Response to Crocetti et al.

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The Phenomenon of Collaboration: A Phenomenologic Study of Collaboration between Family Medicine and Obstetrics and Gynecology Departments at an Academic Medical Center

Collaboration is essential to manage complex real world problems. We used phenomenologic methods to elaborate a description of collaboration between two departments at an academic medical center who considered their relationship to represent a model of effective collaboration. Key collaborative structures included a shared vision and commitment by leaders, rigorous quality improvement, clear delineation of roles with built-in flexibility, ongoing commitment to formal and informal communication channels and conflict resolution, relationship development grounded in respect and responsiveness, and shared training in a supportive learning environment with legitimate participation fostering skill development. This study reveals the complexity and resources required for collaboration which both explains why collaboration is not as easy to achieve and identifies processes that foster collaboration

Image annotation with Photocopain

Photo annotation is a resource-intensive task, yet is increasingly essential as image archives and personal photo collections grow in size. There is an inherent conflict in the process of describing and archiving personal experiences, because casual users are generally unwilling to expend large amounts of effort on creating the annotations which are required to organise their collections so that they can make best use of them. This paper describes the Photocopain system, a semi-automatic image annotation system which combines information about the context in which a photograph was captured with information from other readily available sources in order to generate outline annotations for that photograph that the user may further extend or amend

Evaluation of an Australian indigenous housing programme: community level impact on crowding, infrastructure function and hygiene

Background and Aim: Housing programmes in indigenous Australian communities have focused largely on achieving good standards of infrastructure function. The impact of this approach was assessed on three potentially important housing-related influences on child health at the community level: (1) crowding, (2) the functional state of the house infrastructure and (3) the hygienic condition of the houses.\ud \ud Methods: A before-and-after study, including house infrastructure surveys and structured interviews with the main householder, was conducted in all homes of young children in 10 remote Australian indigenous communities.\ud \ud Results: Compared with baseline, follow-up surveys showed (1) a small non-significant decrease in the mean number of people per bedroom in the house on the night before the survey (3.4, 95% CI 3.1 to 3.6 at baseline vs 3.2, 95% CI 2.9 to 3.4 at follow-up; natural logarithm transformed t test, t=1.3, p=0.102); (2) a marginally significant overall improvement in infrastructure function scores (Kruskal–Wallis test, χ2=3.9, p=0.047); and (3) no clear overall improvement in hygiene (Kruskal–Wallis test, χ2=0.3, p=0.605).\ud \ud Conclusion: Housing programmes of this scale that focus on the provision of infrastructure alone appear unlikely to lead to more hygienic general living environments, at least in this study context. A broader ecological approach to housing programmes delivered in these communities is needed if potential health benefits are to be maximised. This ecological approach would require a balanced programme of improving access to health hardware, hygiene promotion and creating a broader enabling environment in communities.\u

Cultural Competency Observation Tool

This observational assessment rubric includes rating of the elements of patient centered communication defined in the Kalamazoo Consensus Statement regarding patient centered communication: These are augmented with sections that highlight factors that emerged in our observations specific to intercultural communication such as language and interpreters, nonverbal communication, mental and social issues with a large cultural overlay (mental health, pain, and disability). In addition, the tool incorporates issues specific to the medical context such as professional competence and professional regard. The rubric is also informed by the developmental model of intercultural sensitivity and Dreyfus\u27s phenomenology of skill acquisition with skill levels progressing through the stages: novice, beginner, competence, proficient, mastery

Completeness of primary intracranial tumour recording in the Scottish Cancer Registry 2011-12

