Educators often find themselves confronted with the need to address health-related problems of chronically impaired students. Specific needs often are demonstrated by chronically impaired individuals. The roles and responsibilities of the classroom teacher with respect to meeting these needs are discussed. In addition, suggestions about how these concerns can be addressed through existing classroom health instruction are offered. Teachers can use the health curriculum to compliment the efforts of parents and health-care providers in informing, supplementing, and reinforcing disabled students' knowledge, attitudes, and skills. In this way, chronically impaired children can be assisted to meet present and future health needs in a manner conducive to optimal growth and development.

Collecting positive feedback can increase nurses' confidence, show improvements in performance and provide a baseline for measuring patient satisfaction. This article describes how nurses on a dementia assessment ward designed, implemented and evaluated a way of collecting compliments, changing staff attitudes to receiving feedback.

In the years between 1800 and 1914, the real beginning of the twentieth century, different etiological theories and models were developed about illnesses which we today know as schizophrenic disorders. Particularly in the German speaking world, in the first third of the nineteenth century many of these followed a religious metaphysical paradigm. Those who paved the way for modern psychiatry represented an etiological concept with varying emphasis on brain pathological, hereditary-degenerative or psycho-dynamic as well as sociogenic perspectives. It has become apparent that psychiatry was always in danger of giving way to reductionist approaches. Every reductionism emphasises merely partial truths. The systemic perspective teaches us that many points of view do not contradict each other but rather compliment each other.

All hospitals and healthcare facilities, JCAHO-accredited and non accredited, must comply with the revised United States Pharmacopeia Chapter 797 standards. For those facilites that met the January 2008 JCAHP deadline, compliance with the revised standards should be relatively simple to accomplish. The revised chapter should be read and a new gap analysis performed to determine the facility's compliance. Investments should be made in good training programs to make sure that everyone, compounding personnel and other hospital staff, is properly trained. The revised American Society of Health-System Pharmacists' guidelines for sterile compounding that will be published and available by 2010 should be obtained and read. This document will be a compliment to United States Pharmacopeia Chapter 797. Finally, the assessment tools and detailed information from United States Pharmacopeia Chapter 797 should be utilized to develop a good quality-assurance program for your hospital or healthcare facility.

The nature and characteristics of self-directed learning (SDL) by physicians has been transformed with the growth in digital, social, and mobile technologies (DSMTs). Although these technologies present opportunities for greater "just-in-time" information seeking, there are issues for ensuring effective and efficient usage to compliment one's repertoire for continuous learning. The purpose of this study was to explore the SDL experiences of rural physicians and the potential of DSMTs for supporting their continuing professional development (CPD).

Semistructured interviews were conducted with a purposive sample of rural physicians. Interview data were transcribed verbatim and analyzed using NVivo analytical software and thematic analysis.

Fourteen (N = 14) interviews were conducted and key thematic categories that emerged included key triggers, methods of undertaking SDL, barriers, and supports. Methods and resources for undertaking SDL have evolved considerably, and rural physicians report greater usage of mobile phones, tablets, and laptop computers for updating their knowledge and skills and in responding to patient questions/problems. Mobile technologies, and some social media, can serve as "triggers" in instigating SDL and a greater usage of DSMTs, particularly at "point of care," may result in higher levels of SDL. Social media is met with some scrutiny and ambivalence, mainly because of the "credibility" of information and risks associated with digital professionalism.

DSMTs are growing in popularity as a key resource to support SDL for rural physicians. Mobile technologies are enabling greater "point-of-care" learning and more efficient information seeking. Effective use of DSMTs for SDL has implications for enhancing just-in-time learning and quality of care. Increasing use of DSMTs and their new effect on SDL raises the need for reflection on conceptualizations of the SDL process. The "digital age" has implications for our CPD credit systems and the roles of CPD providers in supporting SDL using DSMTs.

BACKGROUND

The purpose of this study is to assess the degree of PICC tip migration with breathing and arm movement to determine whether accurate positioning is feasible or futile.

