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Purpose: To assess the relationship between day 1 postoperative intraocular pressure (IOP) and patient demographic information, indication for vitrectomy, lens status, tamponade medium (air, perfluoroethane, sulfur hexafluoride), and laser treatment. Methods: A prospective observational study of all patients undergoing pars plana vitrectomy (PPV) by a single surgeon within 1 case study. All patients had IOP recorded 1 day after surgery. None of the patients had postoperative antiglaucoma medications. All patients undergoing PPV were previously pseudophakic or underwent combined surgery. Results: Of a final cohort of 161 patients, 6% had raised IOP (defined as >30 mm Hg). A parsimonious regression model showed no strong correlation between raised IOP and type of gas tamponade ( P = .028 for C2F6, P = .067 for SF6, air was the reference category) and a moderate association with the number of laser burns ( P = .067). Conclusion: The use of gas tamponade, in particular C2F6, does not constitute justification for pre/postoperative antiglaucoma prophylactic treatment. In addition, we postulate that careful consideration should be given to the frequency of laser burns during PPV.

Purpose: To investigate the usefulness of Oxane HD for nonposturing surgery on persistent (redo) macular holes by reporting visual and anatomical outcomes as well as complications in a consecutive case series. Methods: Eighteen consecutive patients with a persistent macular hole were recruited from 2008 to 2016. Pre- and postoperative visual acuity and optical coherence tomography data were recorded. Anatomical success was defined as complete circumferential neurosensory reattachment. Postoperative complications were actively looked for and noted. Results: Eighteen (100%) of the 18 persistent holes were closed on the first postoperative day. Visual acuity improved significantly in 15 (83.4%) of the 18 patients from baseline, mean change 0.62 log units (range, 0-1.72). Two (11.1%) of the 18 patients maintained their vision while 1 (5.5%) of the 18 patients lost more than 2 lines. No pre- or postoperative complications were noted. Conclusion: This is the largest prospective study on the use of heavier than water silicone oil to close persistent macular holes without the need for prone posturing. Oxane HD may be successfully used where conventional techniques have already failed and can be associated with functional recovery. Patients’ inability to posture need not preclude redo macular surgery.

Contains fulltext : 175853.pdf (Publisher’s version ) (Open Access) The changing retirement landscape calls on employers to develop practices that respond to individuals’ retirement needs. Line managers are a key stakeholder in managing retirement and this study focuses on how they respond to employee retirement scenarios. This empirical work examines manager openness to involvement in retirement, focusing on three sets of explanatory variables: manager psycho-social characteristics (experience of managing older workers, intention to work past 65), their decision-making environment (influence, discretion and decision-making support) and older employee situational factors (performance, ease of replacement, retirement affect and attitude to work). Data were collected from 129 managers in the United Kingdom's university sector using survey items and a factorial vignette design. The multi-level analysis found support for each category of variables in predicting manager openness to involvement in employee retirement. Managers with more experience of managing older workers were more likely to be open to involvement although managers’ own retirement intentions were not significant as a predictor. Decision-making environment variables were significant predictors of manager openness to involvement. The only older employee situational factor that was associated with manager openness to involvement was employee performance. Practically, organisations need to recognise the potential influence that managers have on employee retirement decisions and this study's findings show that managers may need training to help them understand their own role in supporting older employee retirement. 23 maart 2017

Objective To investigate the clinical effectiveness of silver nitrate (95%) for the treatment of verruca pedis comparing professional and self-application treatments. Methods A single-centre, two-armed randomized evaluation was conducted at a University podiatry clinic. A total of 113 participants (101 analysed) with verruca pedis were included. Participants were randomized to either a clinical group, where silver nitrate was applied by a healthcare professional or a home group, where silver nitrate was self-applied. The main outcome measure was post-treatment pain, controlling for pre-treatment pain, and resolution of the verruca. Secondary outcome measures were participant satisfaction, partial reduction in the verruca and ease of use of the product. Key findings The study showed no significant difference between home treatment and clinically applied treatment for the treatment of verruca pedis in either primary outcome; however, a substantive difference in resolution between groups was recorded, with 34.0% full resolution and 26.4% partial resolution in the clinical treatment group, and 18.8% full resolution and 37.5% partial resolution in the home treatment group. Participants widely reported general ease of use of the product. All participants reported a reduction in pain as a result of the intervention. Conclusion Silver nitrate has been shown to be a safe and effective treatment for verruca pedis, with equal success rates when compared between home and clinical applications.

