminoglycosides). Episodes displaying extended-spectrum cephalosporin resistance (ECR) were also estimated. Episodes were multiplied by site-specific and fixed 14-day treatment durations for conservative and liberal days-of-therapy (DOT) estimates and stratified by site and taxon. Hospital type-specific DOT rates were reliability adjusted to account for random variation; cluster analyses quantified contribution from outbreaks. Findings Across 2 996 271 inpatient encounters and 134 hospitals, there were 1352 DTR-GNI episodes, 1765 episodes involving empirical therapy with colistin or polymyxin B, and 16 632 episodes involving aminoglycosides. Collectively, these yielded 39·0 (conservative estimate) to 138·2 (liberal estimate) DOT per 10 000 encounters for a novel DTR-GNI-targeted drug, whereas greater treatment opportunities were identified for ECR (six times greater) and β-lactam susceptible GNIs (70 times greater). The most common DTR-GNI site and pathogen was lower respiratory (14·3 [43·3%] of 33 DOT per 10 000 encounters) and Pseudomonas aeruginosa (522 [38·1%] of 1371 episodes), whereas Enterobacteriaceae urinary-tract infections dominated the ECR or carbapenem-sparing niche (59·0% [5589 of 9535 episodes]) equating to 210·7 DOT per 10 000 encounters. DTR Stenotrophomonas maltophilia, Burkholderia spp, and Achromobacter spp represented less than 1 DOT per 10 000 encounters each. The estimated need for DTR-GNI-targeted antibiotics saw minor contributions by outbreaks and varied from 0·5 to 73·1 DOT per 10 000 encounters by hospital type. Interpretation Suspected or documented GNIs with no or suboptimal treatment options are relatively infrequent. Non-revenue-based strategies and innovative trial designs are probably essential to the development of antibiotics with improved effectiveness for these GNIs. Funding Center for Drug Evaluation and Research, US Food and Drug Administration; Intramural Research Program, National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Diseases and the National Cancer Institute.

This paper aims to provide an analytic review of contemporary coaching evidence and future research directions through reviewing the development of coaching (e.g. executive, health and life coaching) and coaching psychology definitions. We offer alternative perspectives from psychologist and non-psychologist coaching practice in the development of both traditions over the past two decades. As part of this paper we will summarise systematic reviews and meta-analyses in workplace coaching and outline the key messages for evidence-based practice. Three key messages are identified from this review. First, coaching itself is a professional helping relationship since the process mainly relies on reciprocal actions between the coach and coachee. Second, coachees should be placed in the centre of the coaching relationship, recognising their motivation to change is the essential antecedent for coaching success. Third, social psychological perspectives are an important element in dyadic coaching interactions. Our aim in this paper is to encourage coaching scholars and practitioners towards future research collaborations in the interest of developing evidenced based practice in coaching.

Purpose The purpose of this paper is to identify essential psychological-informed executive coaching approaches that enhance the organisational learning and development process and outcomes through integrating existing research evidence. Since coaching has been widely used in leadership development related areas and previous studies confirmed that this generates positive effects on individual-level learning in the organisational setting. The identified frameworks and influential factors outlined in this paper can serve as explicit guidelines for the organisation and management team when setting selection and evaluation benchmarks for employing executive coaches. Design/methodology/approach An integrated review approach was applied to narratively synthesise 234 (k=234) identified peer-review articles between 1995 and 2018. This review followed a rigorous protocol that the authors consulted ten (n=10) experts in the field. Both qualitative and quantitative psychological-focused research evidence was included in this study. Findings First, certain psychological approaches, such as cognitive behavioural, solution-focused, GROW and strength-based approaches, were highlighted in current research evidence. Second, the essential factors and skills, for instance, building trust, transparency and rapport, and facilitating learning were identified. Third, the main organisational learning and development outcome evaluation methods were outlined in this review, such as the self-efficacy scale, organisational commitment, workplace psychological well-being, 360-degree feedback and the Multifactor Leadership Questionnaire. Research limitations/implications It is always challenging to integrate research evidence on coaching because of the diversity of theoretical disciplines upon which coaching interventions draw. Therefore, it is difficult to generate a meta-analytic review which can generate statistical results. This review also reveals room for improvement in the quality of existing coaching evidence in accordance with the criteria for evidence-based management or practice (Briner et al., 2009), such as research methodology and evaluation design. Moreover, there is a lack of evidence on this reflective process which helps professional coaches to ensure the quality of their practice and organisational support. Practical implications This review offers a new perspective on the role psychology plays in the organisational learning and development practices. The identified coaching approaches, influential interpersonal skills and outcome evaluation methods can serve as practical guidelines when applying external coaching to facilitate a better organisational learning and development process and outcome. Originality/value This is the first literature review to focus on contemporary psychological-informed coaching evidence (between 1995 and 2018) in the workplace setting. Despite the rapid growth in demand for professional coaching practitioners (International Coach Federation, 2016), there is a lack of research-informed evidence to overcome the challenges faced by organisations when employing external coaches, such as what selection criteria or evaluation benchmarks to use. This review takes a practical perspective to identify essential body of knowledge and behavioural indicators required for an executive coach to facilitate an effective learning and development outcome.

Summary: Background: Laparoscopy-assisted robotic transanal total mesorectal excision is a novel surgical technique for rectal cancer resection. Compared to prior DaVinci Si system case series, this case series is the first to report robotic taTME assisted by laparoscopy (r-taTME) in which the “transanal team” operates via the DaVinci Xi system. As a result, we aim to delineate and discuss preliminary findings from our robotic taTME experiences. Methods: A total of twenty patients (twelve males) who underwent robotic taTME assisted by laparoscopy (r-taTME) between January 2016 and November 2016 at a single institution were documented. Surgical outcomes, including complications, pathological outcomes, and short-term results, were then retrospectively analyzed. Results: All patients underwent r-taTME via a two-team approach. The “abdominal team” operated via a single port method (ileostomy site), while the “transanal team” operated via the DaVinci Xi system. The mean patient age was 56.7 ± 14.3 years (range 31–79), and the mean distance from tumor to anal verge was 6.0 ± 2.7 cm (range 2–10). The mean estimated intraoperative blood loss was 88 ± 107 ml (range 30–500), and circular stapling was utilized to restore continuity in 80% of study patients. The overall postoperative complication rate was 35%, and the mean distal margin length was 3.1 ± 1.3 cm. There were three patients who had a circumferential margin (CRM) involved by cancer cells (≤1 mm). Conclusion: Our preliminary series report demonstrates that utilization of r-taTME assisted by laparoscopy is safe and feasible. Development of a novel transanal approach that allows single-port access alongside a multi-arm robotic system may increase the convenience and efficiency of future operation. Keywords: Robotic surgery, Robotic taTME, Rectal cancer, Transanal TME, DaVinci Xi