METHODS

A prospective cohort of 218 consecutive patients undergoing PICC insertion at our institution between January and August 2015 was selected, of which 129 met inclusion criteria. The position of insertion was used as control with the arm at 90° during inspiration, followed by three study images: expiration with arm unchanged, inspiration with arm fully adducted and inspiration with arm fully abducted. Mean and standard deviations (SD) of change in PICC position were determined. ANOVA, Pearson correlation coefficients and Chi-square tests were used to assess the effects of vessel choice, PICC calibre and angle of arm abduction. Complications were recorded.

RESULTS

Movement was predominantly caudal with a mean of 10.4 mm (SD 16.5) with similar degrees of movement in the expiration (12.3 mm) and adduction (12.9 mm) views (P = 0.709). Arm abduction resulted in a mean caudal movement of 6.5 mm. (SD 18.6); however, the degree of abduction had no predictable effect on PICC movement. Thirty-two per cent of cases demonstrated movement into the right atrium. Neither vessel choice nor type of PICC was shown to have a significant effect on PICC movement.

CONCLUSIONS

There is large amplitude of PICC tip position change with depth of inspiration and arm position resulting in frequent right atrial position. Despite this there were no associated complications in our cohort which compliments emerging international opinion regarding intra-atrial PICC tip position.

The response of ions in ionic liquids(ILs) to elevated external pressure facilitates the induced structural changes that give a chance to understand change in chemical and physical properties due to perturbation . Employing classical molecular dynamics simulations, we report various structural properties of IL mixtures with Li-salt under varying pressure. Here, we aim to explore the effect of pressure on three ionic liquids (ILs) N-alkyl-N-methyl-pyrrolidinium bis(trifluoromethanesulfonyl)imide (Pyr1A-TFSI, A=3,6,9) and their mixtures with 30 mol% lithium bis(trifluoromethanesulfonyl)imide (Li-TFSI). The microheterogeneity in these systems was studied by total and partial structure factors. Intramolecular distribution functions were calculated to study the conformational changes. The distribution of clusters of alkyl chains provides information about aggregation behavior. The calculated total structure factors compliments well with the main features of the experimental results. In fact, The pre-peak, charge ordering peak, and main peaks from simulations are in good agreement with the experimental results. The three pure ILs are structurally similar, which show both polarity and charge ordering peaks. The addition of Li-salt makes the charge-ordering peak disappear. We find that three ILs respond quite differently towards the addition of Li-salt. The mesoscopic structure of these ILs is affected by high pressure. The height of pre-peak is diminished significantly with the application of high pressure. This decrease in the height of the pre-peak is due to the reduction of alkyl chain aggregation. This motivated us to calculate the aggregation of the alkyl chain quantitatively. The number of alkyl chains present in a given cluster fades with the rise in pressure. The addition of Li-salt decreases the tendency of alkyl chain aggregation. The presence of lithium-ion causes the absence of charge ordering peak, which is occured around 8.0 nm-1 in pure ILs. From the partial structure factors, the charge ordering is observed to be present in Li-containing mixtures. The conformation change in ionic entity is also observed; the distance between the nitrogen atom and terminal carbon of the alkyl chain in cation decreases with increasing the pressure. When the Li-ion is present in the mixture, the cis configuration of anion slightly dominates the trans configuration. The conformational change of anion from trans to cis occurs when pressure changes from a low to high value.

BACKGROUND

A key challenge in interdisciplinary research is choosing the best approach from a large number of techniques derived from different disciplines and their interfaces.

RESULTS

To address this challenge in the area of Biophysics and Structural Biology, we have designed a graduate level course to teach students insightful use of experimental biophysical approaches in relationship to addressing biological questions related to biomolecular interactions and dynamics. A weekly seminar and data and literature club are used to compliment the training in class. The course contains wet-laboratory experimental demonstration and real-data analysis as well as lectures, grant proposal preparation and assessment, and student presentation components. Active student participation is mandatory in all aspects of the class. Students prepare materials for the class receiving individual and iterative feedback from course directors and local experts generating high quality classroom presentations.

CONCLUSIONS

The ultimate goal of the course is to teach students the skills needed to weigh different experimental approaches against each other in addressing a specific biological question by thinking and executing academic tasks like faculty.

Live imaging is the requisite tool for studying cell behaviors driving embryonic development and tissue formation. Genetically encoded reporters expressed under cell type-specific cis-regulatory elements that drive fluorescent protein expression at sufficient levels for visualization in living specimens have become indispensable for these studies. Increasingly dual-color (red-green) imaging is used for studying the coordinate behaviors of two cell populations of interest, identifying and characterizing subsets within broader cell populations or subcellular features. Many reporters have been generated using green fluorescent protein (GFP) due to its brightness and developmental neutrality. To compliment the large cohort of available GFP reporters that label cellular populations in early mouse embryos, we have generated a red fluorescent protein (RFP)-based transgenic reporter using the red fluorescent tdTomato protein driven by cis-regulatory elements from the mouse Hex locus. The Hex-tdTomato reporter predominantly labels endodermal cells. It is a bright RFP-based reporter of the distal visceral endoderm (DVE)/anterior visceral endoderm (AVE), a migratory population within the early post-implantation embryo. It also labels cells of the definitive endoderm (DE), which emerges at gastrulation. Dual-color visualization of these different early endodermal populations will provide a detailed understanding of the cellular behaviors driving key morphogenetic events involving the endoderm.

A system for automated quality assurance in radiotherapy of a therapist's registration was designed and tested in clinical practice. The approach compliments the clinical software's automated registration in terms of algorithm configuration and performance, and constitutes a practical approach for ensuring safe patient setups. Per our convergence analysis, evolutionary algorithms perform better in finding the global optima of the cost function with discrepancies from a deterministic optimizer seen sporadically.

Homonymous and heteronymous reflex connections of the paraspinal muscles were investigated by the application of a tap to the muscle bellies of the lumbar multifidus and iliocostalis lumborum muscles and observation of surface electromyographic responses in the same muscles on both sides of the trunk. Reflexes were evoked in each of the homonymous muscles with latencies and estimated conduction velocities compatible with being evoked by Ia muscle afferents and having a monosynaptic component. Short latency heteronymous excitatory reflex connections were observed in muscles on the ipsilateral side, whilst reflex responses in the contralateral muscles were inhibitory in response to the same stimulus. The latencies of the crossed responses were on average 9.1 ms longer than the ipsilateral excitatory responses. These results are in contrast to the crossed excitatory responses observed between the abdominal muscles and trapezius muscles on the opposite aspect of the trunk. Such a difference in the reflex pathways between these two groups of trunk muscles compliments the different anatomical arrangement of the muscle groups and suggests a contribution to their commonly observed activation patterns.

The present study examines sociolinguistic features of a particular speech act, paying compliments, by comparing and contrasting native Chinese and native American speakers' performances. By focusing on a relatively understudied speaker group such as the Chinese, typically regarded as having rules of speaking and social norms very different from those of Westerners, this paper aims at illuminating the fact that, in cross-cultural communication, foreign language speakers have to pay close attention to sociolinguistic rules of the target language in addition to structure and discourse rules to meet the needs of linguistic accuracy and fluency. This is due to the fact that such rules play an indispensable role in appropriating the proper use of linguistic forms. The data for this study were collected using ethnographic observation pioneered in this field by Wolfson and Manes (1980). The analysis will first explore both the features of distribution of paying compliments, and the functions they may serve in spoken exchanges for native Chinese and American English speakers. To present a fuller picture of the socio-cultural features this speech act may represent in Chinese and American societies, the analysis will further focus on the issues of topics, the addresser-addressee relationship, and culture-specificity versus universality.

