Sustaining Workforce Effectiveness: Self-Care Practices by Nursing Staff

The paper addresses the health maintenance practices and utilization of complementary and alternative therapies by nurses and nursing students from Canada, Hawaii, and American Samoa. Forecasts of an ongoing nursing shortage coupled with a focus on healthy behavior provided an impetus to describe actual practices of self-care and use of alternative therapies. The study addresses the dearth of knowledge in this area. Nurses and students were asked to anonymously complete a two-part survey that enumerated their perspectives on alternative therapies usage and self-care. Indicators of self-care included sleep, nutrition, exercise, and time. Use of alternative therapies is an integral part of self-care for the nurses and students in the three study regions

Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology.

PurposeThree-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy.Material and methodsThree brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic.ResultsPatient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences.ConclusionsWe established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators

Early risk factors for joint trajectories of bullying victimisation and perpetration

Bullying victimisation is a prevalent stressor associated with serious health problems. To inform intervention strategies, it is important to understand children’s patterns of involvement in bullying victimisation and perpetration across development, and identify early risk factors for these developmental trajectories. We analysed data from the Millennium Cohort Study (N = 14,525; 48.6% female, 82.6% White), a representative birth cohort of British children born in 2000–2002 across the UK. Bullying victimisation and perpetration were assessed via child, mother, and teacher reports at ages 5, 7, 11, and 14 years. Early risk factors (child emotional, cognitive, and physical vulnerabilities, and adverse family environments) were assessed at ages 9 months, 3, and 5 years. Using k-means for longitudinal data, we identified five joint trajectories of victimisation and perpetration across ages 5, 7, 11, and 14: uninvolved children (59.78%), early child victims (9.96%), early adolescent victims (15.07%), early child bullies (8.01%), and bully- victims (7.19%). Individual vulnerabilities (e.g., emotional dysregulation, cognitive difficulties) and adverse family environments (maternal psychopathology, low income) in pre-school years independently forecast multiple trajectories of bullying involvement. Compared to victims, bully-victims were more likely to be male, have cognitive difficulties, and experience harsh discipline and low income. Interventions addressing these risk factors (e.g., via accessible mental health care, stigma-based interventions, or programs to support low-income families) may help to prevent bullying involvement and its associated sequelae

Hydraulic Modeling of a Mixed Water Level Control Hydromechanical Gate

This article describes the hydraulic behavior of a mixed water level control hydromechanical gate present in several irrigation canals. The automatic gate is termed "mixed" because it can hold either the upstream water level or the downstream water level constant according to the flow conditions. Such a complex behavior is obtained through a series of side tanks linked by orifices and weirs. No energy supply is needed in this regulation process. The mixed flow gate is analyzed and a mathematical model for its function is proposed, assuming the system is at equilibrium. The goal of the modeling was to better understand the mixed gate function and to help adjust their characteristics in the field or in a design process. The proposed model is analyzed and evaluated using real data collected on a canal in the south of France. The results show the ability of the model to reproduce the function of this complex hydromechanical system. The mathematical model is also implemented in software dedicated to hydraulic modeling of irrigation canals, which can be used to design and evaluate management strategies

Feasibility Study to Assess Medical Student Visits to Developmentally Disabled Adults

Introduction The Probate Court of Kalamazoo appoints guardians to minors removed from the custody of their parents and to legally incapacitated or disabled adults. The state mandates that any child under age six placed into a guardianship be visited at least once a year to ensure proper care of the child, but there is no such mandate for the approximately 300 developmentally disabled (DD) adults under the care of the Probate Court. The purpose of this ongoing study is to determine the feasibility of annual visits to DD individuals conducted by volunteer medical students. Methods In this feasibility study, the parameters which involve medical students include the number of visits conducted to DD adults, time spent reviewing cases, travel time to and from the visitation site, time spent conducting the visit and completing the required court paperwork, and safety. For the Probate Court Staff we assessed the time spent training students, and preparation time prior to and after visitation. Results We collected data over 17 months, visiting DD wards on six separate occasions, totaling 32 DD adults in 12 homes. On average, we spent 38.4 minutes per location. Over the six occasions, we spent a total of 7.7 hours traveling, 6.1 hours preparing, 6.9 hours visiting wards, and 21 minutes finalizing reports, for a total of 21 hours to complete 32 visits. The average safety rating for these visits was 9.3/10, with a minimum safety of 7/10. Despite the short study, our results indicate that this is a feasible and worthwhile program. We were able to conduct 32 DD visits, which would not have been conducted without our participation. While the court needed 73.3 hours to prepare and review the cases, we saved the Probate Court at least 21 hours of home visitation time. Safety was not a major concern for a large majority of the homes, in part because of the use of a buddy system. Conclusion We believe that continuing program would be a valuable contribution to Probate Court. We suggest that this project continues as a longitudinal, comprehensive study that will assess not only feasibility, but outcomes and benefits of using medical students in particular. In the future we anticipate that the amount of hours contributed by medical students will increase, as a significant portion of our time was spent designing the study and defining its parameters

