Acceptability and feasibility of peer assisted supervision and support for intervention practitioners: a Q-methodology evaluation

Evidence-based interventions often include quality improvement methods to support fidelity and improve client outcomes. Clinical supervision is promoted as an effective way of developing practitioner confidence and competence in delivery; however, supervision is often inconsistent and embedded in hierarchical line management structures that may limit the opportunity for reflective learning. The Peer Assisted Supervision and Support (PASS) supervision model uses peer relationships to promote the self-regulatory capacity of practitioners to improve intervention delivery. The aim of the present study was to assess the acceptability and feasibility of PASS amongst parenting intervention practitioners. A Q-methodology approach was used to generate data and 30 practitioners volunteered to participate in the study. Data were analyzed and interpreted using standard Q-methodology procedures and by-person factor analysis yielded three factors. There was consensus that PASS was acceptable. Participants shared the view that PASS facilitated an environment of support where negative aspects of interpersonal relationships that might develop in supervision were not evident. Two factors represented the viewpoint that PASS was also a feasible model of supervision. However, the third factor was comprised of practitioners who reported that PASS could be time consuming and difficult to fit into existing work demands. There were differences across the three factors in the extent to which practitioners considered PASS impacted on their intervention delivery. The findings highlight the importance of organizational mechanisms that support practitioner engagement in supervision

Influence of mechanical and geometrical properties of embedded long-gauge strain sensors on the accuracy of strain measurement

In many civil and geotechnical applications it is of interest to monitor the strain deep inside the structure; consequently, it is necessary to embed the sensors into the structure's material. Construction and geotechnical materials, such as concrete and soil, can be affected by local defects, e.g. cracks, air pockets and inclusions. To monitor these materials at a structural level it is necessary to use long-gauge sensors. As the sensor has to be embedded in the host material, its presence causes perturbation of the strain field and influences the accuracy of the strain measurement. The aim of this research was to identify the critical parameters that influence the accuracy of the strain measurement, to study how these parameters affect the accuracy, and to give recommendations for sensor users. The study was based on finite element analysis and all involved materials were assumed to have the MöhrCoulomb elastic, perfectly plastic behavior. A suitability of the numerical model for the analysis was verified using the experimental results of two cases reported in the literature and one on-site application. The study revealed that the most important parameters that influence the accuracy of the strain measurement are the goodness of interaction (strain transfer) between the host material and the anchor pieces of the sensor, the ratio between equivalent Young's modulus of the sensor and the Young's modulus of the host material, the radius of the anchor piece and the gauge length. The numerical model and parametric study are presented in detail along with practical recommendations. © 2012 IOP Publishing Ltd.The authors would like to thank the Spanish Ministry of Education, with support received under the National Program for Mobility of Researchers (O.M. EDU/1456/2010, ref. PR2010-0293) which enabled the joint work that made this study possible. The Streicker Bridge project was realized with help of Turner Construction Co., HNTB, AG Construction Corp., Vollers Excavating & Constr., SMARTEC SA, Micron Optics, Princeton Facilities, and staff and students of CEE department of Princeton University.Calderón García, PA.; Glisic, B. (2012). Influence of mechanical and geometrical properties of embedded long-gauge strain sensors on the accuracy of strain measurement. Measurement Science and Technology. (23):1-15. https://doi.org/10.1088/0957-0233/23/6/065604S11523Glišić, B., & Inaudi, D. (2007). Fibre Optic Methods for Structural Health Monitoring. doi:10.1002/9780470517819Ansari, F. (2007). Practical Implementation of Optical Fiber Sensors in Civil Structural Health Monitoring. Journal of Intelligent Material Systems and Structures, 18(8), 879-889. doi:10.1177/1045389x06075760Li, H.-N., Zhou, G.-D., Ren, L., & Li, D.-S. (2009). Strain Transfer Coefficient Analyses for Embedded Fiber Bragg Grating Sensors in Different Host Materials. Journal of Engineering Mechanics, 135(12), 1343-1353. doi:10.1061/(asce)0733-9399(2009)135:12(1343)Torres, B., Payá-Zaforteza, I., Calderón, P. A., & Adam, J. M. (2011). Analysis of the strain transfer in a new FBG sensor for Structural Health Monitoring. Engineering Structures, 33(2), 539-548. doi:10.1016/j.engstruct.2010.11.012Kesavan, K., Ravisankar, K., Parivallal, S., Sreeshylam, P., & Sridhar, S. (2010). Experimental studies on fiber optic sensors embedded in concrete. Measurement, 43(2), 157-163. doi:10.1016/j.measurement.2009.08.010Azenha, M., Faria, R., & Ferreira, D. (2009). Identification of early-age concrete temperatures and strains: Monitoring and numerical simulation. Cement and Concrete Composites, 31(6), 369-378. doi:10.1016/j.cemconcomp.2009.03.004Glisic, B. (2011). Influence of the gauge length on the accuracy of long-gauge sensors employed in monitoring of prismatic beams. Measurement Science and Technology, 22(3), 035206. doi:10.1088/0957-0233/22/3/035206Leng, J. S., Winter, D., Barnes, R. A., Mays, G. C., & Fernando, G. F. (2006). Structural health monitoring of concrete cylinders using protected fibre optic sensors. Smart Materials and Structures, 15(2), 302-308. doi:10.1088/0964-1726/15/2/009Calderón, P. A., Adam, J. M., Ivorra, S., Pallarés, F. J., & Giménez, E. (2009). Design strength of axially loaded RC columns strengthened by steel caging. Materials & Design, 30(10), 4069-4080. doi:10.1016/j.matdes.2009.05.014Adam, J. M., Ivorra, S., Pallarés, F. J., Giménez, E., & Calderón, P. A. (2009). Axially loaded RC columns strengthened by steel caging. Finite element modelling. Construction and Building Materials, 23(6), 2265-2276. doi:10.1016/j.conbuildmat.2008.11.014Adam, J. M., Ivorra, S., Pallares, F. J., Jiménez, E., & Calderón, P. A. (2008). Column–joint assembly in RC columns strengthened by steel caging. Proceedings of the Institution of Civil Engineers - Structures and Buildings, 161(6), 337-348. doi:10.1680/stbu.2008.161.6.337Adam, J. M., Ivorra, S., Pallares, F. J., Giménez, E., & Calderón, P. A. (2009). Axially loaded RC columns strengthened by steel cages. Proceedings of the Institution of Civil Engineers - Structures and Buildings, 162(3), 199-208. doi:10.1680/stbu.2009.162.3.199Johansson, M., & Gylltoft, K. (2001). Structural behavior of slender circular steel-concrete composite columns under various means of load application. Steel and Composite Structures, 1(4), 393-410. doi:10.12989/scs.2001.1.4.393Johansson, M., & Gylltoft, K. (2002). Mechanical Behavior of Circular Steel–Concrete Composite Stub Columns. Journal of Structural Engineering, 128(8), 1073-1081. doi:10.1061/(asce)0733-9445(2002)128:8(1073