OBJECTIVE

Widely used MRI methods show brain morphology both in vivo and ex vivo at very high resolution. Many of these methods (e.g., T2*-weighted imaging, phase-sensitive imaging, or susceptibility-weighted imaging) are sensitive to local magnetic susceptibility gradients produced by subtle variations in tissue composition. However, the spectral resolution of commonly used methods is limited to maintain reasonable run-time combined with very high spatial resolution. Here, the authors report on data acquisition at increased spectral resolution, with 3-dimensional high spectral and spatial resolution MRI, in order to analyze subtle variations in water proton resonance frequency and lineshape that reflect local anatomy. The resulting information compliments previous studies based on T2* and resonance frequency.

METHODS

The proton free induction decay was sampled at high resolution and Fourier transformed to produce a high-resolution water spectrum for each image voxel in a 3D volume. Data were acquired using a multigradient echo pulse sequence (i.e., echo-planar spectroscopic imaging) with a spatial resolution of 50 × 50 × 70 μm(3) and spectral resolution of 3.5 Hz. Data were analyzed in the spectral domain, and images were produced from the various Fourier components of the water resonance. This allowed precise measurement of local variations in water resonance frequency and lineshape, at the expense of significantly increased run time (16-24 h).

RESULTS

High contrast T2*-weighted images were produced from the peak of the water resonance (peak height image), revealing a high degree of anatomical detail, specifically in the hippocampus and cerebellum. In images produced from Fourier components of the water resonance at -7.0 Hz from the peak, the contrast between deep white matter tracts and the surrounding tissue is the reverse of the contrast in water peak height images. This indicates the presence of a shoulder in the water resonance that is not present at +7.0 Hz and may be specific to white matter anatomy. Moreover, a frequency shift of 6.76 ± 0.55 Hz was measured between the molecular and granular layers of the cerebellum. This shift is demonstrated in corresponding spectra; water peaks from voxels in the molecular and granular layers are consistently 2 bins apart (7.0 Hz, as dictated by the spectral resolution) from one another.

CONCLUSIONS

High spectral and spatial resolution MR imaging has the potential to accurately measure the changes in the water resonance in small voxels. This information can guide optimization and interpretation of more commonly used, more rapid imaging methods that depend on image contrast produced by local susceptibility gradients. In addition, with improved sampling methods, high spectral and spatial resolution data could be acquired in reasonable run times, and used for in vivo scans to increase sensitivity to variations in local susceptibility.

An estimated 3% of US pregnancies are affected by maternal thyroid dysfunction, with between one and three of every 1000 pregnancies being complicated by overactive maternal thyroid levels. Excess thyroid hormones are linked to neurological impairment and excessive craniofacial variation, affecting both endochondral and intramembranous bone. Using a geometric morphometric approach, this study evaluates the role of in utero thyroxine overexposure on the growth of offspring mandibles in a sample of 241 mice. Canonical variate analysis utilized 16 unilateral mandibular landmarks obtained from 3D micro-computed tomography to assess shape changes between unexposed controls (n = 63) and exposed mice (n = 178). By evaluating shape changes in the mandible among three age groups (15, 20 and 25 days postnatal) and different dosage levels (low, medium and high), this study found that excess maternal thyroxine alters offspring mandibular shape in both age- and dosage-dependent manners. Group differences in overall shape were significant (P < 0.001), and showed major changes in regions of the mandible associated with muscle attachment (coronoid process, gonial angle) and regions of growth largely governed by articulation with the cranial base (condyle) and occlusion (alveolus). These results compliment recent studies demonstrating that maternal thyroxine levels can alter the cranial base and cranial vault of offspring, contributing to a better understanding of both normal and abnormal mandibular development, as well as the medical implications of craniofacial growth and development.

In post-amputation rehabilitation, a common goal is to return to ambulation using a prosthetic limb, suspended by a customised socket. Prosthetic socket design aims to optimise load transfer between the residual limb and mechanical limb, by customisation to the user. This is a time-consuming process, and with the increase in people requiring these prosthetics, it is vital that these personalised devices can be produced rapidly while maintaining excellent fit, to maximise function and comfort. Prosthetic sockets are designed by capturing the residual limb's shape and applying a series of geometrical modifications, called rectifications. Expert knowledge is required to achieve a comfortable fit in this iterative process. A variety of rectifications can be made, grouped into established strategies [e.g. in transtibial sockets: patellar tendon bearing (PTB) and total surface bearing (TSB)], creating a complex design space. To date, adoption of advanced engineering solutions to support fitting has been limited. One method is numerical optimisation, which allows the designer a number of likely candidate solutions to start the design process. Numerical optimisation is commonly used in many industries but not prevalent in the design of prosthetic sockets. This paper therefore presents candidate shape optimisation methods which might benefit the prosthetist and the limb user, by blending the state of the art from prosthetic mechanical design, surrogate modelling and evolutionary computation. The result of the analysis is a series of prosthetic socket designs that preferentially load and unload the pressure tolerant and intolerant regions of the residual limb. This spectrum is bounded by the general forms of the PTB and TSB designs, with a series of variations in between that represent a compromise between these accepted approaches. This results in a difference in pressure of up to 31 kPa over the fibula head and 14 kPa over the residuum tip. The presented methods would allow a trained prosthetist to rapidly assess these likely candidates and then to make final detailed modifications and fine-tuning. Importantly, insights gained about the design should be seen as a compliment, not a replacement, for the prosthetist's skill and experience. We propose instead that this method might reduce the time spent on the early stages of socket design and allow prosthetists to focus on the most skilled and creative tasks of fine-tuning the design, in face-to-face consultation with their client.

OBJECTIVE

To maximise involvement of the multidisciplinary team using a model of sexual health management for spinal cord-injured persons.

BACKGROUND

Regaining sexual function is a priority following spinal cord injury, with the majority of people remaining sexually active with a satisfying sex life. Nevertheless, rehabilitation programmes often focus on activities related to mobility and elimination, with sexual health relegated to a secondary under-resourced position.

METHODS

Model creation and audit of current and desired status to identify required education.

METHODS

A four-tier model for sexual health management identified phases of management, increasing in complexity, from tier 1 to tier 4. The model was used to audit the current and desired status of the multidisciplinary team on a spinal injuries unit, identifying knowledge levels, barriers to involvement and education requirements.

RESULTS

Fifty-nine questionnaires were completed (85%) by nurses and allied health professionals. Knowledge deficits and discomfort with the topic were the primary reasons prohibiting involvement with sexual health rehabilitation. Two thirds were willing to be involved with sexual health activities, mainly at an introductory level rather than providing education or problem-solving. However, following relevant education, the level of involvement changed: 90% (n = 53) desired involvement at more complex levels, and 10% (n = 6) were unwilling to be involved.

CONCLUSIONS

Developing the necessary skills and knowledge creates potential to increase the resources available to participate in sexual health rehabilitation following a spinal cord injury and ensure that it is a core rehabilitation activity.

CONCLUSIONS

The progressive model portrayed discrete phases of sexual health management, which collectively portray the whole. Team members identified a level of involvement to compliment their skills and knowledge. The audit demonstrated that the primary barriers to involvement were not culture, language or attitude as hypothesised, but inadequate knowledge, addressable through education.

A vital role for Clinical and Translational Science Award (CTSA) evaluators is to first identify and then articulate the necessary change processes that support the research infrastructures and achieve synergies needed to improve health through research. The use of qualitative evaluation strategies to compliment quantitative tracking measures (e.g., number of grants/publications) is an essential but under-utilized approach in CTSA evaluations. The Clinical and Translational Science Institute of Southeast Wisconsin implemented a qualitative evaluation approach using appreciative inquiry (AI) that has revealed three critical features associated with CTSA infrastructure transformation success: developing open communication, creating opportunities for proactive collaboration, and ongoing attainment of milestones at the key function group level. These findings are consistent with Bolman & Deal's four interacting hallmarks of successful organizations: structural (infrastructure), political (power distribution; organizational politics), human resource (facilitating change among humans necessary for continued success), and symbolic (visions and aspirations). Data gathered through this longitudinal AI approach illuminates how these change features progress over time as CTSA funded organizations successfully create the multiinstitutional infrastructures to connect laboratory discoveries with the diagnosis and treatment of human disease.