Prevalence and factors associated with gender incongruence in French healthcare professionals: results from a nationwide survey

OBJECTIVES

The objective of this study was to explore gender incongruence among French healthcare professionals and its associated factors.

STUDY DESIGN

Nationwide online cross-sectional survey.

METHODS

Healthcare professionals were recruited from May 2, 2021, to June 30, 2021, through social networks, professional networks, and email invitations. A multivariate regression model was used to analyze the association between gender incongruence and socio-demographic, professional, mental health, and addiction behavior factors.

RESULTS

The study included 10,325 healthcare professionals, indicating a prevalence of gender incongruence at 2.6% (95% confidence interval [CI]: 2.3-2.9%). In multivariate analyses, we found that healthcare professionals with gender incongruence, when compared to their counterparts, exhibited the following characteristics: they were more frequently male (adjusted odds ratio [aOR] = 1.88, 95% CI: [1.42-2.48], p < 0.001), less frequently physicians (aOR = 0.18, 95%CI: [0.11-0.29], p < 0.001), health executives (aOR = 0.51 [0.34-0.77], p = 0.001), nurses (aOR = 0.47, 95%CI: [0.33-0.68], p < 0.001), and other allied professionals (aOR = 0.33, 95%CI [0.23-0.49], p < 0.001) than nurse assistants, they consumed antidepressants more frequently (aOR = 1.52, 95%CI: [1.02-2.26], p = 0.041) and were more likely to be tobacco smokers (aOR = 1.34 (1.02-1.77), p = 0.035). We did not observe any significant associations with age, hazardous drinking, sustained bullying at the work place, or sexual-orientation-based discrimination (all p > 0.05).

CONCLUSIONS

Gender incongruence should be taken into account at the management, colleague, or institution levels. We found that the professionals reporting gender incongruence consumed more antidepressants and smoked more, which may indicate a certain level of distress that warrants further investigation.

PROTOCOL REGISTRATION

IRB n°C08/21.01.06.93911, CNIL. The protocol was published DOI: 10.1016/j.encep.2021.06.001.

TRIAL AND PROTOCOL REGISTRATION

The protocol was published DOI: 10.1016/j.encep.2021.06.001.

Predicting Office Workers' Productivity: A Machine Learning Approach Integrating Physiological, Behavioral, and Psychological Indicators

This research pioneers the application of a machine learning framework to predict the perceived productivity of office workers using physiological, behavioral, and psychological features. Two approaches were compared: the baseline model, predicting productivity based on physiological and behavioral characteristics, and the extended model, incorporating predictions of psychological states such as stress, eustress, distress, and mood. Various machine learning models were utilized and compared to assess their predictive accuracy for psychological states and productivity, with XGBoost emerging as the top performer. The extended model outperformed the baseline model, achieving an R2 of 0.60 and a lower MAE of 10.52, compared to the baseline model's R2 of 0.48 and MAE of 16.62. The extended model's feature importance analysis revealed valuable insights into the key predictors of productivity, shedding light on the role of psychological states in the prediction process. Notably, mood and eustress emerged as significant predictors of productivity. Physiological and behavioral features, including skin temperature, electrodermal activity, facial movements, and wrist acceleration, were also identified. Lastly, a comparative analysis revealed that wearable devices (Empatica E4 and H10 Polar) outperformed workstation addons (Kinect camera and computer-usage monitoring application) in predicting productivity, emphasizing the potential utility of wearable devices as an independent tool for assessment of productivity. Implementing the model within smart workstations allows for adaptable environments that boost productivity and overall well-being among office workers.

Virtual Human-Delivered Interviews for Patients With Chronic Pain: Feasibility, Acceptability, and a Pilot Randomized Trial of Standard Medical, Psychosocial, and Educational Interviews

OBJECTIVE

Seminal advances in virtual human (VH) technology have introduced highly interactive, computer-animated VH interviewers. Their utility for aiding in chronic pain care is unknown. We developed three interactive telehealth VH interviews-a standard pain-focused, a psychosocial risk factor, and a pain psychology and neuroscience educational interview. We then conducted a preliminary investigation of their feasibility, acceptability, and efficacy. We also experimentally compared a human and a computer-generated VH voice.

METHODS

Patients ( N = 94, age = 22-78 years) with chronic musculoskeletal pain were randomly assigned to the standard ( n = 31), psychosocial ( n = 34), or educational ( n = 29) VH interview and one of the two VH voices. Acceptability ratings included patient satisfaction and expectations/evaluations of the VH interview. Outcomes assessed at baseline and about 1-month postinterview were pain intensity, interference, emotional distress, pain catastrophizing, and readiness for pain self-management. Linear mixed-effects models were used to test between- and within-condition effects.

RESULTS

Acceptability ratings showed that satisfaction with the VH and telehealth format was generally high, with no condition differences. Study attrition was low ( n = 5). Intent-to-treat-analyses showed that, compared with the standard interview, the psychosocial interview yielded a significantly greater reduction in pain interference ( p = .049, d = 0.43) and a marginally greater reduction in pain intensity ( p = .054, d = 0.36), whereas the educational interview led to a marginally greater yet nonsignificant increase in readiness for change ( p = .095, d = 0.24), as well as several significant improvements within-condition. Results did not differ by VH voice.

CONCLUSIONS

Interactive VH interviewers hold promise for improving chronic pain care, including probing for psychosocial risk factors and providing pain-related education.