This article reports on an evaluation of a prescribing workshop to increase ‘sharedlearning’ between registered practitioners undertaking a non-medicalprescribing (NMP) course (midwifery, nursing, physiotherapy, and podiatry) andundergraduate pharmacy students to increase awareness of, and understanding of theroles. The focus was on three domains ofsafe prescribing: Knowledge (of commonly prescribed medicines and theirsuitability for individual patients); Process (of legal requirements and supplyof medicines and associated patient information); and Relationships (betweenprescribers and pharmacists). A cross-sectional evaluation was utilized with6-point Likert-style items and a free text section, completed by 337participants. Participants reported positivelyabout the workshop content and their learning experience, although somedifferences between pharmacy and NMP participants were noted in the knowledgedomain. Quantitative analysis revealed significant differences (p

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. A common barrier to exercise is “lack of time”. Accordingly, interest in low-volume, high-intensity training has grown exponentially since this activity is considered time-efficient. However, the high-intensity nature of this exercise may frequently result in feelings of displeasure creating another barrier for many people. The purpose of this study was to compare affective (pleasure-displeasure) responses to three low-volume, high-intensity exercise conditions, including a novel shortened-sprint protocol. Using a within-subjects, randomised crossover experiment, healthy participants (N = 36) undertook a single bout of: 1) traditional reduced-exertion, high-intensity interval training (TREHIT), 2) a novel, shortened-sprint REHIT (SSREHIT) protocol, and 3) sprint continuous training (SCT). Affect and perceived efforts were recorded throughout exercise using the Feeling Scale (FS) and the 15-point Borg Rating of Perceived Exertion (RPE) scale, respectively. Enjoyment was recorded 5 min post-exercise using the Exercise Enjoyment Scale (EES). Differences were found for FS (condition by time interaction: P = 0.01GG, η2 = 0.26), RPE (P = 0.01GG, η2 = 0.23), and enjoyment (P < 0.01) with all outcomes favouring SSREHIT. Shortened-sprint protocols may diminish feelings of displeasure and might be a time-efficient yet tolerable exercise choice to help motivate some people to increase their physical activity and fitness.

Background Percutaneous Coronary Intervention (PCI) is the commonest invasive procedure in cardiology. Before treatment consent must be given. As part of this communication process patients receive information about the risks and benefits of PCI and alternative treatments. Published studies tell us that the amount and quality of the information received by patients undergoing PCI is variable; benefits are often overestimated, risks forgotten and alternative treatments not always considered. Very little is known about patients' preferences for PCI risk information. Aim: To describe patients' preferences for formation about PCI treatment risk as part of the informed consent process Methods: A cross-sectional survey was distributed to 350 participants treated with PCI across 10 PCI centres in England. Results Three hundred and twenty six participants completed the survey. Thirty percent of the sample reported needing help to understand written medical information. Fifty-one percent were treated with elective PCI, 75% were male, average age of 66.5 years. Recall and comprehension of PCI information given during the consent process was generally limited; 47% and 61% agreed that patients do not usually understand, or remember, the information given to them respectively. Eighty-eight percent of urgent PCI patients wanted to know about all possible risks compared to 90% of elective cases. Most participants (88% urgent and 94% elective) believed that PCI would reduce their risk of a future heart attack. Conclusion A significant proportion of PCI patients find it difficult to recall or understand information about treatment risks. It is recommended that patients are given health-related information designed to accommodate different health literacy levels in advance of their treatment. Acknowledgement/Funding National Institute for Health Research Research for Patient Benefit Programme Grant Reference Number PB-PG-0712-28089

In the light of the increasing recognition of the relevance of spirituality in person-centred, holistic care, this study examines the attitudes of a convenience sample of mental health practitioners, including nurses, to the concepts of spirituality in general and in clinical practice. A series of 5-point Likert-style items assessed two key domains of spirituality in everyday life (SEDL) and spirituality in practice (SIP). The questionnaire was derived from one previously used with healthcare educators (including nurses). Each item was scored from 1 point (strongly disagree) to 5 points (strongly agree). Additional information about how far practitioners believed spirituality had been integrated in their education and how much they believed that spirituality related to religion was also ascertained. Three further items, not part of the main questionnaire, dealt with respondents' views of spirituality competent practice, in the light of a description provided as part of the questionnaire. Data were collected from 104 respondents. Standard statistical procedures, including reliability analyses, were applied to the data. Respondents who viewed spirituality to be distinct from religion, or a place of worship, were likely to place a higher value on spirituality in everyday life, while respondents who experienced the integration of spirituality within their preregistration training and/or clinical education were likely to place a higher value on the place of spirituality in practice. The possible reasons for these associations are discussed in the light of the importance of spiritual care as a part of person-centred, holistic practice.

Background\ud Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI).\ud \ud Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI.\ud \ud Methods\ud IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman’s community physician with logistic regression models derived to model dichotomous outcomes.\ud \ud Results\ud Fifty-three women aged 21–44 years with BMI 30.1–43.9 Kg.m− 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for ‘professional’ opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%;\ud \ud Conclusions\ud IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.

Objective: This study aimed to determine the rate of surgical site infection (SSI) in patients undergoing surgery for spinal metastases, and identify key risk factors for SSI among this patient group. Method: A retrospective case note review was undertaken in adult patients being treated at a single specialist centre for spinal surgery. Results: There were 152 patients identified for inclusion. Overall SSI rate was 11.2 per 100 patients (9.7 per 100 procedures). An increase in the risk of SSI was observed when surgery involved a greater number of vertebral levels (odds ratio 1.26, p=0.019) when controlling for primary spinal region. Controlling for the number of spinal levels, the odds of SSI increased by a factor of 5.6 (p=0.103) when the primary surgical region was thoracic, as opposed to cervical or lumbar. Conclusion: In conclusion, surgery associated with multiple vertebral levels for treatment of spinal metastases, particularly of the thoracic spine, is associated with increased risk of SSI.

