Diagnosis of antiphospholipid syndrome in routine clinical practice.

The updated international consensus criteria for definite antiphospholipid syndrome (APS) are useful for scientific clinical studies. However, there remains a need for diagnostic criteria for routine clinical use. We audited the results of routine antiphospholipid antibodies (aPLs) in a cohort of 193 consecutive patients with aPL positivity-based testing for lupus anticoagulant (LA), IgG and IgM anticardiolipin (aCL) and anti-ß(2)glycoprotein-1 antibodies (aß(2)GPI). Medium/high-titre aCL/aβ(2)GPI was defined as >99th percentile. Low-titre aCL/aβ(2)GPI positivity (>95(th )< 99(th) percentile) was considered positive for obstetric but not for thrombotic APS. One hundred of the 145 patients fulfilled both clinical and laboratory criteria for definite APS. Twenty-six women with purely obstetric APS had persistent low-titre aCL and/or aβ(2)GPI. With the inclusion of these patients, 126 of the 145 patients were considered to have APS. Sixty-seven out of 126 patients were LA-negative, of whom 12 had aCL only, 37 had aβ(2)GPI only and 18 positive were for both. The omission of aCL or aβ(2)GPI testing from investigation of APS would have led to a failure to diagnose APS in 9.5% and 29.4% of patients, respectively. Our data suggest that LA, aCL and aβ(2)GPI testing are all required for the accurate diagnosis of APS and that low-titre antibodies should be included in the diagnosis of obstetric APS

Establishing links between organizational climate, employee well-being and historical patient outcomes

This research undertaken in collaboration with Queensland Health analysed the links between dimensions of workplace climate/employee well-being contained in a number of Queensland Health databases, including the Patient Satisfaction Survey, the Clinical Incident database, the compliments and complaints database, the Variable Life Adjusted Display (VLAD) Database and the Better Workplaces Staff Opinion Survey database. Queensland Health sought to identify in what ways workplace climate is related to patient outcomes using existing datasets collected within the Queensland Health Centre for Healthcare Improvement. The process of establishing links involved matching aggregated data for specific facilities (where possible), or failing that, larger facilities (e.g. Hospital), or the Health Service District. Once the datasets had been matched on location or facility, correlations were calculated between the aggregated scores. The results demonstrated links between the data sets. These links showed that a better workplace climate is associated with greater reported numbers of clinical incidents, especially “no harm” clinical incidents. There was also a link between workplace climate and patient compliments/complaints which show that unsolicited compliments received from patients and their families are clearly related to a number of positive aspects of workplace climate (workplace morale, role clarity, and appraisal and recognition) and individual morale. The results linking workplace climate and patient satisfaction showed that there is a strong positive relationship between overall patient satisfaction and role clarity, and a negative relationship between overall patient satisfaction and both workplace distress and excessive work demands. While these results relate to historical data and therefore should not be construed to reflect the current state of operation within Queensland Health, they are still indicative of some very important relationships. This is the first study to demonstrate that more positive clinical management practices, better perceptions of the workplace climate and better employee well-being are a reflection of a better incident reporting and learning culture in a health care organization, ultimately resulting in improved patient outcomes

Motives for Facebook use in an Australian sample

A survey of 209 Australians (17-69 years) was conducted to examine the motives for Facebook use, and how these factors related to individuals' belonging, self-esteem, control, and meaning. An initial factor analysis identified four distinct factors underlying motives for Facebook use: meeting people, relationship maintenance, monitoring relationships, and seeking information. These four factors extend previous research and help clarify the key reasons for Facebook use. Further analyses found that participants' age was negatively correlated with each of the motives for Facebook use factors. Multiple regressions were performed with each of the four motives regressed on age, gender, and the individuals' belonging, self-esteem, control, and meaning. All four of these variables contributed significantly to the prediction of factor 1 (meeting people). Only belonging was a significant predictor of factor 2 (relationship maintenance) and factor 3 (monitoring relationships). Both self-esteem and belonging were significant predictors of factor 4 (seeking information). This study included general community members and not just undergraduate students and therefore has wider applicability than previous research. Facebook use seems to be closely related to individuals' belonging across a wide age range

