The effect of music on the operating surgeon: a pilot randomized crossover trial (the MOSART study)

OBJECTIVE

The experience of stress is common among surgeons while working in the operating theatre (OT). Understanding and finding ways to mitigate this stress is important for optimizing surgical quality and maintaining clinician wellbeing. In this pilot study, we tested the feasibility and reported the outcomes of measuring the effect of background music on intra-operative surgeon stress in the clinical environment.

METHODS

The effect of Music on the Operating Surgeon: A pilot Randomized crossover Trial (the MOSART study) was conducted over a 9-month period in a single-centre. Vascular and general surgeons acting as primary operators (POs) performing elective, general anaesthetic operations were included. The intervention was surgeon-selected music, and the control was the absence of music. Outcome measures were feasibility (recruitment rate, practicability, and completeness of data), heart rate variability (HRV) indices, the Six-Item State-Trait Anxiety Inventory (STAI-6), and the Surgical Task-load Index (SURG-TLX).

RESULTS

Five POs performed 74 eligible randomized cases. The protocol was well tolerated, and no cases were abandoned. Data was incomplete in 8% of cases. The overall mean (SD) operative SURG-TLX score was 48 (±22). Mean HR increased and RMSSD decreased significantly from baseline, suggesting reduced parasympathetic activity while operating. The presence of intra-operative music was not found to affect the psychological or physiological outcomes.

CONCLUSIONS

A music interventional study of this nature is feasible in the operating theatre environment, though no difference was found between in the music and non-music conditions. Follow-up research in a simulated environment with intensive physiological monitoring could be considered.

Management of thoracoabdominal gunshot wounds - Experience from a major trauma centre in South Africa

INTRODUCTION

The management of thoracoabdominal (TA) gunshot wounds (GSW) remains challenging. This study reviewed our experience with treating such injuries over a decade.

MATERIALS AND METHODS

A retrospective study was conducted at a major trauma centre in South Africa over a ten-year period from December 2012 to January 2022.

RESULTS

Two hundred sixteen cases were included (male: 85 %, mean age: 33 years). Median RTS: 8 and median ISS: 17 (IQR: 10-19). The mean value of physiological parameters: Heart Rate (HR): 98/min, Systolic Blood Pressure (SBP): 119 mmHg, Temperature (T): 36.2 °C, pH: 7.35, Lactate 3.7 mmol/l. Ninety-nine (46 %) underwent a CT scan of the torso. One hundred fifty-four cases (69 %) were managed operatively: thoracotomy only [5/154 (3 %)], laparotomy only [143/154 (93 %)], and combined thoracotomy and laparotomy [6/154 (4 %)]. Those who had surgery following preoperative CT had a lower rate of dual cavity exploration (2 % vs 4 %, p = 0.51), although it did not reach statistical significance. The overall morbidity was 30 % (69). 82 % required intensive care (ICU) admission. The mean length of hospital stay was 14 days. The overall mortality was 13 % (28). Over the 10-year study period, there was a steady increase in the number of cases of TA GSWs managed at our institution. Over the study period, an increasing use of CT was noted, along with a steady reduction in the proportion of operations performed.

CONCLUSIONS

Thoraco-abdominal GSWs remain challenging to manage and continue to be associated with significant morbidity and mortality. The increased use of CT scans has reduced the degree of clinical confusion around which body cavity to prioritize, leading to an apparent decrease in dual cavity exploration, and has allowed for the increased use of minimalistic and non-operative approaches.

Broad Responses and Attitudes to Having Music in Surgery (The BRAHMS Study): An Australia and Aotearoa New Zealand Perspective

Background

Surgery is a stressful exercise, and the experience of occupational stress may have impacts on surgical performance, and surgeon well-being. Music is played in operating theatres (OTs) throughout the world, and while it may improve surgical performance, and reduce clinician stress within the OT, concerns exist over its distracting and noise-creating properties.

Methods

In this prospective observational study, between May to August 2022, Vascular, General and Paediatric surgeons and registrars in Australia and Aotearoa New Zealand (AoNZ) responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. Binomial logistic regression and Chi squared tests of association were performed, accepting p < 0.05 as significant.

Results

In this cohort of 120 surgeons, 45 % were vascular specialists, 30 % were female and 59 % were consultant surgeons. The most commonly preferred music genres were easy listening and pop. Over 75 % of surgeons enjoyed having music in their OTs with the majority reporting it improved their temperament, how mentally fatiguing a procedure felt and how anxious or stressed they felt. Vascular surgeons were more likely to believe music had a positive influence on communication than their general and paediatric surgery colleagues (p < 0.01). Registrars had significantly higher odds of believing music had a positive effect on their temperament, and how stressed and anxious they felt when operating, when compared to consultants (p < 0.05).

Conclusions

This study provides a window into the surgeons' use of and attitudes towards intra-operative background music and its effect on stress and cognitive load in Australia and AoNZ. While overall, music is viewed positively by this cohort, there was some difference seen across specialties and level of experience. Further subjective and objective data in this field may provide useful information to guide hospital policy and inform pathways for clinician wellbeing.

