This study examined couples' (N = 94) behavior resulting from two proximal change interventions. One was a spousal "compliments intervention" to increase positivity, and the other was a "criticize intervention" to increase negativity. Participants were randomly assigned to one of the two intervention conditions or a control group. There was no main effect in affect from the pretest conflict discussion to the posttest conflict discussion between the interventions or control group. However, a manipulation check on how couples acted during either intervention produced a significant interaction effect. Pretest affect during conflict and marital satisfaction significantly predicted couples' construal of the intervention. Professionals may need to monitor how couples use specific interventions and direct the processes how the intervention is construed by the couple.

Objective: Explore patient and dietitian experiences with a multi-component dietary weight loss program for knee osteoarthritis to understand enablers and challenges to success at 6-months.

Design: Qualitative study embedded within a randomised controlled trial. Semi-structured individual interviews with 24 patients with knee osteoarthritis who undertook, and five dietitians who supervised, a weight management program (involving a ketogenic very low calorie diet (VLCD), video consultations, educational resources) over six months. Data were thematically analysed.

Results: Five themes were developed: i) ease and convenience of program facilitated adherence (structure and simplicity of the meal replacements; not feeling hungry on diet; convenience of consulting via video) ii) social and professional support crucial for success (encouragement from partner, family, and friends; guidance from, and accountability to, dietitian; anxiety around going at it alone) iii) program was engaging and motivating (determination to stick to program; rapid weight loss helped motivation) iv) holistic nature of program was important (suite of high-quality educational resources; exercise important to compliment weight loss) v) rewarding experience and lifelong impact (improved knee pain and function; positive lifestyle change).

Conclusions: Patients and dietitians described positive experiences with the weight management program, valuing its simplicity, effectiveness, and convenience. Support from dietitians and a comprehensive suite of educational resources, incorporated with an exercise program, were considered crucial for success. Findings suggest this multi-component dietary program is an acceptable weight loss method in people with knee osteoarthritis that may benefit symptoms. Strategies for supporting long-term independent weight management should be a focus of future research.

Keywords: Osteoarthritis; diet; dietitian; ketogenic; knee; obesity; overweight; pain; qualitative; weight loss.

A patient shouts what he suspects is my racial background at my face. A colleague repeats a patient's racist remarks against me; I lurk in my whiteness to cope. A compliment about my Asianness lands as a racist devaluation of both sides of my heritage. The medical licensing board does not include my race on its registration form. Straddling the boundary of Asian and White as a biracial female psychiatrist, I struggle to handle exoticization, discriminatory assumptions, and subtle marginalization by patients and colleagues. I grapple with the privilege of light-skinned ethnic ambiguity vs the disrespect for having features deviating from the imagined physician appearance. In this piece, I introduce a nuanced dialog about race and advocate for recognition and inclusion of biracial and multiracial minority medical practitioners who defy oversimplified racial categories.

Keywords: biracial; discrimination; physician; minorities; multiracial; race; racism.

Pressure ulcer prevention in the seated patient is a neglected area. The early rehabilitation of bed-bound patients has reinforced the need for suitable seating to compliment pressure-reducing mattresses. Medical Support Systems has developed a hospital chair, the Flo-tech Adjuster, which addresses the problems of both pressure ulcer prevention and manual handling. The launch of the Flo-tech Adjuster has followed many years of research and constant refinement and improvement, and has filled a gap in the market for pressure-relieving devices.

Long term wheelchair usage has been related to a number of problems, among which pressure ulcers are one of most concern. The design of wheelchair seat cushions has been of increasing interest among researchers, as it can influence seat interface pressure and user's comfort. The aim of this study was to investigate the subjects' perception comfort, stability and body posture of six different commercially available wheelchair cushions. The evaluation was through a questionnaire, where the subjects rate their perceptions on a ten point visual analog scale after staying seated in the cushion for two minutes. The results shows that the Roho^TM aircell cushion was preferred by the users, while the least preferred one was the water cushion. Individuals' subjective perceptions may compliment objective data on seat interface pressure, thus contributing to a more complete view of the users' experience during wheelchair cushion usage.

Biopsy material of the gingiva obtained from 15 patients with alveolar pyorrhea and 5 persons comprising a control group at the age of 20 to 40 years were investigated by direct immunofluorescent method with the use of labeled fluorescein-isothiocyanatoms of rabbit antisera against IgG and C3 (the third component of compliment) of man, as well as histologically. Clinically, the degree of severity of the lesion was determined by the Russell's index (1956): 0--healthy persons (25%), 1--moderate gingivitis (5%), 2--gingivitis (10%), 6--parodontitis (55%), 8--severe parodontitis (5%). Histologically, mild, moderate, and severe forms of alveolar pyorrhea were singled out. The mild degree of lesion was noted in 30%, moderate--in 15%, and severe--in 45% of patients. The mild form corresponded to 0, 1, and 2, and the severe form--to 6 and 8 according to the Russell's index. In all observations, control including, the presence of IgG in cells of the connective tissue and inside the epithelium was noted. Positive reaction to C3 was observed only in diseased persons, being most pronounced in severe forms of histopathological changes and maximal clinical manifestations.

OBJECTIVE

To analyze clinical and laboratory features of cryoglobulinemic vasculitis (CGEV) associated with HCV infection.

METHODS

We examined 61 patients with clinical manifestation of CGEV in 2006-2011. CGEV was associated with autoimmune diseases in 31 patients (51%), with HCV infection in 21 patients (34.4%), essential (idiopathic) ctyoglobulinemia in 8 patients (13%) and lymphoproliferative diseases in 1 patient (1.6%). 21 patients with HCV-associated CGEV were studied for main clinical and laboratory manifestations of the disease. Kidney and liver involvement was confirmed morphologically and immunomorphologically. Electroneurophysiological investigation evaluated peripheral nervous system involvement. Biopsy of parotid, lacrimal glands., peripheral lymph nodes, splenectomy and bone marrow trephine biopsy with morphological study and immunohistochemistry were used to identify type of lymphoma. Characteristics of monoclonal secretion were assessed with high-resolution electrophoresis in agarose gel with subsequent immunofixation of sera and concentrated urine.

RESULTS

Liver involvement was detected in 66% of patients with HCV-associated CGEV 34% patients were chronic HCV carriers with persistently normal liver function tests. Common rheumatologic manifestations of HCV-associated CGEV were skin lesions (90%), arthralgia (85%), frequent peripheral nervous system involvement (52%) and glomerulonephritis (38%). Prevalent immunological markers of CGEV associated with HCV were mixed monoclonal cryoglobulinemia with rheumatoid factor activity (62%), rare polyclonal (34%) and olygoclonal (4%) cryoglobulinemia, low levels of C4 compliment fraction (80%). Patients with mixed monoclonal cryoglobulinemia often developed clinical manifestations of Sjögren's syndrome (23%) and malignant lymphoproliferative diseases (14%). CGEV is a prognostically adverse sign in HCV infected patients and caused death of 14% patients even in a short period of follow-up (1-2 years).

BACKGROUND

Barrett's oesophagus (BO) is a premalignant condition associated with the development of oesophageal adenocarcinoma (OAC). Despite the low risk of progression per annum, OAC is associated with significant morbidity and mortality, with an estimated 5-year survival of 10%. Furthermore, the incidence of OAC continues to rise globally. Therefore, it is imperative to detect the premalignant phase of BO and follow up such patients accordingly.

CONCLUSIONS

The mainstay diagnosis of BO is endoscopy and biopsy sampling. However, limitations with white light endoscopy (WLE) and undertaking biopsies have shifted the current focus towards real-time image analysis. Utilization of additional tools such as chromoendoscopy, narrow-band imaging (NBI), confocal laser endomicroscopy (CLE), and optical coherence tomography (OCT) are proving beneficial. Furthermore, it is also becoming more apparent that often these tools are utilized by experts in the field. Therefore, for the non-expert, training in these systems is key. Currently as yet, the methodologies used for training optimization require further inquiry.

UNASSIGNED

(1) Real-time imaging can serve to minimize excess biopsies. (2) Tools such as chromoendoscopy, NBI, CLE, and OCT can help to compliment WLE.

CONCLUSIONS

WLE is associated with limited sensitivity. Biopsy sampling is cost-ineffective and associated with sampling error. Hence, from a practical perspective, endoscopists should aim to utilize additional tools to help in real-time image interpretation and minimize an overreliance on histology.

Objective: The aim of this study was to investigate the utilization of a portable functional near-infrared spectroscopy (fNIRS) system, the fNIRS Pioneer^TM, to examine team experience in high-fidelity simulation-based crisis event management (CEM) training for anesthesiologists in operating rooms. Background: Effective evaluation of team performance and experience in CEM simulations is essential for healthcare training and research. Neurophysiological measures with wearable devices can provide useful indicators of team experience to compliment traditional self-report, observer ratings, and behavioral performance measures. fNIRS measured brain blood oxygenation levels and neural synchrony can be used as indicators of workload and team engagement, which is vital for optimal team performance. Methods: Thirty-three anesthesiologists, who were attending CEM training in two-person teams, participated in this study. The participants varied in their expertise level and the simulation scenarios varied in difficulty level. The oxygenated and de-oxygenated hemoglobin (HbO and HbR) levels in the participants' prefrontal cortex were derived from data recorded by a portable one-channel fNIRS system worn by all participants throughout CEM training. Team neural synchrony was measured by HbO/HbR wavelet transformation coherence (WTC). Observer-rated workload and self-reported workload and mood were also collected. Results: At the individual level, the pattern of HbR level corresponded to changes of workload for the individuals in different roles during different phases of a scenario; but this was not the case for HbO level. Thus, HbR level may be a better indicator for individual workload in the studied setting. However, HbR level was insensitive to differences in scenario difficulty and did not correlate with observer-rated or self-reported workload. At the team level, high levels of HbO and HbR WTC were observed during active teamwork. Furthermore, HbO WTC was sensitive to levels of scenario difficulty. Conclusion: This study showed that it was feasible to use a portable fNIRS system to study workload and team engagement in high-fidelity clinical simulations. However, more work is needed to establish the sensitivity, reliability, and validity of fNIRS measures as indicators of team experience.

