Anomaly Detection and Accuracy Measurement for Categorical Data

The Department of Defense (DoD) recently initiated an effort to compile all inter-service maintenance data for equipment and infrastructure, requiring the consolidation of maintenance records from over 40 different data sources.  This research evaluates and improves the accuracy of this maintenance data warehouse by means of value modeling and statistical methods for anomaly detection. The first step in this work included the categorization of error-identifying metadata, which was then consolidated into a weighted scoring model. The most novel aspect of the work involved error identification processes using conditional probability combinations and likelihood measures. This analysis showed promising results, successfully identifying numerous invalid maintenance description labels through the use of conditional probability tests. This process has potential to both reduce the amount of manual labor necessary to clean the DoD maintenance data records and provide better fidelity on DoD maintenance activities

Sports Rehabilitation and Interprofessional Collaboration

Background: The demand for interprofessional collaboration continues to grow due to changing priorities of the health care system.  The benefits of interprofessional collaboration are well documented; however, the methods of collaboration are often unclear and often difficult to put into practice.  While there is a growing number of studies on the impact of interprofessional collaboration in settings such as inpatient, intensive care units, and acute care, there are limited documented cases regarding the interprofessional management of a physical therapy patient in the outpatient orthopedic private practice setting.   Purpose: The purpose of this paper is to describe the reflections of a physical therapist and an athletic trainer in their experience with interprofessional collaboration, describe the barriers they have experienced that make interprofessional collaboration challenging, and to offer solutions to these barriers.  The barriers discussed in the paper include limited knowledge of and respect for other professionals’ skill set, high-productivity work environments, medical hierarchy, overlapping bodies of knowledge, discrepancy between professional reasoning, territorial behavior, and ineffective communication.  Discussion: It appears that contextual factors, such as community in which the professionals practice, the healthcare setting, and the practice environment, have a far less important impact to successful collaboration than the professionals’ attitudes and investment in the collaborative efforts.  Conclusion: Collaboration between a PT and an AT can lead to power struggles and suboptimal patient care if these barriers are not overcome and collaboration may be necessary to provide the highest quality of patient care

Using expletives to enhance therapeutic outcomes: A case report

# Background Swearing deserves attention in the physical therapy setting due to its potential positive effects on pain, physical performance, and therapeutic alliance. The purpose of this case report is to describe the strategic use of swearing in the clinical setting. # Case Presentation A 44-year-old female completed an episode of physical therapy after undergoing patellofemoral arthroplasty. Swearing was formally included into the plan of care, and the patient swore out loud during the most challenging and painful interventions. # Results The patient reported that repeating a swear word was funny, distracted the patient, and made the patient feel more confident. The patient and physical therapist self-reported a strong therapeutic alliance. # Conclusion There is evidence repeating a swear word out loud can strengthen the therapeutic alliance, improve physical performance, and decrease pain. This is, to our knowledge, the first report of a patient swearing during an episode of physical therapy care

Sexual and Gender Minority College Student Retention: The Unique Effects of Mental Health and Campus Environment on the Potential for Dropout

Background: While limited data has been collected, some findings show that sexual and gender minority (SGM) students are at higher risk for dropping out of college than their peers. Research on issues such as campus connectedness and mental health among this population indicates both may affect retention.  Aim: This study examined how mental health and perceptions of campus connectedness may mediate the relationship between SGM identification and intentions to drop out of college. Methods: Survey data collected from 1,793 randomly selected students across eight different public universities in Mississippi were used to conduct a parallel mediation analysis.   Results: Mediation analyses indicated that there was a significant direct effect of SGM identity on intentions to drop out, and that both mediators had a significant indirect effect. Psychiatric symptoms had a relatively larger indirect effect than campus connectedness. Conclusions: These results contribute to the limited quantitative literature on SGM student retention, supporting previous work indicating these students are at higher risk of attrition. The results suggest that student retention may be bolstered if access to SGM-competent mental health services is provided. Additionally, campuses should continue to support SGM-friendly policies and create inclusive spaces as a protective resource for students

Does Gambling-Focused Treatment Affect Mental Health and Quality of Life? A Systematic Review and Meta-Analysis

Abstract: Cognitive-behavioral (CB) techniques have received substantial empirical support for reducing gambling disorder symptoms and behavior. What has not been established is whether gambling-focused treatment reduces psychological problems and improves quality of life. Individuals experiencing gambling-related harms report that sustained recovery involves changing both gambling behaviors and psychological problems and building a meaningful life. The current systematic review and meta-analysis aimed to examine the effect of CB techniques targeting gambling harms on nontargeted outcomes such as psychological problems and quality of life. Following PRISMA guidelines, a systematic article search was conducted to locate published studies of randomized controlled trials of CB techniques targeting gambling harms and reporting nontargeted outcomes. Random effects meta-analysis was used to quantify the effect of CB techniques on nontargeted outcomes. Ten studies representing 797 participants were included. Eight studies reported the effect of CB techniques on anxiety, 8 on depression, 3 on substance use, and 7 on quality of life. CB techniques significantly reduced anxiety (g = -0.44), depression (g = -0.35), gambling frequency (g = -0.30), and gambling intensity (g = -0.36) at posttreatment, but not substance use. CB techniques also significantly improved quality of life (g = 0.39) at posttreatment. Implications: The targeted reduction of gambling harms may serve as a mechanism of change for reducing psychological problems and improving quality of life. Future studies should employ longitudinal designs to understand the associations between gambling reductions and changes in nontargeted recovery outcomes over time

Recent trends in soft-tissue infection imaging.

This article discusses the current techniques and future directions of infection imaging with particular attention to respiratory, central nervous system, abdominal, and postoperative infections. The agents currently in use localize to areas of infection and inflammation. An infection-specific imaging agent would greatly improve the utility of scintigraphy in imaging occult infections. The superior spatial resolution of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and its lack of reliance on a functional immune system, gives this agent certain advantages over the other radiopharmaceuticals. In respiratory tract infection imaging, an important advancement would be the ability to quantitatively delineate lung inflammation, allowing one to monitor the therapeutic response in a variety of conditions. Current studies suggest PET should be considered the most accurate quantitative method. Scintigraphy has much to offer in localizing abdominal infection as well as inflammation. We may begin to see a gradual increase in the usage of (18)F-FDG-PET in detecting occult abdominal infections. Commonly used modalities for imaging inflammatory bowel disease are scintigraphy with (111)In-oxine/(99m)Tc-HMPAO labeled autologous white blood cells. The literature on central nervous system infection imaging is relatively scarce. Few clinical studies have been performed and numerous new agents have been developed for this use with varying results. Further studies are needed to more clearly delineate the future direction of this field. In evaluating the postoperative spine, (99m)Tc-ciprofloxacin single-photon emission computed tomography (SPECT) was reported to be \u3e80% sensitive in patients more than 6 months after surgery. FDG-PET has also been suggested for this purpose and may play a larger role than originally thought. It appears PET/computed tomography (CT) is gaining support, especially in imaging those with fever of unknown origin or nonfunctional immune systems. Although an infection-specific agent is lacking, the development of one would greatly advance our ability to detect, localize, and quantify infections. Overall, imaging such an agent via SPECT/CT or PET/CT will pave the way for greater clinical reliability in the localization of infection

A study of patent thickets

Report analysing whether entry of UK enterprises into patenting in a technology area is affected by patent thickets in the technology area

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme