Radiographers' organisational commitment and occupational stress: First Covid-19 wave.

INTRODUCTION: Radiographers, like many health professionals, are in a high-risk group for succumbing to workplace demands beyond their ability to cope, particularly in the context of the COVID-19 pandemic resulting in occupational stress. Occupational stress has been linked to poor organisational commitment. Therefore, the purpose of this research was to evaluate radiographers' organisational commitment and occupational stress after the first wave of the COVID-19 pandemic. METHODS: A mixed method approach entailed data collected from purposively sampled Australian radiographers working during the first COVID-19 wave. The quantitative phase used an online commitment questionnaire, and 21 semi-structured individual virtual interviews were conducted in the qualitative phase. Data interpretation and analysis used statistical and thematic approaches. RESULTS: The quantitative data revealed a higher level of continuance than affective and normative commitment. Whereas the qualitative findings showed participants high levels of affective commitment to their occupation and, together with leadership support, working collectively towards a positive outcome. CONCLUSION: Despite the variety of occupational stressors that arose during the COVID-19 crisis, Australian radiographers enjoy a high level of occupational and organisational commitment. IMPLICATIONS FOR PRACTICE: Radiographers' organisational commitment represents their emotional and psychological attachment to their workplace, and radiographers experiencing occupational stress represent high levels of psychosomatic distress and burnout. Therefore, considering radiographers' organisational commitment and occupational stress is essential in the delivery of services, quality of patient care and radiographers well-being.

Hip fracture surgery in mixed-use emergency theatres: is the infection risk increased? A retrospective matched cohort study.

Introduction The National Institute of Health and Care Excellence recommends that people with hip fracture should have surgery on the day of, or the day after, admission. However, there remains unacceptable variation in performance around the country, with a range of 13-91% of patients meeting this target. Dedicated trauma lists have insufficient capacity in many hospitals. We occasionally employ a mixed-use emergency theatre to facilitate early surgery. Increased risk of infection has been raised as a concern owing to microbial surface contamination from a preceding unclean case and lack of laminar flow in these theatres. The objective of this study was to investigate whether there is an increased risk of surgical site infections in patients who had hip fracture surgery in a mixed-use emergency theatre. Methods Between August 2010 and July 2014, 74 patients had hip fracture surgery in a mixed-use emergency theatre without laminar flow. This group was compared with a control group of patients who had hip fracture surgery in dedicated orthopaedic theatres with laminar flow. Infection was the primary outcome measured. Results There was no statistically significant difference in the rate of infection, length of stay or 30-day mortality, readmission or reoperation rates between the two groups. Conclusions Operating on hip fractures in mixed-use theatre did not lead to an increase in infection or other complications in our series. We feel that the risk of infection can be balanced against advantages of timely operation and it may therefore be justified to use these theatres when faced with lack of time on the trauma list. A much larger series would be required to investigate the effects of confounders.

Better environmental decision making - recent progress and future trends.

Recent trends in risk-based decision making are reviewed in relation to novel developments in comparative risk analysis, strategic risk analysis, weight of evidence frameworks, and participative decision making. Delivery of these innovations must take account of organisational capabilities in risk management and the institutional culture that implements decision on risk. We stress the importance of managing risk knowledge within organisations, and emphasise the use of core criteria for effective risk-based decisions by reference to decision process, implementation and the security of strategic added value.

Is a fat stitch required when closing a hip hemiarthroplasty wound without a drain?

Studies have shown no benefit of a subcutaneous fat stitch when closing hip wounds, but all have been in the presence of a drain. Our aim was to determine whether, in the absence of a drain, suturing or not of the subcutaneous fat layer in hip hemiarthroplasty wounds had any significant effect on wound complication rate. We performed a prospective cohort study of 45 hip hemiarthroplasty patients who had a fat stitch and 40 who did not. No drains were used in either group. There were 44 patients in the fat stitch group and 35 in the no fat stitch group after six patients were excluded. The infection rate was 2% for the fat stitch group, and 20% for the no fat stitch group (p=0.02). There were no cases of deep dehiscence in the fat stitch group, but four cases (11%) in the no fat stitch group (p=0.035). The overall complication rate in the fat stitch group was 6.8% compared to 33% in the no fat stitch group (p=0.007). In the absence of a drain, we have found a significant increase in hip hemiarthroplasty wound complications when the subcutaneous fat is not sutured.

157 nm pellicles (thin films) for photolithography: mechanistic investigation of the VUV and UV-C photolysis of fluorocarbons.

