To Purge or Not to Purge.

To remove gaseous microemboli (GME) using an oxygenator with an integrated arterial filter, it is recommended by some manufacturers to purge the oxygenator as an additional safety feature while on bypass. In this in vitro study, we evaluated whether purging of oxygenators with an integrated arterial filter is efficient in reducing GME. Five different types of commercially available contemporary oxygenators with an integrated arterial filter based on progressive filter filtration (1), cascade filtration (1), screen filtration (2), or self-venting (1) were tested for their efficiency in removing GME while keeping the purge line open or closed. A bubble counter was used for pre- and post-oxygenator GME signaling, from which the filter efficiency was computed. Freshly drawn heparinized porcine blood was used at blood flow rates of 3 and 5 L/min. Three units of each oxygenator were tested with its specific reservoir at a fixed volume level of 1,500 mL. GME load was introduced into the venous line at 1,000 mL air/min. Measurements started as soon as GME were detected by the pre-oxygenator probe and then continued for 1 minute. There was no statistically significant difference in filter efficiency between the purged and non-purged groups for specific oxygenators. At a blood flow of 3 L/min, the average filter efficiency stayed approximately invariable when comparing the non-purged and purged groups, where 89.1-88.2% indicated the largest difference between the groups. At a blood flow rate of 5 L/min, the filter efficiency changed in one screen filter group from an average of 55.7% in the non-purged group to 42.4% in the purged group. Other filter efficiencies at the blood flow rate of 5 L/min for non-purged compared with purged groups were, respectively, 98.0 vs. 98.0% (screen filtration), 88.6 vs. 85.8% (self-venting filtration), 82.8 vs. 75.5% (progressive filter filtration), and 65.4 vs. 65.1% (cascade filtration). Based on these results, purging while confronted with continuous GME challenge did not result in an increased filter efficiency.

The effect of flow and pressure on the intraoxygenator flow path of different contemporary oxygenators: an in vitro trial.

INTRODUCTION: This study analyzed the effect of different flows and pressures on the intraoxygenator flow path in three contemporary oxygenators and its consequences for oxygen transfer efficiency. METHODS: In an experimental setup, intraoxygenator flow path parameters were analyzed at post-oxygenator pressures of 150, 200, and 250 mm Hg and at flows ranging from 2 L/min to the oxygenators' maximum permitted flow, with and without pulsatility. The oxygen gradient and the oxygen transfer per minute and per 100 mL blood were calculated using previously collected clinical data and compared with the flow path parameters. RESULTS: Increasing pressure did not affect the flow path parameters, whereas pulsatile flow led to significantly increased dynamic oxygenator blood volumes. Increased flow resulted in decreased values of the flow path parameters in all oxygenators, indicating increased flow through short pathways in the oxygenator. In parallel, oxygen transfer/100 mL blood decreased in all oxygenators (average 2.5 ± 0.4 to 2.4 ± 0.3 mL/dL, p > 0.001) and the oxygen gradient increased from 229 ± 45 to 287 ± 29 mm Hg, p > 0.001, indicating decreased oxygen transfer efficiency. Oxygen transfer/min increased (101 ± 15 to 143 ± 20 mL/min/m2, p > 0.001), however, due to the increased flow through the oxygenator. CONCLUSION: Varying trans-membrane oxygenator pressures did not lead to changes in the intraoxygenator flow path, while an increased flow exhibited lower flow path parameters resulting in less efficient use of the gas exchange compartment. The latter was confirmed by a decrease in O2 transfer efficiency during higher blood flows.

The importance of autonomy support and the mediating role of work motivation for well-being: testing self-determination theory in a Chinese work organisation.

