Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: a systematic literature review.

INTRODUCTION: The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England. METHODS: Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers. RESULTS: The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership. CONCLUSION: The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.

Classification of time-domain waveforms using a speckle-based optical reservoir computer.

Reservoir computing is a recurrent machine learning framework that expands the dimensionality of a problem by mapping an input signal into a higher-dimension reservoir space that can capture and predict features of complex, non-linear temporal dynamics. Here, we report on a bulk electro-optical demonstration of a reservoir computer using speckles generated by propagating a laser beam modulated with a spatial light modulator through a multimode waveguide. We demonstrate that the hardware can successfully perform a multivariate audio classification task performed using the Japanese vowel speakers public data set. We perform full wave optical calculations of this architecture implemented in a chip-scale platform using an SiO2 waveguide and demonstrate that it performs as well as a fully numerical implementation of reservoir computing. As all the optical components used in the experiment can be fabricated using a commercial photonic integrated circuit foundry, our result demonstrates a framework for building a scalable, chip-scale, reservoir computer capable of performing optical signal processing.

Demonstration of speckle-based compressive sensing system for recovering RF signals.

We demonstrate measurement of RF signals in the 2-19 GHz band using a photonic compressive sensing (CS) receiver. The RF is modulated onto chirped optical pulses that then propagate through a multimode fiber that produces the random projections needed for CS via optical speckle. Our system makes 16 independent measurements per optical pulse and we demonstrate several calibration techniques to obtain the CS measurement matrix from these measurements. Then a standard penalized l1 norm method recovers amplitude, phase, and frequency of single-tone and two-tone RF signals with about 100 MHz resolution in a single 4.5 ns pulse. A novel subspace method recovers the frequency to about 20 kHz resolution over 100 pulses in a 2.8 microsecond time window. These experiments use discrete fiber-coupled optical components, but all necessary functions can be realized in photonic and electronic integrated circuits.

Clinicians' perceptions of medication errors with opioids in cancer and palliative care services: a priority setting report.

This paper reports the findings of a priority setting process, undertaken with cancer and palliative care clinicians, to better understand the characteristics of medication errors with opioids within their services. Participants representing six public hospitals in one Australian state took part in a series of priority setting workshops and, drawing on actual incidents occurring in their services, sought to identify where in the opioid medication process errors were most frequently occurring. Opioid error types and perceived contributing factors were explored, and strategies to reduce/prevent opioid errors were proposed. The priority setting process provided valuable insights into the types of opioid errors that occur in cancer and palliative care services and the complexity of addressing opioid errors from the clinician's perspective. The findings from this priority setting process will inform future targeted quality improvement initiatives to support safe opioid medication practices in cancer and palliative care services.

Do carer's levels of unmet needs change over time when caring for patients diagnosed with high-grade glioma and how are these needs correlated with distress?

PURPOSE: The aim of the current study was to determine how carer needs changed longitudinally and understand associations between unmet needs and distress. METHODS: Family carers of patients with high-grade glioma (HGG) were recruited. Carers completed questionnaires during patients' chemoradiotherapy (T1), 3 months (T2) and 6 months (T3) including the following: the Distress Thermometer, the General Health Questionnaire-12, the Partner and Carer Supportive Care (PCS) Needs Scale and its supplement the Access to Services Needs Scale and the Brain Tumour Specific Supportive Care Needs Scale. Linear latent growth models were applied. RESULTS: The time 1 questionnaire was completed by 118 carers; 70 carers provided responses at time 3. While the mean numbers of elevated (moderate to high) needs remained stable over time, the specific needs changed. The most frequently reported PCS needs included the impact of caring on the carer's working life or usual activities, finding more accessible parking, making life decisions in the context of uncertainty, reducing stress in the patient's life and understanding the patient's experience. The most frequently reported need unique to carers of a brain tumour patient was for information on adjusting to cognitive changes in the patient. Other prominent needs included managing difficult aspects of the patient's behaviour and adjusting to changes in the patient's personality, both of which increased over time. Higher numbers of unmet needs were associated cross-sectionally with higher distress levels. CONCLUSION: Carers of people with HGG remain highly distressed and their needs evolve over time, indicating a requirement for ongoing evaluation of unmet needs and interventions to address carer psychological morbidities.

Evidence-practice gaps in lung cancer: A scoping review.

Lung cancer is a significant international health problem. Aligning clinical practice with evidence-based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence-practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence-practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under-utilised; (4) older age and co-morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under-utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under-utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non-disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.

Development and evaluation of an online educational resource about cancer survivorship for cancer nurses: a mixed-methods sequential study.

Cancer survivorship is recognised globally as a key issue. In spite of the key role played by nurses in survivorship care, there is an identified gap in nurse's knowledge in this area. This study reports on the development and evaluation of an educational resource for nurses working with people affected by cancer. The resource was designed using adult learning principles and includes a variety of learning materials and point of care resources. A mixed-methods sequential exploratory design was used to undertake an evaluation of the programme. This included the use of online surveys and semi-structured interviews with pilot participants. A total of 21 participants completed an online survey and 11 participants completed a telephone interview. Overall, the participants found the Cancer Survivorship resource to be engaging, practical and intuitive. A major theme emerging from the survey and interview data was that the resource was applicable to practice and useful in developing survivorship care plans. Respondents requested additional information be included on the role of various health professionals working in survivorship as well as guidelines on when to make referrals. This study provides evidence that the Cancer Survivorship tool may be a promising vehicle for delivering evidence-based education on survivorship care.

Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI).

BACKGROUND: eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals' experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. METHODS: A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. RESULTS: Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. CONCLUSIONS: Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.

Properties of the DASS-21 in an Australian Community Adolescent Population.

BACKGROUND: Although developed for adults, the Depression Anxiety Stress Scales-Short Version (DASS-21) has been used in many research studies with adolescent samples. Evidence as to the applicability of the DASS subscale scores to represent the distinct states of depression, anxiety, and stress as experienced by adolescents is mixed, and the age at which it may be possible to differentiate these 3 states using the DASS-21 has not yet been determined. OBJECTIVE: This study evaluated evidence for a multifactor structure in the DASS-21 in adolescents and the specificity of the 3 subscales for adolescents in general and at different ages. METHOD: Data were from a large cross-sectional survey of 2,873 school students in Grades 6-12 (aged 12-18 years) in Australia. We conducted confirmatory bifactor analyses testing a general mental health distress factor and 3 domain-specific factors for anxiety, depression, and stress for the whole sample and across gender by age groups. The internal consistency reliability of the DASS total and subscale scores was determined using omega coefficients. RESULTS: Analyses identified that most of the variation in the items was explained by the dominance of a single, general factor and the subscales lacked specificity across all age groups. CONCLUSION: The DASS-21 can be reliably used to measure general distress in adolescents, but the subscales fail to discriminate between the 3 states. Our results indicate that this lack of discrimination does not reduce with increasing age. These findings caution against the use of adult theoretical models and measures within adolescent populations.

Multimode waveguide speckle patterns for compressive sensing.

Compressive sensing (CS) of sparse gigahertz-band RF signals using microwave photonics may achieve better performances with smaller size, weight, and power than electronic CS or conventional Nyquist rate sampling. The critical element in a CS system is the device that produces the CS measurement matrix (MM). We show that passive speckle patterns in multimode waveguides potentially provide excellent MMs for CS. We measure and calculate the MM for a multimode fiber and perform simulations using this MM in a CS system. We show that the speckle MM exhibits the sharp phase transition and coherence properties needed for CS and that these properties are similar to those of a sub-Gaussian MM with the same mean and standard deviation. We calculate the MM for a multimode planar waveguide and find dimensions of the planar guide that give a speckle MM with a performance similar to that of the multimode fiber. The CS simulations show that all measured and calculated speckle MMs exhibit a robust performance with equal amplitude signals that are sparse in time, in frequency, and in wavelets (Haar wavelet transform). The planar waveguide results indicate a path to a microwave photonic integrated circuit for measuring sparse gigahertz-band RF signals using CS.

