Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China

Background

Loss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent.

Methods

We collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU.

Results

A total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation.

Conclusion

Loss to follow-up is frequent in the management of patients with TB and can be predicted using patients' treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.

The No-Cloning Life: Uniqueness and Complementarity in Quantum and Quantum-like Theories

This article considers a rarely discussed aspect, the no-cloning principle or postulate, recast as the uniqueness postulate, of the mathematical modeling known as quantum-like, Q-L, modeling (vs. classical-like, C-L, modeling, based in the mathematics adopted from classical physics) and the corresponding Q-L theories beyond physics. The principle is a transfer of the no-cloning principle (arising from the no-cloning theorem) in quantum mechanics (QM) to Q-L theories. My interest in this principle, to be related to several other key features of QM and Q-L theories, such as the irreducible role of observation, complementarity, and probabilistic causality, is connected to a more general question: What are the ontological and epistemological reasons for using Q-L models vs. C-L ones? I shall argue that adopting the uniqueness postulate is justified in Q-L theories and adds an important new motivation for doing so and a new venue for considering this question. In order to properly ground this argument, the article also offers a discussion along similar lines of QM, providing a new angle on Bohr's concept of complementarity via the uniqueness postulate.

COMPLIANCE OF PATIENT COMPANIONS AND VISITORS WITH HAND HYGIENE: AN OBSERVATIONAL STUDY

BACKGROUND

Hand hygiene is a simple and low-cost practice to prevent the spread of many microorganisms that cause healthcare-associated infections (HCAIs). Compliance with hand hygiene, especially by patient companions and visitors, is very important in order to prevent the transmission of pathogenic microorganisms between the health institutions and the community.

AIM

This is a descriptive study designed to investigate the compliance of patient companions and visitors with hand hygiene.

METHODS

The sample of the study included 209 individuals who were the companions and visitors of the patients who were hospitalized in a University Hospital in the west of Turkey. A questionnaire containing Demographics and Hand Hygiene and the Observation Form to assess Hand Hygiene Practice were used to acquire data. In order to conduct the research, permission was obtained from the ethics committee and the institution, and consent was obtained from the patient companions and visitors. To evaluate the data, the numbers, percentage calculations, mean and independent inter-observer agreement coefficient were used.

FINDINGS

96.2% of the patient companions and visitors stated that they did not receive training on the importance of hand washing during their stay in the hospital, and 74.6% stated that hand washing was very important in the prevention of diseases. The patient families reported that they most often washed their hands after touching bodily fluids (91.7%), and that they rarely washed their hands before touching a patient (34.0%). The rates were decreased in the observations, and the lowest rate for handwashing was before touching a patient (22.4%) and the highest rate for handwashing was after the risk for contamination with body fluids of patient (68.6%).

CONCLUSION

The results of this study indicate that patient companions and visitors did not receive any training on the importance of hand hygiene during the hospital stay, and the observed rate of compliance with hand hygiene was lower than stated. Recommendations include delivering planned handwashing training to patient companions and visitors using different teaching methods, and to conduct longer observational studies.

Reliability and Validity of Six Selected Observational Methods for Risk Assessment of Hand Intensive and Repetitive Work

Risk assessments of hand-intensive and repetitive work are commonly done using observational methods, and it is important that the methods are reliable and valid. However, comparisons of the reliability and validity of methods are hampered by differences in studies, e.g., regarding the background and competence of the observers, the complexity of the observed work tasks and the statistical methodology. The purpose of the present study was to evaluate six risk assessment methods, concerning inter- and intra-observer reliability and concurrent validity, using the same methodological design and statistical parameters in the analyses. Twelve experienced ergonomists were recruited to perform risk assessments of ten video-recorded work tasks twice, and consensus assessments for the concurrent validity were carried out by three experts. All methods' total-risk linearly weighted kappa values for inter-observer reliability (when all tasks were set to the same duration) were lower than 0.5 (0.15-0.45). Moreover, the concurrent validity values were in the same range with regards to total-risk linearly weighted kappa (0.31-0.54). Although these levels are often considered as being fair to substantial, they denote agreements lower than 50% when the expected agreement by chance has been compensated for. Hence, the risk of misclassification is substantial. The intra-observer reliability was only somewhat higher (0.16-0.58). Regarding the methods ART (Assessment of repetitive tasks of the upper limbs) and HARM (Hand Arm Risk Assessment Method), it is worth noting that the work task duration has a high impact in the risk level calculation, which needs to be taken into account in studies of reliability. This study indicates that when experienced ergonomists use systematic methods, the reliability is low. As seen in other studies, especially assessments of hand/wrist postures were difficult to rate. In light of these results, complementing observational risk assessments with technical methods should be considered, especially when evaluating the effects of ergonomic interventions.

Observations on strategies used by people with dementia to manage being assessed using validated measures: A pilot qualitative video analysis

BACKGROUND

Analysis of video data was conducted of validated assessments with people with dementia as part of a feasibility control study comparing a lifelong learning service with other dementia services.

OBJECTIVE

The aim was to provide a new perspective on what occurs during the assessment process when using validated measures in research and explore which strategies people with dementia use to manage their participation.

DESIGN

Video recordings were made of pre- and postintervention assessments of people with dementia. An initial pilot analysis of 10 videos of the pre-assessments was conducted.

SETTING

Lifelong learning services and other dementia services situated in six municipalities in Northern Denmark took part in this study, with 55 people with dementia participating.

RESULTS

The themes identified were: 'State of mind' and 'Mental resources', showing how these aspects influenced the participants' reactions and the strategies they used.

DISCUSSION

The results are discussed in relation to how individual personality traits influence the assessment process and the way a person with dementia will manage the situation.

CONCLUSION

The assessment situation is complex and can be influenced by the strategies adopted by individuals with dementia as they try to manage the assessment process.

PATIENT OR PUBLIC CONTRIBUTION

People with dementia supported the decision-making for the choice of validated measure used within this study.

Physical therapy consultation in the emergency department for older adults with falls: A qualitative study

Objectives

Little is known about current practices in consulting physical therapy (PT) in the emergency department (ED) for older adults with falls, a practice that can reduce fall-related ED revisits. This qualitative study aimed to understand perspectives of ED staff about ED PT consultation for older adults with falls and fall-related complaints, specifically regarding perceived value and associated challenges and strategies.

Methods

We performed focus groups and key informant interviews with emergency physicians, advanced practice clinicians, nurses, physical therapists, occupational therapists, and technicians who perform ED geriatric screenings. We used rapid qualitative analysis to identify common themes related to decisions to consult PT from the ED, perceived value of PT, and common challenges and strategies in ED PT consultation.

Results

Twenty-five participants in 4 focus groups and 3 interviews represented 22 distinct institutions with ED PT consultation available for older adults with falls. About two thirds of EDs represented relied on clinician gestalt to request PT consultation (n = 15, 68%), whereas one third used formal consultation pathways (n = 7, 32%). Participants valued physical therapists' expertise, time, and facilitation of hospital throughput by developing safe discharge plans and contact with patients to improve outpatient follow-up. Common challenges included limited ED PT staffing and space for PT evaluations; strategies to promote ED PT consultation included advocating for leadership buy-in and using ED observation units to monitor patients and avoid admission until PT consultation was available.

Conclusion

ED PT consultation for older adults with falls may benefit patients, ED staff, and hospital throughput. Uncertainty remains over whether geriatric screening-triggered consultation versus emergency clinician gestalt successfully identifies patients likeliest to benefit from ED PT evaluation. Leadership buy-in, designated consultation space, and formalized consultation pathways are strategies to address current challenges in ED PT consultation.

Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes

OBJECTIVES

Large (De Serres stage [IV-V]) head and neck lymphatic malformations (HNLMs) often have multiple, high-risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number.

MATERIALS

Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0-18 years.

METHODS

ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0-1), acceptable (2-5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ² ). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post-diagnosis) predicts treatment success (i.e., ≤1 IT).

RESULTS

Median age at HNLM diagnosis was 1.3 months (interquartile range [IQR] 0-45 m) with 107/199(54%) male. HNLM were stage I-III (174 [88%]), IV-V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV-V, oral location, and tracheotomy (p < 0.001). Stage I-III HNLMs were initially observed compared with stage I-III having ITs within 6 months of HNLM diagnosis, had a 82% lower relative treatment failure risk ([i.e., >1 IT], RR = 0.09, 95% CI 0.02-0.36, p < 0.001). Stage I-III HNLMs with non-delayed ITs had reduced treatment failure risk compared with IV-V (RR = 0.47, 95% CI 0.33-0.66, p < 0.001).

