Women in trauma and orthopaedics: are we losing them at the first hurdle?

INTRODUCTION

Diversity in the healthcare workforce is associated with improved performance and patient-reported outcomes. Gender disparity in Trauma and Orthopaedics (T&O) is well recognised. The aim of this study was to compare factors that influence career choice in T&O between male and female final-year students. Furthermore, the trend of representation of women in T&O over the last decade was also compared with other surgical specialities.

METHODS

An online survey of final-year students who attended nationally advertised T&O courses over a 2-year period was conducted. Data from NHS digital was obtained to assess gender diversity in T&O compared with other surgical specialities.

RESULTS

A total of 414 students from 13 UK medical schools completed the questionnaire. Compared with male students (34.2%), a significantly higher proportion of women (65.8%) decided against a career in T&O, p<0.001. Factors that dissuaded a significantly higher percentage of women included gender bias, technical aspects of surgery, unsociable hours, on-call commitments, inadequate undergraduate training and interest in another specialty (p<0.05). Motivating factors for choosing a career in T&O were similar between both sexes. T&O was the surgical specialty with the lowest proportion of women at both consultant and trainee level over the last decade.

CONCLUSION

T&O remains an unpopular career choice among women. To enhance recruitment of women in T&O, future strategies should be directed toward medical students. Universities, orthopaedic departments and societies must work collaboratively to embed culture change, improve the delivery of the undergraduate curriculum, and facilitate students' exposure to operating theatres and female role models.

Preclinical Pharmacokinetic Profile of Topical Ophthalmic and Intravenous Delivery of QLS-101, a Novel ATP-Sensitive Potassium Channel Opening Ocular Hypotensive Agent

Purpose: To evaluate the pharmacokinetic profiles of the ocular hypotensive agent QLS-101, a novel ATP-sensitive potassium channel opening prodrug, and its active moiety levcromakalim, following topical ophthalmic and intravenous dosing of normotensive rabbits and dogs. Methods: Dutch belted rabbits (n = 85) and beagle dogs (n = 32) were dosed with QLS-101 (0.16-3.2 mg/eye/dose) or formulation buffer for 28 days. Pharmacokinetic profiles of QLS-101 and levcromakalim were evaluated in ocular tissues and blood by LC-MS/MS. Tolerability was assessed by clinical and ophthalmic examinations. Maximum systemic tolerated dose was evaluated in beagle dogs (n = 2) following intravenous bolus administrations of QLS-101 (0.05 to 5 mg/kg). Results: Plasma analysis following topical dosing of QLS-101 (0.8-3.2 mg/eye/dose) for 28 days indicated an elimination half-life (T1/2) of 5.50-8.82 h and a corresponding time (Tmax) range of 2-12 h in rabbits, and a T1/2 of 3.32-6.18 h with a Tmax range of 1-2 h in dogs. Maximum tissue concentration (Cmax) values ranged from 54.8-540 (day 1) to 50.5-777 ng/mL (day 28) in rabbits, and 36.5-166 (day 1) to 47.0-147 ng/mL (day 28) in dogs. Levcromakalim plasma T1/2 and Tmax were similar to QLS-101, while Cmax was consistently lower. Topical ophthalmic delivery of QLS-101 was well tolerated in both species, with sporadic mild ocular hyperemia noted in the group treated with the highest concentration (3.2 mg/eye/dose). Following topical ophthalmic dosing, QLS-101 and levcromakalim were found primarily in the cornea, sclera, and conjunctiva. Maximum tolerated dose was determined to be 3 mg/kg. Conclusions: QLS-101 was converted to its active moiety levcromakalim and showed characteristic absorption, distribution, and safety profiles of a well-tolerated prodrug.

The turn of the dice: Patrick Hughes' Hollow Dice and Reverspectives

Patrick Hughes' Reverspectives demonstrate the importance of perspective as a source of information about the structure and layout of the three-dimensional (3D) world. More recently, he has created a new work of art-Hollow Dice-in which the actual concave structure of the dice is seen as convex. In this article, we examine the similarities and differences between these two perceptual phenomena as well as attempting to explain how and why they arise. Popular interest in both effects is based on the fact that "what we perceive" does not correspond to "what the reality is." As a consequence, Reverspectives and Hollow Dice are often categorized and labeled as "illusions." However, if we consider the information that is available in patterns of light reaching our eyes-rather than the "actual" 3D structure of the Reverspectives and the Hollow Dice-we are in a better position to explain how the size, the viewing distance, the perspective features, the convexity bias, and observer movements determine what we see when viewing these novel and fascinating visual effects.