Pathway to the piezoelectronic transduction logic device.

The piezoelectronic transistor (PET) has been proposed as a transduction device not subject to the voltage limits of field-effect transistors. The PET transduces voltage to stress, activating a facile insulator-metal transition, thereby achieving multigigahertz switching speeds, as predicted by modeling, at lower power than the comparable generation field effect transistor (FET). Here, the fabrication and measurement of the first physical PET devices are reported, showing both on/off switching and cycling. The results demonstrate the realization of a stress-based transduction principle, representing the early steps on a developmental pathway to PET technology with potential to contribute to the IT industry.

Communication and technology in genetic counseling for familial cancer.

When a cancer predisposing germline mutation is detected in an index case, the presence of the underlying syndrome is confirmed and the potential for predictive testing of at-risk relatives is established. However, the reporting of a positive family history does not routinely lead to communication of information about risk to close, much less distant relatives. This review summarizes information technology utilized to address penetration or 'reach' of knowledge of risk within extended families, including the use of telephone and video counseling to reach distant patients, and anticipate novel internet-based processes for communication between investigators and relatives.

Three cases of donor-derived pulmonary tuberculosis in lung transplant recipients and review of 12 previously reported cases: opportunities for early diagnosis and prevention.

INTRODUCTION: Solid organ transplant recipients have a higher frequency of tuberculosis (TB) than the general population, with mortality rates of approximately 30%. Although donor-derived TB is reported to account for <5% of TB in solid organ transplants, the source of Mycobacterium tuberculosis infection is infrequently determined. METHODS: We report 3 new cases of pulmonary TB in lung transplant recipients attributed to donor infection, and review the 12 previously reported cases to assess whether cases could have been prevented and whether any cases that might occur in the future could be detected and investigated more quickly. Specifically, we evaluate whether opportunities existed to determine TB risk on the basis of routine donor history, to expedite diagnosis through routine mycobacterial smears and cultures of respiratory specimens early post transplant, and to utilize molecular tools to investigate infection sources epidemiologically. FINDINGS: On review, donor TB risk was present among 7 cases. Routine smears and cultures diagnosed 4 asymptomatic cases. Genotyping was used to support epidemiologic findings in 6 cases. CONCLUSION: Validated screening protocols, including microbiological testing and newer technologies (e.g., interferon-gamma release assays) to identify unrecognized M. tuberculosis infection in deceased donors, are warranted.

Giant piezoresistive on/off ratios in rare-earth chalcogenide thin films enabling nanomechanical switching.

Sophisticated microelectromechanical systems for device and sensor applications have flourished in the past decade. These devices exploit piezoelectric, capacitive, and piezoresistive effects, and coupling between them. However, high-performance piezoresistivity (as defined by on/off ratio) has primarily been observed in macroscopic single crystals. In this Letter, we show for the first time that rare-earth monochalcogenides in thin film form can modulate a current by more than 1000 times due to a pressure-induced insulator to metal transition. Furthermore, films as thin as 8 nm show a piezoresistive response. The combination of high performance and scalability make these promising candidates for nanoscale applications, such as the recently proposed piezoelectronic transistor (PET). The PET would mechanically couple a piezoelectric thin film with a piezoresistive switching layer, potentially scaling to higher speeds and lower powers than today's complementary metal-oxide-semiconductor technology.

Inflammatory arthritis following ustekinumab treatment for psoriasis: a report of two cases.

Psoriasis is a chronic inflammatory skin condition, characterized by T-helper (Th) 1 and Th17 cell activation. Ustekinumab is a fully human immunoglobulin G1κ monoclonal antibody that targets the common p40 subunit that is shared by both interleukin (IL)-12 and IL-23, consequently inhibiting T-cell differentiation along both Th1 and Th17 pathways. This is a report of two patients who developed psoriatic arthritis during ustekinumab treatment for psoriasis. Neither patient had a personal or family history of arthritis.