CONCLUSION

Observation and delayed IT in stage I-III HNLM ("Grade 1") is safe and reduces IT (i.e., ≤1 IT). Stage IV-V HNLMs ("Grade 2") with early IT have a greater risk of multiple ITs.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:956-962, 2023.

Does Observed Conflict Recovery Play a Role in Adolescent Dating Aggression?

In a study of conflict recovery and adolescent dating aggression, 14- to 18-year-old couples (N = 209 dyads) participated in a 1-hr observational assessment. Negative behavior was observed during conflict-evoking "hot" tasks and in a "cooldown" task. Physical and psychological dating aggression were assessed via questionnaires. Negative behavior measured in the cooldown task was not associated with dating aggression after controlling for carryover effects of negativity from the hot to cooldown tasks. Moreover, cooldown negativity moderated the associations of hot task negativity and dating aggression. Actor and partner effects were disentangled via dyadic data analyses. Given the paucity of observational studies of dating aggression, our findings are an important contribution to the literature and in need of replication and extension.

The Sensory Observation Autism Rating Scale (SOAR): Developed using the PROMIS® framework

Autistic people experience the sensory world differently, impacting behavior. First-hand accounts and group-based research have found that sensory differences impact a range of things including family life, anxiety, participation, and daily living. Early sensory differences are widely reported to be associated with a cascade of developmental difference, suggesting that early autism diagnosis and sensory mapping could enable the provision of supports to facilitate flourishing. However, appropriate measurement tools are not available as all rely on proxy report or are observation measures which include limited modalities or domains and require the administration of stimuli. Therefore, following the gold-standard recommendations for measurement development outlined by the PROMIS® framework, we created the Sensory Observation Autism Rating scale (SOAR). We identified sensory behaviors across all primary domains and modalities through an extensive autism-sensory literature review and from focus groups with autism stakeholders. The initial item bank was then refined by an expert panel and through video coding five-minutes of free play from Autism Diagnostic Observation Schedule assessments of 105 age- and gender-matched autistic and developmentally delayed children (aged 13-36 months; 38 female). An additional 25% of the sample were double coded to investigate interrater reliability. Observational data and expert review supported the reduction of the item bank to 37 items. We propose that the refined SOAR has excellent face and ecological validity, along with interrater reliability (Intraclass correlation = 0.87-0.99). Following further data collection and refinement, SOAR has promise to fully characterize sensory behaviors in autistic children and indicate useful supports.

Non-worrisome scenario of acute abdomen

Differential diagnosis between benign and life-threatening pneumatosis intestinalis poses a great dianostic dilemma.

Parental mentalization goes to school: a brief online mentalization-based intervention to improve parental academic support

Parental support of children's learning contributes to children's motivation, efficacy, and academic success. Nonetheless, in the context of homework, many parents struggle to offer adequate academic support and intervene in a manner that can curtail children's academic progress. A mentalization-based online intervention was proposed for improving parental homework support. The intervention involves teaching parents to dedicate the first 5 minutes of homework preparation to observation of the child's and the parent's mental states. Thirty-seven Israeli parents of elementary school children randomly assigned to intervention or waitlist conditions participated in a pilot study assessing the feasibility and initial efficacy of the intervention. Participants completed self-report measures before and after the intervention or a 2-week waiting period and provided feedback on the intervention. Pilot findings suggest that this low-intensity online intervention can be effective in improving parenting practices in the homework supervision context. A randomized controlled trial is required to further establish the intervention's efficacy.

Revisiting Age Criterion for Surgery in Asymptomatic Primary Hyperparathyroidism

OBJECTIVE

To revisit the current age criterion (50 years) for surgical candidacy in patients diagnosed with asymptomatic primary hyperparathyroidism (PHPT).

STUDY DESIGN

A predictive model relying on past publications using the electronic databases "PubMed," "Embase," "Medline," and "Google Scholar."

SETTING

Hypothetical large cohort.

METHODS

A Markov model was constructed, based on relevant literature, to compare 2 potential treatment algorithms for asymptomatic PHPT patients, parathyroidectomy (PTX), and observation. The various potential health states were characterized for the 2 treatment options and included potential surgical complications, end-organ deterioration, and death. A 1-way sensitivity analysis was performed to calculate the quality-adjusted life year (QALY) gains of both strategies. A Monte-Carlo simulation for 30,000 subjects was performed and cycled per annum.

RESULTS

On the basis of the model's assumptions, the QALY value for the PTX strategy was 19.17 versus 17.82 for the observation strategy. The incremental QALY gains for various ages according to the sensitivity analyses for PTX in comparison to observation were: 2.84 QALY for 40-year-old patients, 2.2 QALY for 50-year-old patients, 1.81 QALY for 55-year-old patients, 1.35 QALY for 60-year-old patients, and 0.86 QALY for 65-year-old patients. The incremental QALY is below 0.5 after the age of 75 years.

CONCLUSION

This study found PTX to be advantageous for asymptomatic PHPT patients older than the current age criterion of 50 years. The calculated QALY gains support a surgical approach for medically fit patients in their 50s. The current guidelines for the surgical treatment of young asymptomatic PHPT patients should be revisited by the next steering committee.

Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study

AIMS

The aim of this study was to investigate nursing students' clinical decision-making by using high-fidelity simulation of a deteriorated patient scenario.

DESIGN

A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection.

METHODS

Twenty-three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio-video recorded and observations were collected by the researcher.

RESULTS

There was a significant moderate increase in the 'deduction' and 'analysis' sub-scale scores and overall test score, suggestive of improved analytical decision-making processes through the simulation experience. Think-aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem.

CONCLUSION

Students learn different clinical decision-making skills during the simulation compared to what they learn from debriefing. Using observation and think-aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision-making process.

Learning in nursing home placement: A phenomenological study of student nurses' lived experience

AIM

To explore first-year student nurses' lived experience of learning in clinical placement in nursing homes.

BACKGROUND

Nursing homes traditionally represent students' first clinical placement sites during nurse education, and nursing home residents' care needs can provide opportunities for student nurses to acquire both fundamental and specialised nursing skills. In clinical placements, students have opportunities to apply and integrate theoretical knowledge, practical skills and ethical competence in a clinical setting.

DESIGN

A qualitative design with a hermeneutic phenomenological approach was employed and reported in accordance with the COREQ guidelines.

METHODS

The study was undertaken at three nursing homes affiliated with one Norwegian university. Close observation (173 h) and in-depth individual interviews (n = 7) with first-year student nurses were conducted to explore their lived experience of learning. Data analysis was guided by van Manen's hermeneutic phenomenological approach.

RESULTS

The essential meaning of the phenomenon of learning in clinical placements in a nursing home setting is characterised by four themes: (1) navigating a new and complex learning context, (2) being emotionally affected when facing sickness and frailty, (3) having a vital need for support and guidance and (4) being engaged in learning.

CONCLUSIONS

The findings are discussed against the backdrop of educational learning theory. Learning in clinical placements in nursing homes is a multi-faceted and complex phenomenon related to the students' lived experience on the contextual, relational and individual levels. Overall, our findings demonstrate that learning in clinical placements is part of the process of professional identity development.

RELEVANCE TO CLINICAL PRACTICE

The clinical practice arena should emphasise emotional support for student nurses, enhance their self-directed reflection and explicitly focus on the essence of nursing in nursing homes.

Nursing Staff's Observations of BPSD Amongst Older Adults with Dementia Living in a Nursing Home: A Qualitative Study

The majority of older adults with dementia living in a nursing home exhibit behavioral and psychological symptoms of dementia (BPSD). This behavior is difficult for residents to cope with. Early recognition of BPSD is important in order to implement personalized integrated treatment, and nursing staff are in the unique position to consistently observe residents' behavior. The aim of this study was to explore nursing staff's experiences observing BPSD of nursing home residents with dementia. A generic qualitative design was chosen. Twelve semi-structured interviews were conducted with nursing staff members until data saturation. Data were analyzed using inductive thematic analysis. Four themes were identified: "group harmony" observations from a group perspective, focused on the disturbance of group harmony; an "intuitive approach", which involves observing unconsciously and without a set method; "reactive intervention", which refers to immediate removal of observed triggers without exploring the causes of behaviors; and "sharing information", which is delayed sharing of observed behavior with other disciplines. The current way in which nursing staff observe BPSD and share observations within the multidisciplinary team explain several existing barriers to achieving high treatment fidelity for BPSD with personalized integrated treatment. Therefore, nursing staff must be educated to structure their daily observations methodologically and interprofessional collaboration improved to share their information in a timely manner.