Purpose To evaluate the accuracy of user-adjusted axial length (AL) measured by optical biometry for intraocular lens (IOL) calculations in eyes having combined phacovitrectomy for macula-off rhegmatogenous retinal detachment (RRD). Setting Ophthalmology Department, Calderdale Royal Hospital, Halifax, United Kingdom. Design Retrospective case series. Methods Consecutive eyes having phacovitrectomy for macula-off RRD were evaluated. The ALs were measured using optical biometry with user adjustment to identify a posterior peak corresponding to the eye's AL and ultrasound (US). These were compared with each other and with the postoperative optical biometry and analyzed for accuracy as an indication of the eye's AL. Results The study comprised 22 eyes of 22 patients. There was no statistically significant difference between the mean AL measurements derived from user-adjusted optical biometry and US AL ( P = .964). The user-adjusted optical biometry was not statistically significantly different from the postoperative optical biometry ( P = .242). Compared with the postoperative optical biometry, the IOL power was within ±0.5 diopter in 12 (92%) of 13 cases (95% confidence interval [CI], 77.8 to 100.0) for user-adjusted optical biometry and in 10 (77%) of 13 cases (95% CI, 54.0 to 99.8) for US measurements. Conclusions User-adjusted optical biometry could be used as an alternative method for measuring AL in macula-off RRD with combined phacovitrectomy. However, optical biometry would require assessment of agreement with US AL in cases in which a posterior peak is not easily identifiable. User-adjusted optical biometry might outperform US AL when calculating IOL power; however, a larger study should be performed to confirm this. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

The elements of visual culture preserved in late Roman houses confirm an intense interest in dramatic visual display. This study employs an interpretive lens of spectacle to examine a new form of banquet space amd furnishings in the period, as well as a new style of ‘dinner-theatre’ they served. By considering ancient art as inseparable from active contexts and ephemeral events, a more sophisticated understanding of a society's self-definition through art emerges. Rather than being epiphenomenal to the poliltical culture of late antiquity, spectacle is argued to be central to the creation and contestation of power structures: performance is politics.

Aim: To determine if co-morbidities have an effect on mood in a cohort of morbidly obese patients.

In cold climates, special consideration needs to be given to the design and construction of segmental post-tensioned concrete girder bridges. This article presents the special considerations that e...

Designers of online learning, the review reveals, should pay considerable attention to learner control, dialogue, learner support and opportunities for direct learner involvement. The chapter explores the implications of these different modes for the design, structure and management of online learning and proposes a framework to help practitioners locate their own practice and construct appropriate programmes and systems based on lessons from the review. It is based on a systematic review of such reports. Web-based online learning is too recent a medium to have been the subject of a systematic and comprehensive research programme to test its overall educational effectiveness. Each of the dialogue, involvement, support, control features had different characteristics in each of the paradigms, with implications for the structuring and design of good practice. The learner-managed element of the north-east sector is structured and controlled by the teacher with freedom for the learner to explore.

This book, developed from an expert seminar convened by the International Centre for Learner Managed Learning (ICLML), looks at the developing understanding of approaches to online teaching and the emergence of pedagogies that will ensure the effectiveness of online teaching and learning. The seventeen chapters of the book are divided into six parts: part one focuses on pedagogics; part two reviews current research on online learning; part three discusses the experiences of practitioners; part four looks at some of the challenges of online learning; part five covers the role of the commercial producers of online materials; and part six discusses the future of online learning. The chapters are: Learners still learn from experience when online / Shirley Alexander and David Boud; Learning technology and learning relationships / Terry Mayes; Problems with online learning are systematic, not technical / Stewart Hase and Allan Ellis; Online learning: it is all about dialogue, involvement, support and control - according to the research / Marion Coomey and John Stephenson; Making the right connections: improving quality in online learning / Barry Jackson and Kyriaki Anagnostopoulou; Effective facilitation of online learning: the open university experience / Robin Mason; Finding the instructor in post-secondary online learning: pedagogical, social, managerial and technological locations / Curtis J. Bonk, Jamie Kirkley, Noriko Hara and Vanessa Paz Dennen; Exploring the development of critical thinking skills through a web-supported problem-based learning environment / Ron Oliver; Distance learning through educational networks: the global view experience / Dennis Schlais and Richard Davis; Scenarios for PhD courses in a European network environment, as supported by EuroPACE / Jef van den Branden; Teacher effectiveness and online learning / Sisko Mallinen; From conventional to distance education: adopting a pedagogy and managing the transformation / Mark Woodman, Maya Milankovic-Atkinson, Chris Sadler, Alan Murphy; On the way to online pedagogy / Martin Good; Designing online learning opportunities, orchestrating experiences and managing learning / Keith Shaw; Course design for online learning - what's gone wrong? / Quentin Whitlock; Towards an androgogy for living in an information society / David Dickinson and Valerie Stewart; Television and learning: ways of connecting media and learning / Steve Pollock and David Squire.