The use of 157 nm as the next lower wavelength for photolithography for the production of semiconductors has created a need for transparent and radiation-durable polymers for use in soft pellicles, the polymer films which protect the chip from particle deposition. The most promising materials for pellicles are fluorinated polymers, but currently available fluorinated polymers undergo photodegradation and/or photodarkening upon long term exposure to 157 nm irradiation. To understand the mechanism of the photodegradation and photodarkening of fluorinated polymers, mechanistic studies on the photolysis of liquid model fluorocarbons, including perfluorobutylethyl ether and perfluoro-2H-3-oxa-heptane, were performed employing UV, NMR, FTIR, GC, and GC/MS analyses. All hydrogen-containing compounds showed decreased photostability compared to the fully perfluorinated compounds. Irradiation in the presence of atmospheric oxygen showed reduced photostability compared to deoxygenated samples. Photolysis of the samples was performed at 157, 172, 185, and 254 nm and showed only minor wavelength dependence. Mechanisms for photodegradation of the fluorocarbons are proposed, which involve Rydberg excited states. Time-dependent density functional theory has been used to predict the excitation spectra of model compounds.

Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail.

Fragility fractures of the ankle occur mainly in elderly osteoporotic women. They are inherently unstable and difficult to manage. There is a high incidence of complications with both non-operative and operative treatment. We treated 12 such fractures by closed reduction and stabilisation using a retrograde calcaneotalotibial expandable nail. The mean age of patients was 84 years (75 to 95). All were women and were able to walk fully weight-bearing after surgery. There were no wound complications. One patient died from a myocardial infarction 24 days after surgery. The 11 other patients were followed up for a mean of 67 weeks (39 to 104). All the fractures maintained satisfactory alignment and healed without delay. Six patients refused removal of the nail after union of the fracture. The functional rating using the scale of Olerud and Molander gave a mean score at follow-up of 61, compared with a pre-injury value of 70.

Arthroscopic washout of the knee--a 5-year survival analysis.

Arthroscopy and washout of the knee is commonly performed for early osteoarthritis. Very little information exists regarding long-term prognosis, especially in terms of avoidance of further surgery. Using a prospectively gathered database, 100 consecutive patients having knee arthroscopy with a finding of OA between 1991 and 1993 were identified and their outcome at 5 years ascertained. Ninety-nine patients with 100 arthroscoped knees were identified. Fifty-eight had isolated medial compartment disease and six had isolated lateral compartment disease. In 36, both compartments were affected. Eighteen knees had further major surgery during follow up; 11 had total knee replacement, four had high tibial osteotomy and three had unicondylar knee arthroplasty. Those requiring surgery were significantly older (62 cf. 53 years, P=0.008). Meniscectomy was not an important risk factor (chi2, P=0.67). The rate of knee survival without operation at 5 years was much lower in those aged over 60 years than in those younger (68% cf. 89%). (chi2, P=0.02). Only 18% of patients progress to major knee surgery within 5 years of arthroscopic washout for osteoarthritis. Age greater than 60 years worsens the prognosis considerably.

DI@L-log by design: an integrated tele-care communication infrastructure.

A spoken dialogue system for the acquisition of type 2 diabetes mellitus (T2DM) home monitored patient data known as DI@L-log is presented. The purpose of the system is to collect weight, blood sugar and blood pressure readings from a cohort of hypertensive T2DM patients on a weekly basis using their home telephone. The recent voice-data convergence affords an arguably improved means for doctors to track patient health states at a distance in order to provide health institutions with more frequent and accurate patient profiles. Our system architecture integrates VoiceXML and the standard PSTN, with a Pan-European open source for hosting Internet telephony applications. This paper reports on recent developments in the design of DI@L-log, which aims to serve as a communication intervention that disparages the traditional paper logbook used to document readings by the patient.

An anomalous flexor carpi ulnaris.

We report a muscle with features suggesting an anomalous conjoined palmaris longus and flexor carpi ulnaris. To our knowledge this has not been described previously. In light of improved imaging techniques we question the previously published view that surgery is indicated for swellings suspected as forearm muscle anomalies that are clinically benign and otherwise asymptomatic.

The surgical anatomy of the dorsomedial cutaneous nerve of the hallux.

Most techniques described for the correction of hallux valgus require exposure of the distal aspect of the first metatarsal. A dorsomedial incision is often recommended. Texts counsel against damaging the dorsal digital nerve, as a painful neuroma is an unwelcome surgical complication. Our study on cadavers aimed to investigate the anatomy of the dorsomedial cutaneous nerve in the metatarsophalangeal region, with special reference to surgical incisions. A constant, previously unrecognised branch of the nerve was identified. This branch is likely to be damaged if a dorsomedial approach is used. It is recommended that a mid-medial incision be used instead, i.e. at the junction of the plantar and dorsal skin.