Use of Machine Learning and Lay Care Coaches to Increase Advance Care Planning Conversations for Patients With Metastatic Cancer

PURPOSE

Patients with metastatic cancer benefit from advance care planning (ACP) conversations. We aimed to improve ACP using a computer model to select high-risk patients, with shorter predicted survival, for conversations with providers and lay care coaches. Outcomes included ACP documentation frequency and end-of-life quality measures.

METHODS

In this study of a quality improvement initiative, providers in four medical oncology clinics received Serious Illness Care Program training. Two clinics (thoracic/genitourinary) participated in an intervention, and two (cutaneous/sarcoma) served as controls. ACP conversations were documented in a centralized form in the electronic medical record. In the intervention, providers and care coaches received weekly e-mails highlighting upcoming clinic patients with < 2 year computer-predicted survival and no prior prognosis documentation. Care coaches contacted these patients for an ACP conversation (excluding prognosis). Providers were asked to discuss and document prognosis.

RESULTS

In the four clinics, 4,968 clinic visits by 1,251 patients met inclusion criteria (metastatic cancer with no prognosis previously documented). In their first visit, 28% of patients were high-risk (< 2 year predicted survival). Preintervention, 3% of both intervention and control clinic patients had ACP documentation during a visit. By intervention end (February 2021), 35% of intervention clinic patients had ACP documentation compared with 3% of control clinic patients. Providers' prognosis documentation rate also increased in intervention clinics after the intervention (2%-27% in intervention clinics, P < .0001; 0%-1% in control clinics). End-of-life care intensity was similar in intervention versus control clinics, but patients with ≥ 1 provider ACP edit met fewer high-intensity care measures (P = .04).

CONCLUSION

Combining a computer prognosis model with care coaches increased ACP documentation.

When is an illusion not an illusion? An alternative view of the illusion concept

What is an “illusion”? I would like to argue that (A) there is no coherent and meaningful definition of the word “illusion” and (B) the majority of the things we have previously labelled as “illusions” can be better categorised into three classes of perceptual effects: (i) those that should not be regarded as illusory according to any definition; (ii) those that are simply consequences of “how our perceptual systems work” and (iii) those that are a consequence of using artificial or impoverished stimulus situations.

The impact of mentoring in trauma and orthopaedic training: a systematic review

INTRODUCTION

Trauma and orthopaedics is renowned for being a challenging yet rewarding career. The value of mentorship in medical and surgical training is known to be beneficial; however, the prevalence and quality of mentorship opportunities in orthopaedics are less well studied. Identifying the strengths and weaknesses of mentoring programmes in orthopaedic training and recognising barriers to effective mentorship are key to unlocking the full potential of future orthopaedic surgeons.

METHODS

A comprehensive search of PubMed, Medline, EMBASE and the Cochrane Library was performed. All studies published in the English language that reported data on mentorship programmes in orthopaedic training were included.

FINDINGS

A total of 23 studies met the inclusion criteria. These studies demonstrated that formal mentorship programmes in orthopaedics are lacking but are sought after, with a positive influence on satisfaction and future career choice/subspecialty selection identified. Several barriers to mentoring in the field were recognised including the difficulty faced by female trainees, the availability of mentors and time constraints. The opportunity to choose a mentor, a mentor with the same interests, regular meetings and the option of gender congruent mentorship were all identified as crucial requirements for effective mentorship.

CONCLUSION

Mentorship opportunities must be more accessible to all orthopaedic trainees alike and should aim to incorporate the attributes identified to provide the highest calibre of training to prospective orthopaedic surgeons.

Release of individual surgeon data to the public: patients' and surgeons' views

BACKGROUND

Limited surgeon-specific outcomes data are currently released to the public. Existing schemes generally result from the recommendations of public enquiries, addressing breaches to patient safety and malpractice. We found limited evidence in the literature about patients' or orthopaedic surgeons' wishes regarding the release of such data to the public.