Families have a crucial role supporting a relative with alcohol and/or other drug misuse, but the role has adverse implications for family members' coping, which in turn, affects their ability and willingness to support the relative. The aim of this study was to assess the coping behaviours of affected family members of relatives with alcohol and/or other drug misuse and to assess if there was a relationship between the level of coping and family member type and support-giving experience. A cross-sectional survey design was used, and 90 respondents completed the questionnaire. Results suggest the following associations: that 'Other' family members made more frequent use of maladaptive coping strategies than intimate partners (P = 0.012); family members whose role had a negative effect on their physical health made more frequent use of maladaptive coping strategies than those whose role did not have this effect (P = 0.014); and family members whose role had a negative effect on their ability to socialise used maladaptive coping strategies more often than those whose role did not have this effect (P = 0.003). Engaged and tolerant-inactive maladaptive coping strategies had a significantly greater adverse influence on family members' physical health and/or socialising than withdrawal coping strategies. Affected family members should be supported to use adaptive coping strategies to mitigate the detrimental effects of their support-giving role and to sustain them in this crucial support-giving role. Family and friends, mental health nurses, and other clinicians in the alcohol and other drug field have an important role in supporting family members in this context.

AimsTo assess the ‘Okay to Stay’ plan to investigate if this reduces visits to emergency departments, unplanned admissions and elective admission to hospital in elderly patients with long-term health conditions.BackgroundThe incidence of long-term conditions is rising as the elderly population increases, resulting in more people from this group attending emergency departments and being admitted to hospital. Okay to Stay is a simple plan for people with long-term conditions to help them remain in their own home if they suffer an acute exacerbation in their health. It was co-designed with professional and patient representatives with the aim of empowering patients and their carers to more effectively manage their long-term conditions.MethodsData from 50 patients (20 males, 30 females, mean baseline age 77.5 years) were compared 12 months before implementation of the plan and in the subsequent 12 months, with the significance of effects assessed at the 5 per cent significance level using t-tests.FindingsVisits to emergency departments were reduced by 1.86; unplanned emergency admissions were reduced by 1.28 and planned elective admissions were raised by 0.22 admissions per annum. The reduction in visits to the emergency department was significant (p = 0.009) and the reduction in emergency admissions was significant (p = 0.015). The change in elective admissions was not significant (p = 0.855). The Okay to Stay plan is effective in reducing visits to the emergency department and unplanned hospital admissions in people with long-term conditions. This is a positive step to supporting vulnerable and complex patients who are cared for at home, and facilitates the recognition by the individual of the possibility to stay at home with the support of health professionals. There are potential cost benefits to the investment of initiating an Okay to Stay plan through the avoidance of visits to the emergency department and non-elective admissions to hospital.

Self-harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self-harm injuries, and positive therapeutic patient-nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self-harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta-analyses examined the attitudes of ED nurses towards patients who self-harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta-analysis. The Self-Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta-analysis. The Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta-analysis. Results demonstrated limited empathy and negativity towards patients who self-harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self-harm educational content for ED staff should include areas of knowledge building including explanations and causes of self-harm; range, forms, and functions of self-harm; staff responses to self-harm; assessment, management, and interventions; professional practice issues.

In this work, we investigate CMOS compatible oxygen-inserted Silicon (OI) n-channel MOSFETs with high-K/metal gate stack. Initial results for high-K/metal gate OI transistors show (i) 2.7x lower gate leakage for matched electrical oxide thickness, TOX, E and (ii) 23% increased room temperature electron mobility at 0.6MV/cm Eeff, consistent with previous reports on OISi MOSFETs with SiON/Poly-Si gate stack.

Background The majority of breast cancer patients will experience some level of emotional distress, with some patients having long-term psychological maladjustment. Personal and social resources play a role in recovery yet the interplay between these factors warrants further examination. This study aimed to investigate the interaction of psychosocial factors impacting women in their breast cancer trajectory, at 2 years or less following diagnosis (stages I-III). Design A longitudinal cohort study approach was used in this study. Methods The sample consisted of n = 49 participants. Data were collected between June 2013 and October 2013 and followed for 12 months across the trajectory of the disease. Results The mean age was 56.6 years (SD 11.6 years). Most participants had stage I or stage II breast cancer. Time (over three time points—4 weeks, 6 months, and 12 months) after diagnosis was significantly associated with the body image (P = .003) and age (P = .004). Conclusion Older women with breast cancer reported less concern regarding body image than their younger peers. These findings suggest that posttreatment younger women may require access to psychological support posttreatment.

Objective High levels of environmental noise in hospitals disturbs sleep. We aimed to identify, critically appraise and summarise primary research that reports studies that tested interventions to reduce night-time noise levels in ward-settings. Design Systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources Key health-related and specialist acoustic databases (CINAHL, EMBASE, MEDLINE, The Cochrane Library, PsycINFO, NHS Evidence, Knovel, Journal of the Audio Engineering Society, Journal of the Acoustical Society of America, IEEE Xplore Digital Library, Acta Acustica and Acoustics in Practice) were searched from their inception to April 2017, with no language restrictions. Review methods Experimental, quasi-experimental and observational study designs assessing the effect of noise reduction interventions on patient outcomes and/or environmental noise levels were included. Two reviewers independently conducted a quality appraisal using a published framework. Results In total, 834 records were identified with nine studies meeting inclusion criteria. Quality appraisal showed that the level of evidence was generally weak. A range of noise reduction interventions were identified: one study implemented a single intervention, whilst the remainder were complex, multi-faceted interventions. Findings from individual studies showed mixed results but preliminary evidence suggests that noise reduction interventions can reduce environmental noise levels in ward settings and improve patients' sleep ratings. Quantitative data from 6 studies were pooled. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in total hours sleep (no intervention – intervention) was −0.11 h (95% CI −0.46 to 0.25 h; p = 0.556), with moderate statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the standardised mean difference in awakenings per night (no intervention – intervention) was 0.05 (95% CI −0.20 to 0.29; p = 0.715), with negligible statistical heterogeneity. A random effects meta-analysis determined that a synthesised estimate for the odds ratio for disturbed nights (no intervention: intervention) was 0.75 (95% CI 0.55 to 1.01; p = 0.059), with low statistical heterogeneity. Conclusions Individual studies show that noise reduction interventions are feasible in ward settings and suggest they have potential to improve patients' in-hospital sleep experiences. However meta-analyses show insufficient evidence to support the use of such interventions at present. There is a lack of appropriately designed studies to test intervention effectiveness. Robust studies are required to identify the most effective interventions to address this significant and ubiquitous problem. What is known about the topic • Noise levels in hospital impact on quantity and quality of sleep and patient experience. • Disturbed sleep can have a detrimental impact on health and extend patient recovery. • Noise reduction interventions do not receive the priority they deserve. What this paper adds • A comprehensive review of noise reduction interventions used in general ward settings. • Noise reduction interventions show the potential to reduce environmental noise and improve patient sleep ratings. • Appropriately designed studies are required to provide definitive evidence to demonstrate the effectiveness of noise reduction intervention in ward settings.

Summary Objective: This study aimed to determine how the abilities of the Charlson Index and Elixhauser comorbidities compared with the chronic health components of the Acute Physiology and Chronic Health Evaluation (APACHE II) to predict in-hospital 30 day mortality among adult critically ill patients treated inside and outside of Intensive Care Unit (ICU). Methods: A total of 701 critically ill patients, identified in a prevalence study design on four randomly selected days in five acute care hospitals, were followed up from the date of becoming critically ill for 30 days or until death, whichever occurred first. Multiple data sources including administrative, clinical, pathology, microbiology and laboratory patient records captured the presence of acute and chronic illnesses. The exponential, Gompertz, Weibull, and log-logistic distributions were assessed as candidate parametric distributions available for the modelling of survival data. Of these, the log-logistic distribution provided the best fit and was used to construct a series of parametric survival models. Results: Of the 701 patients identified in the initial prevalence study, 637 (90.9%) had complete data for all fields used to calculate APACHE II score. Controlling for age, sex and Acute Physiology Score (APS), the chronic health components of the APACHE II score, as a group, were better predictors of survival than Elixhauser comorbidities and Charlson Index. Of the APACHE II chronic health components, only the relatively uncommon conditions of liver failure (3.4%) and immunodeficiency (9.6%) were statistically associated with inferior patient survival with acceleration factors of 0.35 (95% CI 0.17, 0.72) for liver failure, and 0.42 (95% CI 0.26, 0.72) for immunodeficiency. Sensitivity analyses on an imputed dataset that also included the 64 individuals with imputed APACHE II score showed identical results. Conclusion: Our study suggests that, in acute critical illness, most co-existing comorbidities are not major determinants of shortterm survival, indicating that observed variations in ICU patient 30-day mortality may not be confounded by lack of adjustment to pre-existing comorbidities.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. The UK nursing workforce is facing a crisis. More nurses are leaving than entering the profession, and there are tens of thousands of unfilled vacancies. Political factors are having a significant impact on numbers, in particular the decision to withdraw bursaries for nursing undergraduates, and a steep decline in EU nurses registering to work in the UK post-Brexit. Against this backdrop, there is a stark gender imbalance in the workforce, with only around 11% of registered nurses being male. We surveyed UK higher education institutions to try to identify whether the gendered nature of nursing was considered a concern and whether steps were being taken to address it. We sent an electronic survey to every UK university offering undergraduate nurse training validated by the Nursing and Midwifery Council (NMC). With a response rate of 42%, the majority of respondents felt that nursing departments should take much more responsibility to increase the proportion of male nurses entering the nursing profession. More needs to be done to diversify the workforce and make nursing an appealing career choice for men and women.

University for Industry (UfI)/learndirect is one of a new breed of organizational brokers established by the state to bring together the capacities and expertise of higher education (HE) institutions to create new opportunities for learning and to widen and increase participation in HE. This chapter illuminates the most important brokerage strategies used to help create a system to support the new learning opportunities. The Learning through Work programme is taps into the main engine of work-place learning, the informal accumulation of knowledge and expertise through the experience of work itself. Three major concerns had to be addressed before a learner managed route to qualifications could be developed and delivered – relevance, quality and feasibility. A deal on these concerns needed to be brokered to the satisfaction of a wide range of key internal and external stakeholders. Brokered solutions were needed to: secure commitment, develop the scheme, build and operate.

