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Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA.A survey was distributed to pediatric institutions participating in three international studies. Survey questions related to center demographics, clinical practice patterns of MRI after CA, neuroimaging resources, and details regarding MRI decision support.Response rate was 31% (44 of 143). Thirty-four percent (15 of 44) of centers have a clinical pathway informing the use of MRI after CA. Fifty percent (22 of 44) of respondents reported that an MRI is obtained in nearly all patients with CA, and 32% (14 of 44) obtain an MRI in those who do not return to baseline neurological status. Poor neurological examination was reported as the most common factor (91% [40 of 44]) determining the timing of the MRI. Conventional sequences (T1, T2, fluid-attenuated inversion recovery, and diffusion-weighted imaging/apparent diffusion coefficient) are routinely used at greater than 97% of centers. Use of advanced imaging techniques (magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI) were reported by less than half of centers.Conventional brain MRI is a common practice for prognostication after CA. Advanced imaging techniques are used infrequently. The lack of standardized clinical pathways and variability in reported practices support a need for higher-quality evidence regarding the indications, timing, and acquisition protocols of clinical MRI studies.

Practical relevance: Inappetence may have many origins and, as a presenting sign or observation in the hospitalised patient, is common in feline practice. Nutritional assessment of every patient is encouraged, to identify the need for, and appropriate type of, intervention indicated. The impact of malnutrition may be significant on the feline patient, perpetuating illness, delaying recovery, slowing wound healing and negatively impacting gut health and immunity. Delayed intervention may result in the cat’s deterioration; hence prompt control of contributing factors such as the underlying illness, pain, nausea, ileus and stress is vital to optimise voluntary food intake. Management is multimodal, comprising reduction of stress, medications and assisted nutrition in the form of tube feeding or parenteral nutrition. Use of antiemetic, analgesic, prokinetic and appetite stimulant medications may restore appetite, but placement of feeding tubes should not be delayed. Feeding tubes are generally well tolerated and allow provision of food, water and medication with minimal stress, although clinicians must be aware of complications such as stoma site infections and refeeding syndrome. Clinical challenges: Cats are vulnerable to malnutrition owing to their unique metabolism and specific nutritional requirements. Moreover, their nature as a species means they are susceptible to stress in the hospital environment, which may result in reduced food intake; previous negative experiences may compound the problem. In particular, an inappropriate clinic environment and/or handling may cause or exacerbate inappetence in hospitalised patients, with negative impacts on recovery. Postponing interventions such as feeding tube placement to await improvement, owing to clinician or caregiver apprehension, may hinder recovery and worsen nutritional deficits. Evidence base: The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM). Information is based on the available literature, expert opinion and the panel members’ experience.

PurposeThis article examines the ways in which the popular music industry markets artists through integrated transmedia marketing campaigns. These campaigns unfold across multiple media and create multiple pathways for audience engagement, particularly fan engagement, across social media platforms. The purpose is to further theorise the relationship between artists, the music industry and audiences.Design/methodology/approachThe study used digital ethnography to scrutinise the activities within a contemporary music transmedia marketing campaign, focusing on the release of Taylor Swift's album Reputation as an illustrative case.FindingsThe study demonstrates how strategically curated activities encompass platforms' affordances and industry events by making use of fan engagement across social media platforms and streaming services. Fans shift through platforms, as well as across digital and physical spaces, through defined marketing activities at specific times. This article proposes the concept of choreographed engagement to specifically address the ways in which the temporal and spatial aspects of social media marketing are used at the intersection of platform logic, algorithm economy and fan engagement to reach wider audiences.Originality/valueBy proposing the concept of choreographed engagement, the authors bridge the gap between fan practices and marketing practices, providing insight into how commodification of fan engagement is utilised spatially and temporally within the contemporary platform economy. Choreographed engagement constitutes a significant aspect of strategic communication and marketing. The term expands the vocabulary used in the debate on the commodification of artistic work, and audience engagement in the platform era.

Linda Ryan, a Veterinary Technician Specialist in Behaviour, and in Oncology, and a Certified Clinical Animal Behaviourist, offers advice on making your clinic ‘dog-friendly’, highlighting in-clinic considerations to help reduce the stress canine patients experience when visiting your practice.

Despite the benefits of utilising community-based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/ patterns within participants’ subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP’s awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user-centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly.

This article presents an action-research study investigating a spatially sensitive innovation process of place-based experiences in a rural area of Sweden. Lately, there have been a growing number of initiatives focused on developing location-aware mobile media – geomedia technologies – to offer place-based digital experiences within tourism. Drawing on contemporary critical studies on geomedia technologies, we stress the importance of reflecting upon the implications of place-based technologies to minimise both the negative impacts on a place and the neglect of local perspectives. We conducted action-research interventions to unpack the complexity of developing place-based mediated experiences. The study makes an illustrative case of how interventions lead to more nuanced development processes of geomedia technologies while simultaneously fostering creativity. We argue that as action research allows researchers to intervene in media innovations, it identifies models for more nuanced place-based development processes, including local spatial and sociocultural perspectives.

