Development of a team-specific research strategy using a modified Delphi method in a regional public hospital dietetics department.

OBJECTIVE: Evaluate research capacity and culture among regional hospital dietitians, develop a team specific research strategy, and build research skills of novice researchers. METHODS: The Research Capacity in Context Tool was used to assess current research capacity and culture at organisational, team and individual levels. Results were analysed using descriptive statistics and content analysis of free text responses. A modified Delphi method gained consensus regarding research capacity building. DESIGN: Mixed method study. SETTING: Dietetics department of a regional tertiary hospital (Modified Monash Category 2). PARTICIPANTS: All clinical dietitians currently employed within the hospital (n = 20) regardless of employment duration. MAIN OUTCOME MEASURES: Self-rated response to research capacity and culture to produce a dietetics-specific research strategy. RESULTS: Fifteen dietitians (75%) completed the Research Capacity in Context Tool. The overall mean score was highest at an organisational level at 7.9 (IQR 2), and lowest at team and individual levels at 4.3 (IQR 2.7) and 4.9 (IQR 3.3) respectively. Common barriers to research included time, lack of skills, knowledge and support. Using the modified Delphi method 39 statements relating to research capacity building met consensus and informed the creation of a research strategy. CONCLUSION: The results of the Research Capacity in Context Tool from this regional study reflect those reported in the literature at metropolitan sites. A dietetic-specific research strategy was developed to assist with increasing research capacity at a team and individual level in a regional setting. Evaluation of long-term outcomes post implementation will be the subject of further research.

Obesity Promotes Cooperation of Cancer Stem-Like Cells and Macrophages to Enhance Mammary Tumor Angiogenesis.

Obesity is correlated with worsened prognosis and treatment resistance in breast cancer. Macrophage-targeted therapies are currently in clinical trials, however, little is known about how obesity may impact treatment efficacy. Within breast adipose tissue, obesity leads to chronic, macrophage-driven inflammation, suggesting that obese breast cancer patients may benefit from these therapies. Using a high fat diet model of obesity, we orthotopically transplanted cancer cell lines into the mammary glands of obese and lean mice. We quantified changes in tumor invasiveness, angiogenesis and metastasis, and examined the efficacy of macrophage depletion to diminish tumor progression in obese and lean mice. Mammary tumors from obese mice grew significantly faster, were enriched for cancer stem-like cells (CSCs) and were more locally invasive and metastatic. Tumor cells isolated from obese mice demonstrated enhanced expression of stem cell-related pathways including Sox2 and Notch2. Despite more rapid growth, mammary tumors from obese mice had reduced necrosis, higher blood vessel density, and greater macrophage recruitment. Depletion of macrophages in obese tumor-bearing mice resulted in increased tumor necrosis, reduced endothelial cells, and enhanced recruitment of CD8+ T cells compared to IgG-treated controls. Macrophages may be an important clinical target to improve treatment options for obese breast cancer patients.

Engagement and social interaction in dementia care settings. A call for occupational and social justice.

As full citizens, people with dementia are entitled to engage in social and occupational activities in residential care settings. Limitation or deprivation of choice and experience of valued occupations has been described elsewhere as occupational injustice. This research frames the unmet needs of people with dementia for occupation and social interaction, as issues of human rights and citizenship. It identifies a gap in current measurement tools of engagement in residential settings and in response, presents the Assessment Tool for Occupational and Social Engagement (ATOSE) as an objective measure of engagement. It examines results from a study of five residential care settings in Ireland using the ATOSE which included 73 residents with dementia and/or enduring mental health diagnoses. Residents spent on average, 38% of their time engaged and 62% of their time not engaged while in their communal sitting rooms. The ATOSE observations supported the rights of residents as citizens to have low levels of engagement addressed. A critical gerontology lens is employed to discuss concepts of citizenship, occupational justice, and social justice in the context of this research project.

Origins and transformations of dissolved organic matter in large Arctic rivers.

Arctic river watersheds are important components of the global climate system and show an amplified response to climate change. Here, we characterize origins and transformations of dissolved organic matter (DOM) in five major Arctic rivers (Kolyma, Lena, Yenisei, Ob, Mackenzie) over 3 years with seasonal sampling periods using measurements of carbohydrates, amino acids, bacterial biomarkers (D-amino acids), and plant protein biomarkers (hydroxyproline). A strong seasonal cycle of bioavailable DOM export was observed that correlated with discharge, vegetation, river morphology and water residence time. The chemical composition of bioavailable DOM was different among rivers reflecting unique characteristics of Arctic river watersheds. Trends in specific bacterial biomarkers were synchronous to changes in bacterial community compositions demonstrating that bacterial communities responded to the seasonal shifts in organic matter quality and chemical composition. Extensive heterotrophic processing of plant and soil-derived DOM resulted in major inputs of bacterial detritus, and bacterial organic matter accounted for 21-42% of DOC in all watersheds. Dissolved organic nitrogen sources were dominated by bacterially-derived nitrogen and important contributions of soluble plant protein during the Spring freshet. Overall, our results demonstrated the importance of watershed characteristics and bacterial metabolism in regulating DOM composition, reactivity and carbon fluxes in Arctic river watersheds.

Internal validation testing for new technologies: bringing telecytopathology into the mainstream.