Which Epidemiological Characteristics Drive Decision Making in the Management of Patients with Vestibular Schwannoma?

The incidence of sporadic vestibular schwannoma has significantly increased over the past few decades. However, there is no method currently available to accurately predict the risk of subsequent tumor growth. The difference in the management of five patient groups has been evaluated: wait and scan, conversion to microsurgery, conversion to stereoradiotherapy, sterioradiotherapy, and microsurgery. In total, 463 patients with vestibular schwannoma have been consulted in our department from 2010 through 2016. Of the 250 patients initially indicated for observation, 32.4% were later indicated for active treatment. Younger patients were more frequently indicated for surgery (mean age 48 years) compared to older patients, who were more often indicated for stereoradiotherapy (mean age 62 years). Tumor growth was observed more often in patients under 60 years of age and in patients with tumors greater than 10 mm. In elderly patients, including those with larger tumors, a conservative approach is the optimal solution. If tumor growth occurs in the wait-and-scan strategy, it is still possible to continue with a conservative approach in some situations. The duration of follow-up scans is still a matter of debate, as tumors can begin to grow after 5 years from the initial diagnosis.

High Altitude Carotid Body Tumors Growth During active Surveillance

BACKGROUND

The gold standard for patients with carotid body tumors (CBT) is surgical resection; nevertheless, some patients are unfit for surgery or, for other reasons, could not be operated on. Active surveillance has been known to be a reasonable strategy for these cases. This study aimed to evaluate tumor growth in unoperated patients with CBTs.

METHODS

A retrospective review of all unoperated patients with CBT from a single academic hospital diagnosed between 2014 and 2021 was performed. Results of nonparametric testing were presented using the median and ranges for Mann-Whitney-U or Kruskal-Wallis. Significance was defined as a 2-tailed P < .05.

RESULTS

The cohort included a total of 31 patients, with a median age of 60 years (range: 37-80 years), of which 27 (87.1%) were females. The patients live at a median altitude of 2800 meters (range: 2756-2980 meters) above sea level. Twenty (64.5%) patients had Shamblin I tumors, eight (25.8%) patients had Shamblin II tumors, and three (9.7%) patients had Shamblin III tumors. Median CBT volume at diagnosis was 14.1 cm3 (range: .9 - 213.3 cm³). Median volume at diagnosis of symptomatic tumors was substantially larger than asymptomatic tumors, 49.2 cm³ vs 7.9 cm³, respectively (P = .03). Median growth of the tumors during a median 15-month follow-up (range: 3-43 months) was 3.3 cm³ (range: 0-199.9 cm³). Overall, 77% (n = 24) of the CBTs grew at least 1 cm³.

CONCLUSION

Most patients in the present study had tumor growth by at least 1 cm³, with a median tumor growth of 3.3 cm.³ In the present study tumor growth was shown to be greater than other low altitude CBT active surveillance studies; therefore, surgical resection should be recommended in patients with CBT living at high altitudes.

The 3Ps: A tool for coach observation

There is growing recognition of the value of "in situ" coach development practice across a variety sporting contexts. Unfortunately, however, there remains a limited number of tools available with which to observe coaching practice. In this study, we pilot and test a quasi-systematic tool for observation in the form of the 3Ps. Drawing on a range of representational perspectives, the theoretically neutral labels of "procedure", "planning", and "process" were developed for the purpose of holistic observation. In order to test the tool, a group of experienced coach development practitioners (n = 10) integrated the tool into their practice over a 12-month programme of professional development. Those participants subsequently took part in semi-structured interviews, in which they expressed a strong sense of acceptability, perceiving effectiveness and positive opportunity cost. We propose that the 3Ps tool presents a holistic and practically useful means of observing coaches' professional judgment and decision making. We also suggest future directions for the researcher who seeks to generate evidence in a naturalistic coaching context.

Adolescent idiopathic scoliosis patients treated with bracing, surgery, or observation showed no difference in behavioral and emotional function over a 2-year period

The purpose of this study was to assess if behavior and emotional function, as measured by the Pearson Behavioral Assessment Survey for Children, Second Edition (BASC-2) in patients and parents, changes with differing treatment protocols in patients with adolescent idiopathic scoliosis (AIS). One previous study showed abnormal BASC-2 scores in a substantial number of patients diagnosed with AIS; however, no study has assessed how these scores change over the course of treatment. AIS patients aged 12 to 21 years completed the BASC-2. The 176-item questionnaire was administered to subjects at enrollment, assessing behavioral and emotional problems across 16 subscales of 5 domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. Parents were given an equivalent assessment survey. Surveys were administered again after 2 years. Subject treatment groups (bracing, surgery, and observation) were established at enrollment. Patients were excluded if they did not complete the BASC-2 at both time points. Forty-six patients met the inclusion criteria, with 13 patients in the surgical, 20 in the bracing, and 13 in the observation treatment groups. At enrollment, 26% (12/46) of subjects with AIS had a clinically significant score in 1 or more subscales, and after 2 years 24% (11/46) of subjects reported a clinically significant score in at least 1 subscale (P = .8). There were no significant differences in scores between enrollment and follow-up in any treatment group. Similar to what was reported in a previous study, only 36% (4/11) of patients had clinically significant scores reported by both patient and parent, conversely 64% (7/11) of parents were unaware of their child's clinically significant behavioral and emotional problems. Common patient-reported subscales for clinically significant and at-risk scores at enrollment included anxiety (24%; 11/46), hyperactivity (24%; 11/46), attention problems (17%; 8/46), and self-esteem (17%; 8/46). At 2-year follow-up, the most commonly reported subscales were anxiety (28%; 13/46), somatization (20%; 9/46), and self-esteem (30%; 14/46). Patients with AIS, whether observed, braced or treated surgically, showed no significant change in behavior and emotional distress over the course of their treatment, or compared with each other at 2-year follow-up.

Multi-year monitoring of Piping Plovers (Charadriusmelodus) and other shorebirds in The Bahamas

Background

The Bahamas provides a wide range of crucial coastal habitats to many declining resident and migratory birds. Amongst these species is the Piping Plover (Charadriusmelodus), whose breeding populations are all listed as federally threatened or endangered in the United States and Canada. This species winters in the southern U.S. and the Caribbean, including The Bahamas, spending most of the year on the wintering grounds. Nonetheless, prior to the census data presented here, reports of Piping Plovers from The Bahamas were few and incidental. Therefore, repeated surveys are essential to increase understanding of the distribution, abundance and movement patterns of Piping Plovers and other shorebirds in the Bahamian territory. This dataset provides information on the abundance and distribution of the Piping Plover across multiple islands and much of the suitable habitat that exists in The Bahamas. It also provides some information on the variability of Piping Plover count data and presence of other shorebird species. Furthermore, these data may serve as baseline information on Piping Plover abundance and shorebird site occupancy by which to assess key candidate sites for protection and also future impacts of climate change, such as sea level rise and hurricanes.

New information

The National Audubon Society (NAS), Environment and Climate Change Canada (ECCC) and the United States Geological Survey (USGS) conducted a multi-year shorebird census in The Bahamas. Surveys initiated by ECCC and many other collaborators were also part of a multi-year survival study. Censuses were conducted across 16 different islands between the years 2006 and 2020. These surveys were performed with the cooperation of the Bahamas National Trust (BNT), volunteer biologists and scientists from the United States and Canada. Biologists working with NAS, ECCC and USGS used satellite imagery, historical records and local knowledge from Bahamian residents to identify sites with suitable habitat for Piping Plovers. Experienced researchers visited each site during winter (November-February), identified and counted Piping Plovers and, when possible, other bird species in each of the sampled locations. In total, the resulting database holds 2,684 observations of 62 bird species, of which 77% belong to 24 shorebird species. Approximately 30% of all presence records belong to the Piping Plover. It is important to emphasise that the counts reported in this dataset represent minimum estimates of local shorebird assemblages. Since abundance and distribution of birds vary with changing conditions, representative estimates are best achieved via repeated surveys that reflect a range of conditions including timing (day, year, month), weather (wind direction and speed, precipitation), tide state etc.

Timing of embolic phenomena after hydrogen peroxide exposure - a systematic review

INTRODUCTION

Hydrogen peroxide ingestions cause significant morbidity and mortality due to oxygen gas emboli and are treatable with hyperbaric oxygen therapy. Recommendations for observation are based on small case series.

OBJECTIVES

The aim of this systematic review is to define the time of onset of embolic phenomena after hydrogen peroxide exposure and to describe the proportion of patients who received hyperbaric oxygen therapy.

METHODS

Cases from a systematic literature search were combined with those from a prior study that used data derived from the American Association of Poison Control Centers National Poison Data System. Air-gas emboli were defined as embolic phenomena (stroke, myocardial infarction, obstructive shock) potentially reversed with hyperbaric oxygen therapy. Simple counts, mean, and interquartile range were used for description and comparisons.

RESULTS

A total of 766 records were identified in the literature search. Three-hundred and eighty-three duplicate records were identified and removed. Of the 383 remaining records, 156 met inclusion criteria; 88 were excluded based on predetermined criteria yielding 68 records with 85 unique cases. Forty-one cases were extracted from the 2017 National Poison Data System study resulting in a total of 126 cases for analysis. Case descriptions: We analyzed these 126 cases and documented 213 discrete clinical events, excluding deaths. There were 108 high-concentration exposures, 10 low-concentration exposures, and 8 were unknown. Thirty-five cases were intentional ingestions but not for self-harm, and 84 were unintentional or accidental. Only 4 cases were for self-harm, and there were 23 pediatric cases. There were 99 air-gas emboli reported in 78 patients. Time to onset: The time to onset of air-gas embolic was documented in 70/78. Time to symptom onset ranged from immediate to 72 h after hydrogen peroxide exposure. Over 90% of embolic symptoms occurred within 10 h of ingestion. Hyperbaric oxygen therapy: A total of 54/126 cases received hyperbaric oxygen therapy. Of those 54 cases, 31 had primary portal venous gas while the remaining 23 had air-gas emboli. Of the 23 air-gas emboli cases treated with hyperbaric oxygen therapy, 13 made full recoveries while 10 had residual symptoms or died. Mean time from air-gas emboli symptom onset to hyperbaric oxygen therapy in the full recovery group was 9 h compared to 18.2 h in the partial recovery/death group. Portal venous gas: There were 63 total reported cases of portal venous gas. Forty-nine of these cases were primary portal venous gas, 13 were secondary findings in patients with air-gas emboli and one case was secondary to non-air-gas emboli symptoms. Twenty-seven of 49 patients with portal venous gas (55%) as the primary finding had gastrointestinal bleeding. Thirty of the 63 cases received hyperbaric oxygen therapy for portal venous gas without any documented air-gas emboli. Deaths: Seventeen deaths occurred in the combined cohort. Of these, 13 were associated with high-concentration exposures. All deaths with reported time to symptom onset had symptoms within 1 h of exposure.

CONCLUSION

This review of hydrogen peroxide exposure cases suggests that clinically significant embolic phenomena occur within 10 h of exposure, although delayed air-gas emboli do happen and should considered when deciding duration of observation. It remains equivocal whether hyperbaric oxygen therapy is beneficial in cases of primary portal venous gas without systemic involvement.

Development of the Observable Well-Being in Living With Dementia-Scale

The Observable Well-being in Living with Dementia-Scale was developed to address conceptual and methodological issues in current observational scales for music therapy. Creative interventions may receive lowered scores, as existing instruments rely heavily on verbal behavior. Methods were (1) Systematic review of observational instruments: (2) field work with music therapy and sociable interactions to operationalize the items; (3) field testing assessing feasibility and preliminary psychometric properties; (4) focus groups with experts to investigate content validity; (5) final field test and revision. 2199 OWLS-ratings were conducted in 11 participants. Hypotheses of construct validity and responsiveness were supported (r = .33 -.65). Inter-rater reliability was good (84% agreement between coders, Cohen's Kappa = .82), and intra-rater reliability was excellent (98% agreement, Cohen's Kappa = .98). Focus groups with 8 experts supported the relevance of the items and suggested further refinements to increase comprehensiveness. The final field-tested OWLS showed improved inter-rater reliability and usability.

An analysis of teachers' instructions and feedback at a contemporary dance university

Background

Given the demands posed by excessive practice quantities in modern dance, physical and mental health can be compromised. Therefore, there is a need to consider how quality of practice may be improved and possibly even reduce training times. Sports literature has shown that instructions and feedback given by coaches can have an effect on the quality of training and influence self-regulation and the performance of athletes. However, currently little is known about the use of instructions and feedback by dance teachers. The aim of the current study was, therefore, to examine the type of instructions and feedback given by dance teachers during various dance classes.

Methods

A total of six dance teachers participated in this study. Video and audio recordings were made of six dance classes and two rehearsals at a contemporary dance university. The dance teacher's coaching behavior was analyzed using the modified Coach Analysis and Intervention System (CAIS). Additionally, feedback and instructions were also examined in terms of their corresponding focus of attention. Absolute numbers, as well as times per minute (TPM) rates were calculated for each behavior before, during, and after an exercise. Absolute numbers were also used to calculate ratios of positive-negative feedback and open-closed questions.

Results

Most feedback comments were given after an exercise (472 out of 986 total observed behaviors). Improvisation had the highest positive-negative feedback ratio (29) and open-closed questions ratio (1.56). Out of the focus of attention comments, internal focus of attention comments were used most frequently (572 out of 900).

Discussion/conclusion

The results make clear that there is a large variability in instructions and feedback over teachers and classes. Overall, there is room for improvement toward a higher positive-negative feedback ratio, a higher open-closed question ratio and producing more comments eliciting an external focus of attention.

Occupational therapists' descriptions of doing observations of people with cognitive impairments in the context of community practice

BACKGROUND

Observation is an important method for occupational therapists (OTs) to gather information on people's occupational performance; yet, not much research has been conducted on OTs' descriptions of doing observations in their practices.

AIMS

This study aimed to explore community OTs descriptions of doing observations during the assessment of persons with cognitive impairments.

MATERIAL AND METHODS

Nineteen OTs participated in focus group interviews. Thematic analysis with an inductive approach was performed.

RESULTS

Three themes were revealed during analysis, the value of doing unstructured observations, the importance of doing observations in familiar contexts, and the importance of experience, structure and competence when doing observation.

CONCLUSIONS AND SIGNIFICANCE

This study showed that the participants regarded observation as one of OTs' core competencies, and they described doing observations in different ways. The results emphasised the importance of doing unstructured observations in persons' familiar contexts when assessing persons with cognitive impairments. However, the participants highlighted the need for increasing OTs structure and competence through implementing more occupation-based standardised assessment tools for OTs in community services to facilitate evidence-based practice.

Ratings of Hand Activity and Force Levels among Women and Men Who Perform Identical Hand-Intensive Work Tasks

We compared hand activity and force ratings in women and men doing identical hand-intensive work tasks. Musculoskeletal disorders are more common in women and hand-intensive work leads to an increased risk of these disorders. Knowledge of the gender influence in the rating of work exposure is lacking. The aim of this study was to investigate whether women and men performing identical hand-intensive work tasks were equally rated using hand activity and normalized peak force levels with the Hand Activity Threshold Limit Value^®. Fifty-six workers participated, comprising 28 women-men pairs. Four observers-two woman-man pairs-were also involved. Self-ratings and observers' ratings of hand activity and force level were collected. The results of these ratings showed no significant gender differences in self-rated hand activity and force, as well as observer-rated hand activity. However, there was a significant gender difference in the observer-rated force, where the women were rated higher (mean (SD): women 3.9 (2.7), men 3.1 (1.8) (p = 0.01)). This difference remained significant in the adjusted model (p = 0.04) with grip strength and forearm-finger anthropometrics. The results provide new insights that observers' estimates of force can be higher in women compared with men in the same work tasks. Force should be further investigated and preferably compared to objective measurements.

Improving occupational health for health workers in a pilot hospital by application of the HealthWISE international tool: An interview and observation study in China

Objective

For a safe and healthy workplace in the health sector, the International Labor Organization (ILO) and the World Health Organization (WHO) jointly developed HealthWISE, an international technical tool that helps health workers (HWs) to identify workplace hazards and apply low-cost solutions. This study sought to gather experiences and lessons from a Chinese pilot hospital for the scale-up application of HealthWISE.

Methods

A qualitative study was undertaken at a Chinese public hospital with a ≥5-year application of HealthWISE through in-depth interviews with targeted HWs who participated in the Training-of-Trainer (TOT) workshops, and observations were gathered using evidence from photos and publications, then, thematic analysis was formulated.