IntroductionA high level of case ascertainment by cancer registries is essential to allow estimation of accurate incidence rates and survival. Nearly 20 years ago, researchers assessed the completeness and accuracy of registration of primary intracranial tumours (Scottish Cancer Registry [SCR]) compared to a database assembled in the context of a detailed incidence study carried out in the Lothian region of Scotland covering the period of diagnosis, 1989–1990.1 and 2 Disappointingly, SCR identified only 54% of cases, although the registry at that time did not attempt to collect information on ‘benign’ intracranial neoplasms which were included in the detailed incidence study. Even so, only 84% of neuro-epithelial tumours were identified by SCR, probably related in part to the fact that the cancer registry was not receiving neuropathology data from the regional neuro-oncology centre. An English study reported similar findings with only 52% of cases appearing in the regional cancer registry.3Over time, access to diagnostic techniques has improved alongside improvements and changes in classification and clinical coding. Furthermore, SCR now receives neuropathology data from all neuro-oncology centres in Scotland, and has sought to collect information on benign tumours of the brain and spinal cord since the year of diagnosis, 2000. In light of these developments, we aimed to determine the completeness of ascertainment of primary intracranial tumours by SCR through independent/clinical case ascertainment in NHS Lothian for the period of diagnosis, 2011–2012.MethodsScottish Cancer RegistrySCR operates by bringing together predominantly electronic information from hospital patient administration systems including patient discharges from hospital (Scottish Morbidity Record 01), radiotherapy, oncology, and pathology records; death records from National Records Scotland; and private hospital records.4 All primary malignant and benign brain tumours are recorded on the SCR.Inclusion and exclusion criteriaThis retrospective cohort study was restricted to the period of diagnosis between 1 January 2011 and 31 December 2012 and limited to adults (age ≥18 years on the date of diagnosis) with a postcode within the NHS Lothian health board region (mid-year population ∼650,000). The date of diagnosis was taken as i) the date of the first abnormal imaging, or ii) the date of biopsy/resection. Patients in whom there was no neuro-radiology or histology were excluded, i.e. diagnosis of prolactinoma had to be supported by blood tests and imaging.All suspected and histologically proven primary intracranial tumours (benign and malignant) of the brain and cranial nerves were counted, including primary central nervous system lymphoma. Meningeal, pituitary region and pituitary gland tumours were also included. Cerebral metastases, tumours of the spinal cord and spinal nerves, and recurrent intracranial tumours of any type were excluded.Extraction from the SCRData were extracted for the study period for all records including the following anatomical site codes selected from the third edition of the International Classification of Diseases for Oncology (ICD-O-3): C70.0; C70.9; C71; C72.2; C72.3; C72.4; C72.5; C72.8; C72.9; C75.1; C75.2; and C75.3 (all behaviour codes).Clinical case ascertainmentThree clinical sources were trawled as follows: i) neuro-oncology multidisciplinary team meeting (MDTM) minutes; ii) an endocrinology database; and iii) neuropathology records (sources i and ii are independent of the SCR data collection system). The neuro-oncology MDTM aims to discuss all intracranial tumours identified via any means including both benign and malignant tumours. The endocrinology database records all patients attending the endocrine outpatient clinics in the NHS Lothian region and each is assigned a diagnosis by a Consultant Endocrinologist. Both sources i and ii for the period 1 January 2011 – 31 March 2013 were reviewed manually by JRM. The neuropathology records hold information on all tissue samples analysed in the pathology system for NHS Lothian hospitals and an electronic extract was obtained using Systematized Nomenclature of Medicine codes matching those above. To ensure cases were true incident cases meeting the full inclusion criteria, each was cross-referenced with the patient's electronic secondary care medical record.AnalysisClinically ascertained cases were reconciled against the SCR extract. We have previously quantified the extent of misclassification of incidence year in the Scottish Cancer Registration database.5 We did not regard misclassifications of incidence year as missed or ‘over-diagnosed’ cases as there is no reason to believe that such misclassification is other than random.Completeness was defined as the proportion of intracranial tumours included in the SCR out of all those identified as diagnosed in residents of NHS Lothian area during the study period. Confidence intervals (95%) for completeness were calculated using the exact method.Completeness was calculated for all intracranial tumours with secondary analysis of completeness by tumour morphology and tumour grade (see Supplementary File for coding definitions).ResultsThere were 320 records of primary intracranial tumours registered on the SCR for the period of interest and 264 clinical cases were ascertained. Fig. 1 shows the final ascertainment of clinical cases missing from the SCR

Understanding concurrent earcons: applying auditory scene analysis principles to concurrent earcon recognition

Two investigations into the identification of concurrently presented, structured sounds, called earcons were carried out. One of the experiments investigated how varying the number of concurrently presented earcons affected their identification. It was found that varying the number had a significant effect on the proportion of earcons identified. Reducing the number of concurrently presented earcons lead to a general increase in the proportion of presented earcons successfully identified. The second experiment investigated how modifying the earcons and their presentation, using techniques influenced by auditory scene analysis, affected earcon identification. It was found that both modifying the earcons such that each was presented with a unique timbre, and altering their presentation such that there was a 300 ms onset-to-onset time delay between each earcon were found to significantly increase identification. Guidelines were drawn from this work to assist future interface designers when incorporating concurrently presented earcons

Detection of protein glycosylation using tip enhanced Raman scattering

The correct glycosylation of biopharmaceutical glycoproteins and their formulations is essential for them to have the desired therapeutic effect on the patient. It has recently been shown that Raman spectroscopy can be used to quantify the proportion of glycosylated protein from mixtures of native and glycosylated forms of bovine pancreatic ribonuclease (RNase). Here we show the first steps towards not only the detection of glycosylation status, but the characterisation of glycans themselves from just a few protein molecules at a time using tip-enhanced Raman scattering (TERS). Whilst this technique generates complex data that are very dependent on the protein orientation, with the careful development of combined data preprocessing, univariate and multivariate analysis techniques, we have shown that we can distinguish between the native and glycosylated forms of RNase. Many glycoproteins contain populations of subtly different glycoforms, therefore with stricter orientation control, we believe this has the potential to lead to further glycan characterisation using TERS, which would have use in biopharmaceutical synthesis and formulation research