METHODS

We surveyed 80 joint replacement patients and 41 orthopaedic surgeons regarding their wishes concerning collection and release of individual surgeon data to the public.

RESULTS

Of 80 patients, 30% (24/80) were aware of data on the NHS-My Choices website, 16% (13/80) had reviewed data prior to operation and 95% (76/80) wanted data concerning surgeons' experience, length of stay and complications including revisions. Patients expected more current monitoring of data than occurs. Of 41 surgeons, 20% (8/41) thought national joint registry (NJR) derived data accurately reflected their NHS work. Surgeons did not think this data improved patient outcomes (34%, 14/41), and that it reduced innovation (61%, 25/41) and training (75%, 31/41) and increased risk of adverse behaviour (61%, 25/41). Surgeons wanted a minimal data set accurately presented and risk adjusted.

CONCLUSION

In the future, it is likely that more individual surgeon data will be released to the public. There needs to be an agreed, accurate minimum dataset collected, reviewed in local clinical governance meetings and published with explanatory notes regarding the interfering variables and what conclusions can be drawn regarding the ability of the surgeon. This process needs to be overseen by an independent body trusted by the public.

Use of a computer model and care coaches to increase advance care planning conversations for patients with metastatic cancer

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Background: Patients with metastatic cancer benefit from advance care planning (ACP) conversations. Despite initiatives which train providers to have ACP conversations using the serious illness care program (SICP) conversation guide, few patients have a documented prognosis discussion due to busy clinic schedules and difficulty in deciding the right times to have such conversations. We designed an intervention to improve ACP by incorporating a validated computer model to identify patients at high risk for mortality in combination with lay care coaches. We investigated whether this would improve end of life quality measures. Methods: Four Stanford clinics were included in this pilot; all received SICP training. Two clinics (thoracic and genitourinary) underwent the intervention (computer model + care coach), and two clinics (sarcoma and cutaneous) served as the control. For providers in the intervention, an email was sent every Sunday listing the metastatic cancer patients who would be seen in clinic the following week and a predicted prognosis generated by the model. A lay care coach contacted patients with a predicted survival ≤2 years to have an ACP conversation with them. After, the care coach notified the provider to suggest discussion regarding prognosis with the patient. Criteria for a patient visit to be included in the analysis were: age ≥18, established patient, has sufficient EMR data for computer model, and no prior prognosis documentation. The primary outcome was documentation of prognosis in the ACP form by the end of the week following the clinic visit. Results: 5330 visits in 1298 unique patients met the inclusion criteria. Median age was 67 (range 19-97); 790 male, 508 female. 1970 visits were with patients with ≤2 year predicted survival. Prognosis discussion was documented by providers in the ACP form for 8.1% of intervention visits compared to 0.07% of control visits (p=0.001 in mixed effects model). Of the 1298 unique patients, 84 were deceased by December 2020. 41.7% died in the hospital. 59.5% were enrolled in hospice prior to death, and 19.0% were hospitalized in the ICU ≤14 days prior to death. Of deceased patients with ACP form prognosis documentation, 5.0% had ≥2 hospitalizations in the 30 days before death compared to 23.4% of deceased patients with no prognosis documented (p=0.10). For ≥ 2 ER visits in the 30 days before death, the proportions were 5.0% and 20.3% (p=0.17). Conclusions: This pilot study supports that our intervention is associated with higher rates of prognosis discussions and documentation. There was a trend towards better quality of end of life care as noted by higher rates of hospice enrollment and less intensive care at end of life. These results merit further investigation as a means to improve goal-concordant care and ensure appropriate care for cancer patients at the end of life.

Prospective Study of Policies and Use of Therapies for COVID-19 Amongst Australian Health Services during 2020

BACKGROUND

The COVID-19 pandemic has generated significant debate about how emerging infections can be treated in the absence of evidence-based therapies to combat disease. In particular, the use of off-label therapies outside of a clinical trial setting has been controversial.

AIM

We aimed to longitudinally study policies and prescribing practices pertaining to therapies for COVID-19 in Australian Health Services in 2020.

METHODS

Prospective data was collected from participating Australian health services who may care for patients with COVID-19 via an electronic portal. A single informant from each health service was emailed a survey link at regular intervals. Information was sought regarding changes to COVID-19 policy at their service and use of therapies for COVID-19.