Limited data is available in the literature on the radiographic results of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment of degenerative scoliosis. The objective of our study was to evaluate the segmental and global correction achieved with MPLIF in the treatment of degenerative scoliosis. Between 2009 and 2014, 42 patients underwent correction of degenerative scoliosis with MPLIF. Several radiological parameters were measured pre- and post-operatively by two independent observers. A statistical analysis was performed to assess the inter-observer reliability of the measurements and to determine the degree of segmental correction achieved at each intervertebral disc. Using sagittal vertical axis (SVA) less than 47 mm; lumbar lordosis (LL) within 11° of pelvic incidence (PI); and pelvic tilt (PT) no more than 22° as radiological criteria for procedural acceptability, we determined predictive factors for a favourable radiological outcome. Forty-two patients (34 female) were included in our study. The average amount of correction per segment was 6.2°. The overall correction achieved with MPLIF was 16.6°. Twenty-six of the 42 patients (61.9 %) had post-operative SVA values less than 47 mm. Nineteen of the 42 patients (45.2 %) had average post-operative LL within 11° of the PI. Sixteen of the 42 patients (38.1 %) had PT less than 22°. Younger age, female gender and a low pre-operative PT were significantly associated with the attainment of a satisfactory sagittal alignment. Our results demonstrate that a satisfactory correction can be achieved in degenerative scoliosis with MPLIF. In addition, our results show that it is significantly more likely to achieve a satisfactory radiological outcome in younger, female patients with low pre-operative PT.

The identification of genes influencing fitness is central to our understanding of the genetic basis of adaptation and how it shapes phenotypic variation in wild populations. Here, we used whole-genome resequencing of wild Rocky Mountain bighorn sheep (Ovis canadensis) to >50-fold coverage to identify 2.8 million single nucleotide polymorphisms (SNPs) and genomic regions bearing signatures of directional selection (i.e. selective sweeps). A comparison of SNP diversity between the X chromosome and the autosomes indicated that bighorn males had a dramatically reduced long-term effective population size compared to females. This probably reflects a long history of intense sexual selection mediated by male-male competition for mates. Selective sweep scans based on heterozygosity and nucleotide diversity revealed evidence for a selective sweep shared across multiple populations at RXFP2, a gene that strongly affects horn size in domestic ungulates. The massive horns carried by bighorn rams appear to have evolved in part via strong positive selection at RXFP2. We identified evidence for selection within individual populations at genes affecting early body growth and cellular response to hypoxia; however, these must be interpreted more cautiously as genetic drift is strong within local populations and may have caused false positives. These results represent a rare example of strong genomic signatures of selection identified at genes with known function in wild populations of a nonmodel species. Our results also showcase the value of reference genome assemblies from agricultural or model species for studies of the genomic basis of adaptation in closely related wild taxa.

The emergence of the Ebola virus disease (EVD) outbreak in West Africa threatens regional and global public health security. This epidemic, first announced in March 2014 in Guinea Conakry, has grown dramatically since June 2014 with an extension into Liberia and Sierra Leone. Nigeria, Mali, and Democratic Republic of the Congo were also transiently affected. It was declared to be a public health emergency of international concern by the World Health Organization (WHO) on 8 August 2014. On 21 January 2015, a cumulative total of more than 21,800 cases was reported by the WHO [1], with a case fatality rate (CFR) of between 57 and 59 % among hospitalized patients. A total of 828 healthcare workers (HCWs) have been infected with the Ebola virus since the beginning of the epidemic, with a CFR of 60 %. Some Western countries have also reported imported cases: six patients in the USA, Spain and UK, including one death (CFR of 16.7 %). Direct contact with infected bodily fluids—usually feces, vomit, or blood—is necessary for transmission. Once the Ebola virus is suspected, based on national versions of WHO’s case definition recommendations [2], specific laboratory tests can confirm or disprove diagnoses in a few hours, but for this, the patient has to be transported to a specialized center with specific management conditions [3]. In this article, the authors compared procedures for the transport of Ebola patients in their respective countries (USA, UK, and France) to identify common principles.

Aim To evaluate the effectiveness of a cognitive behaviour therapy guided self-help manual for enhancing the experience of caregiving of family carers of individuals with depression. Background The prevalence of depression is increasing markedly in Thailand. While primary carers give most of the support for individuals with depression, they receive little support from mental health services in this critical role. Design A randomized controlled trial. Method Carers were randomized to guided self-help (n = 27), while the control group received standard information and support (n = 27). Both groups also received a short weekly telephone call. Participants were assessed at three time points; the outcome measure was the Experience of Caregiving Inventory. A doubly multivariate analysis of variance (anova) procedure, including between-group and within-group factors, was implemented. Fieldwork was from October 2007–May 2008. Results Fifty-four carers completed the study and intent-to-treat analyses were undertaken. The findings showed there was a significant reduction in the total negative experience of caring, from baseline to post-treatment, in the intervention group recipients of the manual compared with the control group and treatment effects were maintained at one-month follow-up. Similarly, a significant improvement in the total positive experience of caring occurred, from baseline to post-treatment, in the intervention group in contrast with the control group and these outcomes were sustained at one-month follow-up. Conclusion Guided self-help strengthen carers’ positive and reduces their negative, experience of caring. The study contributes to the limited evidence base about this approach in a developing country such as Thailand.