Action Camera Choreography is an artistic practice that utilizes wearable technology (primarily, but not limited to, action cameras) in dance. It produces a simultaneous physical and virtual performance that blends live performance and live video. This exposes an innate tension in dance/technology work: that a physical body, when coerced to a non-physical medium, is both more and less intimate than its physical counterparts. In contrasting both iterations of embodiment (the physical and the non-), the practice attempts to reconcile this tension and directly involve the viewer in the act of resolution - or, barring this, a recognition that the juxtaposition exists at all. Action Camera Choreography has been used in 6 performances and 2 teaching series in the last 2 years, engaging audiences and prompting introspection to the way one interacts with technology, intimacy, and personhood in performance settings and daily life. More work is needed to pinpoint the specific successes and failures of the methodology as an iterative artistic practice, teaching tool, and performance series. Future sub-topics of interest include the role of the observer in either differentiating or synthesizing the physical and digital components; and the implications of visibility in reference to certain performers (e.g. queer bodies).

Awareness for improving patients’ veterinary experiences is growing. A patient-friendly approach is not only considered better for our patients, but it makes working with them easier and safer for ...

There are many aspects of care involved in patient-friendly practice. Veterinary professionals may utilise recognition and response to canine and feline body language and behavioural signals to affect patient-friendly practice and improve safety in the context of the veterinary environment. Visits to the veterinary clinic are potentially stress-inducing for many reasons. Stress and distress have potentially problematic physical and emotional impacts on patients, both in health and disease, and therefore recognition and pre-emption of problems could reduce the impact of escalating stress during veterinary interactions.

This book introduces and develops the concept of geomedia studies as the name of a particular subfield of communication geography. Despite the accelerating societal relevance of 'geomedia' technolo ...

Artists out of Place : The Invalidation of Network Capital in a Small-Town Cultural Community

Manufacturing companies are increasingly moving up the value chain by expanding their value offering to include service components, namely Product Service Systems (PSS). Due to the fundamental differences between the provision of products and services, many struggle to effectively integrate the two into a single cohesive offering. This is particularly true of companies operating in the medical device field as, due to the high level of regulatory requirements and controls, implementation of the ‘soft' components of service provision is difficult. The aim of the research is to facilitate companies to move up the value chain from product to product-service provision. Once identified, barriers can then be directly addressed and overcome, thereby allowing the development of a cohesive PSS offering. This will be achieved by identifying existing cultural barriers in relation to the application of PSS strategy within a product-orientated business. This information can be used to facilitate the application of PSS models with produc-orientated companies. This paper details qualitative research, undertaken with eight product-orientated medical device companies and two service practitioners, which establishes, details and analyses the primary cultural barriers in relation to product to product-service transition. These cultural barriers are further extrapolated through a supporting literature research.

A one-day Watson’s caring theory educational seminar was presented to 10 staff nurses from a community hospital with the intent to improve patients’ perception of care. A quasi-experimental design was employed, using descriptive statistics and t tests to compare measures of perceptions of care pre and post the educational session. A statistically significant increase in nurse’s confidence in caring attitudes and behaviors was found as measured by the caring nurse patient interaction scale nurse version (CNPI-70N). Increases in Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores for nurses, on treating patients with courtesy and respect and for nurses listening carefully to patients, were also realized for the majority of units involved.

This article visits the subject of nasal lymphoma in cats, its incidence, presenting signs, treatment options and nursing care. Lymphosarcoma, or lymphoma, is a systemic, round cell cancer, which arises from lymphoid tissues. Whilst multicentric lymphoma is more commonly diagnosed in dogs, it is more usual for cats to present with a specific anatomical site affected. Lymphoma is the most commonly diagnosed cancer in the nasal cavity, although nasal lymphoma is a relatively uncommon tumour. Nasal lymphoma is termed an extranodal lymphoma, commonly affecting older cats, and representing 5 – 10% of anatomic-specific lymphoma cases. Presenting signs are a consequence of the anatomical location of the tumour and its local effects. Diagnostics for nasal lymphoma follow a stepwise approach to initially establish a general health profile of the individual patient, as well as more specific modalities, including advanced imaging. A variety of treatment options may be employed and will depend on the grade a...

Cost, quality and technology leadership are no longer sufficient for businesses to secure critical advantage. Instead, differentiations are being provided through the supply of innovative services, which can rapidly develop into a firm’s unique selling proposition. However, although services can provide additional competitive advantage, the inherent differences between product and service can cause difficulty in the effective integration of the two processes. Services are dominated by intangible elements which can be difficult to perceive and quantify. Within the medical device industry, the growing focus on usability, patient safety and increasing regulatory requirements has further complicated the already complex development process. In order to meet regulations, development is undertaken within strict boundaries to produce tightly controlled outputs. It can be seen that there is an incongruity between the nature of medical device development and the service development processes. This paper explores the constraints and inhibitors of service creation within the context of the medical device industry. Service innovation and its application is discussed. Difficulties in the addition of a service element and their potential solution within a medical device context are explored.