Pilot randomised controlled trial of a radiation therapist-led educational intervention for breast cancer patients prior to commencing radiotherapy.

PURPOSE: Although patients receive information prior to commencing radiotherapy, they often experience anxiety and distress. We conducted a pilot randomised controlled trial to determine whether a radiation therapist led psycho-educational intervention for breast cancer patients prior to radiotherapy is likely to be effective in reducing radiotherapy-related concerns, patient anxiety and depression. METHODS: The intervention comprised two face-to-face consultations with a radiation therapist (one prior to radiation planning and the other prior to treatment). Patients completed surveys at baseline, prior to treatment planning and on the first day of treatment. Outcome measures included the Hospital Anxiety and Depression Scale, Radiation Therapy Related Patient Concerns and Radiation Therapy Knowledge Scales. RESULTS: One hundred and twenty two patients completed baseline measures. Fifty-eight patients received usual care, and 64 received the intervention. After the first consultation, patient anxiety was significantly lower in the intervention group (p = 0.048), as were concerns about radiotherapy (p = 0.001). There were no differences between groups for depression. Patient knowledge for the intervention group was higher after the first consultation (p < 0.001). CONCLUSION: This intervention is likely to be effective in reducing patient anxiety and concerns and increasing knowledge. Future research is required to test this intervention with a larger population.

A (Sub)field Guide to Quality Control in Hippocampal Subfield Segmentation on Highresolution T2-weighted MRI.

Inquiries into properties of brain structure and function have progressed due to developments in magnetic resonance imaging (MRI). To sustain progress in investigating and quantifying neuroanatomical details in vivo, the reliability and validity of brain measurements are paramount. Quality control (QC) is a set of procedures for mitigating errors and ensuring the validity and reliability of brain measurements. Despite its importance, there is little guidance on best QC practices and reporting procedures. The study of hippocampal subfields in vivo is a critical case for QC because of their small size, inter-dependent boundary definitions, and common artifacts in the MRI data used for subfield measurements. We addressed this gap by surveying the broader scientific community studying hippocampal subfields on their views and approaches to QC. We received responses from 37 investigators spanning 10 countries, covering different career stages, and studying both healthy and pathological development and aging. In this sample, 81% of researchers considered QC to be very important or important, and 19% viewed it as fairly important. Despite this, only 46% of researchers reported on their QC processes in prior publications. In many instances, lack of reporting appeared due to ambiguous guidance on relevant details and guidance for reporting, rather than absence of QC. Here, we provide recommendations for correcting errors to maximize reliability and minimize bias. We also summarize threats to segmentation accuracy, review common QC methods, and make recommendations for best practices and reporting in publications. Implementing the recommended QC practices will collectively improve inferences to the larger population, as well as have implications for clinical practice and public health.

Compressive sensing of sparse radio frequency signals using optical mixing.

We demonstrate an optical mixing system for measuring properties of sparse radio frequency (RF) signals using compressive sensing (CS). Two types of sparse RF signals are investigated: (1) a signal that consists of a few 0.4 ns pulses in a 26.8 ns window and (2) a signal that consists of a few sinusoids at different frequencies. The RF is modulated onto the intensity of a repetitively pulsed, wavelength-chirped optical field, and time-wavelength-space mapping is used to map the optical field onto a 118-pixel, one-dimensional spatial light modulator (SLM). The SLM pixels are programmed with a pseudo-random bit sequence (PRBS) to form one row of the CS measurement matrix, and the optical throughput is integrated with a photodiode to obtain one value of the CS measurement vector. Then the PRBS is changed to form the second row of the mixing matrix and a second value of the measurement vector is obtained. This process is performed 118 times so that we can vary the dimensions of the CS measurement matrix from 1×118 to 118×118 (square). We use the penalized ℓ(1) norm method with stopping parameter λ (also called basis pursuit denoising) to recover pulsed or sinusoidal RF signals as a function of the small dimension of the measurement matrix and stopping parameter. For a square matrix, we also find that penalized ℓ(1) norm recovery performs better than conventional recovery using matrix inversion.