We examine relations between perceived organisational autonomy support and different types of work motivation and well-being outcomes in 266 teachers from two government schools in China. We hypothesised that greater autonomy support would be associated with more autonomous forms of employee motivation, and that teacher motivation would in turn mediate the effects of autonomy support on indicators of work well-being (i.e., job satisfaction, work stress and physical ill symptoms). Results generally supported the hypothesised relations between perceived autonomy support and SDT's five types of motivations. Findings also showed that perceived autonomy support predicted job satisfaction directly and indirectly through the mediating roles of intrinsic motivation, identified regulation, introjected regulation and external regulation. Perceived autonomy support predicted work stress directly and indirectly through the mediating roles of external regulation and amotivation. Autonomy support also predicted illness symptoms via the mediating roles of intrinsic motivation, introjected regulation and amotivation. The current findings highlight how perceived organisational support for autonomy relates to motivational differences in a Chinese work context, and the potential relevance of autonomy support for employee well-being.

Career choice of tourism students in a triple-whammy crisis.

Hong Kong hospitality and tourism industry has been battered by the triple whammy of social unrest, Sino-US trade war and COVID-19 pandemic in recent years. To understand how vulnerable tourism students may be in terms of career shock when facing the three major challenges, 407 tourism students in Hong Kong were surveyed. Structural equation modelling found a positive correlation between affect (an intrinsic, motivating factor) and extraneous events (an extrinsic, demotivating factor), indicating that motivation and demotivating factors may co-exist. Affect was more positively correlated with three career choice outcomes (intent to join the industry, desire for a lifelong career, and resilience in face of unfavourable circumstances) than was Extraneous. In face of career shock arising from extraneous events, tourism students still tend to have a strong intent to join the workforce, take it as a lifelong career, and remain resilient despite the hardship. However, the career shock was a greater concern for those in hotel-related disciplines and for students aged over 20 than younger ones. The findings offer an empirical basis to guide policy makers, academia and the industry in strategy formulation to ensure sustainable quality and manpower supply in the post-crisis future.

The associations between basic psychological need satisfaction at work and the wellbeing of Indigenous and non-Indigenous employees.

We investigated how satisfaction of the basic psychological needs at work was associated with the psychological and physical wellbeing of Indigenous and non-Indigenous employees both within and outside of the workplace. Participants included 1,146 Indigenous (n = 559) and non-Indigenous Australians (60.9% female), aged 18 to 81 years (Mage = 43.54) who were recruited through their employer or online advertisements. Structural equation modelling (SEM) was used to analyse the data, and Indigenous status and occupation type were investigated as moderators. Results revealed that independent of income, autonomy satisfaction was related to better physical and psychological health, satisfaction of the need for relatedness was associated with increased family and community thriving, and competence satisfaction was linked to decreased psychological distress. Results also showed that autonomy, competence, and relatedness need satisfaction was lower among Indigenous employees compared to non-Indigenous employees. Moderation analyses suggested that relatedness at work was especially important for non-Indigenous employees' connection with their community, as were high levels of competence satisfaction for Indigenous employees. These findings are discussed in the context of self-determination theory and the implications for organizations wanting to improve the wellbeing of their Indigenous and non-Indigenous workforce.

Diabetic keratopathy.

Diabetic keratopathy is a significant problem that is commonly overlooked and underdiagnosed by many healthcare providers. More than half of the diabetic population can have tear film changes, corneal epithelial abnormalities, neurotrophic keratopathy, and increased postoperative surgical complications. Clinical manifestations can be quite variable and thus diabetic patients with ocular complaints should be referred to an eye care professional. Treatment of diabetic keratopathy can be managed with a stepwise approach that includes increasing corneal surface lubrication, preventing infections of corneal epithelial defects with prophylactic antibiotic eye drops, and reducing exposure to avoid corneal melting .

Optimization: In-Depth Examination and Proposition.