Management of secondary aorto-enteric fistulae: a multi-centre study

BACKGROUND

Secondary aorto-enteric fistulae (SAEF) are a rare, complex and life-threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long-term management.

METHODS

This was a retrospective, observational, multi-institutional cohort study. Patients who had been treated for SAEF between 2003 and 2020 were identified using a standardized database. Baseline characteristics, presenting features, microbiological, operative, and post-operative variables were recorded. The primary outcomes were short and mid-term mortality. Descriptive statistics, binomial regression, Kaplan-Meier and Cox age-adjusted survival analyses were performed.

RESULTS

Across 5 tertiary centres, a total of 47 patients treated for SAEF were included, 7 were female and the median (range) age at presentation was 74 years (48-93). In this cohort, 24 (51%) patients were treated with initially with OAR, 15 (32%) with EVAR-first and 8 (17%) non-operatively. The 30-day and 1-year mortality for all cases that underwent intervention was 21% and 46% respectively. Age-adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR-first group compared to the OAR-first group, HR 0.99 (95% CI 0.94-1.03, P = 0.61).

CONCLUSION

In this study there was no difference in all-cause mortality in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad-spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.

Southern ocean carbon and heat impact on climate

The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea-ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

Broad responses and attitudes to having music in surgery (the BRAHMS study) - a South African perspective

BACKGROUND

Music is played in operating theatres (OTs) throughout the world, though controversy around its use exists. While some clinicians may find background music favourable to the theatre mood and a way to augment surgical performance, there is concern raised over its distracting and noise-creating properties.

METHODS

In this prospective observational study, between August and December 2021, 110 surgeons and registrars in South Africa responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment.

RESULTS

In this cohort, 66% were male, 29% were consultants and the most common age range was 30-39 years old. Eighty per cent of respondents reported that music was played at least "sometimes", with 74% reporting that they enjoyed it. Easy Listening was the most played and preferred genre followed by Top 40/Billboard hits. Overwhelmingly, respondents reported that background music in the OT improved temperament, focus, mood, and performance, though over a quarter felt it worsened communication. Thirty-one per cent of respondents reported that the choice of music depended on the type of operation, and 70% would turn music down or off during crises. Those who enjoyed music in their spare time were significantly more likely to enjoy music in the OT and perceive it positively.

CONCLUSION

This study provides a window into the surgeons' use of and attitudes to intraoperative music in South Africa. While overall, music is viewed positively by this cohort, some concerns remain regarding communication and distractedness. Further interventional and qualitative studies would be useful.

The effect of background music on stress in the operating surgeon: scoping review

Background

Despite the ubiquitous sounds of music playing in operating theatres (OTs) around the world, the effect that music has on intraoperative clinician stress is ill-defined. In the present scoping review the aim was to map the available evidence for the effect of background music in the OT on the experience of stress in the operating surgeon.

Methods

The present review was conducted in accordance with the PRISMA Protocols for Scoping Reviews. Using Embase, MEDLINE, and the Cochrane databases, peer-reviewed research studies reporting the effect of intraoperative background music on an outcome measure of clinician stress or respondent perceptions on this effect were included.

Results

A total of 4342 studies were screened and 15 studies met the inclusion criteria, of which 10 were interventional studies, and five were observational survey-based studies. Of the 10 interventional studies, four showed reduced anxiety and mental workload scores with music, although only two demonstrated a significant improvement in a physiological outcome. The survey-based studies generally reported a positive perception among surgeons and theatre staff towards the effect of music on OT stress.

Conclusion

While there is generally a positive perception towards intraoperative music and surgeon stress, there are few objective physiological and psychological data to support this. Studies were varied in their design. The present review can be used to guide future experimental, observational, and mixed-method research on this topic.

Students' use of caffeine, alcohol, dietary supplements, and illegal substances for improving academic performance in a New Zealand university

This study aimed to describe patterns of use and attitudes towards a broad variety of substances for improving academic performance at a New Zealand university. 685 students (from 1800 invited) completed an online questionnaire (38% response rate). They were asked about their lifetime and current substance use for improving academic performance, as well as their reasons for use, attitudes and perceptions of: caffeine, alcohol, dietary supplements, prescription stimulants, other prescription substances, and illicit substances. 80% (95% CI: 76.3, 82.5) reported ever using any substance to help improve academic performance, mainly to stay awake and improve concentration. Caffeine (70%, 95% CI: 66.3, 73.3) and dietary supplements (32%, 95% CI: 28.3, 35.5) were most commonly used. 4% (95% CI: 2.7, 5.9) reported use of prescription stimulants, mostly methylphenidate, and another 4% (95% CI: 2.7, 5.9) reported using illicit substances for improving academic performance. Users of prescription stimulants were more likely than non-users to believe that they were safe, morally acceptable, and that they should be available legally for enhancing academic performance. We close with discussions on broadening the focus of substances for improving academic performance in public health debates. Further qualitative research from small countries is also needed to move towards a place-based approach for clarifying ethical implications, inform policy in universities, and understand how injustices are created through the use of and ability to purchase different substances.

