While conducting a study on the costs and benefits of electronic health records (EHRs) in solo and small group practices, use of the EHR to improve quality of care emerged as an important issue. An on-line provider survey was conducted to compliment our qualitative data. We found providers using an EHR were quite proficient at replicating their paper processes, but were less apt to use EHR features designed to improve quality of care.

Baumeister, Tice, and Hutton proposed that individuals with low self-esteem (LSEs) adopt a more cautious, self-protective self-presentational style than individuals with high self-esteem (HSEs). The authors predicted that LSEs' self-protectiveness leads them to be less expressive--less revealing of their thoughts and feelings--with others than HSEs, and that this self-esteem difference is mediated by their perceptions of the interaction partner's regard for them. Two correlational studies supported these predictions (Studies 1 and 2). Moreover, LSEs became more expressive when their perceived regard was experimentally heightened--when they imagined speaking to someone who was unconditionally accepting rather than judgmental (Study 3) and when their perceptions of regard were increased through Marigold, Holmes, and Ross's compliment-reframing task (Study 4). These findings suggest that LSEs' expressiveness can be heightened through interventions that reduce their concerns about social acceptance.

We present negative ion-mode simulations within the QCEIMS program [Grimme, Angew. Chem., Int. Ed., 2013, 52, 6306]. It is an exhaustive and robust ab initio molecular dynamics/stochastic algorithm used to perform simulations of unimolecular decomposition of anions, in unprecedented detail. The objective of this approach is to compliment electron attachment spectroscopy and aid in the interpretation of relevant dissociation dynamics. Prototypical simulations are performed for the four nitrile compounds acetonitrile, cyanamide, aminoacetonitrile, and trifluoroacetonitrile. The unique decomposition pathways which naturally occur in the simulations are addressed along with fractional yields, reaction times and relative intensities of the fragments. Furthermore, trajectories of selected decomposition pathways of the aminoacetonitrile anion are investigated in greater detail, where we find that the relevant HOMO of the anion has a mixed π* and σ* character delocalized over the entire molecule.

Internet referrals provide a potential solution to limited staff time in emergency departments for health education. One hundred fifteen adolescents were surveyed and referred to a violence prevention website; 22% logged on the website. Although this study bears replication, Internet referral may be a low-intensity intervention that could compliment other violence prevention strategies among adolescents.

Two computer modeling techniques have been developed that aid in the selection of optimal magnetic resonance imaging (MRI) pulse sequences and timing intervals for specific clinical situations. The "parameter sensitivity" technique provides a means of selecting three separate MRI scans which are individually sensitive to changes in each of the three NMR tissue parameters N, T1, and T2. The "contrast" technique allows selection of a single optimal MRI sequence using the expected changes in all three tissue parameters simultaneously. Excellent correlation is demonstrated between the models and images obtained in a normal volunteer and in a patient with multiple sclerosis. The two methods compliment each other; the parameter sensitivity method is most useful in situations where subtle changes in tissue parameters are expected, whereas the contrast method is suited to circumstances where large differences in tissue parameters are anticipated and the magnitude and direction of these changes are known.

Three-dimensional (3D) ultrasound plays an important role in obstetrics, predominantly for assessing fetal anatomy. Presenting volume data in a standard anatomic orientation valuably assists both ultrasonographers and pregnant patients to recognize the anatomy more readily. Three-dimensional ultrasound is advantageous in studying normal embryonic and/or fetal development, as well as providing information for families at risk for specific congenital anomalies by confirming normality. This method offers advantages in assessing the embryo in the first trimester due to its ability to obtain multiplanar images through endovaginal volume acquisition. Rotation allows the systematic review of anatomic structures and early detection of fetal anomalies. Three-dimensional ultrasound imaging in vivo compliments pathologic and histologic evaluation of the developing embryo, giving rise to a new term: 3D sonoembryology. Rapid technological development will allow real-time 3D ultrasound to provide improved and expanded patient care on the one side, and increased knowledge of developmental anatomy on the other.

Fish screens can help prevent the entrainment or injury of fish at irrigation diversions, but only when designed appropriately. Design criteria cannot simply be transferred between sites or pump systems and need to be developed using an evidence-based approach with the needs of local species in mind. Laboratory testing is typically used to quantify fish responses at intake screens, but often limits the number of species that can studied and creates artificial conditions not directly applicable to screens in the wild. In this study a field-based approach was used to assess the appropriateness of different screen design attributes for the protection of a lowland river fish assemblage at an experimental irrigation pump. Direct netting of entrained fish was used along with sonar technology to quantify the probability of screen contact for a Murray-Darling Basin (Australia) fish species. Two approach velocities (0.1 and 0.5 m.sec(-1)) and different sizes of woven mesh (5, 10 and 20 mm) were evaluated. Smaller fish (<150 mm) in the assemblage were significantly more susceptible to entrainment and screen contact, especially at higher approach velocities. Mesh size appeared to have little impact on screen contact and entrainment, suggesting that approach velocity rather than mesh size is likely to be the primary consideration when developing screens. Until the effects of screen contacts on injury and survival of these species are better understood, it is recommended that approach velocities not exceed 0.1 m.sec(-1) when the desire is to protect the largest range of species and size classes for lowland river fish assemblages in the Murray-Darling Basin. The field method tested proved to be a useful approach that could compliment laboratory studies to refine fish screen design and facilitate field validation.