RESULTS

Overall, 78 hospitals were represented from 39 respondents with longitudinal data collection from May to December 2020. All Australian states/territories were represented with the majority of respondents located in a major city (34/39; 87%). Just over half (20/39) of respondents had a written policy for COVID-19 therapy use at their health service at survey enrolment and policies changed frequently throughout the pandemic. Therapy use outside of a clinical trial was reported in 54% of health services, most frequently in Victoria, correlating with higher numbers of COVID-19 cases. At study commencement hydroxychloroquine was most frequently used, with corticosteroids and remdesivir use increasingly throughout the study period.

CONCLUSION

Our results reflect the reactive nature of prescribing of therapies for COVID-19 and highlight the importance of evidence-based guidelines to assist prescribers. This article is protected by copyright. All rights reserved.

292 Publication of Individual Surgeon Outcomes Data: The Wishes of Orthopaedic Patients and Their Surgeons

Background

The Paterson report recommended increased release of individual surgeon data to the public. There is limited evidence in the literature about patients’ or orthopaedic surgeons’ wishes regarding release of such data to the public.

Method

We surveyed 80 joint replacement patients and 41 orthopaedic surgeons to determine their wishes regarding collection and release of individual surgeon data to the public.

Results

Patients expected more current monitoring of data than actually occurs. Of the patients, 95% wanted data to be available describing surgeon experience, length of stay and complications. Regarding currently available data, 50% of patients who were aware of it were likely to view it on the internet.

Surgeons were aware of the data available, but 80% did not think it was accurate. Surgeons did not think this data improved standards, that it negatively affected innovation (61%) and training (76%) and led to risk averse behaviour (61%). Surgeons wanted a minimal data set accurately presented and risk adjusted.

Conclusions

We recommend an agreed minimum dataset of good quality data is collected and discussed in clinical governance sessions. It can then be released to the public with explanatory notes.

The effect of the COVID-19 lockdown on the epidemiology of hip fractures in the elderly: a multicentre cohort study

INTRODUCTION

The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative.

METHODS

An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020-11 May 2020), and the corresponding period in 2019 (period A).

RESULTS

A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the 'Best Practice Tariff' during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015).

CONCLUSIONS

The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential 'second wave'.

Optic Flow: Perceiving and Acting in a 3-D World

In 1979, James Gibson completed his third and final book "The Ecological Approach to Visual Perception". That book can be seen as the synthesis of the many radical ideas he proposed over the previous 30 years - the concept of information and its sufficiency, the necessary link between perception and action, the need to see perception in relation to an animal's particular ecological niche and the meanings (affordances) offered by the visual world. One of the fundamental concepts that lies beyond all of Gibson's thinking is that of optic flow: the constantly changing patterns of light that reach our eyes and the information it provides. My purpose in writing this paper has been to evaluate the legacy of Gibson's conceptual ideas and to consider how his ideas have influenced and changed the way we study perception.

Study of the Effect of Methyldiethanolamine Initiator on the Recording Properties of Acrylamide Based Photopolymer

The use of Holographic Optical Elements (HOEs) in applications, such as in light shaping and redirection, requires certain characteristics such as a high Diffraction Efficiency, low angular selectivity and stability against UV damage. In order to maximize the performance of the HOEs, photosensitive materials are needed that have been optimised for the characteristics that are of particular importance in that application. At the core of the performance of these devices is the refractive index modulation created during holographic recording. Typically, a higher refractive index modulation will enable greater light Diffraction Efficiency and also operation with thinner devices, which in turn decreases the angular selectivity and the stability of the refractive index modulation introduced during recording, which is key to the longevity of the device. Solar concentrators based on volume HOEs can particularly benefit from thinner devices, because, for a solar concentrator to have a high angular working range, thinner photopolymer layers with a smaller angular selectivity are required. This paper presents an optimisation of an acrylamide-based photopolymer formulation for an improved refractive index modulation and recording speed. This was achieved by studying the effect of the concentration of acrylamide and the influence of different initiators in the photopolymer composition on the diffraction efficiency of holographic gratings. Two initiators of different molecular weights were compared: triethanolamine (TEA) and methyldiethanolamine (MDEA). A fivefold increase in the rate of grating formation was achieved through the modification of the acrylamide concentration alone, and it was also found that holograms recorded with MDEA as the initiator performed the best and recorded up to 25% faster than a TEA-based photopolymer. Finally, tests were carried out on the stability of the protected and unprotected photopolymer layers when subjected to UV light. The properties exhibited by this photopolymer composition make it a promising material for the production of optical elements and suitable for use in applications requiring prolonged exposure to UV light when protected by a thin melinex cover.