1515 A Survey on The Perceived Effect of Background Music on Intra-Operative Stress, Anxiety and Surgical Task Load On the Operating Surgeon

Introduction

Music is commonly played in operating theatres throughout the world though its use remains controversial. There is growing literature supporting the notion that playing background music can improve a surgeon’s task performance and reduce performance stress. We present findings from our survey of surgeons about their perceptions of the effect of intra-operative music on their stress levels.

Method

Surgeons and registrars from three different specialties – general, vascular, and paediatric surgery – in a single tertiary centre were surveyed on their views on the effect of music in theatre. Two instruments were used to assess parameters of stress: the modified 6-point state trait anxiety inventory (STAI-6) and the surgical task load index (SURG-TLX).

Results

There were 35 respondents across the three surgical specialties (78% response rate). Pop and “easy listening” were the most popular genres. A majority felt music improved their temperament (75%) and perceived stress (63%). 59% of respondents reported no to low perceived anxiety with music, compared with 31% reporting moderate and 9% high anxiety based on STAI-6 parameters. Regarding SURG-TLX parameters and music, respondents overall perceived feeling less anxious, rushed and mentally fatigued though more distracted.

Conclusions

Music is generally thought to have positive subjective effects on the theatre environment with regards to anxiety levels, temperament, perceived stress, and parameters within the surgical task load index. This is counterbalanced by a smaller group of respondents who felt that music can impair communication and increase distraction within theatre. Music used appropriately may reduce perceptions of stress in theatre.

A split-tattoo randomized Q-switched neodymium-doped yttrium-aluminium-garnet laser trial comparing the efficacy of a novel three-pass, one-session method with a conventional method in the treatment of blue/black tattoos in darker skin types

Tattoos with blue/black ink show good lightening of pigment after treatment with 1064 nm Q-switched (QS) neodymium-doped yttrium-aluminium-garnet (Nd:YAG) laser. In this randomized trial, we compared the efficacy of a novel three pass, one session procedure (R15 method) with a conventional method for treating blue/black tattoos in darker skin types. Tattoos were treated with 1064 nm QS Nd:YAG Laser with a spot size of 4 mm, fluence of 5 J/cm² and frequency of 5 Hz. The tattoo pigment lightening was comparable with both methods. Thread-like tattoos had significantly better pigment lightening with fewer side effects than the broad band-like tattoos. We would like to recommend the R15 method of the QS Nd:YAG laser for thread-like tattoos, which can save patients' time, cut short the frequency of their hospital visits and, more importantly, decrease the cost involved in it.

Understanding children's perceptions of, and priorities for, healthy neighbourhoods in Aotearoa New Zealand: study protocol for a cross-sectional study

INTRODUCTION

Neighbourhood environments can have significant and enduring impacts on children's physical, psychological and social health. Environments can impact health through promoting or hindering physical activity, active travel, and healthy eating in addition to opportunities for social interaction, cognitive development, rest and relaxation. There is a paucity of research that has examined neighbourhood and health priorities, strengths and needs from the perspectives of the community, and even less that has focused on the perspectives of children within communities. The aim of this article is to describe the research protocol for a project to gather child-identified needs and strengths-based solutions for promoting child health and well-being in urban neighbourhood environments.

METHODS AND ANALYSIS

This participatory research project is designed to partner with children in school settings in Tāmaki Makaurau Auckland and Ōtepoti Dunedin, Aotearoa New Zealand. An abundant communities approach will be used with children to identify needs and strengths related to neighbourhoods and health. Specific methods including collaborative, creative, play-based methods such as concept-mapping activities and co-creation of final dissemination material on the key messages are described. Plans for researcher reflections, data analysis and dissemination are also detailed.

ETHICS AND DISSEMINATION

This research has been approved by the University of Auckland Human Participants Ethics Committee. Results will be disseminated through child and researcher co-created output, a technical report and academic journal articles. By using evidence-based child-centred approaches to knowledge generation, we anticipate the research will generate new localised insights about children's preferences and needs for healthy neighbourhoods which will be shared with stakeholders in planning and practice. The detailed session protocol including critical researcher reflections is shared in this manuscript for application, development and refinement in future research.

Atypical case of Crohn's colitis in a patient with adult-onset Still's disease

A 65-year-old woman with a background of adult-onset Still's disease (AOSD) presented acutely to a general surgical unit with signs of bowel obstruction and sepsis. A CT scan was indicative of a mesenteric lymphadenopathy suspicious of malignancy. At the time of the surgery, a clinical diagnosis of lymphoma was made given the large number of lymph nodes; however, histological diagnosis was resulted as Crohn's colitis. There is only one other case of AOSD and Crohn's disease in the literature, and there is no clear pathological connection between the two inflammatory conditions. This case highlights the surgical management of an unusual presentation.

504 Can Measuring Heart Rate Variability in The Operating Surgeon Provide Insight into Intra-Operative Stress? A Literature Review and Direction for Research

Introduction

Stress affects the internal environment of the operating surgeon. Examining ways to mitigate this could prove important to the health of both surgeon, and patients.

Heart rate variability (HRV) is emerging as a novel, validated measure of autonomic nervous system (ANS) function with developing accessible and non-invasive technologies. HRV parameters correlate to ANS function and can be used to measure responses to various stimuli.

Method

A search strategy was developed to identify 23 articles that matched inclusion criteria. These included data collected intra-operatively with ambulatory monitoring, in simulated settings and one systematic review.

Results

Several studies found increased sympathetic response in the operating surgeon – which correlates with subjective reporting of stress. Some studies compared variables; one study suggested that laparoscopic colorectal surgery caused higher mental strain than open, while another suggested higher stress in surgeons while teaching compared to when primary operator. There have been no comparative trials using HRV in surgeons.

Conclusions

We present a review of the growing literature regarding HRV measurement in surgeons. This novel tool is a promising avenue to provide psychophysiological insight into the operating surgeon. This could guide future research into optimising the theatre environment for intra-operative performance using controlled or in-situ design.

Describing objectively measured intensive care nurses' physical work activity behavioural patterns during a 12-hr shift

AIM AND OBJECTIVES

To describe intensive care unit (ICU) nurses' physical work activity behavioural patterns over 12 hr using dual accelerometry, following a job demands-recovery framework.

BACKGROUND

Limited studies utilised accelerometry to objectively analyse nurses' physical workloads. Little is known about intensive care nurses' physical activity patterns during a 12-hr shift.

DESIGN

A cross-sectional study was conducted with intensive care nurses from four units in Auckland, New Zealand.

METHODS

Each participant wore two Axivity AX3 accelerometers to measure physical activity during a 12-hr day or night shift. An online survey captured participants' demographic information. R software (version 3.6.1) and SPSS version 26 were utilised for data analysis. The STROBE was followed.

RESULTS

A total of 102 nurses were included in this study. A high level of light intensity activity behaviours (standing, dynamic standing, walking) was observed throughout the day shifts, with no higher intensity behaviours identified. Activity levels were highest at the beginning of shifts and followed a consistent pattern, with an additional peak around midday for day shifts and at the end of the shift for night shifts. Observable differences were seen between day and night shifts with a greater prevalence of sitting and lying during night shifts. Standing, dynamic standing, sitting, lying and walking were significant factors in the differences of the physical work behaviours between the day shift nurses and the night shift nurses. Significant differences in dynamic standing and lying were found between ICUs.

CONCLUSIONS

Intensive care nurses' physical work activity involved a large amount of standing and dynamic standing during a 12-hr shift. The overall physical workload during a 12-hr day shift was significantly higher than that during a 12-hr night shift.

RELEVANCE TO CLINICAL PRACTICE

Results may help managers attain a better understanding of nurses' physical workloads during a 12-hr shift.

A Dual-Accelerometer System for Detecting Human Movement in a Free-living Environment

PURPOSE

Accurate measurement of various human movement behaviors is essential in developing 24-h movement profiles. A dual-accelerometer system recently showed promising results for accurately classifying a broad range of behaviors in a controlled laboratory environment. As a progressive step, the aim of this study is to validate the same dual-accelerometer system in semi free-living conditions in children and adults. The efficacy of several placement sites (e.g., wrist, thigh, back) was evaluated for comparison.

METHODS

Thirty participants (15 children) wore three Axivity AX3 accelerometers alongside an automated clip camera (clipped to the lapel) that recorded video of their free-living environment (ground truth criterion measure of physical activity). Participants were encouraged to complete a range of daily-living activities within a 2-h timeframe. A random forest machine-learning classifier was trained using features generated from the raw accelerometer data. Three different placement combinations were examined (thigh-back, thigh-wrist, back-wrist), and their performance was evaluated using leave-one-out cross-validation for the child and adult samples separately.

RESULTS

Machine learning models developed using the thigh-back accelerometer combination performed the best in distinguishing seven distinct activity classes with an overall accuracy of 95.6% in the adult sample, and eight activity classes with an overall accuracy of 92.0% in the child sample. There was a drop in accuracy (at least 11.0%) when other placement combinations were evaluated.

CONCLUSIONS

This validation study demonstrated that a dual-accelerometer system previously validated in a laboratory setting also performs well in semi free-living conditions. Although these results are promising and progressive, further work is needed to expand the scope of this measurement system to detect other components of behavior (e.g., activity intensity and sleep) that are related to health.

A Dual-Accelerometer System for Classifying Physical Activity in Children and Adults

INTRODUCTION

Accurately monitoring 24-h movement behaviors is a vital step for progressing the time-use epidemiology field. Past accelerometer-based measurement protocols are either hindered by lack of wear time compliance, or the inability to accurately discern activities and postures. Recent work has indicated that skin-attached dual-accelerometers exhibit excellent 24-h uninterrupted wear time compliance. This study extends this work by validating this system for classifying various physical activities and sedentary behaviors in children and adults.

METHODS

Seventy-five participants (42 children) were equipped with two Axivity AX3 accelerometers; one attached to their thigh, and one to their lower back. Ten activity trials (e.g., sitting, standing, lying, walking, running) were performed while under direct observation in a lab setting. Various time- and frequency-domain features were computed from raw accelerometer data, which were then used to train a random forest machine learning classifier. Model performance was evaluated using leave-one-out cross-validation. The efficacy of the dual-sensor protocol (relative to single sensors) was evaluated by repeating the modeling process with each sensor individually.

RESULTS

Machine learning models were able to differentiate between six distinct activity classes with exceptionally high accuracy in both adults (99.1%) and children (97.3%). When a single thigh or back accelerometer was used, there was a pronounced drop in accuracy for nonambulatory activities (up to a 26.4% decline). When examining the features used for model training, those that took the orientation of both sensors into account concurrently were more important predictors.

CONCLUSIONS

When previous wear time compliance results are taken together with our findings, it represents a promising step forward for monitoring and understanding 24-h time-use behaviors. The next step will be to examine the generalizability of these findings in a free-living setting.

A Standardized PMML Format for Representing Convolutional Neural Networks with Application to Defect Detection

Convolutional neural networks are becoming a popular tool for image processing in the engineering and manufacturing sectors. However, managing the storage and distribution of trained models is still a difficult task, partially due to the lack of standardized methods for deep neural network representation. Additionally, the interoperability between different machine learning frameworks remains poor. This paper seeks to address this issue by proposing a standardized format for convolutional neural networks, based on the Predictive Model Markup Language (PMML). A new standardized schema is proposed to represent a range of convolutional neural networks, including classification, regression and semantic segmentation systems. To demonstrate the practical application of this standard, a semantic segmentation model, which is trained to detect casting defects in Xray images, is represented in the proposed PMML format. A high-performance scoring engine is developed to evaluate images and videos against the PMML model. The utility of the proposed format and the scoring engine is evaluated by benchmarking the performance of the defect detection models on a range of different computational platforms.

First, do no harmony: an examination of attitudes to music played in operating theatres

AIM

It is common for music to be played in operating theatres around the world. The benefits or harms of this music on practitioners and patients are not well known. The aim of this paper is to examine the attitudes and perceptions of theatre staff towards the presence of music during operations on the theatre environment.

METHOD

This observational study was conducted in a single-centre at a tertiary teaching hospital in New Zealand. Over a two-week period in 2014, the entire theatre staff population were sent an online survey. We gathered data on demographics (eg, age, gender, theatre role), perceived frequency of music being played in operating rooms, types of music, disposition to music in different situations, the perception of an effect on the theatre team, and on with whom the decision to have music played lay with. Appropriate statistical analyses were applied.

RESULTS

A hundred and six responses were received (45% response rate). 98% of people said that music is played in their operating rooms, with 50% saying it was played more than 50% of the time. 60% liked having it, whereas 30% disliked it. Easy Listening was the genre most played closely followed by Pop and Classical. Easy Listening was the most preferred and classical music the second most. Music was preferred for longer, more familiar and non-urgent procedures, at a low to medium volume, preferably from a CD or MP3 player, though 84% felt it was a distraction in a crisis situation. Surgeons were the most empowered group, and anaesthetic technicians the least when it came to choosing music. Most respondents felt music improved calmness, overall mood, overall team performance and surgeon's performance, though worsened communication.

CONCLUSION

This study, while limited in size, demonstrates that theatre staff generally like music in the operating theatre, and most believe it has a positive impact on several aspects of the theatre environment, though a negative influence on communication. There have been no clinical impact studies on patient and this could be an avenue for future research.

Wear-Time Compliance with a Dual-Accelerometer System for Capturing 24-h Behavioural Profiles in Children and Adults

To advance the field of time-use epidemiology, a tool capable of monitoring 24 h movement behaviours including sleep, physical activity, and sedentary behaviour is needed. This study explores compliance with a novel dual-accelerometer system for capturing 24 h movement patterns in two free-living samples of children and adults. A total of 103 children aged 8 years and 83 adults aged 20-60 years were recruited. Using a combination of medical dressing and purpose-built foam pouches, participants were fitted with two Axivity AX3 accelerometers—one to the thigh and the other to the lower back—for seven 24 h periods. AX3 accelerometers contain an inbuilt skin temperature sensor that facilitates wear time estimation. The median (IQR) wear time in children was 160 (67) h and 165 (79) h (out of a maximum of 168 h) for back and thigh placement, respectively. Wear time was significantly higher and less variable in adults, with a median (IQR) for back and thigh placement of 168 (1) and 168 (0) h. A greater proportion of adults (71.6%) achieved the maximum number of complete days when compared to children (41.7%). We conclude that a dual-accelerometer protocol using skin attachment methods holds considerable promise for monitoring 24-h movement behaviours in both children and adults.

Predictive Model Markup Language (PMML) Representation of Bayesian Networks: An Application in Manufacturing

Bayesian networks (BNs) represent a promising approach for the aggregation of multiple uncertainty sources in manufacturing networks and other engineering systems for the purposes of uncertainty quantification, risk analysis, and quality control. A standardized representation for BN models will aid in their communication and exchange across the web. This paper presents an extension to the Predictive Model Markup Language (PMML) standard, for the representation of a BN, which may consist of discrete variables, continuous variables, or their combination. The PMML standard is based on Extensible Markup Language (XML) and used for the representation of analytical models. The BN PMML representation is available in PMML v4.3 released by the Data Mining Group. We demonstrate the conversion of analytical models into the BN PMML representation, and the PMML representation of such models into analytical models, through a Python parser. The BNs obtained after parsing PMML representation can then be used to perform Bayesian inference. Finally, we illustrate the developed BN PMML schema for a welding process.

Development and initial validation of the Cat HEalth and Wellbeing (CHEW) Questionnaire: a generic health-related quality of life instrument for cats

OBJECTIVES

The aims of the study were to define factors that owners consider relevant to the health-related quality of life (HRQoL) of cats, to develop an instrument based on this information, and to evaluate the validity and reliability of the final instrument (the Cat HEalth and Wellbeing [CHEW] Questionnaire).

METHODS

Psychometric research techniques and guidance from the US Food and Drug Administration on outcome measures were used to develop a valid and reliable instrument. Fifty-four cat owners and caregivers participated in the qualitative research, while 1303 cat owners were included in the quantitative validation phase (development dataset, n = 648; validation dataset, n = 655). A random subset of cat owners (n = 391) also participated in test-retest evaluation. Qualitative research was used to generate a draft instrument, which was then subjected to quantitative validation techniques. These included item reduction, domain identification, data quality assessment, and exploratory and confirmatory analysis to develop a final instrument, which underwent confirmatory reliability and validity assessment.

RESULTS

A draft instrument with 11 domains and 100 items based on qualitative research underwent online quantitative validation testing which refined the instrument to eight domains and 33 items. Confirmatory reliability and validity assessment showed that the final instrument had good validity, was able to discriminate between cats by age and overall health status, and demonstrated good internal and test-retest reliability.

CONCLUSIONS AND RELEVANCE

The CHEW Questionnaire was developed and validated. Additional research is needed to verify its ability to differentiate cats with and without disease, and to assess its potential as a screening tool.

Damage assessment in concrete structures using piezoelectric based sensors

Damage assessment in concrete structures using piezoelectric based sensorsABSTRACTPiezoelectric based PZT (Lead Zirconate Titanate) smart sensors offer significant potential for continuously monitoring the development and progression of internal damage in concrete structures. Changes in the resonant behavior in the measured electrical conductance obtained from electro-mechanical (EM) response of a PZT bonded to a concrete substrate is investigated for increasing levels of damage. Changes in the conductance resonant signature from EM conductance measurements are detected before visible signs of cracking. The root mean square deviation of the conductance signature at resonant peaks is shown to accurately reflect the level of damage in the substrate. The findings presented here provide a basis for developing a sensing methodology using PZT patches for continuous monitoring of concrete structures.Keywords: PZT; electro-mechanical impedance; conductance; microcracks.Evaluación de daños en estructuras de concreto utilizando sensores piezoeléctricosRESUMENLos sensores inteligentes PZT (Lead Zirconate Titanate) basados en piezoeléctricos ofrecen un potencial significativo para monitorear continuamente el desarrollo y la progresión de los daños internos en estructuras de concreto. Se investigan los cambios en el comportamiento resonante a través de la conductancia eléctrica medida, obtenida a partir de la respuesta electromecánica (EM) de un PZT unido a un sustrato de concreto para aumentar los niveles de daño. Los cambios en la resonancia de la conductancia EM se detectan antes de que aparezcan signos visibles de agrietamiento. La desviación cuadrática media de la raíz de la conductancia en los picos resonantes refleja con precisión el nivel de daño en el sustrato. Los hallazgos presentados aquí proporcionan una base para desarrollar una metodología de detección utilizando parches PZT para el monitoreo continuo de estructuras de concreto.Palabras clave: PZT; impedancia electromecánica; conductancia; microfisuras.Avaliação de danos em estruturas de concreto usando sensores piezoelétricos RESUMOOs sensores piezoelétricos inteligentes PZT (Lead Zirconate Titanate) oferecem um potencial significativo para o monitoramento contínuo do desenvolvimento e progressão de danos internos em estruturas de concreto. As alterações de ressonância através da medida da condutância elétrica obtida a partir da resposta eletromecânica (EM) de um PZT ligado a um substrato de concreto é investigada para níveis crescentes de danos. As alterações no perfil de ressonância de condutância EM são detectadas antes de sinais visíveis de fissuras. O desvio quadrático médio da raiz do perfil de condutância nos picos ressonantes é mostrado para refletir com precisão o nível de dano no substrato. Os resultados aqui apresentados fornecem uma base para o desenvolvimento de uma metodologia de detecção usando PZT para monitoramento contínuo de estruturas de concretoPalavras chave: PZT; impedância eletromecânica; condutância; microfissuras.

