How Service Dogs Enhance Veterans’ Occupational Performance in the Home: A Qualitative Perspective

Background: This qualitative study explored the lives of veterans diagnosed with posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI) and how the partnerships with their service dogs supported improved occupational performance in their homes. Method: Semi-structured individual interviews were conducted with six veterans with PTSD and/or TBI who graduated and received their service dogs from the Paws and Stripes Program in Albuquerque, NM. Home activities of daily living (self-care, household tasks, leisure activities, and family and friend relationships) guided the interview questions. The individual interviews were audio recorded, transcribed, and coded using qualitative data analysis software. Preliminary themes were independently developed by two graduate research assistants. Final themes and subthemes were generated by team consensus. Results: The overarching theme was veteran and service dog partnerships improved occupational performance in the home. Four primary themes arose that supported the overarching theme: (a) providing physical safety and peace of mind; (b) supporting healthy behaviors; (c) my service dog, my hero; and (d) influencing family and friend relationships. Discussion: Findings from this study support that veteran and service dog partnerships improved the veterans’ occupational performance in their homes. The service dogs assisted the veterans on physical and emotional levels and improved their healthy behaviors

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

Background: Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. Methods: During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. Result: Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. Conclusions: Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learnin

Quantitative analysis of the ACL and PCL using T1rho and T2 relaxation time mapping: an exploratory, cross-sectional comparison between OA and healthy control knees.

BACKGROUND: Quantitative magnetic resonance imaging (MRI) methods such as T1rho and T2 mapping are sensitive to changes in tissue composition, however their use in cruciate ligament assessment has been limited to studies of asymptomatic populations or patients with posterior cruciate ligament tears only. The aim of this preliminary study was to compare T1rho and T2 relaxation times of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) between subjects with mild-to-moderate knee osteoarthritis (OA) and healthy controls. METHODS: A single knee of 15 patients with mild-to-moderate knee OA (Kellgren-Lawrence grades 2-3) and of 6 age-matched controls was imaged using a 3.0 T MRI. Three-dimensional (3D) fat-saturated spoiled gradient recalled-echo images were acquired for morphological assessment and T1ρ- and T2-prepared pseudo-steady-state 3D fast spin echo images for compositional assessment of the cruciate ligaments. Manual segmentation of whole ACL and PCL, as well as proximal / middle / distal thirds of both ligaments was carried out by two readers using ITK-SNAP and mean relaxation times were recorded. Variation between thirds of the ligament were assessed using repeated measures ANOVAs and differences in these variations between groups using a Kruskal-Wallis test. Inter- and intra-rater reliability were assessed using intraclass correlation coefficients (ICCs). RESULTS: In OA knees, both T1rho and T2 values were significantly higher in the distal ACL when compared to the rest of the ligament with the greatest differences in T1rho (e.g. distal mean = 54.5 ms, proximal = 47.0 ms, p < 0.001). The variation of T2 values within the PCL was lower in OA knees (OA: distal vs middle vs proximal mean = 28.5 ms vs 29.1 ms vs 28.7 ms, p = 0.748; Control: distal vs middle vs proximal mean = 26.4 ms vs 32.7 ms vs 33.3 ms, p = 0.009). ICCs were excellent for the majority of variables. CONCLUSION: T1rho and T2 mapping of the cruciate ligaments is feasible and reliable. Changes within ligaments associated with OA may not be homogeneous. This study is an important step forward in developing a non-invasive, radiological biomarker to assess the ligaments in diseased human populations in-vivo.Declarations Ethics approval and consent to participate This study was approved by the East of England Cambridge Central Research Ethics Committee and written informed consent was given by all subjects included in the study. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not Applicable Availability of data and materials The datasets generated and analysed during the current study are not publicly available due to unattained permission from participants and research ethics committee but could be made available from JWM (email: [email protected]). Competing interests JWM, DAK and JDK acknowledge funding support from GlaxoSmithKline for their studentships and fellowships, respectively. JWM is an employee of AstraZeneca. CDSR, VAC and SMM have no competing interests to declare. Acknowledgements The Addenbrooke's Hospital Magnetic Resonance Imaging and Spectroscopy (MRIS) staff are thanked for their help with arranging and conducting the study MRI examinations. We also acknowledge the support of the Addenbrooke's Charitable Trust and the National Institute for Health Research Cambridge Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding The study was funded by an Experimental Medicine Initiative PhD studentship from the University of Cambridge [grant number RG81329] and by GlaxoSmithKline [grant number RG87552]. Authors' contributions Writing of original draft manuscript: CDSR. Study design and coordination: CDSR, JWM, JDK and SMM. Data acquisition: JWM and JDK. Data curation, analysis and interpretation: CDSR, JWM, VAC, JDK, DAK and SMM. Statistical analysis: CDSR and JWM. Review and editing of manuscript: JWM, VAC, JDK, DAK and SMM. All authors read and approved the final manuscript

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

Objective To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. Data Sources/Study Setting Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. Study Design A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. Data Collection Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. Principal Findings The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. Conclusions Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls

The optimisation of deep neural networks for segmenting multiple knee joint tissues from MRIs.