One notable concept that is of interest is a person's state of optimal functioning. Achieving optimal functioning (e.g., subjective well-being at school), aside from personal autonomy, requires some form of "optimization." Optimization, we argue, is more than just an "enhancement," a "predictive effect," and/or a "causal flow" between an independent variable (IV) and a dependent variable (DV). We note from existing literature that optimization has often been referred to without a clear, definitive explanation of what this term actually entails. At the same time, we acknowledge that unlike other areas of development (e.g., engagement), no theoretical article is available to explain the concept of optimization. This article considers a number of theoretical tenets for advancement: (1) the tenet of three major criteria that could assist in the explanation, assessment, and measurement of optimization, (2) the tenet of the development of a methodological conceptualization that could measure and assess optimization, and (3) the tenet of the "quantification" of optimization, and in particular, a proposed index of optimization and a corresponding scientific notation of "γ", which we coin as an "optimizing effect." Overall, we contend that this examination is insightful and holistic, seeking clarity into an important topical theme in psychology.

Identifying teachers at risk in Hong Kong: Psychosomatic symptoms and sources of stress.

OBJECTIVE: The present study attempts to examine the relationships between certain common psychosomatic symptoms and sources of stress in Hong Kong teachers. METHODS: A total of 261 teachers (134 males and 127 females) from 13 high schools in different regions of Hong Kong responded to the Teacher Stress Inventory (TSI) with a return rate of 52.2%. Retired and in-service teachers were involved in the development of TSI, which included items related to sources of stress in the context of Hong Kong education system, psychosomatic symptoms in the form of stress arousal, and global stress. RESULTS: Confirmatory factor analysis identified six distinct teacher stress sources: students, others, curriculum, nonteaching duties, teaching workload, and recognition. These stress sources were positively correlated with a global teacher stress measure, supporting their construct validity. Structural equation models showed that each stress source was positively related to teachers' psychosomatic symptoms, to which the path coefficient from teaching workload was the highest (beta=.47, P<.05). CONCLUSION: The heavy workload experienced by the Hong Kong teachers that is directly related to the daily teaching routine tends to be the most detrimental to their health conditions. Measures such as reducing teacher-student ratio by adopting smaller class sizes, increasing teacher numbers, and reframing teaching practice should be given due consideration in Hong Kong. There is a need for the inclusion of stress management programs for both trainees and in-service teachers.

Attitude to Non-Violence Scale: Validity and Practical Use.

This study used recent advances in attitude and self-perception research to develop an Attitude to Non-Violence Scale (ANVS). Participants were students from six high schools in Australia ( N = 727). Confirmatory factor analysis using within-construct and between-construct validation approaches found two positive attitude sub-scales: Cognitive (proactive understanding) and Affective (do not endorse violence), both showing convergent and discriminant validity. Scale equivalence tests found that the sub-scales were applicable to boys and girls and to junior and senior grades. Structural equation modeling found that boys had less supportive attitudes to non-violence cognitively, whereas female students in senior secondary classes had less positive attitudes to non-violence affectively. The ANVS can be easily administered to assess youth's non-violence attitudes, which may direct interventions focusing on boys' cognitive aspects while maintaining girls' positive affective attitudes toward non-violence as they mature. The positively framed instrument is suitable for education settings especially in high-risk locations where violence is prevalent.

A Systematic Review of Machine Learning for Assessment and Feedback of Treatment Fidelity / Revisión sistemática del aprendizaje automático para la evaluación y feedback de la fidelidad al tratamiento

Many psychological treatments have been shown to be cost-effective and efficacious, as long as they are implemented faithfully. Assessing fidelity and providing feedback is expensive and time-consuming. Machine learning has been used to assess treatment fidelity, but the reliability and generalisability is unclear. We collated and critiqued all implementations of machine learning to assess the verbal behaviour of all helping professionals, with particular emphasis on treatment fidelity for therapists. We conducted searches using nine electronic databases for automated approaches of coding verbal behaviour in therapy and similar contexts. We completed screening, extraction, and quality assessment in duplicate. Fifty-two studies met our inclusion criteria (65.3% in psychotherapy). Automated coding methods performed better than chance, and some methods showed near human-level performance; performance tended to be better with larger data sets, a smaller number of codes, conceptually simple codes, and when predicting session-level ratings than utterance-level ones. Few studies adhered to best-practice machine learning guidelines. Machine learning demonstrated promising results, particularly where there are large, annotated datasets and a modest number of concrete features to code. These methods are novel, cost-effective, scalable ways of assessing fidelity and providing therapists with individualised, prompt, and objective feedback. (AU)

