Acupuncture for dry eye syndrome after refractive surgery: study protocol for a randomized controlled trial

Agile software development is increasingly adopted by companies evolving and maintaining software products to support better planning and tracking the realization of user stories and features. While convincing success stories help to further spread the adoption of Agile, mechatronics-driven companies need guidance to implement Agile for non-software teams. In this comparative case study of three companies from the Nordic region, we systematically investigate expectations and challenges from scaling Agile in organizations dealing with mechatronics development by conducting on-site workshops and surveys. Our findings show that all companies have already successfully implemented Agile in their software teams. The expected main benefit of successfully scaling agile development is a faster time-to-market product development; however, the two main challenges are: (a) An inflexible test environment that inhibits fast feedback to changed or added features, and (b) the existing organizational structure including the company\u27s mind-set that needs to be opened-up for agile principles

‘Shared intelligibility’ and two reflexive strategies as methods of supporting ‘responsible decisions’ in a hermeneutic phenomenological study

Hermeneutic phenomenologists propose that researchers inescapably bring themselves into their research because interpretation must inevitably be influenced by their contexts and pre-understandings. They propose that interpretation is a dynamic and active part of the construction of a text’s meaning, and involvement in this construction process leads to deep empathic understanding of others’ experience, reappraisal of accepted social and cultural systems, and a level of self-enlightenment. The strengths of the hermeneutic methodological approach have led to its use in a number of disciplines, however, there remains concerns about interpretative validity. It is widely acknowledged that in order to support rigour and validity in hermeneutic studies, researchers are required to develop and integrate strategies within the research process to promote awareness of the interplay between their pre-understandings and interpretation. This paper discusses how episodic interviewing which capitalises on ‘shared intelligibility’, and the reflexive strategies of ‘oppositional arrangement of perspectives’ and ‘backgrounding’ were used to shed light on data from a study of the experiences and views of nursing home nurses regarding their occupational role and status, and work identity

ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis

ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis.BackgroundIn dialysis patients, only a few follow-up studies have addressed the relationship between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and mortality, but the available data are contradictory.MethodsA cohort of 453 consecutive patients starting dialysis between January 1999 and January 2002 and participating in a Dutch multicenter prospective study was examined. Patients who died within 3 months after the start of dialysis were excluded. Patients were followed until date of death or censoring in November 2003.ResultsThe ACE II, ID, and DD genotype frequencies were 24.3% (N = 110), 50.1% (N = 227), and 25.6% (N = 116). Besides a slightly higher number of Caucasians in the DD group, all other patient characteristics of the 3 ACE groups were similar at the start of dialysis. After adjustment for age, comorbidity, and ethnic background, patients with the ID and DD genotype showed an increased hazard ratio (HR) for all-cause mortality of 1.55 (95% CI 1.00-2.42) and 2.30 (95% CI 1.41-3.75), compared to patients with the II genotype. Slightly lower HRs were found for cardiovascular mortality. All groups of primary kidney disease showed a 2- to 3-fold increased adjusted HR for DD.ConclusionThe DD genotype identifies dialysis patients at an increased risk for mortality

Sacred work? Exploring spirituality with therapists working with stroke patients with aphasia

Speech and language therapists (SLT), occupational therapists (OT) and physiotherapists (PT) on stroke rehabilitation wards have long worked in an holistic way, with the client at the centre of their interventions. However, if we consider our clients to be tripartite beings, comprising body, mind and spirit, do we, in fact, give credence to the spiritual dimension? Are there particular considerations in this regard when we consider those patients who present with communication difficulties following a stroke? Are we able to facilitate expressions of spiritual distress/need in our clients with aphasia who have difficulty verbalising their thoughts and, if so, is it our role to do so? As part of a larger study exploring stories of spirituality with people with aphasia, I interviewed members of the multidisciplinary team on an acute stroke ward. I wanted to explore their understanding of their professional role vis-à-vis spirituality. This article focusses on some of the themes which emerged in the interviews with the therapists on the stroke ward: an OT, SLT and PT. Using a hermeneutic phenomenological approach, I encouraged them to talk about their interventions with people with aphasia, their definition of spirituality, and whether they considered facilitation of expressions of spirituality in their clients with aphasia part of their therapeutic remit. Although, of course, this represents a very small sample of therapists, nevertheless some interesting themes have begun to emerge, which I hope will contribute to further dialogue

Reflective Journaling: A Theoretical Model and Digital Prototype for Developing Resilience and Creativity

Reflection is commonly discussed as a tool for personal and professional development that is becoming increasingly important in today’s global and digital world. In this paper, we propose a model that suggests ways in which reflection, in the form of Reflective Journaling, can support the development of creativity and resilience, which are needed to enable individuals to function effectively in a fast-changing environment. In addition, the model proposes ways in which external support and progress monitoring can be used in conjunction with skills in adaptive resilience and structured creativity, to support the maintenance of reflective journaling as a habit, in the longer term, thus creating virtuous cycles of skills and behaviours that can reinforce each other. Based on our model, and additional user research, we describe the design of a first digital prototype that aims to support the use of Reflective Journaling and to develop creativity and resilience through suggested mechanisms. Initial evaluations of our prototype are positive. It has been well-received by early test users, and has the potential to address all the connections defined. We therefore suggest that the theoretical model can be used to develop digital tools, such as the one included, to help those who wish to develop the habit of reflective journaling, and through that a range of other skills associated with resilience and creative thinking. We see this as a starting point for investigating this potential in more depth

Wigs, disguises and child's play : solidarity in teacher education

It is generally acknowledged that much contemporary education takes place within a dominant audit culture, in which accountability becomes a powerful driver of educational practices. In this culture both pupils and teachers risk being configured as a means to an assessment and target-driven end: pupils are schooled within a particular paradigm of education. The article discusses some ethical issues raised by such schooling, particularly the tensions arising for teachers, and by implication, teacher educators who prepare and support teachers for work in situations where vocational aims and beliefs may be in in conflict with instrumentalist aims. The article offers De Certeau’s concept of ‘la perruque’ to suggest an opening to playful engagement for human ends in education, as a way of contending with and managing the tensions generated. I use the concept to recover a concept of solidarity for teacher educators and teachers to enable ethical teaching in difficult times

Biogeochemistry of iron in coastal Antarctica: isotopic insights for external sources and biological uptake in the Amundsen Sea polynyas

Seasonal phytoplankton blooms in the Antarctic Amundsen Sea Polynyas are thought to be supported by an external supply of iron (Fe) from circumpolar deep waters, benthic sediments, and/or ice shelf meltwaters. However, largely due to the limited amount of Fe data reported for the Amundsen Sea Polynyas, understanding of the sources and processes that affect the biogeochemistry of Fe in this region (notably within the ice shelf system) remains limited. Here, we present the first investigation of dissolved Fe isotope distributions (δ56Fe) along the conveyer belt of waters into and through the Amundsen Sea, via the Dotson Ice Shelf, from samples collected during austral summer (2017–2018). Our dataset allows us to characterize and compare the dissolved δ56Fe signatures of incoming modified Circumpolar Deep Water (mCDW) and of sedimentary sources on the continental shelf. The range in dissolved δ56Fe (–1 to +0.1 ‰) observed in the Amundsen Sea close to the seafloor, coupled with elevated dissolved Fe concentrations (up to 1.6 nmol/L), suggests that Fe is released from shelf sediments via a combination of reductive and non-reductive processes, with non-reductive dissolution input being relatively more important (20–56 %) than reductive dissolution (4–12 %). Near the Dotson Ice Shelf, the δ56Fe in the mCDW inflow (–0.70 ‰) was lower than the mCDW outflow (–0.23 ‰), whereas any change in dissolved Fe concentrations was negligible. We speculate that this shift in dissolved δ56Fe underneath the ice shelf is driven by a combination of enhanced preservation (and addition) of lithogenic colloidal Fe(III) and/or complexation with Fe-binding ligands, together with a differential loss of Fe2+. We also found distinct δ56Fe signatures in surface waters of the polynya, with apparent preferential uptake of isotopically light Fe in a bloom dominated by diatoms leading to a relatively heavy remnant dissolved δ56Fe signature of +1.06 ‰, compared to a bloom dominated by haptophytes where more modest and variable isotope fractionation was observed. The different isotopic composition between the two regions could be related to the dominance of different species, but this remains speculative. Despite prominent biological uptake, we suggest that other factors such as rapid recycling (e.g., adsorption and regeneration), bacterial regeneration, and complexation with organic ligands, together with the supply of lithogenic particles also play important roles in setting surface dissolved δ56Fe in the Amundsen Sea Polynyas. Overall, this study provides a further understanding of the external Fe sources and the biogeochemical processes in the Amundsen Sea and thus a baseline on how changing conditions in Antarctica can affect Fe cycling in the Southern Ocean and beyond

The experience of employment strain and activation among temporary agency workers in Canada

This article integrates the employment strain model with the social stress model in order to reveal the mechanisms that explain the relation between precarious employment and mental well-being. This model is applied to the case of temporary agency employment by analysing 41 in-depth interviews with temporary agency workers from Canada. The results show how temporary agency workers perceive employment-related uncertainties and efforts mainly as negative and to a lesser extent as positive experiences, respectively evoking strain or activation. Further, it is revealed how uncertainties and efforts mutually reinforce each other, which increases strain, and how support can serve as a buffer.This work is supported by a research grant [FWO1.1.B13.12N] and a travel grant [V4.018.14N] assigned to the first author by the Research Foundation Flanders. The data collection is funded by the Social Sciences and Humanities Research Council and by funds made available by McMaster University and United Way Toronto.Peer Reviewe

Being in want of control: Experiences of being on the road to, and making, a suicide attempt

Attempted suicide is a risk factor for future suicidal behaviour, but understanding suicidality from the perspective of people who have experienced attempted suicide is limited. The aim of the study was to explore the lived experience of being suicidal and having made a suicide attempt, in order to identify possible implications for health care professionals. Semi-structured individual interviews were held with 10 persons shortly after they attempted suicide and were analysed through qualitative content analysis. The participants’ experience of being suicidal and of having attempted suicide could be described as “Being on the road towards suicidal action”, which culminated in an experience of either chaos or turned off emotions, “Making sense of the suicide attempt”, and “Opening the door to possible life lines”. An overall theme, “Being in want of control”, captured their all-embracing lack of sense of control and was seen in relation to different aspects of oneself, overall life-situation, the immediate suicide attempt situation and in the outlook on the future. Being in want of control may be a relevant and general feature of being suicidal. People who have attempted suicide need more adequate help to break vicious circles before they reach a point of no return and enter an acute suicidal state of mind. Patients’ experience-based knowledge is highly important to listen to and use clinically as well as theoretically when constructing suicide prevention programs

BODE index versus GOLD classification for explaining anxious and depressive symptoms in patients with COPD – a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Anxiety and depression are common and treatable risk factors for re-hospitalisation and death in patients with COPD. The degree of lung function impairment does not sufficiently explain anxiety and depression. The BODE index allows a functional classification of COPD beyond FEV₁. The aim of this cross-sectional study was (1) to test whether the BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms; and (2) to assess which components of the BODE index are associated with these psychological aspects of COPD.</p> <p>Methods</p> <p>COPD was classified according to the GOLD stages based on FEV_1%predictedin 122 stable patients with COPD. An additional four stage classification was constructed based on the quartiles of the BODE index. The hospital anxiety and depression scale was used to assess anxious and depressive symptoms.</p> <p>Results</p> <p>The overall prevalence of anxious and depressive symptoms was 49% and 52%, respectively. The prevalence of anxious symptoms increased with increasing BODE stages but not with increasing GOLD stages. The prevalence of depressive symptoms increased with both increasing GOLD and BODE stages. The BODE index was superior to FEV_1%predictedfor explaining anxious and depressive symptoms. Anxious symptoms were explained by dyspnoea. Depressive symptoms were explained by both dyspnoea and reduced exercise capacity.</p> <p>Conclusion</p> <p>The BODE index is superior to the GOLD classification for explaining anxious and depressive symptoms in COPD patients. These psychological consequences of the disease may play a role in future classification systems of COPD.</p