Pseudocollinia brintoni gen. nov., sp. nov. (Apostomatida: Colliniidae), a parasitoid ciliate infecting the euphausiid Nyctiphanes simplex.

A novel parasitoid ciliate, Pseudocollinia brintoni gen. nov., sp. nov. was discovered infecting the subtropical sac-spawning euphausiid Nyctiphanes simplex off both coasts of the Baja California peninsula, Mexico. We used microscopic, and genetic information to describe this species throughout most of its life cycle. Pseudocollinia is distinguished from other Colliniidae genera because it exclusively infects euphausiids, has a polymorphic life cycle, and has a small cone-shaped oral cavity whose left wall has a field of ciliated kinetosomes and whose opening is surrounded on the left and right by 2 'oral' kineties (or ciliary rows) that terminate at its anterior border. Two related species that infect different euphausiid species from higher latitudes in the northeastern Pacific Ocean, Collinia beringensis Capriulo and Small, 1986, briefly redescribed herein, and Collinia oregonensis Gómez-Gutiérrez, Peterson, and Morado, 2006, are transferred to the genus Pseudocollinia. P. brintoni has between 12 and 18 somatic kineties, and its oral cavity has only 2 oral kineties, while P. beringensis comb. nov. has more somatic kineties, including 3 oral kineties. P. oregonensis comb. nov. has an intermediate number of somatic kineties. P. beringensis comb. nov. also infects Thysanoessa raschi (a new host species). SSU rRNA and cox1 gene sequences demonstrated that Pseudocollinia ciliates are apostome ciliates and that P. brintoni is different from P. beringensis comb. nov. High densities of rod-shaped bacteria (1.7 µm length, 0.2 to 0.5 µm diameter) were associated with P. brintoni. After euphausiid rupture, high concentrations of P. brintoni and bacteria cluster to form 3 to 6 cm long filaments where tomites encyst and transform to the phoront stage; this is a novel place for encystation. P. brintoni may complete its life cycle when the euphausiids feed on these filaments.

Evaluate, assess, treat: development and evaluation of the EAT framework to increase effective communication regarding sensitive oral-systemic health issues.

Oral healthcare providers are likely to encounter a number of sensitive oral/systemic health issues whilst interacting with patients. The purpose of the current study was to develop and evaluate a framework aimed at oral healthcare providers to engage in active secondary prevention of eating disorders (i.e. early detection of oral manifestations of disordered eating behaviours, patient approach and communication, patient-specific oral treatment, and referral to care) for patients presenting with signs of disordered eating behaviours. The EAT Framework was developed based on the Brief Motivational Interviewing (B-MI) conceptual framework and comprises three continuous steps: Evaluating, Assessing, and Treating. Using a group-randomized control design, 11 dental hygiene (DH) and seven dental (D) classes from eight institutions were randomized to either the intervention or control conditions. Both groups completed pre- and post-intervention assessments. Hierarchical linear models were conducted to measure the effects of the intervention whilst controlling for baseline levels. Statistically significant improvements from pre- to post-intervention were observed in the Intervention group compared with the Control group on knowledge of eating disorders and oral findings, skills-based knowledge, and self-efficacy (all P < 0.01). Effect sizes ranged from 0.57 to 0.95. No statistically significant differences in outcomes were observed by type of student. Although the EAT Framework was developed as part of a larger study on secondary prevention of eating disorders, the procedures and skills presented can be applied to other sensitive oral/systemic health issues. Because the EAT Framework was developed by translating B-MI principles and procedures, the framework can be easily adopted as a non-confrontational method for patient communication.