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

A nomenclature for restriction enzymes, DNA methyltransferases, homing endonucleases and their genes

A nomenclature is described for restriction endonucleases, DNA methyltransferases, homing endonucleases and related genes and gene products. It provides explicit categories for the many different Type II enzymes now identified and provides a system for naming the putative genes found by sequence analysis of microbial genomes

From evolutionary computation to the evolution of things

Evolution has provided a source of inspiration for algorithm designers since the birth of computers. The resulting field, evolutionary computation, has been successful in solving engineering tasks ranging in outlook from the molecular to the astronomical. Today, the field is entering a new phase as evolutionary algorithms that take place in hardware are developed, opening up new avenues towards autonomous machines that can adapt to their environment. We discuss how evolutionary computation compares with natural evolution and what its benefits are relative to other computing approaches, and we introduce the emerging area of artificial evolution in physical systems

Hyphal Development in Candida albicans Requires Two Temporally Linked Changes in Promoter Chromatin for Initiation and Maintenance

Phenotypic plasticity is common in development. For Candida albicans, the most common cause of invasive fungal infections in humans, morphological plasticity is its defining feature and is critical for its pathogenesis. Unlike other fungal pathogens that exist primarily in either yeast or hyphal forms, C. albicans is able to switch reversibly between yeast and hyphal growth forms in response to environmental cues. Although many regulators have been found involved in hyphal development, the mechanisms of regulating hyphal development and plasticity of dimorphism remain unclear. Here we show that hyphal development involves two sequential regulations of the promoter chromatin of hypha-specific genes. Initiation requires a rapid but temporary disappearance of the Nrg1 transcriptional repressor of hyphal morphogenesis via activation of the cAMP-PKA pathway. Maintenance requires promoter recruitment of Hda1 histone deacetylase under reduced Tor1 (target of rapamycin) signaling. Hda1 deacetylates a subunit of the NuA4 histone acetyltransferase module, leading to eviction of the NuA4 acetyltransferase module and blockage of Nrg1 access to promoters of hypha-specific genes. Promoter recruitment of Hda1 for hyphal maintenance happens only during the period when Nrg1 is gone. The sequential regulation of hyphal development by the activation of the cAMP-PKA pathway and reduced Tor1 signaling provides a molecular mechanism for plasticity of dimorphism and how C. albicans adapts to the varied host environments in pathogenesis. Such temporally linked regulation of promoter chromatin by different signaling pathways provides a unique mechanism for integrating multiple signals during development and cell fate specification

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care