BACKGROUND

Supportive interventions for enhancing dietary intake in malnourished or nutritionally at risk adults are frequently recommended. A recent systematic review of randomised controlled trials identified limited and poor quality evidence to support their use. Observational studies have been shown to compliment and extend their evidence. This review aimed to synthesise evidence from nonrandomised studies aiming to improve nutritional intake in nutritionally vulnerable individuals and to describe their effects on cost, nutritional, clinical and patient centred outcomes.

METHODS

Systematic searches of 10 electronic databases were undertaken to May 2013. Reference lists of identified studies and systematic reviews were scrutinised and hand searching of relevant meeting abstracts was undertaken. Titles and abstracts were reviewed, data extracted by two research-ers working independently and summarised using a structured narrative format.

RESULTS

Forty-one studies (n = 3751 participants) were identified for inclusion. Interventions identified included changes to the organisation of nutritional care (n = 15), changes to the feeding environment (n = 11), modification to meals (n = 6), supplementation of meals (n = 7) and recipients of home delivered meals (n = 2). Eighteen of 23 studies reported improvements in nutritional intake; however, effects on nutritional status, clinical outcomes and costs were reported in few studies and findings were inconsistent. Eighteen studies reported patient experience, highlighting benefits to nutritional status most commonly as judged by the carers but the methods used lacked rigour.

CONCLUSIONS

This systematic review describes a range of interventions that may be implemented in clinical practice. A limited range of outcomes are reported and it is difficult to draw any meaningful conclusions on the effect of the different methods.

OBJECTIVE

To know the underlying dimensional structure of personality disorders in the MCMI-II through factor analysis.

METHODS

A sample of 749 patients who start a treatment by substance abuse or dependence, according to DSM-IV criteria, compliment the MCMI-II, once free of the direct influences (intoxication, withdrawal) of abuse drugs. Their answers in the MCMI-II were studied, through first and second order factorial analysis.

RESULTS

An initial factorial solution of 46 components is obtained. The first of them refers to changes experienced in last years, explaining 25.51% of the variance. A second order factor analysis groups the former factors in 7 components. The first of them reunites symptoms of Axis I around the components of change in two last years and in the last months and weeks (14.17% of the total variance). The other components reflect those dimensions usually found in some other factor studies of personality.

CONCLUSIONS

Results show that a wide proportion of the variance in the MCMI-II is better explained by recent changes than stable traits and their extreme combinations. As these results are obtained in substance addict population, it is suggested part of which the MCMI-II measures can be referred to changes in personality. These changes may be associated to inadequate answers to stressful environmental factors. They can be also associated to changes in brain functions due to direct or indirect influences of substances on brain locations.

At present, in-vitro bioassays are predominantly being seen as tools to identify, through screening programs, whether or not individual chemical compounds have an effect on the endocrine system. However, as the techniques mature, they are likely to find use in the future in monitoring of discharges to the environment for any biological effect and will compliment the range of chemical and biological techniques also available for monitoring environmental quality. Such an approach has already been utilised by a number of workers to fractionate mixtures (e.g. final effluents from STW), to isolate the oestrogenically active components and subsequently identify the compounds which are active. This paper reviews the present state of in-vitro techniques for determination of oestrogenic activity and discusses present approaches to their use in environmental monitoring in conjunction with chemical analyses in toxicity identification and evaluation.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy is a congenital disease that may present with sudden cardiac death as the first manifestation. Standards for the difficult clinical diagnosis are the so-called modified Task Force criteria that incorporate imaging-based, electrocardiographic and anamnestic information. Cardiac magnetic resonance imaging (MRI) is the standard technique for imaging of the right ventricle and can compliment the recent ARVD/C diagnosis criteria by providing exact information on right ventricular size and function. It is the most reliable modality available for the detection of right ventricular aneurysms and the quantification of ventricular size. Furthermore, MRI is able to identify areas of fatty or fibrous replacement within the right ventricular myocardium in a non-invasive way. However, a suspicion of ARVD/C cannot be confirmed or excluded based on MRI findings alone. In clinical routine cardiac MRI is an enormously important component in the ARVD/C diagnostic toolbox; however, MRI can only act as one part of the diagnostic puzzle and should exclusively be performed by experienced centers using specifically tailored protocols.