Ecological and evolutionary drivers of phenotypic and genetic variation in the European crabapple [Malus sylvestris (L.) Mill.], a wild relative of the cultivated apple

BACKGROUND AND AIMS

Studying the relationship between phenotypic and genetic variation in populations distributed across environmental gradients can help us to understand the ecological and evolutionary processes involved in population divergence. We investigated the patterns of genetic and phenotypic diversity in the European crabapple, Malus sylvestris, a wild relative of the cultivated apple (Malus domestica) that occurs naturally across Europe in areas subjected to different climatic conditions, to test for divergence among populations.

METHODS

Growth rates and traits related to carbon uptake in seedlings collected across Europe were measured in controlled conditions and associated with the genetic status of the seedlings, which was assessed using 13 microsatellite loci and the Bayesian clustering method. Isolation-by-distance, isolation-by-climate and isolation-by-adaptation patterns, which can explain genetic and phenotypic differentiation among M. sylvestris populations, were also tested.

KEY RESULTS

A total of 11.6 % of seedlings were introgressed by M. domestica, indicating that crop-wild gene flow is ongoing in Europe. The remaining seedlings (88.4 %) belonged to seven M. sylvestris populations. Significant phenotypic trait variation among M. sylvestris populations was observed. We did not observe significant isolation by adaptation; however, the significant association between genetic variation and the climate during the Last Glacial Maximum suggests that there has been local adaptation of M. sylvestris to past climates.

CONCLUSIONS

This study provides insight into the phenotypic and genetic differentiation among populations of a wild relative of the cultivated apple. This might help us to make better use of its diversity and provide options for mitigating the impact of climate change on the cultivated apple through breeding.

The field of human building interaction for convergent research and innovation for intelligent built environments

Human-Building Interaction (HBI) is a convergent field that represents the growing complexities of the dynamic interplay between human experience and intelligence within built environments. This paper provides core definitions, research dimensions, and an overall vision for the future of HBI as developed through consensus among 25 interdisciplinary experts in a series of facilitated workshops. Three primary areas contribute to and require attention in HBI research: humans (human experiences, performance, and well-being), buildings (building design and operations), and technologies (sensing, inference, and awareness). Three critical interdisciplinary research domains intersect these areas: control systems and decision making, trust and collaboration, and modeling and simulation. Finally, at the core, it is vital for HBI research to center on and support equity, privacy, and sustainability. Compelling research questions are posed for each primary area, research domain, and core principle. State-of-the-art methods used in HBI studies are discussed, and examples of original research are offered to illustrate opportunities for the advancement of HBI research.

Coronal STIR MRI sequences in unexplained limping in children under 6 years old: A single-center retrospective study of 130 cases

INTRODUCTION

Limping is a common presenting symptom in young children. Clinical examination backed up by laboratory analysis, standard radiography, and/or ultrasound may fail to determine the diagnosis, and limping may prove persistent, requiring repeated consultation. Magnetic resonance imaging (MRI) can suggest the etiology or provide welcome reassurance when normal. We advocate the use of MRI in cases of persistent unexplained limping in young children. The study hypothesis was that coronal short TI inversion recovery (STIR) MRI has good negative predictive value (NPV) in unexplained limping in children under 6 years of age.

MATERIAL AND METHOD

Coronal STIR MRI sequences were analyzed in 130 children younger than 6 years (84 boys, 46 girls) during the period April 2007 to May 2017. They extended from the lower thoracic spine down to the feet. Agreement was analyzed between the radiologist's initially suggested diagnosis and the pediatric orthopedic specialist's final diagnosis.

RESULTS

Overall, 49 scans were normal (37.7%) and 81 abnormal (62.3%). The mean age at MRI was 32.3 months. Coronal STIR MRI had 98% NPV. There was 99.2% agreement between the radiologist's diagnosis and the final diagnosis.

DISCUSSION

The recently reported contribution of STIR MRI in bone and joint infections was extended to unexplained limping.

CONCLUSION

First-line MRI with coronal STIR sequences improved the diagnostic efficacy, thanks to its speed and relative lack of movement artifacts.

Cognitive performance, creativity and stress levels of neurotypical young adults under different white noise levels

Noise is often considered a distractor; however recent studies suggest that sub-attentive individuals or individuals diagnosed with attention deficit hyperactivity disorder can benefit from white noise to enhance their cognitive performance. Research regarding the effect of white noise on neurotypical adults presents mixed results, thus the implications of white noise on the neurotypical population remain unclear. Thus, this study investigates the effect of 2 white noise conditions, white noise level at 45 dB and white noise level at 65 dB, on the cognitive performance, creativity, and stress levels of neurotypical young adults in a private office space. These conditions are compared to a baseline condition where participants are exposed to the office ambient noise. Our findings showed that the white noise level at 45 dB resulted in better cognitive performance in terms of sustained attention, accuracy, and speed of performance as well as enhanced creativity and lower stress levels. On the other hand, the 65 dB white noise condition led to improved working memory but higher stress levels, which leads to the conclusion that different tasks might require different noise levels for optimal performance. These results lay the foundation for the integration of white noise into office workspaces as a tool to enhance office workers’ performance.

Working from home during the COVID-19 pandemic: Impact on office worker productivity and work experience

BACKGROUND

With the COVID-19 pandemic, organizations embraced Work From Home (WFH). An important component of transitioning to WFH is the effect on workers, particularly related to their productivity and work experience.

OBJECTIVES

The objective of this study is to examine how worker-, workspace-, and work-related factors affected productivity and time spent at a workstation on a typical WFH day during the pandemic.

METHODS

An online questionnaire was designed and administered to collect the necessary information. Data from 988 respondents were included in the analyses.

RESULTS

Overall perception of productivity level among workers did not change relative to their in-office productivity before the pandemic. Female, older, and high-income workers were likely to report increased productivity. Productivity was positively influenced by better mental and physical health statuses, having a teenager, increased communication with coworkers and having a dedicated room for work. Number of hours spent at a workstation increased by approximately 1.5 hours during a typical WFH day. Longer hours were reported by individuals who had school age children, owned an office desk or an adjustable chair, and had adjusted their work hours.

CONCLUSION

The findings highlight key factors for employers and employees to consider for improving the WFH experience.

Office Worker Perspective on an Artificial Intelligence Workstation: A Qualitative Study

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This study explored office workers' perspectives on including artificial intelligence (AI) in their office workspace. Following an iterative analysis of six focus-group interviews with a total of 45 participants, three constructs emerged. Rich discussions demonstrated how acceptability of an AI workstation is complex and affected by the person, context, and their occupations.

Primary Author and Speaker: Yoko E. Fukumura

Contributing Authors: Julie McLaughlin Gray, Gale Lucas, Burcin Becerik-Gerber, and Shawn C. Roll

974 Paget-Schroetter Syndrome in A Young Fitness Enthusiast with A Negative D-Dimer. Highlighting the Balance Between Clinical Suspicion and Diagnostic Modalities

This case illustrates an athletic 22-year-old, who presented to the hospital with a 3-week history of spontaneous right arm ache, discolouration and swelling. His blood tests were normal, with a negative D-dimer (&lt;150ng/ml). He underwent a CT venogram for suspicion of venous obstruction which was unremarkable. However due to a high clinical suspicion, an ultrasound doppler was performed. This identified the presence of axillary-subclavian thrombosis which in conjunction with other clinical and radiological parameters confirmed the diagnosis of Paget-Schroetter Syndrome (PSS). Our patient was commenced on anticoagulation as the venous obstruction was suspected to be sub-acute with clinical suggestion of collateral formation. Unfortunately, his symptoms failed to resolve over a 6-month period, and he underwent an elective right rib resection with right subclavian bypass using the great saphenous vein with good outcome post-operatively.

PSS is a rare manifestation of venous thoracic outlet syndrome (TOS) commonly seen in young, healthy, athletic individuals. Despite the high effectiveness of D-Dimers in ruling out acute thrombotic process and the accuracy of dedicated CT angiography in excluding vascular thrombotic events, both tests proved inconclusive in this particular case. This latter observation highlights the importance of the clinical context, and risk profiling in guiding results interpretation.

Impacts of Working From Home During COVID-19 Pandemic on Physical and Mental Well-Being of Office Workstation Users

OBJECTIVE

To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH).

METHODS

A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues.

RESULTS

Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors.

CONCLUSION

This study highlights factors that impact workers' physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience.

The Effects of Experience on Deception in Human-Agent Negotiation

Negotiation is the complex social process by which multiple parties come to mutual agreement over a series of issues. As such, it has proven to be a key challenge problem for designing adequately social AIs that can effectively navigate this space. Artificial AI agents that are capable of negotiating must be capable of realizing policies and strategies that govern offer acceptances, offer generation, preference elicitation, and more. But the next generation of agents must also adapt to reflect their users’ experiences.      The best human negotiators tend to have honed their craft through hours of practice and experience. But, not all negotiators agree on which strategic tactics to use, and endorsement of deceptive tactics in particular is a controversial topic for many negotiators. We examine the ways in which deceptive tactics are used and endorsed in non-repeated human negotiation and show that prior experience plays a key role in governing what tactics are seen as acceptable or useful in negotiation. Previous work has indicated that people that negotiate through artificial agent representatives may be more inclined to fairness than those people that negotiate directly. We present a series of three user studies that challenge this initial assumption and expand on this picture by examining the role of past experience.      This work constructs a new scale for measuring endorsement of manipulative negotiation tactics and introduces its use to artificial intelligence research. It continues by presenting the results of a series of three studies that examine how negotiating experience can change what negotiation tactics and strategies human endorse. Study #1 looks at human endorsement of deceptive techniques based on prior negotiating experience as well as representative effects. Study #2 further characterizes the negativity of prior experience in relation to endorsement of deceptive techniques. Finally, in Study #3, we show that the lessons learned from the empirical observations in Study #1 and #2 can in fact be induced—by designing agents that provide a specific type of negative experience, human endorsement of deception can be predictably manipulated.

Effectiveness of an Empathic Chatbot in Combating Adverse Effects of Social Exclusion on Mood

From past research it is well known that social exclusion has detrimental consequences for mental health. To deal with these adverse effects, socially excluded individuals frequently turn to other humans for emotional support. While chatbots can elicit social and emotional responses on the part of the human interlocutor, their effectiveness in the context of social exclusion has not been investigated. In the present study, we examined whether an empathic chatbot can serve as a buffer against the adverse effects of social ostracism. After experiencing exclusion on social media, participants were randomly assigned to either talk with an empathetic chatbot about it (e.g., “I’m sorry that this happened to you”) or a control condition where their responses were merely acknowledged (e.g., “Thank you for your feedback”). Replicating previous research, results revealed that experiences of social exclusion dampened the mood of participants. Interacting with an empathetic chatbot, however, appeared to have a mitigating impact. In particular, participants in the chatbot intervention condition reported higher mood than those in the control condition. Theoretical, methodological, and practical implications, as well as directions for future research are discussed.