Many statistical analyses in ophthalmic and other clinical fields are concerned with describing relationships between one or more ‘predictors’ (explanatory or independent variables) and usually one outcome measure (response or dependent variable). Our earlier statistical notes make reference to the fact that statistical techniques often make assumptions about data.1 ,2 Assumptions may relate to the outcome variable, to the predictor variable or indeed both; common assumptions are that data follow normal (Gaussian) distributions and that observations are independent. It is, of course, entirely possible to ignore such assumptions, but doing so is not good statistical practice and in medicine; poor statistical practice can impact negatively upon patients and the public.3 One approach when assumptions are not adhered to is to use alternative tests which place fewer restrictions on the data – non-parametric or so-called distribution free methods.2 A more powerful alternative, however, is to transform your data. While your ‘raw’ (untransformed) data may not satisfy the assumptions needed for a particular test, it is possible that a mathematical function or transformation of the data will. Analyses may then be conducted on the transformed data rather than the raw data. Scenario 1: A study to evaluate the accuracy of intraocular lens power estimation in eyes having phacovitrectomy for rhegmatogenous retinal detachment4 measured the axial length (in mm) of 71 eyes. The raw data (figure 1A) exhibited a fairly strong positive skew (rather than being symmetric there is an extended tail in the histogram to the right); the same data with a logarithmic transformation applied (figure 1B) appears much more normal (less of a …

Aims and objectives To explore young adults' knowledge and attitudes of cardiovascular disease and its risk factors. Background Cardiovascular disease morbidity is rising and mortality is declining among young adults. However, the knowledge of cardiovascular disease by young adults is not well known. Design A systematic review with meta‐analysis was used. Methods The databases of CINHAL, MEDLINE Complete, PsycINFO and Psycarticles were searched for all studies published before June 2016. Search terms included cardiovascular disease, young adult, attitude and knowledge. Papers were included if they were published in English and reported quantitative research with a study population between the ages of 18–34 years, with a focus on knowledge and attitudes to cardiovascular disease. Meta‐analyses were conducted to assess the extent of knowledge of risk factors on heart disease. Results Nine risk factors for cardiovascular disease were identified by the respondents; smoking (synthesised estimate of 55% of respondents identifying as a risk factor, 95% confidence interval of synthesised estimate 45%–65%); obesity (27%, 95% CI, 26%–29%); high blood cholesterol (33%, 95% CI, 12%–54%); high blood pressure (25%, 95% CI, 18%–32%); genetic factors (26%, 95% CI, 23%–29%); physical inactivity (39%, 95% CI, 30%–47%); stress (49%, 95% CI, 48%–51%); advancing age (10%, 95% CI, 8%–12%) and diet (55%, 95% CI, 54%–56%). Conclusion Young adults demonstrate limited knowledge and poor attitudes regarding cardiovascular disease and its risk factors. The finding of this review demonstrates that there is an urgent need to build knowledge of cardiovascular risk identification in this population group. Relevance to clinical practice Increasing cardiovascular disease in young adults will put stress in the healthcare system financially and economically. There is a need of awareness of cardiovascular disease in this population group.

Objective: To provide an in-depth understanding of patients' views about the impact of transcatheter aortic valve implantation on self-reported quality of life. Background: Transcatheter aortic valve implantation is considered to be the gold standard of care for inoperable patients diagnosed with severe symptomatic aortic stenosis. Mid- to long-term clinical outcomes are favourable and questionnaire data indicates improvements in quality of life but an in-depth understanding of how quality of life is altered by the intervention is missing. \ud \ud Methods: A mixed methods study design with a total of 89 in-depth qualitative interviews conducted with participants (39% male; mean age 81.7 years), 1 and 3 months post TAVI, recruited from a regional centre in England. Data were triangulated with questionnaire data (SF-36 and EQ5D-VAS) collected, pre, 1 and 3 months post implantation.\ud \ud Results: Participants' accounts were characterised by four key themes; shortened life, extended life, limited life and changed life. Quality of life was changed through two mechanisms. Most participants reported a reduced symptom burden and all explained that their life expectancy was improved. Questionnaire data supported interview data with gradual improvements in mean EQ-5D scores and SF-36 physical and mental domain scores at 1 and 3 months compared to baseline. \ud \ud Conclusion: Findings suggest that TAVI was of variable benefit, producing considerable improvements in either mental or physical health in many participants, while a smaller proportion continued to deteriorate.

Objective: To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR. Methods: This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. Results: We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091). Conclusions: Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.

This article describes the implementation of a postoperative nausea and vomiting (PONV) risk prediction and prophylaxis protocol.This is a retrospective pre/post implementation quality improvement project.This project used chart reviews to assess the impact of the implemented PONV assessment and prophylaxis in a sample population of adult females undergoing gynecologic surgical procedures.The mean number of prophylactic antiemetics administered significantly increased during the postimplementation period from 3.64 (SD, 0.878) in the preimplementation period to 4.07 (SD, 1.021) in the postimplementation period (P .001). The greatest increase in antiemetic administration occurred in the moderate-risk (risk score, 4) and the high-risk (risk score, 5 to 6) groups. The incidence of PONV decreased from 32.3% in the preimplementation period to 28.9% in the postimplementation period; however, this reduction did not meet statistical significance. Antiemetic administration compliance increased from 37% in the preimplementation group to 61% in the postimplementation group (P .001).The results of this project suggest that a risk-tailored approach to PONV prophylaxis using a risk assessment tool along with treatment recommendations is effective at reducing the incidence of PONV. The effectiveness of this approach is limited by the involvement of the anesthesia providers responsible for completing the assessments and administering PONV prophylaxis.