In a pilot developmental neurotoxicity study, a protocol was designed to utilize three-dimensional magnetic resonance (MR) images for linear and volumetric measurements of the developing rat brain. MR imaging, because of its non-destructive nature, provides a complement to traditional optical microscopy. Sprague–Dawley dams received 0, 1.25, 4.0 or 7.5 mg/kg methylazoxymethanol acetate (MAM) by intraperitoneal injection during gestation days 13–15. At postnatal days (PND) 23 and 60, brains from representative male and female rats from two dams in each dose group were fixed with 10% neutral buffered formalin by transcardial perfusion for in situ MR imaging. A 7 T small animal magnet system was used to obtain isotropic images at 100 μm resolution for PND 23 and 150 μm resolution for PND 60. Data from a rapid screening method based on midpoint MR slices of whole brain, cerebrum, cerebellum, and hippocampus showed a dose-related decreased volume of whole brain, cerebrum, and hippocampus in treated rats. Subsequent volumetric estimates using the Cavalieri method confirmed these findings. The brains were subsequently removed and processed for conventional histologic examination of hematoxylin and eosin-stained sections. It is concluded that MR imaging in rat developmental neurotoxicity studies offers the advantages of in situ volumetric measurements of brain structures while preserving the samples for conventional optical microscopy.

Purpose The purpose of this study was to determine if patients would perceive a numbing spray to be an effective method of anesthetizing an intravenous (IV) site. Design A quasi-experimental design was used. Methods The first 50 patients were given no pain management strategy before their IV insertion, and the next 50 patients were given a numbing spray. Findings The hypothesis that pain scores reported from the numbing spray group would be less than pain scores reported from the non-numbing spray group was not supported. Conclusion The numbing spray is an effective method of anesthetizing an IV site based on both groups' responses to the other research questions. Both groups indicated they would try a numbing spray with future IV insertions, would prefer a numbing spray over a numbing injection, and were satisfied with their IV insertion. Patients wanted a less intrusive method than intradermal lidocaine.

Nurses in all settings care for patients who have underlying alcohol dependencies. Approximately 18-20% of patients in ambulatory settings have alcohol abuse or dependency problems, and 30-50% of all hospital admissions are related to the effects of alcohol abuse. Yet clinicians practicing in hospitals frequently have minimal training in the field of chemical dependency. Nurses practicing in general acute care facilities must assess for and intervene with the withdrawal process when alcohol-dependent patients are hospitalized for medical or surgical treatment. This study hypothesized that, if an alcohol withdrawal program were instituted in a medical surgical setting, patient outcomes might be improved. An alcohol program was developed and instituted at a large urban, teaching, community hospital. Variables were compared between the alcohol abusive/dependent populations preprogram and post-program implementation. The results demonstrated a 78% reduction in the occurrence of delirium tremens, a 67% reducti...

The author describes how deciding when a software product is ready for release is being made easier by a program package that automatically collects data from beta testers so developers can know exactly who has tested which features on what platforms.

Resilience, the ability to maintain or regain positive levels of functioning despite adversity, is one of several strengths that can assist people in positive life adaptation. Midlife (35 - 60 years) is a period when individuals need to adapt to several major changes and challenges. However, no scale exists to measure resilience specifically in the midlife population. Therefore, this study develops a new scale to measure resilience in midlife. The RIM scale consists of 25 items, each self-rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to a sample of 130 men and women, aged 35 - 60 years, from the normal population. The reliability, validity and factor analytic structure of the scale were evaluated, and reference scores established. The RIM scale demonstrated sound psychometric properties and factor analysis yielded five factors. The RIM scale has potential utility in clinical and research settings.

The liver is structurally and functionally complex and has been considered second only to brain in its complexity. Many mysteries still exist in this heterogeneous tissue whose functional unit of the lobule has continued to stump morphologists for over 300 years. The primary lobule, proposed by Matsumoto in 1979, has been gaining acceptance as the functional unit of the liver over other conceptual views because it’s based on vessel architecture and includes the classic lobule as a secondary feature. Although hepatocytes comprise almost 80% of the liver, there are at least another dozen cell types, many of which provide “cross-talk” and play important functional roles in the normal and diseased liver. The distribution and functional roles of all cells in the liver must be carefully considered in both the analysis and interpretation of research data, particularly data in the area of genomics and “phenotypic anchoring” of gene expression results. Discoveries regarding the functional heterogeneity of the various liver cell types, including hepatocytes, hepatic stellate cells, sinusoidal endothelia, and Kupffer cells, are providing new insights into our understanding of the development, prevention and treatment of liver disease. For example, functional differences along zonal patterns (centrilobular or periportal) have been demonstrated for sinusoidal endothelium, Kupffer cells, and hepatocytes and can explain the gradients and manifestations of disease observed within lobules. Intralobular gradients of bile uptake, glycogen depletion, glutamine synthetase, and carboxylesterase by hepatocytes; widened fenestrations in centrilobular sinusoidal lining cells; and differences in the components of centrilobular extracellular matrix or function of Kupffer cells have been demonstrated. Awareness of the complexities and heterogeneity of the liver will add to a greater understanding of liver function and disease processes that lead to toxicity, cancer, and other diseases.