Oral supplementation of trans-cinnamaldehyde reduces uropathogenic Escherichia coli colonization in a mouse model

Urinary tract infections (UTIs) in the United States result in more than 7 million hospital visits per year. Uropathogenic Escherichia coli (UPEC) is responsible for more than 80% of UTIs. Although antibiotics are the drug of choice to control UTIs, their repeated use has resulted in the emergence of antibiotic-resistant UPEC. Thus, there is a need for effective alternate strategies to control UPEC infections. This study investigated the efficacy of trans-cinnamaldehyde (TC), a food-grade molecule present in cinnamon, in reducing UPEC colonization and pathogenesis in the lower UTI. Female C57BL/6 mice (6-8 weeks old) were fed ad libitum with 0, 0·1, 0·2 and 0·4% TC containing mouse chow for 10 days. Following TC supplementation, animals were experimentally infected with UPEC by transurethral catheterization. Mice were euthanized on days 1, 2 and 4 postinfection, and the bladder, urethra and urine were collected for bacterial enumeration. Prophylactic TC supplementation significantly (P ≤ 0·05) reduced UPEC colonization in the urinary bladder and urethra compared to the control. Results indicate that TC could potentially be used as an oral supplement to control UPEC-associated lower UTIs, however, follow-up clinical trials are warranted.

SIGNIFICANCE AND IMPACT OF THE STUDY

In this study, we have demonstrated that oral supplementation of trans-cinnamaldehyde (TC) reduced uropathogenic Escherichia coli (UPEC)-associated lower urinary tract infection (UTI) in mice. Specifically, in-feed supplementation of TC significantly decreased UPEC populations in the urethra and bladder, thereby reducing the infectious load. These findings are particularly significant given the increase in incidence and prevalence of antibiotic-resistant UTIs. Our study offers new insights into the potential use of natural antimicrobials including TC, the active ingredient in cinnamon, as a nonantibiotic-based natural dietary intervention in the prophylaxis of lower UTIs.

Analysis and Optimization based on Reusable Knowledge Base of Process Performance Models

In this paper, we propose an architectural design and software framework for fast development of descriptive, diagnostic, predictive, and prescriptive analytics solutions for dynamic production processes. The proposed architecture and framework will support the storage of modular, extensible, and reusable Knowledge Base (KB) of process performance models. The approach requires developing automated methods that can translate the high-level models in the reusable KB into low-level specialized models required by a variety of underlying analysis tools, including data manipulation, optimization, statistical learning, estimation, and simulation. We also propose an organization and key structure for the reusable KB, composed of atomic and composite process performance models and domain-specific dashboards. Furthermore, we illustrate the use of the proposed architecture and framework by prototyping a decision-support system for process engineers. The decision support system allows users to hierarchically compose and optimize dynamic production processes via a graphical user interface.

Population Pharmacokinetics and Pharmacodynamics of the Calcimimetic Etelcalcetide in Chronic Kidney Disease and Secondary Hyperparathyroidism Receiving Hemodialysis

Etelcalcetide is a novel calcimimetic in development for the treatment of secondary hyperparathyroidism (SHPT). A population pharmacokinetic/pharmacodynamic (PK/PD) model was developed relating etelcalcetide exposures to markers of efficacy (parathyroid hormone [PTH]) and safety (calcium) using data from three clinical studies. The semimechanistic model was developed that included allosteric activation pharmacology and understanding of calcium homeostasis. The temporal profiles for all biomarkers were well described by the model. The cooperativity constant was 4.94, confirming allosteric activation mechanism. Subjects with more severe disease (higher PTH baseline) were predicted to experience less pronounced reduction in PTH (percentage change from baseline), but more reduction in calcium (Ca; percentage change from baseline). There was no evidence that dose adjustment by any covariate was needed. Model‐based simulations provided quantitative support to several elements of dosing, such as starting dose, monitoring, and titration timing for registration trials.

Inaccessible Masturbation, Impossible Mourning: Collective Melancholia, the Prohibition on Female Sexual Subjects in India, and Masturbation Fantasy as a Zone of the Strange

This paper explores a subjective experience-and identification-that a cohort of Indian women identifies as "home." This experience of "home" provides an attachment to a collective melancholia that keeps in place a prohibited female sexual subjectivity. The paper provides a brief historical overview of the prohibition of female sexual subjectivity and erotic agency in India. Following this, it discusses women's masturbation fantasies that illustrate the toggle between women's permitted and prohibited identifications. A clinical case example is presented to illustrate the hopelessness and mourning inherent in the psychoanalytic journey into subjectivity, a journey involving a departure from a shared cultural history.