Learning to network and networking to learn: facilitating the process of adaptive management in a local response to the UK's National Air Quality Strategy.

The adaptive management leitmotiv of "learning to manage and managing to learn" sets out an attractive agenda for dealing with the overwhelming complexity of environmental phenomena that humans have problematized. To ensure that this rallying cry translates into effective action, it is important to give consideration to structures and procedures for facilitating the efforts of those willing or able to respond to the adaptive management call. To date, calls to establish the right organization to coordinate multiagency responses have tended to emphasize the noun, or bounded-entity, sense of the word organization. We believe that this is at the expense of its other, verb or process, connotation. In this paper, rather than searching for the perfect organization structure that mandates mutual trust and collective action shaped by all relevant parties' perspectives and possible contributions, we direct attention towards the process of nurturing integrated adaptive responses among individuals who have diverse organizational allegiances. By shifting the balance towards the process connotation of the right organization, we hope that a new mindscape can be discerned for those interested in putting adaptive management principles into practice. We seek to conjure up an image of this mindscape through the phrase "learning to network and networking to learn," and set out to strengthen this by demonstrating how adaptive response networks can arise from the mutually defining relationship between stakeholders and issues. This is demonstrated through a local response to the United Kingdom's National Air Quality Strategy.

Overexpression of mutant ras in human melanoma increases invasiveness, proliferation and anchorage-independent growth in vitro and induces tumour formation and cachexia in vivo.

Malignant melanoma is the deadliest form of skin cancer. Previous studies have shown that the incidence of ras mutation increases with progression of melanoma, but that such mutations may not be present in the earliest radial growth phase melanomas. Recently it has been proposed that introduction of ras mutations into cells deficient in tumour suppressor genes such as p16 (INK4a) is sufficient to induce characteristics of cellular transformation such as anchorage-independent growth and tumour formation in vivo. To test this hypothesis in human melanoma, mutant N-ras, mutant H-ras or wild-type H-ras genes were transfected by electroporation into WM35 cells, a p16-deficient human melanoma cell line of low invasive potential. Increased expression of mutant ras p21 enhanced anchorage-dependent cell growth on tissue culture plastic. In addition, overexpression of mutant N-ras and H-ras, but not of wild-type H-ras, increased the experimental invasive potential, inducing anchorage-independent growth in soft agar, increasing cell motility measured by time-lapse video microscopy, and increasing invasiveness through reconstituted basement membranes. Finally, overexpression of mutant H-ras in melanoma cells was shown to increase tumorigenicity and to induce cachexia when H-ras transfected cell lines were injected subcutaneously in severe combined immunodeficiency (SCID) mice. Thus the addition of activating ras mutations to a melanoma cell line already deficient in p16 leads to enhanced proliferation, survival and migration in vitro and to enhanced subcutaneous tumour formation in vivo. This phenotype is typical of the behaviour of vertical growth phase (VGP) melanoma, and we propose that activation of the ras signalling pathway in the presence of deletions in p16 or related tumour suppressors can induce the VGP melanoma phenotype.

Ox-40 ligand: a potent costimulatory molecule for sustaining primary CD4 T cell responses.

Ox-40 and Ox-40 ligand (Ox-40L) are thought to be involved in T cell-APC interactions. However, their exact role in T cell responses is undefined. Using fibroblast transfectants expressing Ox-40L and/or B7-1, and CD4 cells from TCR transgenic mice, we investigated the effect of Ox-40 signaling on primary responses to the Ag pigeon cytochrome c. Ox-40 expression on naive CD4 cells peaked 2 to 3 days after activation, and was lost by 4 to 5 days. APCs with Ox-40L promoted partial activation of naive T cells with some IL-2 secretion, but were unable to enhance proliferation, unlike those with B7-1. APCs coexpressing Ox-40L with B7-1 induced large quantities of IL-2 and promoted proliferative responses that persisted for several days. Effector cells taken 5 days after naive T cell activation reexpressed Ox-40 within 4 h and responded strongly to APCs expressing Ox-40L, whereas B7-1 had little effect. Synergy was also seen between Ox-40L and B7-1, with primarily IL-2 being elevated, although IL-4 and IL-5 were also up-regulated. The most striking action was on effector T cell proliferation, which continued at high levels for up to 4 days, with little proliferation evident at this time in the absence of Ox-40 signals. These data suggest that Ox-40/Ox-40L interactions act after initial activation events to prolong clonal expansion and enhance effector cytokine secretion, and may be involved in promoting long-lived primary CD4 responses.