Results

Driven by motivation, the participants learned from the HealthWISE TOT workshop alongside the favorite and worst parts of it. Positive changes and results of occupational health for HWs occurred after the workshop, the participants trained others and planned to implement HealthWISE within their responsibility. During the COVID-19 Pandemic, the Hospital acted the approaches of protecting the health, safety and well-being of HWs with significant results. Further suggestions on workshop and HealthWISE implementing as well as the national policies were collected. The study indicated the Hospital's experience of leadership and participation, supporting and facilitating, system establishment, and culture creation. The suggestion included keeping staff engaged under a positive safety and health culture, promoting recognition of HealthWISE among public health institutions nationwide, developing online courses for medical colleges, focusing on the alignment among various law systems, and adopting measures under the principle of the hierarchy of occupational hazards controls.

Conclusion

This study has demonstrated the systematic improvement of occupational health for HWs by HealthWISE implementation in the Chinese hospital. The valuable experiences and lessons derived here can be shared with other hospitals in China and beyond, especially under the unprecedented challenges of the COVID-19 pandemic, to achieve the goals of safety, health, and well-being for HWs by building a resilient health system.

Is Pain Contagious? Innocuous Stimulation Can be Transformed Into the Pain Experience by Observational Learning

Studies indicate that classical and operant conditioning have potential to play a role in the formation of the allodynic effect. Only a few studies have examined the role of observational learning in pain induction. Due to some methodological challenges, evidence that the allodynic effect can be learned through observation is limited. In the present study, healthy participants (n = 88) received 2 series of innocuous electrocutaneous stimuli: at the beginning of the study and after observation of a model who rated all the stimuli as painful. Participants and the model rated all the stimuli alternately (real-time group), or the participant first observed the model and then rated the stimuli, while the model stayed in (post-hoc+ group) or left (post-hoc- group) the laboratory. There was no model in the control group. The study demonstrated that allodynia can be induced by observational learning. Furthermore, this effect was shown to be similar, regardless of whether stimuli were received during the observation of the model and rated immediately afterwards, or when the observation and stimuli reception were time-separated. The mere presence of the model during the stimuli reception also did not affect the magnitude of this effect. This research may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it. PERSPECTIVE: This article presents study results on the role of observational learning in allodynia induction without tissue injury. The results may contribute to our understanding of the mechanisms of chronic pain development and assist in the development of suitable treatment for it.

Generating Trust in Participatory Research on Plasmodium knowlesi Malaria: A Study with Rural Community Gatekeepers during the COVID-19 Pandemic

BACKGROUND

Plasmodium knowlesi malaria is a zoonotic infection that affects rural communities in South East Asia. Although the epidemiology of the disease has been extensively researched, the voices of individuals within affected communities often go unheard. Here, we describe a study that explores the importance of gatekeepers in conducting research among rural communities, their perspectives on the challenges encountered when attempting to avoid malaria infection, and their views on participatory research.

METHODS

Between 1 November 2021 and 28 February 2022, we conducted a study in Kudat district, Sabah, using a multi-method design. All participants consented to the study, which included health care workers (HCWs) (n = 5), community leaders (n = 8), and faith leaders (n = 1). We conducted interviews, transect walks, and observations with gatekeepers to ensure data trustworthiness. All interviews were conducted in the Sabah Malay dialect. The sessions were audio- and video-recorded, transcribed into English and analyzed using thematic analysis.

RESULTS

Between 2017 and 2021, the number of cases of P. knowlesi malaria detected in humans ranged from 35 to 87 in villages under the care of the Lotong primary health care clinic. The challenges in controlling malaria include social norms, lifestyles, socioeconomic factors, environmental factors, and limitations of basic resources. Critical discussions regarding participation with the gatekeepers identified that face-to-face interviews were preferable to online discussions, and influenced willingness to participate in future research.

CONCLUSION

This study was conducted among village gatekeepers during the COVID-19 pandemic and generated information to drive methodological changes, opening up new ideas by sharing perspectives on challenges in P. knowlesi malaria control among vulnerable communities. The study generated trust in the community and expanded knowledge regarding participation that is critical for future community-based studies.

Health surveillance representative of koala (Phascolarctos cinereus) distribution in Victoria, Australia

Health surveillance of wildlife populations is essential for conservation and reduction of the impacts of disease. Population declines and areas of overabundance of koalas (Phascolarctos cinereus) can disrupt the overall survival of the species as well as its habitat. This retrospective study was conducted to describe population distributions, identify areas which need increased surveillance and improve koala health surveillance methodology by Wildlife Health Victoria: Surveillance (WHV:S) at the Veterinary School of The University of Melbourne. Twelve years of Victorian koala observation data from the Atlas of Living Australia combined with surveillance data from WHV:S were used to create choropleth maps, using Quantum Geographic Information Systems of populations and surveillance events, visually representing hot spots. This data was further used to calculate health surveillance efforts between 2008 to the beginning of 2020. Analysis ranked postcodes throughout Victoria from low surveillance efforts to high, using standardised surveillance ratio's 95% confidence interval upper limits which were mapped using a colour gradient. This identified postcodes which need increased surveillance effort, corresponding to areas with high koala observations and low surveillance submissions. This analysis can guide surveillance for postcodes with koalas that were under-represented and inform improved methodology of future surveillance by WHV:S. The specific advice for improvements to WHV:S includes utilisation of citizen science and syndromic surveillance, website improvement, increasing community awareness and more. The limitations of this study were discussed.

Epistemics of the soul: Epistemic logics in German 18th-century empirical psychology

This article examines epistemic logics in 18th-century German empirical psychology and distinguishes three basic patterns at play throughout the century. First, as empirical psychology was introduced in the 1720s, it relied on the Aristotelian-scholastic conception of experience as universal and evidently true propositions of how things typically behave in nature. Empirical psychology was here a matter of defining and demonstrating the general nature, structure, and functions of the soul by referring to experiences that most people could recognize as universally and evidently true. Second, around midcentury this logic was challenged as a new generation of philosopher-physicians launched an empirical psychology based on extraordinary medical cases. Rather than focusing on the general and universal, this new strand of case-based empirical psychology charted the individual, unique and often abnormal. Third, from the early 1770s, the interest in the individual was complemented by a new discourse on psychological method. Adopting the epistemic techniques developed within natural and experimental philosophy, empirical knowledge of the soul was seen as the result of rigorously conducted singular observations that were frequently repeated and carefully documented and analyzed. Rather than replacing one another sequentially, these three epistemic logics should be understood as cumulative. That is, despite sometimes profound differences, each new logic was layered on top of the existing ones, thereby broadening and increasing the epistemic complexity of empirical psychology.

Exploration of motorcyclists' red-light running and helmet use at signalized intersections in Ghana

OBJECTIVE

There is a dearth of empirical studies on motorcyclists' red-light running and helmet use at signalized intersections in low and middle-income countries like Ghana, Nigeria and Malaysia. This study seeks to fill the gap by looking at red-light running and helmet use at signalized intersections in the Cape Coast metropolis, Ghana. The study also identified potential areas of intervention to reduce the dangers posed by motorcyclists' red-light running in the Cape Coast Metropolis without the use of a helmet.

METHOD

A naturalistic exploratory un-obstructive observational approach was used in assessing this phenomenon. The relationship between motorcyclists' behaviors and motorcyclists' observed demographic characteristics, the locality of the intersection, time of the week and presence of pillion passengers were analyzed. Chi-Square test of independence was used to establish the statistically significant relationships between dependent and independent variables.

RESULTS

In all, 2,225 motorcyclists and 744 pillion passengers were observed. The results revealed that 33.1% of the motorcyclists ran a red light with 45.4% not using a helmet. Red-light running at signalized intersections was significantly linked to the locality of the intersection, time of the week, and helmet use. The helmet use was low and significantly associated with the presence of a pillion passenger and whether the pillion passenger used a helmet or not.

CONCLUSION

Red-light running is influenced by locality of intersection, time of the week and helmet use. Efforts to reduce red-light running and improve helmet use should involve road safety education, awareness creation, and enforcement of traffic laws by the officials of the National Road Safety Authority and Motor Transport and Traffic Department of the Ghana Police Service. City managers in other low and middle-income countries can use the findings in the study to inform policy.

