Jeffersonian Restoration

"Fall 2014""Mizzou and the Smithsonian Institution restore Jefferson's marble epitaph."[Story by] Rob Hill and Marcus Wilkins ; Photos by Rob Hill, Rachel Coward, courtesy University Archive

THE EVOLUTION OF OXYGEN AND IRON FLUENCE DURING SOLAR PARTICLE EVENTS AND THEIR CONTRIBUTION TO SKIN DOSE FOR EVENTS FROM OCTOBER 1997 TO DECEMBER 2005

One of the primary concerns with space travel is the protection of astronauts from potentially lethal radiation. A major source of potentially lethal radiation is our own sun. During Solar Cycle 23 there were 97 detected Solar Particle Events (SPEs). In order to develop radiation protection guidelines and establish methods to protect astronauts the spectrum of particles emitted during a SPE must be understood. Data for oxygen and iron particle fluence was taken from the Solar Isotope Spectrometer. The fluence was sorted and formatted for each solar particle event. After determining the contribution to skin dose for oxygen, the time evolution of each event was analyzed. After analyzing the raw count data, a threshold was set that could be applied to each event. Using this threshold count rate as the starting point, each event was plotted and fitted with a smoothing polynomial function. The slope calculated from this function was then plotted against the previously calculated skin dose and a Weibull function was fitted to the data. The resulting plot provides a method to predict the cumulative dose due to the oxygen fluence over the first 24 hours of an event and thereby provide a warning of future high dose rate in time to achieve significant dose sparing for most events. For the ten events that delivered the highest oxygen dose, the dose sparing that could be achieved by taking shelter when the high dose rate was predicted was greater than 70 percent for all but one event. The one outlier achieved a dose paring of only 57 percent

Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy:a consensus study using an online nominal group technique

OBJECTIVES: There are a wide range of physiotherapy treatment options for people with lateral elbow tendinopathy (LET); however, previous studies have reported inconsistent approaches to treatment and a lack of evidence demonstrating clinical effectiveness. This study aimed to combine the best available research evidence with stakeholder perspectives to develop key components of an optimised physiotherapist-led treatment protocol for testing in a future randomised controlled trial (RCT). DESIGN: Online consensus groups using nominal group technique (NGT), a systematic approach to building consensus using structured multistage meetings. SETTING: UK National Health Service (NHS). PARTICIPANTS: 10 physiotherapists with special interest in LET, 2 physiotherapy service managers and 3 patients who had experienced LET. INTERVENTIONS: Two consensus groups were conducted; the first meeting focused on agreeing the types of interventions to be included in the optimised treatment protocol; the second meeting focused on specific details of intervention delivery. Participants were sent an evidence summary of available treatments for LET prior to the first meeting. All treatment options were discussed before anonymous voting and ranking of priority. Consensus for inclusion of each treatment option was set at ≥70% based on OMERACT guidelines. Options with 30%-69% agreement were discussed again, and a second vote was held, allowing for a change of opinion. RESULTS: The optimised physiotherapist-led treatment package included: advice and education, exercise therapy and orthotics. Specific components for each of these interventions were also agreed such as: condition-specific advice, health-promotion advice, exercise types, exercise into 'acceptable' levels of pain, exercise dosage and type of orthoses. Other treatment options including electrotherapy, acupuncture and manual therapy were excluded. CONCLUSION: An optimised physiotherapist-led treatment protocol for people with LET was successfully developed using an online NGT consensus approach. This intervention is now ready for testing in a future pilot/feasibility RCT to contribute much needed evidence about the treatment of LET. TRIAL REGISTRATION NUMBER: This is the pre-cursor to the OPTimisE Pilot and Feasibility Randomised Controlled Trial. Registration: https://www.isrctn.com/ISRCTN64444585

An Exit Strategy for Resuming Nonemergency Neurosurgery after Severe Acute Respiratory Syndrome Coronavirus 2: A United Kingdom Perspective

INTRODUCTION: Substantial healthcare resources have been diverted to manage the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and nonemergency neurosurgery has been effectively closed. As we begin to emerge from the crisis, we will need to manage the backlog of nonemergency neurosurgical patients whose treatment has been delayed and remain responsive to further possible surges of SARS-CoV-2 infections. METHODS: In the present study, we aimed to identify the core themes and challenges that will limit resumption of a normal neurosurgical service after the SARS-CoV-2 pandemic and to provide pragmatic advice and solutions that could be of utility to clinicians seeking to resume nonemergency neurosurgical care. We reviewed the relevant international policies, a wide range of journalistic and media sources, and expert opinion documents to address the stated aims. RESULTS: We have presented and discussed a range of factors that could become potential barriers to resuming full elective neurosurgical provision and important steps that must be completed to achieve pre-SARS-CoV-2 surgical capacity. We also explored how these challenges can be overcome and outlined the key requirements for a successful neurosurgical exit strategy from the pandemic. CONCLUSION: The performance of nonemergency neurosurgery can start once minimum criteria have been fulfilled: 1) a structured prioritization of surgical cases; 2) virus infection incidence decreased sufficiently to release previously diverted healthcare resources; 3) adequate safety criteria met for patients and staff, including sufficient personal protective equipment and robust testing availability; and 4) maintenance of systems for rapid communication at organizational and individual levels

The Lived Experience of People with Lateral Elbow Tendinopathy – a Qualitative Study from the OPTimisE Pilot & Feasibility Trial.