Virtual Human Role Players for Studying Social Factors in Organizational Decision Making

The cyber domain of military operations presents many challenges. A unique element is the social dynamic between cyber operators and their leadership because of the novel subject matter expertise involved in conducting technical cyber tasks, so there will be situations where senior leaders might have much less domain knowledge or no experience at all relative to the warfighters who report to them. Nonetheless, it will be important for junior cyber operators to convey convincing information relevant to a mission in order to persuade or influence a leader to make informed decisions. The power dynamic will make it difficult for the junior cyber operator to successfully influence a higher ranking leader. Here we present a perspective with a sketch for research paradigm(s) to study how different factors (normative vs. informational social influence, degree of transparency, and perceived appropriateness of making suggestions) might interact with differential social power dynamics of individuals in cyber decision-making contexts. Finally, we contextualize this theoretical perspective for the research paradigms in viable training technologies.

Inducing a long-term potentiation in the dentate gyrus is sufficient to produce rapid antidepressant-like effects

Recent hypotheses propose that one prerequisite to obtain a rapid antidepressant (AD) effect would reside in processes of synaptic reinforcement occurring within the dentate gyrus (DG) of the hippocampus independently from neurogenesis. However, to date no relationship has been established between an increased DG synaptic plasticity, and rapid AD-like action. To the best of our knowledge, this study shows for the first time that inducing a long-term potentiation (LTP) within the DG by stimulating the perforant pathway (PP) is sufficient to induce such effects. Thus, Sprague-Dawley rats having undergone a successful LTP displayed a significant reduction of immobility when passed acutely 3 days thereafter in the forced swimming test (FST). Further, in a longitudinal paradigm using the pseudo-depressed Wistar-Kyoto rat strain, LTP elicited a decrease of FST immobility after only 2 days, whereas the AD desipramine was not effective before 16 days. In both models, the influence of LTP was transient, as it was no more observed after 8-9 days. No effects were observed on the locomotor activity or on anxiety-related behavior. Theta-burst stimulation of a brain region anatomically adjacent to the PP remained ineffective in the FST. Immunoreactivity of DG cells for phosphorylated histone H3 and doublecortin were not modified three days after LTP, indicating a lack of effect on both cell proliferation and neurogenesis. Finally, depleting brain serotonin contents reduced the success rate of LTP but did not affect its subsequent AD-like effects. These results confirm the 'plastic DG' theory of rapid AD efficacy. Beyond, they point out stimulations of the entorhinal cortex, from which the PP originates, as putative new approaches in AD research.

Preventing Prescription Drug Misuse in Work Settings: Efficacy of a Brief Intervention in Health Consciousness

BACKGROUND

It is becoming more commonplace for employees to use prescription medication outside of intended use. Opioid and other prescription misuse has implications for the health and productivity of workers. Easy-to-access webinars that help employees learn about alternatives to prescription use may decrease risk.

OBJECTIVE

The aim of this study was to examine the efficacy of an interactive but brief health consciousness and prescription drug intervention for a diverse sample of employees and show effectiveness via both Internet-delivered webinar and classroom delivery.

METHODS

Employees from a variety of workplaces filled out pre- and post-questionnaires upon completion of a one-hour long intervention.

RESULTS

A total of 114 participants completed the pre- and post-questionnaires. Results showed that, compared with before the training, participants reported significantly more knowledge about prescription drug misuse and alternatives to prescription drug use after the training (t113=7.91, P<.001). Moreover, the medium of presentation (ie, face-to-face vs webinar) did not significantly impact effectiveness of the training (F1,98=1.15, P=.29).

CONCLUSIONS

In both webinar and classroom formats, participants gained knowledge about alternatives to prescription drug use. This intervention appears to be beneficial to employees and assists in the awareness of prescription drug use in general and in the workplace.

ACL reconstruction in 11 children using the Clocheville surgical technique: Objective and subjective evaluation

INTRODUCTION

The over-the-top position of the femoral metaphyseal tunnel during extraphyseal ligament reconstruction of the anterior cruciate ligament (ACL) according to Clocheville may be responsible for negative anisometry. Until now, the follow-up of children operated using this pediatric technique was limited to screening for iatrogenic epiphysiodesis and the search for postoperative clinical instability. The objective of this study was to measure residual laxity using objective tests, to quantify muscle recovery, and to evaluate the quality of life of these patients in terms of the sports activities.

MATERIAL AND METHODS

Eleven patients with a mean age of 13.5years were seen at a mean 2.1years of follow-up. They underwent objective clinical tests (GNRB(®) arthrometer and CON-TREX(®) dynamometer) as well as subjective questionnaires (IKDC and KOOS).

RESULTS

No significant difference was found between the healthy knee and the operated knee for either the GNRB(®) at 134N (P=0.79) or at 200N (P=0.98). The CON-TREX(®) system allowed us to measure a median percentage of quadriceps recovery of 80.7% (range, 52.2-114.5) in terms of muscle power (60°/s) and 81.2% (range, 51.6-109.6) for muscle response (180°/s). The median subjective IKDC score was 94.73/100 (range, 73.68-98.93); 72.7% of the patients resumed competitive sports.