Reversed Phi and the "Phenomenal Phenomena" Revisited

Reversed apparent motion (or reversed phi) can be seen during a continuous dissolve between a positive and a spatially shifted negative version of the same image. Similar reversed effects can be seen in stereo when positive and spatially shifted negative images are presented separately to the two eyes or in a Vernier alignment task when the two images are juxtaposed one above the other. Gregory and Heard reported similar effects that they called "phenomenal phenomena." Here, we investigate the similarities between these different effects and put forward a simple, spatial-smoothing explanation that can account for both the direction and magnitude of the reversed effects in the motion, stereo and Vernier domains. In addition, we consider whether the striking motion effects seen when viewing Kitaoka's colour-dependent Fraser-Wilcox figures are related to the reversed phi illusion, given the similarity of the luminance profiles.

Toward a new theory of stereopsis: A critique of Vishwanath (2014)

The title of Dhanraj Vishwanath's (2014) Psychological Review article is, of course, adapted from the title of George Berkeley's (1709/1922) book, "Towards a New Theory of Vision," and, as a consequence, it promises to provide us with a radically new understanding of 3D vision. Does it succeed? Vishwanath certainly raised important questions about what we mean by stereopsis, and he does a good job in reviewing some of the more recent findings on how particular viewing conditions affect stereopsis; however, it disappoints with respect to the claim that it offers a "new theory of stereopsis." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Quantification of nutritive sucking among preterm and full-term infants

Purpose

We developed summaries of oral bottle-feeding skills among preterm (<37 gestational weeks) and full-term (≥37 gestational weeks) infants using a mechanical device (Orometer) to measure intraoral pressure changes, with accompanying automated software and analytics. We then compared the rates of change in feeding skills over several weeks (feeding trends) between preterm and full-term infants. We also compared group means at 40 weeks post menstrual age (PMA).

Patients and methods

Healthy full-term and preterm infants capable of oral feeding were recruited from the Pediatric Outpatient Clinic at University of California San Francisco, Fresno, and from the Oregon Health & Science University Doernbecher Neonatal Critical Care Unit, respectively. Feeding skill was quantified using an Orometer and automated suck-analysis software. Factor analysis reduced the >40 metrics produced by the Orometer system to the following seven factors that accounted for >99% of the sample covariance: suck vigor, endurance, resting, irregularity, frequency, variability, and bursting. We proposed that these factors represent feeding skills and they served as the dependent variables in linear models estimating trends in feeding skills over time for full-term and preterm infants (maturation). At approximately 40 weeks PMA we compared mean feedings skills between infants born preterm and those born full-term using predictions from our models.

Results

Feeding skills for 117 full-term infants and 82 preterm infants were first captured at mean PMA of 42.3 and 36.0 weeks, respectively. For some feeding skills, preterm and full-term infants showed different trends over time. At 37-40 weeks PMA, preterm infants took approximately 15% fewer sucks than infants born full-term (p=0.06) and generally had weaker suck vigor, greater resting, and less endurance than full-term babies. Preterm infant-feeding skills appeared similar to those of full-term infants upon reaching ≥40 weeks PMA, although preterm infants showed greater variability for all factors.

Conclusion

The Orometer device, accompanying software, and analytic methods provided a framework for describing trends in oral feeding, thereby allowing us to characterize differences in maturation of feeding between healthy preterm and full-term infants.

Informed consent: the view from the trenches

We review some of the recent literature on consent for surgical procedures and suggest a scheme for obtaining surgical consent.

The incidence of anterior pituitary hormone deficiencies in patients with microprolactinoma and idiopathic hyperprolactinaemia

INTRODUCTION

Patients with microprolactinoma and idiopathic hyperprolactinaemia are not generally considered to be at risk of hypopituitarism and are therefore not routinely screened for this abnormality. In our clinical practice, we have observed a number of patients with nonmacroadenomatous hyperprolactinaemia to have anterior pituitary hormone deficits.

