Dynamic ‘Spot Sign’ Resolution following INR Correction in a Patient with Warfarin-Associated Intracerebral Hemorrhage

Hematoma expansion in intracerebral hemorrhage is associated with poor clinical outcome. The ‘spot sign’ is a radiological marker that is associated with hematoma expansion, and thought to represent active extravasation of contrast. This case demonstrates the use of dynamic CT angiography in identifying the time-dependent appearance of a spot sign in a patient with warfarin-associated intracerebral hemorrhage. Repeat imaging is also presented which verified cessation of the spot sign after INR correction

Distributed-Pair Programming can work well and is not just Distributed Pair-Programming

Background: Distributed Pair Programming can be performed via screensharing or via a distributed IDE. The latter offers the freedom of concurrent editing (which may be helpful or damaging) and has even more awareness deficits than screen sharing. Objective: Characterize how competent distributed pair programmers may handle this additional freedom and these additional awareness deficits and characterize the impacts on the pair programming process. Method: A revelatory case study, based on direct observation of a single, highly competent distributed pair of industrial software developers during a 3-day collaboration. We use recordings of these sessions and conceptualize the phenomena seen. Results: 1. Skilled pairs may bridge the awareness deficits without visible obstruction of the overall process. 2. Skilled pairs may use the additional editing freedom in a useful limited fashion, resulting in potentially better fluency of the process than local pair programming. Conclusion: When applied skillfully in an appropriate context, distributed-pair programming can (not will!) work at least as well as local pair programming

Ray-based description of normal mode amplitudes in a range-dependent waveguide

An analogue of the geometrical optics for description of the modal structure of a wave field in a range-dependent waveguide is considered. In the scope of this approach the mode amplitude is expressed through solutions of the ray equations. This analytical description accounts for mode coupling and remains valid in a nonadiabatic environment. It has been used to investigate the applicability condition of the adiabatic approximation. An applicability criterion is formulated as a restriction on variations of the action variable of the ray.Comment: 11 pages, 5 figure

Structuring specification in Z to build a unifying framework for hypertext systems

A report is given on work undertaken to produce a structured specification in Z of a model which aims to capture the essential abstractions of hypertext systems. The specification is presented in part and the potential value of this specification to the hypertext community is explored and discussed. We argue that this specification provides a framework for hypertext systems in that it provides: explicit and unambiguous definitions of hypertext terms, an explicit environment for the presentation, comparison and evaluation of hypertext systems and a foundation for future research and development in the field. Although there are many formal reference models of hypertext, we have found Z expressive enough to allow a unified account of a system and its operations. Our model does not restrict the specifier to any particular design, but provides a mathematical framework within which different models may be compared. Further, we were able to structure the specification in order that the model could be described initially at the highest level of abstract with complexity added at increasingly lower levels of abstraction. This structure

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed

Systematic review: a resource that allows for the incorporation of evidence into nursing practice

A revisão sistemática é um recurso importante da prática baseada em evidências, que consiste em uma forma de síntese dos resultados de pesquisas relacionados com um problema específico. O presente artigo tem como objetivo oferecer subsídios que proporcionem reflexões para a construção e/ou aplicação de revisões sistemáticas no cenário da enfermagem. Fundamentados na literatura, apresentamos as fases que compõem uma revisão sistemática e aspectos relevantes a serem considerados para a utilização desse recurso.La revisión sistemática es un recurso importante de la práctica basada en evidencias, que consiste en una forma de síntesis de los resultados de las investigaciones relacionadas con un determinado problema. El presente artículo tiene como objetivo ofrecer elementos que permitan reflexionar sobre la construcción y/o aplicación de revisiones sistemáticas en el ámbito de la enfermería. Basados en la literatura, presentamos las etapas que componen una revisión sistemática y los aspectos relevantes que deben ser considerados para la utilización de este recurso.Systematic review is an important resource in evidence-based practice, which consists in a form of synthesizing the research results related to a specific problem. This article aimed to offer subsidies for reflections with a view to the construction and/or application of systematic reviews in the nursing environment. Based on the literature, authors presented the phases comprising a systematic review and the relevant aspects that must be considered for using this resource

Lessons learned from the London Exercise and Pregnant (LEAP) Smokers randomised controlled trial process evaluation : implications for the design of physical activity for smoking cessation interventions during pregnancy

BACKGROUND: The challenges of delivering interventions for pregnant smokers have been poorly documented. Also, the process of promoting a physical activity intervention for pregnant smokers has not been previously recorded. This study describes the experiences of researchers conducting a randomised controlled trial of physical activity as an aid to smoking cessation during pregnancy and explores how the effectiveness of future interventions could be improved. METHODS: Two focus groups, with independent facilitators, were conducted with six researchers who had enrolled pregnant smokers in the LEAP trial, provided the interventions, and administered the research measures. Topics included recruitment, retention and how the physical activity intervention for pregnant smokers was delivered and how it was adapted when necessary to suit the women. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis. RESULTS: Five themes emerged related to barriers or enablers to intervention delivery: (1) nature of the intervention; (2) personal characteristics of trial participants; (3) practical issues; (4) researchers' engagement with participants; (5) training and support needs. Researchers perceived that participants may have been deterred by the intensive and generic nature of the intervention and the need to simultaneously quit smoking and increase physical activity. Women also appeared hampered by pregnancy ailments, social deprivation, and poor mental health. Researchers observed that their status as health professionals was valued by participants but it was challenging to maintain contact with participants. Training and support needs were identified for dealing with pregnant teenagers, participants' friends and family, and post-natal return to smoking. CONCLUSIONS: Future exercise interventions for smoking cessation in pregnancy may benefit by increased tailoring of the intervention to the characteristics of the women, including their psychological profile, socio-economic background, pregnancy ailments and exercise preferences. Delivering an effective physical activity intervention for smoking cessation in pregnancy may require more comprehensive training for those delivering the intervention, particularly with regard to dealing with teenage smokers and smokers' friends and family, as well as for avoiding post-natal return to smoking. TRIAL REGISTRATION: ISRCTN48600346 , date of registration: 21/07/2008