Although the fundamentals of Endovascular Surgery were set down over 30 years ago, only recently has the potential impact of this therapy become readily apparent. Endovascular therapies with new instrumentation for the treatment of arterial aneurysms, occlusions, trauma, and venous thrombotic disorders have progressed dramatically over the past 5 years. Guidewire and catheter techniques for endovascular instrumentation of vessels have also been shown to compliment standard vascular surgical interventions. The need for vascular surgeons to obtain the knowledge and professional skills to perform wire and catheter techniques is essential to convert the professional "threat" of endovascular surgery to a future of "opportunity."

The correlations between different quantum-mechanical degrees of freedom of molecular species dictate their chemical and physical properties. Generally, these correlations are reflected in the optical response of the system but in low-order or low-dimensionality measurement the signals are highly averaged. Here, we describe a novel four-dimensional coherent spectroscopic method that directly correlates within and between the manifold of electronic and vibrational states. The optical response theory is developed in terms of both resonant and non-resonant field-matter interactions. Using resonance to select coherences on specific electronic states creates opportunities to directly distinguish coherent dynamics on the ground and electronically excited potentials. Critically, this method is free from lower-order signals that have plagued other electronically non-resonant vibrational spectroscopies. The theory presented here compliments recent work on the experimental demonstration of the 4D spectroscopic method described. We highlight specific means by which non-trivial effects such as anharmonicity (diagonal and off-diagonal), mode-specific vibronic coupling, and curvature of the excited states manifest in different projections of the 4D spectrum.

OBJECTIVE

The Canadian Occupational Performance Measure (COPM) is an outcome measure of clients' self perceptions of performance and satisfaction with occupational performance and is widely used in paediatric research. The aim of this study was to explore how a new outcome measure, the Belief in Goal Self-Competence Scale (BiGSS), was perceived by paediatric occupational therapists to compliment the COPM as a way of documenting client confidence in goal pursuit.

METHODS

Two hundred and forty-one occupational therapists participated in an online survey through paediatric listserv groups and professional networks. Therapists' views about goal setting and the utility of the BiGSS were analysed descriptively and open ended questions were analysed thematically.

RESULTS

Overall, goal setting was viewed as a highly important aspect of therapy (n = 221, 90.7%) although only 22% (n = 52) of respondents indicated using formal goal setting tools. For the subset of respondents who frequently used the COPM (n = 101, 42%) almost all (97.87%) indicated that they would find the BiGSS to be moderately or highly useful to their current practice. Suggestions for improvement of the measure involved wording and formatting.

CONCLUSIONS

This study supports existing evidence that goal setting is highly valued by occupational therapists, however, formal tools are not always used. There was preliminary support for a measure such as the BiGSS as a means of documenting children's and families confidence in goal pursuit.

Instructors are increasingly integrating interprofessional education (IPE) activities into academic programs to address curricular demands. IPE aims to increase the quality of collaborative services provided to patients. This article describes a case-based IPE activity designed for occupational therapy and speech-language pathology graduate students. This activity was designed as a small-scale integration of IPE to compliment large scale, multi-discipline learning activities. Students from two courses participated in an IPE activity that included one online and one in-class activity. The purpose of the activity was for students to gain knowledge of their respective roles in augmentative and alternative communication services. Students perceived increased knowledge and skills following this activity. Despite the somewhat small scale of this educational intervention, the instructors viewed the activity a valuable addition to their courses.

Multiparametric MRI (mpMRI) is currently the test of choice for imaging sites of prostate cancer located within the pelvis. However, molecular imaging with PET radiotracers that bind to prostate-specific membrane antigen is increasingly being used for this purpose and may compliment mpMRI findings. We present a case of a 59-year-old man with elevated postprostatectomy serum prostate-specific antigen level who was found on both mpMRI and prostate-specific membrane antigen-targeted PET to harbor residual prostate cancer in the corpus spongiosum along the proximal urethra.

The advent of PCR technology and use of short tandem repeat (STR) loci improves throughput and reduces costs whilst a high level of discrimination can be achieved. A new system, comprising seven STRs, was developed to compliment the existing systems. This paper describes the preparation of allelic ladders of the most commonly observed alleles of a new STR multiplex system (third generation; TGM multiplex); all alleles have been sequenced. Meioses studies estimated a mutation rate of 0-0.4% across loci. Statistical independence was investigated by employing exact tests; chi(2)-tests and excess homozygosity tests. The results demonstrated that the allele proportions do not differ from those expected and that there was no consequential dependence between loci. The discriminating power of the system was examined using 295 Caucasian, 140 Afro-Caribbean and 212 Asian unrelated samples, and was found to be approximately 1 in 50 million, 1 in 85 million and 1 in 20 million for each of these groups, respectively.