AIMS

We aimed to establish the frequency and clinical significance of anterior pituitary hormone deficiencies, comparing patients with radiologically proven microprolactinomas and patients with idiopathic hyperprolactinaemia.

STUDY DESIGN

We retrospectively examined the casenotes of 206 patients with hyperprolactinaemia from our centre. Patients who did not fit the profile of surgically naïve microprolactinoma or idiopathic hyperprolactinaemia or who had incomplete data were excluded, resulting in a study group of 56 patients.

RESULTS

A total of 35 patients with MRI evidence of microprolactinoma were identified, three (8.57%) of whom had one or more anterior pituitary hormone deficiencies. A total of 21 patients with MRI-negative idiopathic hyperprolactinaemia were identified, nine (42%) of whom had one or more anterior pituitary hormone deficiencies (P<.01). Only one patient in the MRI-positive group had deficiency that required hormone replacement, in contrast six patients in the MRI-negative group had deficiencies that were of clinical significance and which required hormone replacement.

SUMMARY

This study shows a clinically significant incidence of anterior pituitary hormone deficiency in patients with idiopathic hyperprolactinaemia. The authors recommend that dynamic pituitary assessment should be considered routinely in this patient group. A prospective study would be required to assess the underlying cause for these abnormalities, as they suggest a nontumour pan-pituitary process.

Collateral Damage and Critical Turning Points: Public Health Implications of HPV Vaccine News Coverage for Boys and Men in 2011

In 2009, the Food and Drug Administration (FDA) officially expanded approval of the Gardasil vaccine to include human papillomavirus (HPV) vaccination for boys and men, and in 2011, the Centers for Disease Control and Prevention (CDC) issued a formal recommendation for routine vaccination for this population. Despite these efforts, HPV vaccination rates for boys and men continue to fall short of public health targets. While news was breaking about the benefits of the HPV vaccine for boys and men, public attention shifted as a result of political debates concerning the vaccine. This study examines a pivotal time period for public health in which the vaccine became officially recommended for boys and men and at the same time became the center of political controversies in the lead-up to the 2012 presidential campaign. The current study extends previous research and presents a content analysis of newspaper articles (N = 154) about the HPV vaccine for the year 2011. Results indicate that the lack of comprehensive coverage of HPV and the HPV vaccine found in previous studies continued in this year. Results shed light on key political events that may have functioned to overshadow the recommendation of the HPV vaccine for boys and men. The implications of this pattern of news coverage can inform public health efforts to address low rates of HPV vaccination uptake among boys and men in present day.

Revisiting Motion Parallax as a Source of 3-D Information

There are many similarities between binocular disparity and motion parallax as sources of information about the structure and layout of 3-D objects and surfaces. The former can be thought of as a transformation that maps one eye's image onto the other while the latter is a transformation that maps the changes in one eye's image over time. There are many empirical similarities in the ways we use the two sources of information but there are also significant differences. A consideration of those differences leads to the conclusion that, rather than seeing motion parallax as a close analogue of binocular stereopsis, motion parallax is better thought of as a special case of the kinetic depth effect in which the depth order of the depicted 3-D object or surface can be disambiguated by vertical perspective information.

The Effectiveness of Vertical Perspective and Pursuit Eye Movements for Disambiguating Motion Parallax Transformations

In the kinetic depth effect, the direction of the perceived depth and the direction of apparent rotation of a 3-D structure are linked, and typically ambiguous, whereas depth from motion parallax during both observer- and object-movement is stable and unambiguous. Rogers and Rogers demonstrated that the vertical perspective transformations play an important role in disambiguating the direction of the perceived depth in parallax-defined surfaces but more recently Nawrot et al. have proposed that pursuit eye movements provide the crucial disambiguating information. Theoretical considerations suggest that pursuit eye movements could not, in principle, provide the necessary information because 3-D objects as surfaces may rotate during observer- or object-movement. The empirical evidence presented here shows that vertical perspective transformations are sufficient for the unambiguous perception of parallax depth whereas pursuit eye movements are not necessary and may not even be sufficient.