Background: It is commonly believed lifting is dangerous and the back should be straight during lifting. These beliefs may arise from healthcare professionals, yet no study has evaluated the lifting and back beliefs of manual handling advisors (MHAs) and physiotherapists (PTs).\ud \ud Objectives: To evaluate (i) what lifting technique MHAs and PTs perceive as safest, and why, and (ii) the back pain beliefs of MHAs with PTs.\ud \ud Design: Data was collected via an electronic survey.\ud \ud Method: Participants selected the safest lifting posture from four options: two with a straight back and two with a more rounded back, with justification. Back beliefs were collected via the Back-Pain Attitudes Questionnaire (Back-PAQ). Relationships were investigated using multiple linear and logistic regression models.\ud \ud Results: 400 PTs and MHAs completed the survey. 75% of PT and 91% of MHAs chose a straight lifting posture as safest, mostly on the basis that it avoided rounding of the back. MHAs scored significantly higher than PTs on the Back-PAQ instrument (mean difference = 33.9), indicating more negative back beliefs. Those who chose the straight back position had significantly more negative back beliefs (mean 81.9, SD 22.7) than those who chose a round back lift (mean 61.7, SD 21.1). \ud \ud Conclusion: Avoiding rounding the back while lifting is a common belief in PT and MHA, despite the lack of evidence that any specific spinal posture is a risk factor for low back pain. MHAs, and those who perceived a straight back position as safest, had significantly more negative back beliefs.

Background Context Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. Purpose This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. Study Design This is a retrospective controlled study. Patient Sample A total of 176 patients undergoing MSTS were included in the study. Methods All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. Results Data included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. Conclusions We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.

Background\ud Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (

Background Up to 50% of people with rheumatoid arthritis (RA) have foot symptoms at diagnosis, hence early foot health intervention is recommended and this should include patient education. This study identifies, for the first time, the foot health education (FHE) needs of people with RA. Methods An online survey of people with RA (n = 543) captured quantitative data in relation to the aims, methods of delivery, content, timing and accessibility of FHE. Results The majority concurred about the aims of FHE. Verbal delivery and websites were the most common methods. Written and verbal FHE were perceived to be the most effective methods. The point of diagnosis was the preferred time to receive it. Lack of access to FHE included minimal focus on foot health during consultations by both health practitioners and patients with RA. Participant gender, age, disease duration and living situation had a statistically significant influence on the results. Conclusion Foot health education is rarely considered within the medical consultation. There is a lack of patient and/or health professional awareness of this need with a detrimental impact on foot health. Patients require health professionals to identify their foot education health needs. Tailored foot health education should begin at initial diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s13047-017-0193-6) contains supplementary material, which is available to authorized users.

The growing incidence of depression in developing countries, such as Thailand, is placing increasing pressure on public mental health services, and those living in rural areas have limited access to mental health services and specialised support. Resilience is integral to the recovery of people with depression and to caregivers. This parallel group randomised controlled trial evaluated the effectiveness of a guided self-help manual in improving resilience in adults diagnosed with moderate depression and their primary caregivers in Thailand. Our findings indicate that the approach is an accessible and low-cost approach to increasing resilience in adults with depression and their caregivers.

An experimental and simulation study of short- channel planar bulk nMOSFET performance enhancement achieved with oxygen insertion technology is presented. The benefits of this technology for low-power digital logic circuits make it a promising evolutionary approach to extend bulk MOSFET scaling. Index Terms— Low-power (LP) logic circuits, mobility enhancement, oxygen insertion (OI), super-steep retrograde well (SSRW), variability.

Purpose: To evaluate the accuracy of intraocular lens power estimation in eyes having phacovitrectomy for rhegmatogenous retinal detachment.\ud \ud Methods: Retrospective case review of 100 consecutive eyes that underwent phacovitrectomy for rhegmatogenous retinal detachment. Axial lengths were measured using optical biometry and/or ultrasound A-scan. Achieved and predicted refraction were compared to calculate the mean postoperative refractive prediction error and the mean absolute prediction error. Factorial analysis of variance models were developed to assess outcome on the whole and that between the subgroups.\ud \ud Results: Ninety-five eyes had postoperative refraction: 41 macula-on (43%) and 54 macula-off (57%). The mean postoperative prediction error was -0.34 +/- 0.89 diopters. There was no statistical significant difference in the refractive outcomes between macula-on and macula-off groups (P > 0.05). Overall, using mean absolute prediction error as the outcome measure, optical biometry was more accurate than ultrasound (P = 0.040). However, significantly more ultrasound-measured axial lengths were selected for intraocular lens power estimation in macula-off group compared with the macula-on group (P = 0.016).\ud \ud Conclusion: Combined phacovitrectomy in rhegmatogenous retinal detachment included a small biometric error that was within the tolerable range in most cases. Both optical biometry and ultrasound should be used to estimate axial lengths, for macula-off rhegmatogenous retinal detachment cases, to improve the accuracy of intraocular lens power calculation.