Implementing new technology in the laboratory can improve processes and patient care, but compliance with regulatory requirements can be a significant hurdle to clear. This study provides a detailed procedure to address user training, competency assessment, and internal validation of telecytopathology simultaneously, while fulfilling regulatory requirements set forth by the College of American Pathologists and CLIA '88. Six pathologists participated in this study. Methods and materials used included a blind correlation study between diagnoses rendered via telecytopathology and via direct microscopy on 10 finalized fine needle aspiration (FNA) cases. The first step of this procedure involved each pathologist to render a diagnosis for each specimen using telecytopathology. The second step was to allow each pathologist to diagnose each specimen via direct microscopic review after a wait period of at least 6 weeks. The diagnoses rendered via telecytopathology were then compared to both the established final diagnoses and the secondary direct microscopic review diagnoses to examine interpathologist and intrapathologist reproducibility with a passing rate of 90% or better. Results of the study yielded an average concordance rate of 96.67% for interpathologist reproducibility and 95% for intrapathologist reproducibility across all participating pathologists. All participants passed the assessment with a rate of 90% or better, proving evidence of competency. This study confirmed user competency and validated telecytopathology as an effective tool for examining and diagnosing cytology FNA specimens remotely. It also satisfied regulatory compliance requirements to ensure high quality of diagnostic testing and patient care.

Emergency mental health admissions for children: a naturalistic study.

OBJECTIVE: Emergency mental health admissions (EA) for children under 13 years are not routinely offered in the UK, which may be related to preconceptions about their safety, appropriateness and acceptability. Our aim was to evaluate routinely offered EA of children in a national unit over a three-year period. METHOD: A retrospective, naturalistic study was conducted, comparing EA with planned admissions (PA) in terms of children's functioning on admission and discharge, clinical characteristics, significant risk-related incidents and parental and children satisfaction. RESULTS: EA children (N=47) did not differ from PA children (N=35) in age, length of admission, medication treatment, significant risk-related incidents, functioning at discharge, access to education at discharge and satisfaction. EA children had lower functioning and were less likely to have been out of education on admission. Parental satisfaction in EA was higher compared to PA. CONCLUSIONS: EA for children are an appropriate, clinically indicated and safe alternative to PA, associated with higher parental satisfaction.

Focus on technology: How important is resolution in telecytopathology?

BACKGROUND: The authors conducted an analysis of 2 telepathology systems with different resolutions to determine how resolution affects the pathologists' ability to provide preliminary diagnoses for fine-needle aspirations (FNA). METHODS: FNA cases evaluated by telepathology between February 1, 2011 and January 18, 2012 were reviewed. Concordance indices between preliminary and final diagnoses were calculated for cases assessed with two proprietary systems (the Remote Meeting Technologies iMedHD system and the Olympus NetCam system) using 3 diagnostic classifications (negative, atypical, and suspicious/positive). A Wilcoxon rank-sum test was used to compare the number of passes necessary to determine adequacy. RESULTS: In total, 298 NetCam cases and 26 iMedHD cases were evaluated. The concordance index, which was calculated using the 3 classifications, was 0.943 (95% confidence interval, 0.922-0.963) for NetCam compared with 0.951 (95% confidence interval, 0.898-1.000) for iMedHD. The mean value for the number of passes required to determine adequacy was 2.2 for NetCam and 2.1 for iMedHD (P = .838). CONCLUSIONS: The results from statistical analyses demonstrated no difference in the concordance indices between preliminary and final diagnoses or in the number of passes necessary to render adequacy between the 2 telepathology systems. However, because it had higher resolution along with other features, the iMedHD system achieved greater user satisfaction.

Danger-early maladaptive schemas at work!: The role of early maladaptive schemas in career choice and the development of occupational stress in health workers.

The schema-focused model of occupational stress and work dysfunctions (Bamber & Price, 2006; Bamber, 2006) hypothesizes that individuals with EMS (unconsciously) gravitate toward occupations with similar dynamics and structures to the toxic early environments and relationships that created them. They subsequently re-enact these EMS and their associated maladaptive coping styles in the workplace. For most individuals, this results in 'schema healing', but for some individuals with more rigid and severe EMS, schema healing is not achieved and the structures and relationships of the workplace, together with the utilization of maladaptive coping styles, serve to perpetuate their EMS. The model hypothesizes that it is these individuals who are most vulnerable to developing occupational stress syndromesTo date, this model has been subjected to very little empirical investigation, so the main aim of this study was to address this gap in the literature by testing out some of its main assumptions and to provide empirical data, which would either support or reject the model using a population of health workers. Specifically, it was hypothesized that 'occupation-specific' EMS would be found in health workers from a range of different healthcare professions. It was also hypothesized that the presence of higher levels of EMS would be predictive of raised levels of occupational stress, psychiatric caseness and increased sickness absence in those individuals.A cross-sectional study design was employed and a total of 249 staff working within a NHS Trust, belonging to one of five occupational groups (medical doctors, nurses, clinical psychologists, IT staff and managers), participated in the study. All participants completed the Young Schema Questionnaire-Short Form (Young, 1998); the Maslach Burnout Inventory-Human Services Form (Maslach & Jackson, 1981), and the General Health Questionnaire-28-item version (Goldberg, 1978). A demographic questionnaire and sickness absence data was also collected. The results of a between groups analysis of variance and further post hoc statistical analyses identified a number of occupation specific EMS. Also, the results of a series of multiple linear regression analyses indicated the presence of some EMS to be predictive of higher levels of burnout, psychiatric caseness and sickness absence in health workers. In conclusion, the findings of this study provide empirical support for the schema-focused model of occupational stress and work dysfunctions (Bamber & Price, 2006; Bamber, 2006), and it appears that the existence of underlying EMS may constitute a predisposing vulnerability factor to developing occupational stress.