The center of pure complex braid groups

Brou\'e, Malle and Rouquier conjectured in that the center of the pure braid group of an irreducible finite complex reflection group is cyclic. We prove this conjecture, for the remaining exceptional types, using the analogous result for the full braid group due to Bessis, and we actually prove the stronger statement that any finite index subgroup of such braid group has cyclic center

Phase I study of dose escalation to dominant intraprostatic lesions using high-dose-rate brachytherapy.

PurposeRadiation dose escalation for prostate cancer improves biochemical control but is limited by toxicity. Magnetic resonance spectroscopic imaging (MRSI) can define dominant intraprostatic lesions (DIL). This phase I study evaluated dose escalation to MRSI-defined DIL using high-dose-rate (HDR) brachytherapy.Material and methodsEnrollment was closed early due to low accrual. Ten patients with prostate cancer (T2a-3b, Gleason 6-9, PSA < 20) underwent pre-treatment MRSI, and eight patients had one to three DIL identified. The eight enrolled patients received external beam radiation therapy to 45 Gy and HDR brachytherapy boost to the prostate of 19 Gy in 2 fractions. MRSI images were registered to planning CT images and DIL dose-escalated up to 150% of prescription dose while maintaining normal tissue constraints. The primary endpoint was genitourinary (GU) toxicity.ResultsThe median total DIL volume was 1.31 ml (range, 0.67-6.33 ml). Median DIL boost was 130% of prescription dose (range, 110-150%). Median urethra V120 was 0.15 ml (range, 0-0.4 ml) and median rectum V75 was 0.74 ml (range, 0.1-1.0 ml). Three patients had acute grade 2 GU toxicity, and two patients had late grade 2 GU toxicity. No patients had grade 2 or higher gastrointestinal toxicity, and no grade 3 or higher toxicities were noted. There were no biochemical failures with median follow-up of 4.9 years (range, 2-8.5 years).ConclusionsDose escalation to MRSI-defined DIL is feasible. Toxicity was low but incompletely assessed due to limited patients' enrollment

A Randomized, Double‐Blind Study Comparing Pharmacokinetics and Pharmacodynamics of Proposed Biosimilar ABP 798 With Rituximab Reference Product in Subjects With Moderate to Severe Rheumatoid Arthritis

ABP 798 is a proposed biosimilar to rituximab reference product (RP), an anti-CD20 monoclonal antibody. Pharmacokinetics (PK), pharmacodynamics (PD), and safety results from the comparative clinical study that evaluated the PK, PD, safety, efficacy, and immunogenicity of ABP 798 versus rituximab RP are presented here. Subjects with moderate to severe rheumatoid arthritis (RA) received 2 doses of ABP 798, United States-sourced RP (rituximab US) or European Union-sourced RP (rituximab EU), each consisting of two 1000-mg infusions 2 weeks apart. For the second dose (week 24), ABP 798- and rituximab EU-treated subjects received the same treatment; rituximab US-treated subjects transitioned to ABP 798. End points included area under the serum concentration-time curve from time 0 extrapolated to infinity and maximum observed serum concentration following the second infusion of the first dose (PK) and percentage of subjects with complete CD19+ cell depletion days 1-33 (PD). Primary analysis established PK similarity between ABP 798 and rituximab RP based on 90% confidence intervals of the adjusted geometric mean ratios being within a prespecified equivalence margin of 0.8 and 1.25. Complete CD19+ B-cell depletion on day 3 among groups confirmed PD similarity. These findings demonstrated PK/PD similarity between ABP 798 and rituximab RP in subjects with moderate to severe RA

DeepPhase: Surgical Phase Recognition in CATARACTS Videos

Automated surgical workflow analysis and understanding can assist surgeons to standardize procedures and enhance post-surgical assessment and indexing, as well as, interventional monitoring. Computer-assisted interventional (CAI) systems based on video can perform workflow estimation through surgical instruments' recognition while linking them to an ontology of procedural phases. In this work, we adopt a deep learning paradigm to detect surgical instruments in cataract surgery videos which in turn feed a surgical phase inference recurrent network that encodes temporal aspects of phase steps within the phase classification. Our models present comparable to state-of-the-art results for surgical tool detection and phase recognition with accuracies of 99 and 78% respectively.Comment: 8 pages, 3 figures, 1 table, MICCAI 201