Doctors and nurses subjective predictions of 6-month outcome compared to actual 6-month outcome for adult patients with spontaneous intracerebral haemorrhage (ICH) in neurocritical care: An observational study.

Acute spontaneous intracerebral haemorrhage is a devastating form of stroke. Prognostication after ICH may be influenced by clinicians' subjective opinions. To evaluate subjective predictions of 6-month outcome by clinicians' for ICH patients in a neurocritical care using the modified Rankin Scale (mRS) and compare these to actual 6-month outcome. We included clinicians' predictions of 6-month outcome in the first 48 h for 52 adults with ICH and compared to actual 6-month outcome using descriptive statistics and multilevel binomial logistic regression. 35/52 patients (66%) had a poor 6-month outcome (mRS 4-6); 19/52 (36%) had died. 324 predictions were included. For good (mRS 0-3) versus poor (mRS 4-6), outcome, accuracy of predictions was 68% and exact agreement 29%. mRS 6 and mRS 4 received the most correct predictions. Comparing job roles, predictions of death were underestimated, by doctors (12%) and nurses (13%) compared with actual mortality (36%). Predictions of vital status showed no significant difference between doctors and nurses: OR = 1.24 {CI; 0.50-3.05}; (  = 0.64) or good versus poor outcome: OR = 1.65 {CI; 0.98-2.79}; (  = 0.06). When predicted and actual 6-month outcome were compared, job role did not significantly relate to correct predictions of good versus poor outcome: OR = 1.13 {CI;0.67-1.90}; (  = 0.65) or for vital status: OR = 1.11 {CI; 0.47-2.61};  = 0.81). Early prognostication is challenging. Doctors and nurses were most likely to correctly predict poor outcome but tended to err on the side of optimism for mortality, suggesting an absence of clinical nihilism in relation to ICH. [Abstract copyright: © 2024 The Authors. Published by Elsevier B.V.

Cosmic Microwave Background constraint on residual annihilations of relic particles

Energy injected into the Cosmic Microwave Background at redshifts z<10^6 will distort its spectrum permanently. In this paper we discuss the distortion caused by annihilations of relic particles. We use the observational bounds on deviations from a Planck spectrum to constrain a combination of annihilation cross section, mass, and abundance. For particles with (s-wave) annihilation cross section, =\sigma_0, the bound is f[(\sigma_0/6e-27cm^3/s)(\Omega_{X\bar{X}}h^2)^2]/(m_X/MeV)<0.2, where m_X is the particle mass, \Omega_{X\bar{X}} is the fraction of the critical density the particle and its antiparticle contribute if they survive to the present time, h=H_0/(100km/s/Mpc), H_0 is the Hubble constant, and f is the fraction of the annihilation energy that interacts electromagnetically. We also compute the less stringent limits for p-wave annihilation. We update other bounds on residual annihilations and compare them to our CMB bound.Comment: submitted to Phys. Rev.

Rhetoric But Whose Reality? The Influence of Employability Messages on Employee Mobility Tactics and Work Group Identification

Over the last decade, employability has been presented by its advocates as the solution to employment uncertainty, and by its critics as a management rhetoric possessing little relevance to the experiences of most workers. This article suggests that while employability has failed to develop into a key research area, a deeper probing of its message is warranted. In particular, it is suggested that employability may have resonance with employees as workers rather than as employees of their immediate employing organisation. This demands a slightly different approach to studying employability than some other related phenomena such as employee commitment which has resonance only in relation to the employing organization. In adopting a social identity approach, the significance of the employability message is shown not only to lie in employees’ willingness to disassociate from their existing work groups and pursue individual mobility, but also in its capacity to undermine workers’ collective responses to grievances and unwanted organizational changes. A future research agenda is presented which highlights the need to address recent attempts to develop employability expectations among graduate career entrants, and for a closer critical engagement with management writings that attempt to justify the unnecessary espousal of the self development message

Knowledge network modelling to support decision-making for strategic intervention in IT project-oriented change management

This is the Accepted Manuscript version of an article published by Taylor & Francis in Journal of Decision Systems on 20 March 2014, available online: http://www.tandfonline.com/doi/abs/10.1080/12460125.2014.886499.This paper focuses on knowledge management to enhance decision support systems for strategic intervention in information technology (IT) project-oriented change management. It proposes a model of change management knowledge networks (CMKNM) to support decision by tackling three existing issues: insufficient knowledge traceability based on the relationships between knowledge elements and key factors, lack of procedural knowledge to provide adequate policies to guide changes, and lack of ‘lessons learned’ documentation in knowledge bases. A qualitative method was used to investigate issues surrounding knowledge mobilisation and knowledge networks. Empirical study was undertaken with industries to test the CMKNM. Results are presented from the empirical study on the key factors influencing knowledge mobilisation in IT project-oriented change management, knowledge networks and connections. The CMKNM model allows key knowledge mobilisation factors to be aligned with each other; it also defines the connections between knowledge networks allowing knowledge to be mobilised by tracing knowledge channels to support decision.Peer reviewe

Systems genetics identifies a role for Cacna2d1 regulation in elevated intraocular pressure and glaucoma susceptibility

Glaucoma is a multi-factorial blinding disease in which genetic factors play an important role. Elevated intraocular pressure is a highly heritable risk factor for primary open angle glaucoma and currently the only target for glaucoma therapy. Our study helps to better understand underlying genetic and molecular mechanisms that regulate intraocular pressure, and identifies a new candidate gene, Cacna2d1, that modulates intraocular pressure and a promising therapeutic, pregabalin, which binds to CACNA2D1 protein and lowers intraocular pressure significantly. Because our study utilizes a genetically diverse population of mice with kno