A pilot randomized controlled trial for a videoconference-delivered mindfulness-based group intervention in a nonclinical setting

Technology is increasingly being integrated into the provision of therapy and mental health interventions. While the evidence base for technology-led delivery of mindfulness-based interventions is growing, one approach to understanding the effects of technology-delivered elements includes so-named blended programs that continue to include aspects of traditional face-to-face interaction. This arrangement offers unique practical advantages, and also enables researchers to isolate variables that may be underlying the effects of technology-delivered interventions. The present study reports on a pilot videoconference-delivered mindfulness-based group intervention offered to university students and staff members with wait-list controls. Apart from the first session of the six-week course, the main facilitator guided evening classes remotely via online videoconferencing, with follow-up exercises via email. Participants Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation were taught a variety of mindfulness-based exercises such as meditation, breathing exercises, mindful tasting, as well as the concepts underpinning such practice. Participants completed pre- and post-intervention questionnaires on depression, anxiety, repetitive negative thinking, dysfunctional attitudes, positive and negative affect, self-compassion, compassion for others, and mindfulness. For participants who attended at least five of the six sessions, scores on all outcome measures improved significantly post intervention and remained stable at three-week follow up. The videoconference-delivered mindfulness-based group intervention appears to provide a viable alternative format to standard mindfulness programs where the facilitator and participants need to live in close physical proximity with each other

Reinserting physiology into cardiac mapping using omnipolar electrograms

Unipolar electrograms are voltage signals that reflect time-varying extracellular currents. Bipolar electrograms provide differential extracellular voltages along an axis and resemble a local directional derivative. Both are based on the fundamental concept of electric fields in tissues. Omnipolar electrograms are derived from a clique, a group of nearby electrodes that generate bipolar signals from multiple directions. They are electrode and catheter-orientation independent. • Omnipolar electrograms provide wavefront characteristics, such as amplitude, timing, direction, and speed, in physiologically relevant directions located at the center of the electrode clique. This enables determinations of a maximal bipolar voltage amplitude termed OT Vmax, the generalization of peak-to-peak in the presence of directionality, and is not affected by catheter orientation and is less sensitive to electrode distance for small cliques. • Specialized catheters and three-dimensional mapping system software enable omnipolar electrograms and derived quantities to be generated and displayed in real-time. • Omnipolar electrograms during atrial fibrillation are significantly less influenced by directional factors, allowing for robust and consistent substrate assessment. • Mapping the ventricles using an equispaced electrode grid catheter and omnipolar electrograms can provide reliable substrate assessment within infarcted and noninfarcted regions of the ventricles to aid in determining ablation targets, such as a lesion gap or an isthmus

Physiological assessment of ventricular myocardial voltage using omnipolar electrograms

Background Characterization of myocardial health by bipolar electrograms are critical for ventricular tachycardia therapy. Dependence of bipolar electrograms on electrode orientation may reduce reliability of voltage assessment along the plane of arrhythmic myocardial substrate. Hence, we sought to evaluate voltage assessment from orientation‐independent omnipolar electrograms. Methods and Results We mapped the ventricular epicardium of 5 isolated hearts from each species—healthy rabbits, healthy pigs, and diseased humans—under paced conditions. We derived bipolar electrograms and voltage peak‐to‐peak (Vpps) along 2 bipolar electrode orientations (horizontal and vertical). We derived omnipolar electrograms and Vpps using omnipolar electrogram methodology. Voltage maps were created for both bipoles and omnipole. Electrode orientation affects the bipolar voltage map with an average absolute difference between horizontal and vertical of 0.25±0.18 mV in humans. Vpps provide larger absolute values than horizontal and vertical bipolar Vpps by 1.6 and 1.4 mV, respectively, in humans. Bipolar electrograms with the largest Vpps from either along horizontal or vertical orientation are highly correlated with omnipolar electrograms and with Vpps values (0.97±0.08 and 0.94±0.08, respectively). Vpps values are more consistent than bipoles, in both beat‐by‐beat (CoV, 0.28±0.19 versus 0.08±0.13 in human hearts) and rhythm changes (0.55±0.21 versus 0.40±0.20 in porcine hearts). Conclusions Omnipoles provide physiologically relevant and consistent voltages that are along the maximal bipolar direction on the plane of the myocardium

The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: Trends, enabling factors, cost, and safety

To evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety. In this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression. We identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%. A significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs

Employability of offshore service sector workers in the Philippines: opportunities for upward labour mobility or dead-end jobs?

Critical concerns have been raised about the quality of employment in the offshore service sector in developing countries, suggesting that many activities have an inherent paradox of highly educated workers performing low-skilled jobs. Based on empirical data collected in the offshore service sector in Baguio City (the Philippines), this article analyses the knowledge and skills acquisition of workers using the concepts of employability and generic skills. The article demonstrates that offshore service sector work is part of a longer-term career planning of workers and an opportunity for strengthening their employability on the global labour market. The early stage of development of the offshore service sector provides workers with opportunities for local upward labour mobility. The article argues that the sector should be looked at from an employee-based perspective that emphasizes their employability and generic skills acquisition in order to understand the longer-term benefits of the sector for developing countries