Floppy swimming: Viscous locomotion of actuated elastica

Actuating periodically an elastic filament in a viscous liquid generally breaks the constraints of Purcell's scallop theorem, resulting in the generation of a net propulsive force. This observation suggests a method to design simple swimming devices - which we call "elastic swimmers" - where the actuation mechanism is embedded in a solid body and the resulting swimmer is free to move. In this paper, we study theoretically the kinematics of elastic swimming. After discussing the basic physical picture of the phenomenon and the expected scaling relationships, we derive analytically the elastic swimming velocities in the limit of small actuation amplitude. The emphasis is on the coupling between the two unknowns of the problems - namely the shape of the elastic filament and the swimming kinematics - which have to be solved simultaneously. We then compute the performance of the resulting swimming device, and its dependance on geometry. The optimal actuation frequency and body shapes are derived and a discussion of filament shapes and internal torques is presented. Swimming using multiple elastic filaments is discussed, and simple strategies are presented which result in straight swimming trajectories. Finally, we compare the performance of elastic swimming with that of swimming microorganisms.Comment: 23 pages, 6 figure

Quantitative sensory testing with Electronic von Frey Anesthesiometer and von Frey filaments in nonpainful cats: a pilot study

Measurement of sensory thresholds could represent a complementary tool to behavioural pain scores in cats. The aim of this study was to investigate the feasibility of quantitative sensory testing (QST) with the Electronic von Frey Anesthesiometer (EVF) and von Frey filaments (VFF) in healthy cats, and to assess the limits of agreement (LOA) between the two devices

Are Asians comfortable with discussing death in health valuation studies? A study in multi-ethnic Singapore

BACKGROUND To characterize ease in discussing death (EID) and its influence on health valuation in a multi-ethnic Asian population and to determine the acceptability of various descriptors of death and "pits"/"all-worst" in health valuation. METHODS In-depth interviews (English or mother-tongue) among adult Chinese, Malay and Indian Singaporeans selected to represent both genders and a wide range of ages/educational levels. Subjects rated using 0–10 visual analogue scales (VAS): (1) EID, (2) acceptability of 8 descriptors for death, and (3) appropriateness of "pits" and "all-worst" as descriptors for the worst possible health state. Subjects also valued 3 health states using VAS followed by time trade-off (TTO). The influence of sociocultural variables on EID and these descriptors was studied using univariable analyses and multiple linear regression (MLR). The influence of EID on VAS/TTO utilities with adjustment for sociocultural variables was assessed using MLR. RESULTS Subjects (n = 63, 35% Chinese, 32% Malay, median age 44 years) were generally comfortable with discussing death (median EID: 8.0). Only education significantly influenced EID (p = 0.045). EID correlated weakly with VAS/TTO scores (range: VAS: -0.23 to 0.07; TTO: -0.14 to 0.11). All subjects felt "passed away", "departed" and "deceased" were most acceptable (median acceptability: 8.0) while "sudden death" and "immediate death" were least acceptable (median acceptability: 5.0). Subjects clearly preferred "all-worst" to "pits" (63% vs. 19%, p < 0.001). CONCLUSION Singaporeans were generally comfortable with discussing death and had clear preferences for several descriptors of death and for "all-worst". EID is unlikely to influence health preference measurement in health valuation studies

Synchronization of active mechanical oscillators by an inertial load

Motivated by the operation of myogenic (self-oscillatory) insect flight muscle, we study a model consisting of a large number of identical oscillatory contractile elements joined in a chain, whose end is attached to a damped mass-spring oscillator. When the inertial load is small, the serial coupling favors an antisynchronous state in which the extension of one oscillator is compensated by the contraction of another, in order to preserve the total length. However, a sufficiently massive load can sychronize the oscillators and can even induce oscillation in situations where isolated elements would be stable. The system has a complex phase diagram displaying quiescent, synchronous and antisynchrononous phases, as well as an unsual asynchronous phase in which the total length of the chain oscillates at a different frequency from the individual active elements.Comment: 5 pages, 4 figures, To appear in Phys. Rev. Let