Objectives: To explore the lived experience of people with lateral elbow tendinopathy (LET) and its impact on everyday life. Design: Qualitative semi-structured interviews, analysed using thematic analysis. Setting: Conducted as part of the mixed-methods OPTimisE pilot and feasibility randomised controlled trial of outpatient physiotherapy patients in the UK. Participants: 17 participants with LET, purposively sampled from the trial to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation. Results: Four themes were identified from the participants’ responses: (1) cause of onset—typically symptoms were attributed to: sudden changes in activity, repetitive work or compensating for other musculoskeletal conditions; (2) impact on everyday life—which included substantial impacts on quality-of-life, particularly due to pain disturbing sleep and difficulties performing daily tasks (related to work and hobbies) due to pain, although most reported being able to persevere with work; (3) self-help and understanding of the condition—with uncertainty about the appropriateness and potential harm of online advice and confusion from the diagnostic term ‘Tennis Elbow’ that non-sporting individuals struggled to relate to; (4) healthcare experiences—the treatments received were highly variable and often perceived as ineffectual. Conclusions: For the first time, the lived experience of people from a range of backgrounds suffering from LET has been explored. Findings suggest that people frequently related the cause to a specific activity. They reported substantial impacts on daily tasks, sleep, work and hobbies. People also reported hesitancy to trust online information without formal healthcare advice, were confused by the common label of ‘Tennis Elbow’, and perceived the wide array of healthcare treatment options they had received to offer false hope and be largely ineffective. This study provides stimulus for clinicians to consider the advice and treatment provided, and whether the messages conveyed reflect the favourable natural history of the condition. Trial registration number: ISRCTN6444458

A Network Approach to Understanding Narcissistic Grandiosity via the Narcissistic Admiration and Rivalry Questionnaire and the Narcissistic Personality Inventory

The narcissistic admiration and rivalry concept (NARC) model of grandiose narcissism posits that striving for uniqueness, grandiose fantasies, and charmingness define narcissistic admiration, whereas striving for supremacy, devaluation, and aggressiveness define narcissistic rivalry. Given these complex interrelationships, we explored the structure of grandiose narcissism using the Narcissistic Admiration and Rivalry Questionnaire (NARQ) and Narcissistic Personality Inventory (NPI) via network analysis in four separate samples which allowed us to assess the extent to which these networks replicated across these samples (total N = 3,868). Overall, grandiose cognitions from the NARQ emerged as a highly central node in each network, providing compound evidence for its replicability and generalizability as an important feature of grandiose narcissism within the NARC model. Charmingness from the NARQ emerged as a central node throughout Samples 1, 2, and 3, with strong connections to features of narcissistic admiration and narcissistic rivalry (e.g., grandiose fantasies and aggressiveness), but was less central in Sample 4. To our knowledge, this is the first research to examine the replicability of the network structure of grandiose narcissism across various samples. These findings add to an increasingly important dialogue regarding replicability in psychological network science

Exploring the feasibility and acceptance of an optimised physiotherapy approach for lateral elbow tendinopathy: a qualitative investigation within the OPTimisE trial

Objectives: To explore the acceptability of an optimised physiotherapy (OPTimisE) intervention for people with lateral elbow tendinopathy (LET) and feasibility of comparing it to usual care in a randomised controlled trial. Design: Semistructured interviews, analysed using thematic analysis and mapped onto the COM-B model of behaviour change. Setting: Conducted as part of the OPTimisE Pilot & Feasibility randomised controlled trial within physiotherapy departments in the United Kingdom National Health Service. Participants: 17 patients with LET (purposively sampled to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation) and all 8 physiotherapists involved as treating clinicians or site principal investigators. Results: Four themes were identified. First, participants reported the OPTimisE intervention as acceptable. Second, differences between the OPTimisE intervention and usual care were identified, including the use of an orthosis, holistic advice/education including modifiable risk factors, forearm stretches, general upper body strengthening and a more prescriptive exercise-dosing regimen. Third, participants provided feedback related to the trial resources, which were viewed positively, but identified language translation as a need. Fourth, feedback related to trial processes identified the need for changes to outcome collection and reduction of administrative burden. From the perspective of adopting the OPTimisE intervention, we found evidence that participants were able to change their behaviour. Considering the findings through the lens of the COM-B model, the intervention is likely to be deliverable in practice and the trial can be delivered at scale with some additional support for physiotherapists. Conclusions: Overall, the OPTimisE intervention was found to be different to usual care and acceptable to patients and physiotherapists. The study highlighted the need to refine trial processes and resources prior to a full-scale trial, to reduce administrative burden, increase support for physiotherapists, improve return rate of outcome questionnaires and provide language translation. Trial registration number: ISRCTN database 19 July 2021. https://www.isrctn.com/ISRCTN64444585

The development of the adult deterioration detection system (ADDS) chart

The Adult Deterioration Detection System (ADDS) observation chart described in this short report was developed as part of a research project carried out at The University of Queensland for Queensland Health and the Australian Commission on Safety and Quality in Health Care (ACSQHC). The aim of the project was to investigate the design and use of observation charts in recognising and managing patient deterioration, including the design and evaluation of a new adult observation chart that incorporated human factors principles

Paper-based patient chart design information sheet

The purpose of this document is to help those involved in creating paper-based patient charts improve the human factors aspects of the design of their charts. It is based on the outcomes of a research project (“Human Factors Research Regarding Observation Charts”) carried out at the University of Queensland for the Australian Commission on Safety and Quality in Health Care, the Queensland Health Patient Safety and Quality Improvement Service and the Clinical Skills Development Service. Copies of the reports associated with this project are available online from the Commission’s website (www.safetyandquality.gov.au). As part of this project, we systematically reviewed 25 existing patient observation charts and developed a new chart (the “ADDS chart”) designed to identify patient deterioration, which was then evaluated in behavioural experiments. In this document, we will use some of the issues arising from this process to illustrate human factors design considerations for paper-based patient charts in general