Linear magnetoresistance caused by mobility fluctuations in n-doped Cd(3)As(2)

Cd(3)As(2) is a candidate three-dimensional Dirac semimetal which has exceedingly high mobility and nonsaturating linear magnetoresistance that may be relevant for future practical applications. We report magnetotransport and tunnel diode oscillation measurements on Cd(3)As(2), in magnetic fields up to 65 T and temperatures between 1.5 and 300 K. We find that the nonsaturating linear magnetoresistance persists up to 65 T and it is likely caused by disorder effects, as it scales with the high mobility rather than directly linked to Fermi surface changes even when approaching the quantum limit. From the observed quantum oscillations, we determine the bulk three-dimensional Fermi surface having signatures of Dirac behavior with a nontrivial Berry phase shift, very light effective quasiparticle masses, and clear deviations from the band-structure predictions. In very high fields we also detect signatures of large Zeeman spin splitting (g∼16).

Takotsubo cardiomyopathy following electroconvulsive therapy: an increasingly recognised phenomenon

Treatment of patients with severe depressive illnesses requiring electroconvulsive therapy (ECT) is challenging. This is compounded by the presence of physical comorbidities and potential complications. We report the case of a patient, on long-term bisoprolol, who developed acute epigastric pain and dyspnoea shortly after receiving ECT for treatment-refractory depression. An ECG showed new-onset ischaemic changes and a troponin-I level was elevated at 12 h. A diagnosis of Takotsubo cardiomyopathy was reached following angiography, which demonstrated left ventricular hypokinesia in the absence of coronary artery disease. With supportive treatment the patient made a good recovery. This report highlights the risk of developing Takotsubo cardiomyopathy following ECT despite β-adrenergic receptor blockade, and adds to a growing number of cases reporting this complication. Clinicians involved in the care of patients undergoing ECT must be aware of this complication and should consider Takotsubo cardiomyopathy in patients who develop atypical chest pain after ECT.

The Dental Practice Questionnaire: a patient feedback tool for improving the quality of dental practices

BACKGROUND

The recently introduced Practice Accreditation Scheme as part of the Australian National Safety and Quality Health Service (NSQHS) standards raises the question of how dental practices can implement valid and reliable patient experience feedback mechanisms for performance evaluation and enhancement. This article describes the development and use of a dental patient questionnaire (DPQ) that can be used for this purpose.

METHODS

DPQ was piloted on 58 voluntary dental practices across Australia and resulted in an average of just over 50 patient responses to 35 practices returned. Statistical properties of the DPQ were tested through validity (construct, content and criterion), structural integrity and reliability measurements.

RESULTS

DPQ is valid and reliable, with statistical analysis showing that there are significant differences in patients' scores depending on their age, gender, regularity of visit and number of years attending the practice. Two patient satisfaction models were derived. However, there may be scope for improving DPQ to more effectively produce patient feedback on summative aspects of services provided by dental practices.

CONCLUSIONS

DPQ has been shown to be 'fit for purpose' in its first pilot and may prove to be a useful tool for supporting dental practices in the Practice Accreditation Scheme.

Strongyloides, dengue fever, and tuberculosis conversions in New Zealand police deploying overseas

BACKGROUND

Members of New Zealand Police (NZP) deploy overseas in a variety of roles. There is limited published data on travel-related morbidity in police as a subgroup of travelers.

METHODS

An audit of pre- and postdeployment medical files for all NZP personnel deploying overseas during 2004 to 2010 was undertaken. Of all deployments, 58.9% were within Oceania.

RESULTS

Positive Strongyloides stercoralis serology was returned in 6.07% (95% CI: 3.80%-9.13%) at a rate of 9.00/1,000 person deployment months (pdm) (95% CI: 5.57-13.8). Dengue fever seroconversion was recorded in 4.91% (95% CI: 3.40%-6.83%) at a rate of 8.57/1,000 pdm (95% CI: 5.90-12.0). The relative risk of dengue infection was 7.47 for Timor Leste compared to all other deployment destinations. An association between seroconverting for both dengue fever and Strongyloides was found. Tuberculosis conversion was recorded in 1.76% (95% CI: 0.85%-3.21%) at a rate of 2.92/1,000 pmd (95% CI: 1.48-5.375). A single case of human immunodeficiency virus (HIV) seroconversion was recorded. There were no recorded hepatitis C seroconversions.

CONCLUSIONS

Police deploying overseas appear to have similar rates of dengue and tuberculosis conversion as other groups of travelers, and they appear to be at low risk of hepatitis C and HIV. Strongyloidiasis appears to be a significant risk; postdeployment prevalence was markedly higher than that reported in a small number of studies.