This paper presents the water and contaminant daily simulation model of the total water cycle, called UVQ. The model has been developed to provide a means for rapidly assessing conventional and nonconventional approaches to providing water supply, stormwater and wastewater services to urban allotments, neighbourhoods and study areas. The model is placed the context of other such models developed internationally through a brief literature review. This is followed by a description of the model and output examples, which is used to illustrate the utility of the model. UVQ is an effective preliminary assessment tool for determining the impacts of urban development options on the total water cycle, as well as the performance of a wide range of non-conventional demand and supply side management techniques. It compliments other aspects of an environmental assessment of options, along with more traditional aspects such as infrastructure costing.

Atomistic simulations have emerged in recent years as an important compliment to experiment for understanding how the properties of ionic liquids are controlled by their underlying chemical structure. The ability to obtain reliable thermodynamic and transport properties from a simulation depends both on the quality of the force field and on the use of a proper simulation method. Properties such as densities and heat capacities may be obtained readily using standard techniques. With more effort and advanced simulation methods, solid-liquid and vapor-liquid phase equilibria may also be determined. Transport properties can also be computed, but the notoriously slow dynamics of many ionic liquid systems means that great care must be taken to ensure that the simulations are accurate.

The results of a self-consistent kinetic model of heating the solar corona and accelerating the fast solar wind are presented for plasma flowing in a nonuniform magnetic field configuration of near-Sun conditions. The model is based on a scale separation between the large transit or inhomogeneity scales and the small dissipation scales. The macroscale instability of the marginally stable particle distribution function compliments the resonant frequency sweeping dissipation of transient Alfvén waves by their induced emission in inhomogeneous streaming plasma that provides enough energy for keeping the plasma temperature decaying not faster than r(-1) in close agreement with in situ heliospheric observations.

Eight persons (7 females & 1 male) with moderately-severe to severe dementia diagnoses residing at an urban healthcare facility, participated in this study. Informed consent procedures were followed and agreed upon by participants and their families. The participants ranged in age from 73-90 years, with an average age of 81 years. An experienced board-certified music therapist led 16 singalong sessions. The sessions were divided into 4 sessions of each of the following 4 conditions in randomized order of presentation: (a) live music of simple guitar accompaniment, (b) live music of complex guitar accompaniment, (c) recorded music of simple guitar accompaniment, and (d) recorded music of complex guitar accompaniment. Results indicated no significant differences in the amount of singing by the group for the 4 conditions. However, there were significant differences in group behavior related to the 4 conditions before and after song presentations, including attention, leaving the group, reading lyrics, compliments, and applause. Implications for music therapy training and programming are discussed.

In this study an easy and efficient assay for simultaneous quantitation of plasma concentrations of probe drugs and their metabolically relevant metabolites for the phenotypic analysis of cytochrome P450 2D6 and 2C19, respectively, has been established. This sensitive method makes use of a simple initial sample preparation, followed by a 6-min automated analysis that includes online solid-phase extraction (SPE), column switching and tandem mass spectrometry. Validation over a concentration range of 1.3-2500 ng/mL for dextromethorphan, omeprazole, dextrorphan and 5'-hydroxyomeprazole was performed with LOQ between 215 and 1145 pg/mL. Intra- and inter-day precision and accuracy over the calibration ranges were within 15% for all analytes with recoveries of greater than 85%. Advantages are small sample volumes required, a robust, sensitive and highly selective method suitable for pre-prescription metabolic screening. This method could compliment or offer an alternative to DNA mutation analysis for determining appropriate dosage regimens for personalised medicine.

We derive rigorous quantum mechanical bounds for the heat current through a nanojunction connecting two thermal baths at different temperatures. Based on exact sum rules, these bounds compliment the well-known quantum of thermal conductance κ_{Q}≡πk_{B}^{2}T/6ℏ, which provides a bound for low-temperature heat transport in all systems, but is saturated only for noninteracting transport. In contrast, our bounds are saturated at high temperatures-but still in the quantum regime-even when interactions are very strong. We evaluate these bounds for harmonic and strongly anharmonic junction models and compare with numerical approaches.

An operation for a herniated disc is successful in the majority of cases. In most patients the pain in the affected leg disappears almost immediately. However in 10-40% of cases the symptoms either do not disappear or recur. In spite of this high complication rate, it is reported that almost 90% of patients are satisfied with the operation. This should be interpreted as a compliment to the attending physician and not as the outcome of the operation. The high rate of symptoms or recurrences after operation calls for better prognostic studies. Based on better predictions, patients and their doctors may make better decisions on treatment.