DISCUSSION

This study's lack of statistical power did not show a significant difference in terms of residual laxity at rest of GNRB(®) transplants, while a mean differential of +0.4mm was observed. Although pediatric transphyseal ligament reconstruction techniques are increasingly used, the Clocheville technique remains, in our opinion, an attractive surgical alternative in the youngest subjects, with no major risk of iatrogenic epiphysiodesis even though it is theoretically anisometric.

LEVEL OF EVIDENCE

IV.

Clinical experience with a highly purified factor IX concentrate in patients undergoing surgical operations

The haemostatic efficacy of a new highly purified factor IX concentrate, prepared by metal chelate affinity chromatography, was assessed in 13 patients with haemophilia B undergoing a variety of surgical operations. Four of the patients had developed post-operative thromboembolic complications following previous operations, when treated with a prothrombin complex concentrate. None of the patients in the present series developed any evidence of post-operative thrombotic complications. Effective haemostasis was achieved in all patients, with the exception of a surgical bleed in one case, and late post-operative bleeding in a second patient when the factor IX activity fell below 20iu/dl. The product is treated with a solvent-detergent process that destroys lipid-enveloped viruses, while the affinity chromatography process during manufacture removes in excess of 4 log10 of a non-lipid-enveloped virus. In follow-up studies, none of the patients has shown evidence of fresh infection from the concentrate, when assessed by virological markers. It is concluded that this high-purity concentrate (tradenane 'Replenine') is effective for the treatment of patients with haemophilia B who undergo surgical operations.

L5S1 spondylolisthesis in children and adolescents

The precise etiology of childhood and adolescent spondylolisthesis (SPL) remains undetermined, but would seem to be multifactorial, deriving from anthropological adaptations of spinal sagittal balance combined with microtraumatic, genetic and dysplastic factors. Description of sagittal parameters not only lends weight to etiopathogenetic hypotheses, but also seeks to improve the classification of severity so as to optimize treatment according to clinical and radiological presentation. Thus, surgery should not only stabilize the lumbosacral junction by solid fusion but also correct pelvic abnormalities so as to restore overall sagittal balance in the long-term, without requiring spinal, pelvic or sub-pelvic compensation and with the lowest possible energy cost. Methods are still under debate; surgical technique, whether instrumental or not and whether aiming at in situ fusion or to correct lumbosacral deformity, all incur neurological risk of which child and family should be informed. Only long-term follow-up of functional results on quality-of-life scales, combined with radiological results for surgery aiming at lumbosacral angle correction, will be able to demonstrate superiority over in situ fusion surgery.

Automatic Behavior Analysis During a Clinical Interview with a Virtual Human

SimSensei is a Virtual Human (VH) interviewing platform that uses off-the-shelf sensors (i.e., webcams, Microsoft Kinect and a microphone) to capture and interpret real-time audiovisual behavioral signals from users interacting with the VH system. The system was specifically designed for clinical interviewing and health care support by providing a face-to-face interaction between a user and a VH that can automatically react to the inferred state of the user through analysis of behavioral signals gleaned from the user's facial expressions, body gestures and vocal parameters. Akin to how non-verbal behavioral signals have an impact on human-to-human interaction and communication, SimSensei aims to capture and infer user state from signals generated from user non-verbal communication to improve engagement between a VH and a user and to quantify user state from the data captured across a 20 minute interview. Results from of sample of service members (SMs) who were interviewed before and after a deployment to Afghanistan indicate that SMs reveal more PTSD symptoms to the VH than they report on the Post Deployment Health Assessment. Pre/Post deployment facial expression analysis indicated more sad expressions and few happy expressions at post deployment.

Natural Language Understanding Performance & Use Considerations in Virtual Medical Encounters

A virtual standardized patient (VSP) prototype was tested for natural language understanding (NLU) performance. The conversational VSP was evaluated in a controlled 61 subject study over four repetitions of a patient case. The prototype achieved more than 92% appropriate response rate from naïve users on their first attempt and results were stable by their fourth case repetition. This level of performance exceeds prior efforts and is at a level comparable of accuracy as seen in human conversational patient training, with caveats. This level of performance was possible due to the use of a unified medical taxonomy underpinning that allows virtual patient language training to be applied to all cases in our system as opposed to benefiting a single patient case.

[Peroneal nerve palsy in children: Uncommon diagnosis of a proximal tibiofibular synovial cyst]

Compression of the common peroneal nerve by synovial cysts of the tibiofibular joint is a rare disease. Two macroscopic forms may be encountered: extraneural cysts and intraneural cysts. In a review of the literature, we found only three pediatric cases of common peroneal nerve palsy due to extraneural cysts and about 60 cases reported in adults. Taking advantage of the clinical history of two children operated in our department for this disease, we describe this uncommon entity, which must be diagnosed and treated rapidly. Even in the presence of severe clinical and electrophysiological symptoms, a full clinical recovery is possible, as observed in these two children. However, follow-up is needed because recurrence is possible.

Effective interprofessional simulation training for medical and midwifery students

Introduction

Good interprofessional teamworking is essential for high quality, efficient and safe clinical care. Undergraduate interprofessional training has been advocated for many years to improve interprofessional working. However, few successful initiatives have been reported and even fewer have formally assessed their educational impact.

Methods

This was a prospective observational study of medical and midwifery students at a tertiary-level maternity unit. An interprofessional training module was developed and delivered by a multiprofessional faculty to medical and midwifery students, including short lectures, team-building exercises and practical simulation-based training for one obstetric (shoulder dystocia) and three generic emergencies (sepsis, haemorrhage, collapse). Outcome measures were interprofessional attitudes, assessed with a validated questionnaire (UWE Interprofessional Questionnaire) and clinical knowledge, measured with validated multiple-choice questions.