The highest compliment a patient can give a dental staff is to say that they make him or her feel like part of the "family." Building this kind of positive long-term patient relationship begins with the first telephone contact. Taking the time to fully "immerse" the patient in the practice through confidence- and communication-building steps will help create a fulfilling patient-staff relationship.

We read with interest the news item 'Complementary therapy first' (June 15) regarding another centre for complementary therapies and research and would like to draw attention to the services offered at The Royal London Homeopathic Hospital NHS Trust. Based in Great Ormond Street, homeopathy and complementary therapies are and have been available on the NHS for many years.

Periodic flow inversions have been shown as an effective means to eliminate both density (D system) and size (S system) segregation. The frequency of these inversions, however, is the key to applying this technique and is directly related to the inverse of the characteristic time of segregation. In this work, we study size segregation (S system) and adapt a size segregation model to compliment existing work on density segregation and, ultimately, aid in determining the critical forcing frequency for S systems. We determine the impact on mixing and segregation of both the binary size ratio and the length of each leg of a "zigzag chute". Mixing is observed when L < U tS, where L, U, and t(S) denote the length of each leg of the zigzag chute, the average streamwise flow velocity of the particle, and the characteristic time of segregation, respectively.

A system, to collect, analyse and display biological data, is developed using IBM PC AT compatibles (PCs) or CED1401/1609 devices networked to a VAX environment. It can be operated in three separate modes: using the CED/IEEE/VAX network; using the PC/Ethernet/VAX network; as a standalone PC. The original system comprised CED 1401/1609 data collection devices running on the IEEE bus. This has been superseded by a PC-286 or better incorporating an analogue-to-digital convertor (DT2824-PGH) and a communications interface board (DEPCA) linked by thinwire Ethernet (ThinWire) running DECnet with their product network application software PCSA. This network has not only doubled the original throughput but has also removed the two major IEEE constraints: 4 m between devices and the physical linking of devices to the VAX. The PCs are logically linked to clustered VAXes on Ethernet, giving flexible networking supporting multiple ThinWire segments, each supporting a maximum of 30 PCs per 185 m segment length. As the enhanced design compliments the original, both may operate concurrently, appear similar in operation to the user and use the same analysis software, all of which help reduce the rate of system obsolescence.

Language plays an important role in romantic attachment. However, it is unclear whether the structure and topic of language use might influence potential mate choice. We investigated 124 female students' preference for compliments paid by males incorporating either literal or metaphoric (conventional/novel) language and targeting their appearance or possessions (house) throughout their menstrual cycle. Male faces paired with novel metaphorical compliments were rated as more attractive by women than those paired with literal ones. Compliments targeting appearance increased male attractiveness more than possessions. Interestingly, compliments on appearance using novel metaphors were preferred by women in a relationship during the fertile phase but by single women during the luteal phase. A similar pattern of altered face attraction ratings was subsequently shown by subjects in the absence of the verbal compliments and even though they were unable to recognize the faces. Thus the maintained attraction bias for faces previously associated with figurative language compliments appears to be unconscious. Overall this study provides the first evidence that women find men who typically use novel metaphorical language to compliment appearance more attractive than those using prosaic language or complimenting possessions. The evolutionary significance for such a language use bias in mate selection is discussed.

Objectives: An impactor is a standard instrument that applied for particle deposition assessment in the pharmaceutical aerosols. It provides data comparison between inhaler formulations. However, the deposition pattern in the impactor is not clearly understood. In practice monodisperse aerosols were employed to calibrate the impactor.

Materials and methods: This study used polydisperse aerosols together with the computer simulation to track the particles in the impactor to understand the deposition pattern. Particles deposited on each stage of the Andersen cascade impactor were compared with its stage cut-off diameter using polydisperse aerosols by three particle sizing techniques. The relationship of cut-off diameter with particle size distribution was established for each stage. Also, the computational verification was used to complement the real experiments.

Results: Projected diameters from microscope images showed that the size of particles varied on the stage's collection plate, and the median size of each stage decreased along the lower stages from 8.53 to 0.92 μm. The median sizes measured by laser diffraction were close to the impactor's cut-off diameters. In silico data showed that the outlet mass fractions gradually changed in size towards the lower stages.

Conclusion: Polydisperse aerosols and in silico computer fluid dynamics may compliment to standard calibration method.

Keywords: Particle size distribution; andersen cascade impactor; computer fluid dynamic; polydisperse aerosols.

This article discusses a survey of the nursing care of older people with mental health problems in inpatient units. The survey considered assessment and care planning, record keeping, the environment, staff, user and carer feedback, staffing systems, compliments, complaints, incidents, dementia care mapping, and a clinical supervision and training needs audit. Practice development work, undertaken to ensure that the project's recommendations were implemented, is also described.