Seatbelt use among bus passengers in Ghana: observed versus self-reported measures

Many road traffic injuries in low- and middle-income countries (LMICs) are to bus passengers. We sought to determine the availability, functionality, and observed vs. self-reported use of seatbelts in large intercity buses in Ghana. We observed seatbelt use for 1,184 passengers in 35 large intercity buses. We interviewed a separate group of 633 bus passengers. All buses observed had seatbelts and most (92.6%) were functional. A little over a fifth (21.6%) of passengers were observed to wear seatbelts. However, 34.5% of passengers in the self-reported survey indicated always wearing seatbelts when riding in buses. Passengers on 5 buses out of the 35 observed where the driver verbally prompted them to wear seatbelts were more likely (57.8%) to wear seatbelts than on the other buses (15.3%, p = 0.001). Comparing the self-reported survey with observations, passengers tended to overinflate seatbelt use by a factor of 1.6. This study provides useful information for efforts to increase and monitor seatbelt use among large intercity bus passengers in LMICs.Supplemental data for this article is available online at.

A descriptive study on reading instruction provided to students with intellectual disability

Little is known about the content and quality of reading instruction provided to students with intellectual disability. This study aimed to describe the reading instruction provided to students with intellectual disability who were not yet readers in self-contained elementary classrooms. The teachers of 24 classrooms participated in the study. Systematic observations of reading lessons, follow-up interviews with the teachers, review of teaching material, and content analysis of students' individualized education plans were conducted. Findings indicate that phonics and phonological awareness were taught in most of the classrooms. However, phonics was taught systematically, as recommended in the research, in only less than half of the classes. Sight-word instruction and vocabulary instruction were observed in more than half of the classes. Comprehension instruction of texts read aloud by the teacher was observed in only about a third of the classrooms. Recommendations to support teachers in enhancing the quality of reading instruction are provided.

Observation: its role in Anna Freud's developmental approach and therapeutic parent-toddler groups

Starting in Vienna in the 1920s, Anna Freud's first tentative attempts at observing children became a crucial component of the 'double approach' which integrated direct child observation with psychoanalytic reconstruction. This enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Her identification of disturbances that were developmental rather than neurotic led to the broadening of child analysis. Interventions aimed at freeing and supporting development rather than giving insight, became known as 'developmental therapy'. These interventions are used in the parent-toddler groups that embody Anna Freud's endeavour to link psychoanalytic theory, direct observation and clinical practice. Observations of a toddler, who attended a parent-toddler group with his mother, show how intervening early in the child's life and soon after concerns were identified, contributed to preventing maladaptive affective states and ways of relating from becoming entrenched.

Suprarenal Masses in Very Young Infants: Is It Safe to Watch and Wait? Report of a SIOPEN Observational Study Results

Simple Summary

Optimal management of small suprarenal masses (sSRMs) is not clearly defined in the literature. Among the differential diagnosis of these sSRMs without a clearly defined clinical management, neuroblastoma is the malignant neuroblastic tumor, with very good prognosis in most cases at this age and a very intriguing biology. The concept of the sSRM study is to attempt to safely minimize invasive procedures (including surgery) without jeopardizing the final outcome. We report the first International Society of Paediatric Oncology European Neuroblastoma (SIOPEN) cooperative prospective study of expectant observation as primary approach for neonates and infants less than or equal to 90 days of age with small localized suprarenal masses. In most cases, patients avoided surgery and, consequently, morbidity and mortality related to surgery. The study contributes to improving knowledge about the natural history and biology of neuroblastoma during early infancy.

Abstract

Background: To assess whether expectant observation of infants ≤ 90 days old with small suprarenal masses (sSRMs) could avoid unnecessary surgery without impacting outcome. Methods: Infants ≤ 90 days with a ≤ 5 cm mass, without midline extension or lymph node or distant spread were registered (ClinicalTrials.org:NCT01728155). Once staging was completed, they were followed with ultrasound, MRI and urinary catecholamines. Surgical resection was only planned if there was a ≥40% mass volume increase or for a mass persisting after 48 weeks of the planned observation. Results: Over a 5-year period, 128 infants were registered. No infant had detectable MYCN amplification in the peripheral blood. Surgery was performed in 39 (30.5%) patients, in 18 during and in 21 after the planned 48-week observation, and 74% were confirmed to be neuroblastomas. Non-life-threatening surgical complications occurred in two cases. The 3-year overall survival and event-free survival were 100% and 87.1%, respectively. The 16 events observed were volume increase (N = 11) and progression to neuroblastoma stage MS (N = 5). Patients with solid masses or MIBG-positive masses had lower EFS. Conclusions: Expectant observation for infants with sSRMs with clinical follow-up and timely imaging (including MRI scan) is safe and effective, allowing surgery to be avoided in the majority of them.

Photo-elicited conversations about meetings with a therapy dog as a tool for communication in dementia care: An observational study

INTRODUCTION

It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos.

METHODS

In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72-92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017-2018. Each participant was video recorded 2-4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective.

FINDINGS

The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was 'somewhat positive'. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity.

CONCLUSION

Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

SailBuoy Ocean Currents: Low-Cost Upper-Layer Ocean Current Measurements

This study introduces an alternative to the existing methods for measuring ocean currents based on a recently developed technology. The SailBuoy is an unmanned surface vehicle powered by wind and solar panels that can navigate autonomously to predefined waypoints and record velocity profiles using an integrated downward-looking acoustic Doppler current profiler (ADCP). Data collected on two validation campaigns show a satisfactory correlation between the SailBuoy current records and traditional observation techniques such as bottom-mounted and moored current profilers and moored single-point current meter. While the highest correlations were found in tidal signals, strong current, and calm weather conditions, low current speeds and varying high wave and wind conditions reduced correlation considerably. Filtering out some events with the high sea surface roughness associated with high wind and wave conditions may increase the SailBuoy ADCP listening quality and lead to better correlations. Not yet resolved is a systematic offset between the measurements obtained by the SailBuoy and the reference instruments of ±0.03 m/s. Possible reasons are discussed to be the differences between instruments (various products) as well as changes in background noise levels due to environmental conditions.

Anatomizing the pulse: Edmund King's analogy, observation and conception of the tubular body

In an unpublished anatomical treatise written around 1670, the English anatomist and fellow of the Royal Society of London Edmund King proposed that the human body was ultimately an assemblage of tubes and contained liquids. Without literally seeing every of its constituents to be tubular, how did King come to posit a tubular body? This article tackles the question by examining King's inquiry about the pulse against his framing of the circulatory system into a universally tubular model. Asking how King registered this model despite the limited visibility of vascularity in practice, I discuss the place of analogy in his anatomical observation. I argue that analogy constituted an essential strategy for extending what King had perceived to account for the hardly perceptible nuances of the human body. I concentrate on two of his analogies, in which the artery was compared to the cord and the ureter. These two analogies revealed remarkable epistemic potency in representing and reasoning the pulse as the inherent motion of the living artery. They suggest that in seventeenth-century observation accounts, analogy was not simply a rhetoric suspicious of violating the principle of scientific empiricism; rather, they opened up ways of seeing and imagining nature.

Observing Music Therapy in Dementia: Repeated Single-case Studies Assessing Well-being and Sociable Interaction

OBJECTIVES

This study compared behavioral expressions of momentary well-being and sociable behavior toward significant others during music therapy and regular social interaction.

METHODS

A 10-week active music therapy intervention was provided for people living with dementia and family caregivers. A bi-phasic AB single-case design was replicated for three sessions per dyad and coded using the Observable Well-being in Living with Dementia-Scale (OWLS) and the Verbal and Nonverbal Sociable Interaction Scale-Care Receiver (VNVIS-CR). Effect sizes (Log Response Ratio) were calculated for each session and analyzed with robust cluster meta-analysis.

RESULTS

Eleven dyads were included, and 32 sessions analyzed (2102 observations). Within sessions we found a 48% increase in well-being, and a 32% increase in sociable interaction during music therapy. Heterogeneity was high. Dementia severity predicted an increase in nonverbal sociable interaction (93% for moderate dementia). Depression and time did not predict any change.

CONCLUSION

The potential of music therapy to increase well-being and sociable interactions toward significant others calls for further investigation of heterogeneity and covariates. Single-case designs are demonstrated to be feasible for these investigations.

CLINICAL IMPLICATIONS

Preference-based music therapy may alleviate some of the individual and relational consequences of living with dementia, facilitating positive emotions and connection to significant others.