Results

Seventy-two students participated (34 medical, 38 midwifery). Following training median interprofessional attitude scores improved in all domains (p<0.0001), and more students responded in positive categories for communication and teamwork (69-89%, p=0.004), interprofessional interaction (3-16%, p=0.012) and interprofessional relationships (74-89%, p=0.006). Scores for knowledge improved following training for medical students (65.5% (61.8-70%) to 82.3% (79.1-84.5%) (median (IQR)) p<0.0001) and student midwives (70% (64.1-76.4%) to 81.8% (79.1-86.4%) p<0.0001), and in all subject areas (p<0.0001).

Conclusions

This training was associated with meaningful improvements in students' attitudes to teamwork, and knowledge acquisition. Integrating practical tasks and teamwork training, in authentic clinical settings, with matched numbers of medical and non-medical students can facilitate learning of both why and how to work together. This type of training could be adopted widely in undergraduate healthcare education.

Astroglial Control of the Antidepressant-Like Effects of Prefrontal Cortex Deep Brain Stimulation

Although deep brain stimulation (DBS) shows promising efficacy as a therapy for intractable depression, the neurobiological bases underlying its therapeutic action remain largely unknown. The present study was aimed at characterizing the effects of infralimbic prefrontal cortex (IL-PFC) DBS on several pre-clinical markers of the antidepressant-like response and at investigating putative non-neuronal mechanism underlying DBS action. We found that DBS induced an antidepressant-like response that was prevented by IL-PFC neuronal lesion and by adenosine A₁ receptor antagonists including caffeine. Moreover, high frequency DBS induced a rapid increase of hippocampal mitosis and reversed the effects of stress on hippocampal synaptic metaplasticity. In addition, DBS increased spontaneous IL-PFC low-frequency oscillations and both raphe 5-HT firing activity and synaptogenesis. Unambiguously, a local glial lesion counteracted all these neurobiological effects of DBS. Further in vivo electrophysiological results revealed that this astrocytic modulation of DBS involved adenosine A₁ receptors and K⁺ buffering system. Finally, a glial lesion within the site of stimulation failed to counteract the beneficial effects of low frequency (30 Hz) DBS. It is proposed that an unaltered neuronal–glial system constitutes a major prerequisite to optimize antidepressant DBS efficacy. It is also suggested that decreasing frequency could heighten antidepressant response of partial responders.

•

The antidepressant effect of prefrontal cortex DBS was prevented by neuronal lesion and adenosine A₁ receptor antagonists.

•

DBS rapidly increased hippocampal mitosis, cortical oscillations, raphe 5-HT firing activity and synaptogenesis.

•

Local glial lesions prevented the neurobiological effects of DBS in a frequency-dependent manner.

•

Although deep brain stimulation (DBS) is a promising therapy for patients with treatment-resistant depression, the neurobiological bases underlying its therapeutic action remain largely unknown. Here, we demonstrated that DBS produced a robust antidepressant-like effect that was associated with a fast induction of markers of the antidepressant-like response. Unambiguously, the effects of high-frequency, but not low-frequency, DBS were counteracted by a glial lesion within the site of stimulation. Thus, it is proposed that an unaltered neuronal–glial system constitutes a major prerequisite to optimize antidepressant DBS efficacy. It is also suggested that decreasing frequency of DBS could heighten antidepressant response of partial responders.

Minimally invasive harvesting of nonvascularized fibular graft in children

Using a nonvascularized fibular graft is part of the therapeutic arsenal for filling bone loss defects. It is conventionally performed by open surgery. The authors propose a minimally invasive technique for harvesting a free fibular graft. The fibula was removed subperiosteally by two or three small incisions in five patients with a mean age of nine years and nine months. The mean surgical time was 21 min and 40.5% of the length of the fibula was harvested. At the donor site, we found no removal-related complications, regeneration of the fibula was observed in 80% of cases, and the cosmetic result was considered excellent by all patients with a mean 4.3 years follow-up. This minimally invasive technique is simple and fast, with very low morbidity in our experience.

Monopolar-probe monitoring during spinal surgery with expandable prosthetic ribs

BACKGROUND

Intraoperative monitoring (IOM) has been proven to decrease the risk of neurological injury during scoliosis surgery. The vertical expandable prosthetic titanium rib (VEPTR) is a device that allows spinal growth. However, injuries to the spinal cord and brachial plexus have been reported after VEPTR implantation in 2 and 5% of patients, respectively. Simultaneous monitoring of these two structures requires the use of multiple time-consuming and complex methods that are ill-suited to the requirements of paediatric surgery, particularly when repeated VEPTR lengthening procedures are needed. We developed a monopolar stimulation method derived from Owen's monitoring technique. This method is easy to implement, requires only widely available equipment, and allows concomitant monitoring of the spinal cord and brachial plexus. The primary objective of this study was to assess the reliability of our technique for brachial plexus monitoring by comparing the stability of neurogenic mixed evoked potentials (NMEPs) at the upper and lower limbs.

HYPOTHESIS

We hypothesised that the coefficients of variation (CVs) of NMEPs were the same at the upper and lower limbs.