Automated semantic segmentation of multiple knee joint tissues is desirable to allow faster and more reliable analysis of large datasets and to enable further downstream processing e.g. automated diagnosis. In this work, we evaluate the use of conditional Generative Adversarial Networks (cGANs) as a robust and potentially improved method for semantic segmentation compared to other extensively used convolutional neural network, such as the U-Net. As cGANs have not yet been widely explored for semantic medical image segmentation, we analysed the effect of training with different objective functions and discriminator receptive field sizes on the segmentation performance of the cGAN. Additionally, we evaluated the possibility of using transfer learning to improve the segmentation accuracy. The networks were trained on i) the SKI10 dataset which comes from the MICCAI grand challenge "Segmentation of Knee Images 2010″, ii) the OAI ZIB dataset containing femoral and tibial bone and cartilage segmentations of the Osteoarthritis Initiative cohort and iii) a small locally acquired dataset (Advanced MRI of Osteoarthritis (AMROA) study) consisting of 3D fat-saturated spoiled gradient recalled-echo knee MRIs with manual segmentations of the femoral, tibial and patellar bone and cartilage, as well as the cruciate ligaments and selected peri-articular muscles. The Sørensen-Dice Similarity Coefficient (DSC), volumetric overlap error (VOE) and average surface distance (ASD) were calculated for segmentation performance evaluation. DSC ≥ 0.95 were achieved for all segmented bone structures, DSC ≥ 0.83 for cartilage and muscle tissues and DSC of ≈0.66 were achieved for cruciate ligament segmentations with both cGAN and U-Net on the in-house AMROA dataset. Reducing the receptive field size of the cGAN discriminator network improved the networks segmentation performance and resulted in segmentation accuracies equivalent to those of the U-Net. Pretraining not only increased segmentation accuracy of a few knee joint tissues of the fine-tuned dataset, but also increased the network's capacity to preserve segmentation capabilities for the pretrained dataset. cGAN machine learning can generate automated semantic maps of multiple tissues within the knee joint which could increase the accuracy and efficiency for evaluating joint health.European Union's Horizon 2020 Framework Programme [grant number 761214] Addenbrooke’s Charitable Trust (ACT) National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre University of Cambridge Cambridge University Hospitals NHS Foundation Trust GSK VARSITY: PHD STUDENTSHIP Funder reference: 300003198

How Service Dogs Enhance Veterans ’ Occupational Performance in the Home: A Qualitative Perspective

Background: This qualitative study explored the lives of veterans diagnosed with posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI) and how the partnerships with their service dogs supported improved occupational performance in their homes. Method: Semi-structured individual interviews were conducted with six veterans with PTSD and/or TBI who graduated and received their service dogs from the Paws and Stripes Program in Albuquerque, NM. Home activities of daily living (self-care, household tasks, leisure activities, and family and friend relationships) guided the interview questions. The individual interviews were audio recorded, transcribed, and coded using qualitative data analysis software. Preliminary themes were independently developed by two graduate research assistants. Final themes and subthemes were generated by team consensus. Results: The overarching theme was veteran and service dog partnerships improved occupational performance in the home. Four primary themes arose that supported the overarching theme: (a) providing physical safety and peace of mind; (b) supporting healthy behaviors; (c) my service dog, my hero; and (d) influencing family and friend relationships. Discussion: Findings from this study support that veteran and service dog partnerships improved the veterans’ occupational performance in their homes. The service dogs assisted the veterans on physical and emotional levels and improved their healthy behaviors

Manganese and cobalt redox cycling in laterites; Biogeochemical and bioprocessing implications

This research was developed during the PhD studies of Agustín Solano Arguedas in the University of Manchester, United Kingdom. PhD scholarship was funded by the Ministerio de Ciencia, Tecnología y Telecomunicaciones (MICITT) of the Government of Costa Rica and the Universidad de Costa Rica (UCR). Agustín Solano Arguedas is a researcher at the Unidad de Recursos Forestales (Reforesta, Unit of Forest Resources) of the Instituto de Investigaciones en Ingeniería (INII, Engineering Research Institute), UCR.Cobalt is essential for the modern technology that underpins the decarbonisation of our economies, but its supply is limited leading to its designation as a critical metal. Cobalt biogeochemistry is poorly understood, yet knowledge of how biogeochemical cycling impacts cobalt behaviour could assist the development of new techniques to recover cobalt from ores, and so improve the security of supply. Laterites are an important source of cobalt, they are primarily processed for nickel using energy or chemical intensive processes, with cobalt recovered as a by-product. Metal-reducing conditions were stimulated in laterite sediment microcosms by the addition of simple and cheaply available organic substrates (acetate or glucose). At the end of the experiment the amount of easily recoverable cobalt (aqueous or extractable with acetic acid) increased from < 1% to up to 64%, which closely mirrored the behaviour of manganese, while only a small proportion of iron was transformed into an easily recoverable phase. Sequencing of the microbial community showed that the addition of organic substrates stimulated the growth of indigenous prokaryotes closely related to known manganese(IV)/iron(III)-reducers, particularly from the Clostridiales, and that fungi assigned to Penicillium, known to produce organic acids beneficial for leaching cobalt and nickel from laterites, were identified. Overall, the results indicate that the environmental behaviour of cobalt in laterites is likely to be controlled by manganese biogeochemical cycling by microorganisms. These results are compelling given that similar behaviour was observed in four laterites (Acoje, Çaldağ, Piauí and Shevchenko) from different continents. A new bioprocessing strategy is proposed whereby laterites are treated with an organic substrate to generate metal-reducing conditions, then rinsed with acetic acid to remove the cobalt. Not only are organic substrates environmentally-friendly and potentially sourced from waste carbon substrates, a minimal amount of iron oxides was mobilised and consequently less waste generated.Natural Environment Research Council/[CoG3 NE/M011518/1]/NERC/Reino UnidoDiamond Light Source/[SP16735]//Reino UnidoDiamond Light Source/[SP17313]//Reino UnidoOffice of Science User Facility/[DE-AC02-05CH11231]//Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ingeniería::Instituto Investigaciones en Ingeniería (INII