Straight Lines, ‘Uncurved Lines’, and Helmholtz's ‘Great Circles on the Celestial Sphere’

Helmholtz's famous pincushioned chessboard figure has been used to make the point that straight lines in the world are not always perceived as straight and, conversely, that curved lines in the world can sometimes be seen as straight. However, there is little agreement as to the cause of these perceptual errors. Some authors have attributed the errors to the shape of the retina, or the amount of cortex devoted to the processing of images falling on different parts of the retina, while others have taken the effects to indicate that visual space itself is curved. Helmholtz himself claimed that the ‘uncurved lines on the visual globe’ corresponded to ‘direction circles’ defined as those arcs described by the line of fixation when the eye moves according to Listing's law. Careful re-reading of Helmholtz together with some additional observations lead us to the conclusion that two other factors are also involved in the effect: (i) a lack of information about the distance of peripherally viewed objects and (ii) the preference of the visual system for seeing the pincushion squares as similar in size.

All Adventurous Women Do: HPV, Narrative, and HBO's Girls

This study looks at media portrayals of sexual health through the popular HBO television show Girls. This rhetorical criticism of Girls delineates two emergent narrative themes. First, the show repeatedly discusses human papillomavirus (HPV) in terms of its severity, but it oscillates in terms of representing the degree of significance. Second, the show frames the source of infection as more important than other concerns related to HPV. Ultimately, this analysis demonstrates that Girls perpetuates a problematic narrative plot structure related to issues of HPV transmission; it also provides a largely scientifically accurate portrayal of HPV and promotes open and frank discussions of sexual health. It is argued that mediated narratives, such as Girls, might have the potential to transform social attitudes and actions and should thereby garner attention from health communication scholars and public health advocates.

Awaiting diagnosis of breast cancer: strategies of enduring for preserving self

PURPOSE/OBJECTIVES

To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy.

RESEARCH APPROACH

Glaserian Grounded Theory.

SETTING

Urban area in western Canada.

PARTICIPANTS

37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear.

METHODOLOGIC APPROACH

Unstructured, recorded telephone interviews.

FINDINGS

Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring.

CONCLUSIONS

A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering.

INTERPRETATION

The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.

Delusions about illusions

For centuries, philosophers and psychologists have distinguished between correct or veridical perception and illusory perception. Illusions have become an essential topic in textbooks on perception, and we amuse our lecture classes with demonstrations that reveal the fallibility of perceptual systems--what we see, hear, feel, taste, and smell does not correspond to what is really there. This special issue of Perception contains the descriptions of many new and interesting illusions as well as speculations about the causes of familiar illusions. There have also been many attempts to classify illusions that date back to Al-Haytham (1083) in the 11th century through to Richard Gregory (2009 Seeing through Illusions, Oxford: Oxford University Press) in the last decade, but there have been far fewer attempts to analyse and critique the concept itself. That is the purpose of this paper, and the conclusion reached is that there is no satisfactory way of distinguishing between those aspects of our perception that we regard as veridical and those we label as illusions.

Health level seven interoperability strategy: big data, incrementally structured

OBJECTIVES

Describe how the HL7 Clinical Document Architecture (CDA), a foundational standard in US Meaningful Use, contributes to a "big data, incrementally structured" interoperability strategy, whereby data structured incrementally gets large amounts of data flowing faster. We present cases showing how this approach is leveraged for big data analysis.

METHODS

To support the assertion that semi-structured narrative in CDA format can be a useful adjunct in an overall big data analytic approach, we present two case studies. The first assesses an organization's ability to generate clinical quality reports using coded data alone vs. coded data supplemented by CDA narrative. The second leverages CDA to construct a network model for referral management, from which additional observations can be gleaned.

RESULTS

The first case shows that coded data supplemented by CDA narrative resulted in significant variances in calculated performance scores. In the second case, we found that the constructed network model enables the identification of differences in patient characteristics among different referral work flows.

DISCUSSION

The CDA approach goes after data indirectly, by focusing first on the flow of narrative, which is then incrementally structured. A quantitative assessment of whether this approach will lead to a greater flow of data and ultimately a greater flow of structured data vs. other approaches is planned as a future exercise.

CONCLUSION

Along with growing adoption of CDA, we are now seeing the big data community explore the standard, particularly given its potential to supply analytic en- gines with volumes of data previously not possible.