MATERIAL AND METHODS

Twelve VEPTR procedures performed in 6 patients between 1st January 2012 and 1st September 2014 were monitored using a monopolar stimulating probe. NMEPs were recorded simultaneously at the upper and lower limbs, at intervals of 150 s. The recording sites were the elbow over the ulnar nerve and the popliteal fossa near the sciatic nerve. Wilcoxon's test for paired data was used to compare CVs of the upper and lower limb NMEPs on the same side.

RESULTS

Mean CV of NMEP amplitude at the lower limbs was 16.34% on the right and 16.67% on the left; corresponding values for the upper limbs were 18.30 and 19.75%, respectively. Mean CVs of NMEP latencies at the lower limbs were 1.31% on the right and 1.19% on the left; corresponding values for the upper limbs were 1.96 and 1.73%. The risk of type I error for a significant difference between the upper and lower limbs was 0.5843 on the right and 0.7312 on the left for NMEP amplitudes and 0.7618 on the right and 0.4987 on the left for NMEP latencies.

CONCLUSION

Using an epidural active electrode and a sternal return electrode allows simultaneous stimulation of the cervical spinal cord and brachial plexus roots. The NMEPs thus obtained are as stable (reliable) at the upper limbs as at the lower limbs. This easy-to-implement method allows simultaneous monitoring of the upper and lower limbs. It seems well suited to VEPTR procedures.

LEVEL OF EVIDENCE

IV, retrospective single-centre non-randomised study.

Isolated meniscal injuries in paediatric patients: outcomes after arthroscopic repair

BACKGROUND

The management of isolated meniscal tears in paediatric patients is poorly standardised, and few published data are available. Nevertheless, there is widespread agreement that meniscectomy, even when partial, produces poor outcomes including the premature development of osteoarthritis.

HYPOTHESIS

Arthroscopic repair of isolated meniscal tears in paediatric patients yields good outcomes and should be attempted routinely.

MATERIALS AND METHODS

We retrospectively assessed 19 arthroscopic repair procedures performed between 2006 and 2010 by a single surgeon in 17 patients with a mean age of 14 years. In every case, the knee was stable and the meniscus normal before the meniscal tear, which was the only injury. Mean follow-up was 22 months. In all 19 cases, the evaluation included a physical examination, pre-operative magnetic resonance imaging (MRI), and determination of the Tegner and Lysholm scores. Post-operative MRI was performed in 10 cases.

RESULTS

The outcome was good in 12/17 (70%) patients with significant improvements in the mean Tegner score, from 3.9 to 7.1, and mean Lysholm score, from 55.9 to 85.4, between the pre-operative and post-operative assessments. The clinical outcomes were not significantly associated with time to arthroscopic repair, gender, lesion site, or lesion type. Neither was any correlation demonstrated between clinical outcomes and meniscal healing as assessed by MRI.

DISCUSSION

The known poor outcomes after meniscectomy in paediatric patients, the results of our study, and previously published data support routine arthroscopic repair of isolated meniscal tears in this age group, regardless of the site and type of injury. In addition, in asymptomatic patients, clinical follow-up is sufficient and post-operative MRI unnecessary.

LEVEL OF EVIDENCE

Level IV. Retrospective study.

Current Products and Practices

Personal Digital Assistants (PDAs) have certain advantages over conventional diaries and are thought of as the 'electronic filofax'. They can be backed up, used for personal and professional organization, integrated with mobile phones for email and Internet access, image storage, logbook functions and audit. They are limited when used for desktop functions. This article attempts to highlight the current advantages and disadvantages of PDAs for use in orthodontics, and provides some guidance to those who are considering the purchase of such a device.

Measurement and control systems for an imaging electromagnetic flow metre

Electromagnetic flow metres based on the principles of Faraday's laws of induction have been used successfully in many industries. The conventional electromagnetic flow metre can measure the mean liquid velocity in axisymmetric single phase flows. However, in order to achieve velocity profile measurements in single phase flows with non-uniform velocity profiles, a novel imaging electromagnetic flow metre (IEF) has been developed which is described in this paper. The novel electromagnetic flow metre which is based on the 'weight value' theory to reconstruct velocity profiles is interfaced with a 'Microrobotics VM1' microcontroller as a stand-alone unit. The work undertaken in the paper demonstrates that an imaging electromagnetic flow metre for liquid velocity profile measurement is an instrument that is highly suited for control via a microcontroller.

External quality assessment of human neutrophil antigen (HNA)-specific antibody detection and HNA genotyping from 2000 to 2012

Since 2000, Quality Assurance (QA) exercises for the detection and identification of granulocyte antibodies and DNA typing for human neutrophil antigens (HNA) have been distributed within the International Granulocyte Immunobiology Workshops, which are linked to International Society of Blood Transfusion. The exercises were standardised at the outset to enable laboratory performance to be monitored. Between 2000 and 2012, nine exercises were distributed to 20 laboratories. Overall, 45 examples of 42 unique samples containing defined granulocyte reactive antibodies were distributed for serological analysis together with 20 samples for HNA genotyping. The level of satisfactory serological performance was initially set at 50% and later increased to 70%, while the 'cut-off' for HNA genotyping was set at 100% after 2008. Failure to achieve the minimum score in the QA exercises in consecutive years resulted in temporary exclusion. In 2000, the 15 participating laboratories had a mean score of 56.1% for serological analysis and 13 laboratories attempted HNA-1a and -1b genotyping, while 11 attempted HNA-1c typing. Steady improvements in proficiency for serological testing and HNA typing occurred in subsequent exercises. In 2012, the mean score for serology was 88.5% and 12/13 laboratories scored 100% for HNA-1a, -1b, -1c, -3a, -3b, -4a, -4bw, -5a and -5bw genotyping. These QA exercises have provided an invaluable tool to monitor and improve the standard of granulocyte immunology investigations for participating laboratories, thereby enhancing performance for both clinical investigations and donor screening programmes to reduce the incidence of TRALI.