A Mathematical Model to Assess the Effect of Residual Positive Lymph Nodes on the Survival of Patients With Papillary Thyroid Microcarcinoma

Background

Active surveillance (AS) has been considered the first-line management for patients with clinical low-risk papillary thyroid microcarcinoma (PTMC) who often have lymph node micrometastasis (m-LNM) when diagnosed. The "low-risk" and "high prevalence of m-LNM" paradox is a potential barrier to the acceptance of AS for thyroid cancer by both surgeons and patients.

Methods

Patients diagnosed with PTMC who underwent thyroidectomy with at least one lymph node (LN) examined were identified from a tertiary center database (n = 5,399). A β-binomial distribution was used to estimate the probability of missing nodal disease as a function of the number of LNs examined. Overall survival (OS) probabilities of groups with adequate and inadequate numbers of LNs examined were estimated using the Kaplan-Meier method in the Surveillance, Epidemiology, and End Results (SEER) database (n = 15,340). A multivariable model with restricted cubic splines was also used to verify the association of OS with the number of LNs examined.

Results

The risk of residual m-LNM (missed nodal disease) ranged from 31.3% to 10.0% if the number of LNs examined ranged from 1 and 7 in patients with PTMC. With 7 LNs examined serving as the cutoff value, the intergroup comparison showed that residual positive LNs did not affect OS across all patients and patients aged ≥55 years (P = 0.72 and P = 0.112, respectively). After adjusting for patient and clinical characteristics, the multivariate model also showed a slight effect of the number of LNs examined on OS (P = 0.69).

Conclusions

Even with the high prevalence, OS is not significantly compromised by persistent m-LNM in the body of patients with low-risk PTMC. These findings suggest that the concerns of LNM should not be viewed as an obstacle to developing AS for thyroid cancer. For patients with PTMC who undergo surgery, prophylactic central LN dissection does not provide a survival benefit.

A Quality Improvement Initiative Using Peer Audit and Feedback to Improve Compliance with the Surgical Safety Checklist

Background

The Surgical Safety Checklist (SSC) published by the WHO in 2009 is used as standard in surgery worldwide to reduce perioperative patient mortality. However, compliance with the SSC and quality of its application are often not satisfactory. Internal audits and feedbacks seem promising for improving SSC application.

Objective

The purpose of this study is to investigate whether an intervention consisting of peer observation and immediate peer feedback can be implemented with high fidelity and acceptance.

Method

Data were obtained from a national pilot programme that was initiated in Switzerland in 2018 to measure and improve compliance with the SSC using peer audit and feedback. A total of 11 hospitals with 14 sites implemented the full intervention. Each hospital formed an interprofessional project team that should perform at least 30 observations with feedback on SSC application documented in an observation tool developed specifically for this programme. Since the SSCs of the study hospitals differ greatly regarding checklist items, for each of the three SSC sections standard items were defined: four at Sign In, five at Team Time Out and two at Sign Out. Frequency analyses were performed for initiation characteristics, SSC application at item level, feedback characteristics and programme evaluation.

Results

The 11 hospitals documented 715 valid observations, and feedback on SSC application was provided for 79% of the observations. In 61%, all team members stopped their work for the SSC application, and in 71%, the items were read off from the checklist (instead of recalled from memory). On average, 86% of the standard items were read out by the checklist coordinator, whilst the two items at Sign Out were read out only in 60% and 74%. Additional visual checks with another source (e.g. patient wristband) took place in only 41%, and verbal confirmation of the items (by someone else other than the checklist coordinator) was obtained on an average of 76% across all three checklist sections. The surgical teams reacted positively in 64% to the peer feedback.

Conclusion

Both implementation fidelity and acceptability of the intervention were high—the present intervention seems suitable for regular monitoring of the quality of SSC application with internal resources. Peer observation facilitated identifying weaknesses regarding the SSC process and application at item level. Across all hospitals, the Sign Out section in general, visual control for item checks and lack of work interruption of all team members during SSC application showed up as the main areas of improvement.

Low-risk meningioma: Initial outcomes from NRG Oncology/RTOG 0539

BACKGROUND

Three- and five-year progression-free survival (PFS) for low-risk meningioma managed with surgery and observation reportedly exceeds 90%. Herewith we summarize outcomes for low-risk meningioma patients enrolled on NRG/RTOG 0539.

METHODS

This phase II trial allocated patients to one of three groups per World Health Organization grade, recurrence status, and resection extent. Low-risk patients had either gross total (GTR) or subtotal resection (STR) for a newly diagnosed grade 1 meningioma and were observed after surgery. The primary endpoint was 3-year PFS. Adverse events (AEs) were scored using Common Terminology Criteria for Adverse Events (CTCAE) version 3.

RESULTS

Among 60 evaluable patients, the median follow-up was 9.1 years. The 3-, 5-, and 10-year rates were 91.4% (95% CI, 84.2 to 98.6), 89.4% (95% CI, 81.3 to 97.5), 85.0% (95% CI, 75.3 to 94.7) for PFS and 98.3% (95% CI, 94.9 to 100), 98.3%, (95% CI, 94.9 to 100), 93.8% (95% CI, 87.0 to 100) for overall survival (OS), respectively. With centrally confirmed GTR, 3/5/10y PFS and OS rates were 94.3/94.3/87.6% and 97.1/97.1/90.4%. With STR, 3/5/10y PFS rates were 83.1/72.7/72.7% and 10y OS 100%. Five patients reported one grade 3, four grade 2, and five grade 1 AEs. There were no grade 4 or 5 AEs.

CONCLUSIONS

These results prospectively validate high PFS and OS for low-risk meningioma managed surgically but raise questions regarding optimal management following STR, a subcohort that could potentially benefit from adjuvant therapy.

From word list learning to successful shopping: The neuropsychological assessment continuum from cognitive tests to cognition in everyday life

Cognitive deficits are common after brain injury and can be measured in various ways. Many neuropsychological tests are designed to measure specific cognitive deficits, and self-report questionnaires capture cognitive complaints. Measuring cognition in daily life is important in rehabilitating the abilities required to undertake daily life activities and participate in society. However, assessment of cognition in daily life is often performed in a non-standardized manner. In this opinion paper we discuss the various types of assessment of cognitive functioning and their associated instruments. Drawing on existing literature and evidence from experts in the field, we propose a framework that includes seven dimensions of cognition measurement, reflecting a continuum ranging from controlled test situations through to measurement of cognition in daily life environments. We recommend multidimensional measurement of cognitive functioning in different categories of the continuum for the purpose of diagnostics, evaluation of cognitive rehabilitation treatment, and assessing capacity after brain injury.

Principles, Scope, and Limitations of the Methodological Triangulation

This article sought to collect basic and relevant information about methodological triangulation and make a first approach to the principles underlying its use, potentiality and scope, advances and limitations, and some alternative proposals to surpass them. In that sense, it is an attempt to operationalize concepts and present the procedures to conduct it rigorously. In the first place, conceptual aspects and types of triangulation are presented, and in the second place, the principles, uses and difficulties. But, beyond what must be done, an approach is made to how to do it. The assumption underlying through the article is the complementarity among methods. It is emphasized in the principle through which the nature of objects must guide the selection of the methods and of the most effective techniques to approach and account for phenomena that are socially pertinent of being studied.

Comparison of Fine Arts- and Pathology-Based Observational Skills Training for Veterinary Students Learning Cytology

Keen observational skills are essential for veterinarians; however, the development of these skills is not usually an explicit part of the veterinary curriculum. Fine arts-based (FAB) observation training has been shown to improve medical students' observational skills and might also improve veterinary students' observational skills. We compared FAB and pathology-based (PB) observation training in a veterinary cytology course. Students initially wrote a pre-test in which they described two cytology images and one art image, followed by participation in either FAB or PB observation training. Both groups completed a similar post-test immediately after training and a delayed post-test 4 weeks later following instruction in cytology. Differences between groups were noted only in the immediate post-test cytology descriptions. The PB group used significantly more specific vocabulary terms and significantly more accurate observations than the FAB group, suggesting an immediate benefit to the discipline-specific information gained in the PB observation training. In the delayed post-test, results for both groups were similar. The FAB group significantly increased their use of specific vocabulary terms and maintained but did not increase accurate observations following cytology instruction, while accurate observations decreased significantly for the PB group. The FAB group might have been able to generalize their observation skills to the discipline of cytology and to better retain these skills. Neither type of training resulted in both achievement and maintenance of the highest recorded scores for accurate observations. Both FAB and PB training led to improved observational skills, and explicit observation training may be useful for veterinary students.