Se ha puesto de manifiesto que muchos tratamientos psicológicos tienen un coste efectivo y son eficaces siempre que se apliquen con fidelidad. La evaluación de esta y el feedback son caros y exigen mucho tiempo. El aprendizaje automático se ha utilizado para evaluar la fidelidad al tratamiento, aunque su fiabilidad y capacidad de generalización no estén claras. Recopilamos y analizamos todas las aplicaciones de aprendizaje automático con el fin de evaluar el comportamiento verbal de todos los profesionales de ayuda, con el acento particular en la fidelidad al tratamiento de los terapeutas. Llevamos a cabo búsquedas en nueve bases de datos electrónicas para enfoques automáticos de codificación de comportamiento verbal en terapia y contextos semejantes. Llevamos a cabo el cribado, la extracción y la evaluación de la calidad por duplicado. Cincuenta y dos estudios cumplían nuestros criterios de inclusión (el 65.3% en psicoterapia). Los métodos de codificación automática resultaban mejor que el azar y algunos de ellos mostraban un desempeño casi al nivel humano, que tendía a ser mejor con conjuntos más grandes de datos, un número de códigos menor, códigos conceptualmente simples y cuando predecían índices al nivel de sesión que los de tipo declaración. Escasos estudios cumplían las directrices de buena praxis en aprendizaje automático. Este presentó unos resultados alentadores, sobre todo donde había conjuntos de datos grandes y anotados y un escaso número de características concretas que codificar, modos expansibles de evaluar la fidelidad y facilitar a los terapeutas un feedback individualizado, rápido y objetivo. (AU)

Toward a hierarchical goal theory model of school motivation.

Instead of concentrating on mastery and performance goal orientations, recent research on school motivation has suggested a multidimensional structure of achievement goal orientations. Students in Australian high schools (N =774) responded to 35 survey items on 10 goal orientation constructs (effort, task, sense of purpose, praise, competition, power, token, social concern, social dependence, and affiliation) and 14 items on general mastery, general performance, general social, and global motivation constructs. Confirmatory factor analysis results supported a hierarchical, multidimensional school motivation construct. The hierarchical, multidimensional model has provided a strong theoretical structure for further school motivation research.

Gene expression based evidence of innate immune response activation in the epithelium with oral lichen planus.

OBJECTIVE: Oral lichen planus (OLP) is a disease of the oral mucosa of unknown cause producing lesions with an intense band-like inflammatory infiltrate of T cells to the subepithelium and keratinocyte cell death. We performed gene expression analysis of the oral epithelium of lesions in subjects with OLP and its sister disease, oral lichenoid reaction (OLR), in order to better understand the role of the keratinocytes in these diseases. DESIGN: Fourteen patients with OLP or OLR were included in the study, along with a control group of 23 subjects with a variety of oral diseases and a normal group of 17 subjects with no clinically visible mucosal abnormalities. Various proteins have been associated with OLP, based on detection of secreted proteins or changes in RNA levels in tissue samples consisting of epithelium, stroma, and immune cells. The mRNA level of twelve of these genes expressed in the epithelium was tested in the three groups. RESULTS: Four genes showed increased expression in the epithelium of OLP patients: CD14, CXCL1, IL8, and TLR1, and at least two of these proteins, TLR1 and CXCL1, were expressed at substantial levels in oral keratinocytes. CONCLUSIONS: Because of the large accumulation of T cells in lesions of OLP it has long been thought to be an adaptive immunity malfunction. We provide evidence that there is increased expression of innate immune genes in the epithelium with this illness, suggesting a role for this process in the disease and a possible target for treatment.