Determination of human neutrophil antigen-1, -3, -4 and -5 allele frequencies in English Caucasoid blood donors using a multiplex fluorescent DNA-based assay

BACKGROUND AND OBJECTIVES

A number of DNA-based methods to genotype the alleles coding for HNA have been described, but all require the separate amplification and analysis of each allele. The aim was to develop a DNA-based method for simultaneous detection of HNA-1, HNA-3, HNA-4 and HNA-5 alleles.

MATERIALS AND METHODS

An allele-specific primer extension method was used in combination with magnetic beads from Luminex technology. PCR-sequence-specific primers (SSP) was used to resolve the presence of the HNA-1b allele in samples assigned by the Luminex bead assay as HNA-1a/-1b/-1c or HNA-1b/-1c. HNA allele frequencies were determined in a panel of 140 randomly selected English Caucasoid blood donors.

RESULTS

HNA allelic types were compared with historical results, and 100% concordance was found. Only eight of the 97 samples used in the validation required additional testing by PCR-SSP. Allele frequencies were determined in the blood donor population as follows: 0·318 for HNA-1a, 0·668 for HNA-1b, 0·014 for HNA-1c, 0·768 for HNA-3a, 0·232 for HNA-3b, 0·882 for HNA-4a, 0·118 for HNA-4b, 0·736 for HNA-5a and 0·264 for HNA-5b.

CONCLUSION

A multiplex Luminex bead assay for the simultaneous detection of HNA-1, HNA-3, HNA-4 and HNA-5 alleles is described that enables rapid typing of donors to support HNA alloimmunized patients who require HNA-compatible blood products.

An International reference reagent for the detection of anti-human neutrophil antigen-1a

BACKGROUND AND OBJECTIVES

Testing for neutrophil antibodies has become more common as awareness of transfusion-related acute lung injury (TRALI) has increased. However, unlike other areas of blood cell antibody testing, there are no certified reference reagents available with which laboratories can determine the sensitivity of detection of their assays. This report describes the production and evaluation of a freeze-dried preparation of human plasma, code 09/284, containing anti-human neutrophil antigen-1a (anti-HNA-1a) for use as a minimum sensitivity reagent.

MATERIALS AND METHODS

One-millilitre of aliquots of plasma containing anti-HNA-1a were freeze-dried in glass ampoules. To characterize the material, 24 laboratories took part in an international collaborative study. The participants evaluated doubling dilutions of the material using their in-house routine assays and recorded the highest dilution in which the antibody could be detected.

RESULTS

When diluted 1 in 4, most laboratories were able to detect the anti-HNA-1a in the material, and the participants agreed that this was an appropriate level to set as the minimum sensitivity required.

CONCLUSIONS

In October 2011, the WHO Expert Committee on Biological Standardization approved the material 09/284 as an International Reference Reagent for the detection of anti-HNA-1a.

An environment-dependent interatomic potential for silicon carbide: calculation of bulk properties, high-pressure phases, point and extended defects, and amorphous structures

An interatomic potential has been developed to describe interactions in silicon, carbon and silicon carbide, based on the environment-dependent interatomic potential (EDIP) (Bazant et al 1997 Phys. Rev. B 56 8542). The functional form of the original EDIP has been generalized and two sets of parameters have been proposed. Tests with these two potentials have been performed for many properties of SiC, including bulk properties, high-pressure phases, point and extended defects, and amorphous structures. One parameter set allows us to keep the original EDIP formulation for silicon, and is shown to be well suited for modelling irradiation-induced effects in silicon carbide, with a very good description of point defects and of the disordered phase. The other set, including a new parametrization for silicon, has been shown to be efficient for modelling point and extended defects, as well as high-pressure phases.

Recommendations of the ISBT Working Party on Granulocyte Immunobiology for leucocyte antibody screening in the investigation and prevention of antibody-mediated transfusion-related acute lung injury

BACKGROUND

Transfusion-related acute lung injury (TRALI) is currently one of the most common causes of transfusion-related major morbidity and death. Among the many TRALI mediators, leucocyte antibodies have been identified as important triggers of severe TRALI.

STUDY DESIGN AND METHODS

These recommendations were compiled by experts of the ISBT Working Party on Granulocyte Immunobiology, based on the results obtained in eight international granulocyte immunology workshops, their personal experiences and on published study results.

RESULTS

Leucocyte antibody screening has to include the detection of human leucocyte antigen (HLA) class I, class II and human neutrophil alloantigen antibodies using established and validated techniques. HLA class I antibody detection should be restricted to antibodies clinically relevant for TRALI. To avoid unnecessary workload, TRALI diagnosis should be assessed by consultation with the reporting clinician and thorough exclusion of transfusion-associated circulatory overload/cardiac insufficiency. In patients diagnosed with TRALI having donors with detectable leucocyte antibodies, evidence of leucocyte incompatibility should be provided by either cross-matching or typing of patient for cognate antigen.

CONCLUSION

Leucocyte antibody screening for the immunological clarification of TRALI cases as well as for identification of potentially alloimmunized blood donors is feasible and can be performed in a reasonable and quality assured manner. This practice can contribute to the prevention of antibody-mediated TRALI.