Initial observation or treatment for diabetic macular oedema with good visual acuity: two-year outcomes comparison in routine clinical practice: data from the Fight Retinal Blindness! Registry

Purpose

To compare visual acuity (VA) change at 24 months in eyes with clinically significant DME (CSDME) and good VA initially treated versus initially observed in routine clinical practice.

Methods

Retrospective analysis of treatment‐naïve eyes with CSDME and good VA (baseline VA ≥ 79 letters), with at least 24 months of follow‐up and initially managed with treatment (intravitreal treatment and/or macular laser) or observation with possible treatment after 4 months that were tracked in a prospectively designed observational registry.

Results

We identified 150 eligible eyes (98 initially observed, 52 initially treated) of 130 patients. The proportion of eyes with at least a 5‐letter VA loss at 24 months was not significantly different between the groups: 65% with initial observation and 42% with initial treatment (p = 0.39). However, initially observed eyes were more likely to have a 10‐letter VA loss at 24 months (OR = 4.6, p = 0.022). Most of eyes in the initial observation group received at least one treatment (an intravitreal injection in 66% and macular laser in 20%) during the 24‐month period.

Conclusions

The risk of 5 letters loss was similar between both management groups. However, initially observed eyes were more at risk of developing moderate visual loss and more than 80% of them required treatment over 24 months.

Population-level Outcomes of Early Thyroid Cancers: A Need to Revisit Current Practice

BACKGROUND

Early thyroid cancers have excellent long-term outcomes, yet the word "cancer" draws unnecessary apprehension. This study aimed to define when the recommendations for observation and surveillance may be extended to early thyroid cancers at the population level.

METHODS

Non-metastasized thyroid cancers ≤40 mm diameter were identified from the 1975-2016 Surveillance, Epidemiology and End Results (SEER) database. Causes of death were compared across demographic data. Disease-specific outcomes were compared to the age-adjusted healthy United States (US) population. Survival estimates were computed using Kaplan-Meier and compared using the Cox proportional hazard model. Dynamic benchmarks impacting disease-specific overall survival were determined by decision tree modeling and tested by the Cox model.

RESULTS

Of the 28,728 thyroid cancers included in this study, 98.4% underwent some form of thyroid-specific treatment and were followed for a maximum of 10.9 years. This group had a 4.3% mortality rate at the end of follow-up (10.9 years maximum), with 13 times more deaths attributed to competing risks rather than thyroid cancer (stage T1a versus stage T1b, P=1.000; T1 versus T2, P<0.001). Among the untreated T1a or T1b tumors, the risk of disease-specific death was 21 times lower than death due to other causes. There was no significant difference between T1a and T1b tumors nor across sex. The age-adjusted risk of death for the healthy US population was higher than for the population with thyroid cancer. Dynamic categorization demonstrated worsening outcomes up to 73 years, uninfluenced by sex or tumor size. For patients over 73 years of age, only tumors >26 mm impacted outcomes.

CONCLUSION

Based on the current data, T1a and T1b nodules have similar survival outcomes and are not significantly impacted even when left untreated. Multi-institutional prospective studies are needed to confirm these findings so that current observation and surveillance recommendations can be extended to certain T1 thyroid nodules.

Does histologic subtype impact overall survival in observed T1a kidney cancers compared with competing risks? Implications for biopsy as a risk stratification tool

OBJECTIVES

We sought to assess if adding a biopsy proven histologic subtype to a model that predicts overall survival that includes variables representing competing risks in observed, biopsy proven, T1a renal cell carcinomas, enhances the model's performance.

METHODS

The National Cancer Database was assessed (years 2004-2015) for patients with observed T1a renal cell carcinoma who had undergone renal mass biopsy. Kaplan-Meier curves were utilized to estimate overall survival stratified by histologic subtype. We utilized C-index from a Cox proportional hazards model to evaluate the impact of adding histologic subtypes to a model to predict overall survival for each stage.

RESULTS

Of 132 958 T1a renal masses identified, 1614 had biopsy proven histology and were managed non-operatively. Of those, 61% were clear cell, 33% papillary, and 6% chromophobe. Adjusted Kaplan-Meier curves demonstrated a difference in overall survival between histologic subtypes (P = 0.010) with greater median overall survival for patients with chromophobe (85.1 months, hazard rate 0.45, P = 0.005) compared to clear cell (64.8 months, reference group). Adding histology to a model with competing risks alone did not substantially improve model performance (C-index 0.65 vs 0.64 respectively).

CONCLUSIONS

Incorporation of histologic subtype into a risk stratification model to determine prognostic overall survival did not improve modeling of overall survival compared with variables representing competing risks in patients with T1a renal cell carcinoma managed with observation. These results suggest that performing renal mass biopsy in order to obtain tumor histology may have limited utility. Future studies should further investigate the overall utility of renal mass biopsy for observed T1a kidney cancers.

Outcomes of Acute Repair Versus Nonrepair of Zone I Flexor Digitorum Profundus Tendon Injuries

PURPOSE

The aim of this study was to determine whether the clinical results of zone I flexor digitorum profundus (FDP) tendon injuries managed with acute surgical repair are comparable to the clinical results of those managed without repair (eg, primary FDP excision or observation).

METHODS

Patients aged ≥18 years presenting to a level 1 trauma center between 2015 and 2020 with zone I FDP tendon injury were identified with retrospective chart review. We assessed the following data: age, sex, physical therapy visits, surgical intervention, surgical complications (including infection, repeat surgery after the primary intervention, and rupture of repair), and patient-reported outcomes measurement information system scores.

RESULTS

Twenty-six patients met the inclusion criteria. Group 1 (N = 15 patients, 23 fingers) patients were treated with acute surgical repair. Group 2 (N = 11 patients, 11 fingers) patients were managed without surgical repair, including FDP excision (N = 7) or observation alone (N = 4). In group 1, the average distance from the distal palmar crease to fingertip at the final follow-up was 1.6 cm (range, 0-4 cm). Fourteen of the 15 patients participated in >3 therapy visits. The following complications occurred: 4 fingers with rerupture (2 patients), 4 fingers with surgical wound dehiscence (2 patients), 3 infections (2 patients), and 4 repeat surgeries for these complications. In group 2, the average distance from the distal palmar crease to fingertip at the final follow-up was 1.1 cm (range, 0.5-3 cm). There were no infections, episodes of wound dehiscence, or repeat surgeries. At the final follow-up, both groups showed clinically meaningful improvement on Patient Reported Outcomes Measurement Information System (PROMIS) upper extremity, pain interference, and physical function scores, with similar PROMIS domain scores between groups.

CONCLUSIONS

Patients treated without FDP tendon repair had similar outcomes to, and fewer complications than, patients treated with acute tendon repair. Our data suggest that the notable commitment of health care costs, time, and adherence to protocols/restrictions after surgical repair may not confer functional benefit.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

A 21-Year Retrospective Study of 387 Cases

PURPOSE

This study investigated the characteristics, diagnosis, and treatment of Warthin tumors (WTs) to explore the possibility of managing patients by observation.

METHODS

We reviewed the records of 1167 patients with benign parotid tumors who were seen in our department between September 1999 and April 2021. Among them, 387 cases were WT and 668 cases were pleomorphic adenoma. We evaluated preoperative diagnoses of WT by symptoms/signs, fine-needle aspiration cytology (FNAC), imaging, such as ultrasonography and magnetic resonance imaging, and technetium-99m pertechnetate (Tc-99m) scintigraphy. Fisher's exact test and the Mann-Whitney U test were used in statistical analyses.

RESULTS

Warthin tumors were treated by surgery in 238 cases and follow-up in 149 cases. The 238 patients were diagnosed as WT at the final pathology after surgery. Among them, 172 patients (72.3%) were determined as benign histological type by preoperative FNAC; in these 172 patients, 170 (71.4%) were correctly diagnosed as WT in the final pathology. Preoperative Tc-99m scintigraphy was performed in 69 patients diagnosed with WT by final pathology or FNAC, and the positive rate of Tc-99m scintigraphy in WT was 75.4%.

CONCLUSIONS

Combining FNAC and Tc-99m scintigraphy, as well as considering clinical findings, enables the diagnosis of WT in most cases. In particular, WT is more common in the elderly, grows more slowly, and is less likely to be malignant. Therefore, if WT can be diagnosed preoperatively with a high rate of correct diagnosis, it could be an accurate and effective means of managing patients through follow-up without surgery.