Shifting from an individual to an organizational perspective in work environment management - a process evaluation of a six-year intervention program within the Swedish public sector.

BACKGROUND: Working systematically with the work environment, particularly the organizational and psychosocial work environment entails several challenges for employers. There is a lack of knowledge on how to best undertake this work. Thus, the aim of this study is to evaluate the process of a six-year organizational-level intervention program where workplaces could apply for additional funds to implement preventive intervention measures, with the intention of improving working conditions and reducing sickness absence within the Swedish public sector. METHODS: The program management process was studied using a mixed-method approach combining qualitative document and content analyses based on process documentation produced between 2017 and 2022 (n = 135), interviews with internal occupational health services professionals in 2021 (n = 9) and quantitative descriptive analyses of submitted applications with decisions from 2017 to 2022 (n = 621). RESULTS: Qualitative analyses of the process documentation revealed concerns from the project group regarding access to sufficient competence and resources among stakeholders and participating workplaces, and role conflicts and ambiguities between the program and everyday operations. To address these challenges, the application process was developed over time using the knowledge gained from previous years. A change in the mental models in work environment management, from an individual to an organizational perspective, was seen among the project group and the internal occupational health services responsible for implementing most of the granted intervention measures. In addition, the proportion of granted intervention measures on an organizational level increased throughout the years from 39% in 2017 to 89% in 2022. The changes in the application process were believed to be the main contributor to the change among the applying workplaces. CONCLUSIONS: Results indicate that a long-term organizational-level workplace intervention program may be used, by the employer, as a tool for shifting from an individual- to an organizational perspective in the work environment management. However, additional measures on multiple levels need to be implemented to secure a sustainable shift in perspective within the organization.

Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics.

Purpose This study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics. Methods 1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores. Cronbach α and Spearman rho's indicated measurement properties were good to acceptable for the SILQ-NL37. Results Thirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher. Conclusions According to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.

Multi-disciplinary assessment of the entrustable professional activities of surgery residents.

Purpose: Medicine is practiced in a collaborative and interdisciplinary manner. However, medical training and assessment remain largely isolated in traditional departmental silos. Two Entrustable Professional Activities (EPAs) developed by the American Board of Surgery are multidisciplinary in nature and offer a unique opportunity to study interdisciplinary assessment. Methods: EPA microassessments were collected from Surgery and Emergency Medicine (EM) faculty between July 2018 and May 2020. Differences in feedback provided by faculty were assessed using natural language processing (NLP) techniques, (1) automated algorithms; and (2) topic modeling. Summative content analysis was used to identify themes in text feedback. We developed automated coding algorithms for these themes using regular expressions. Topic modeling was performed using latent Dirichlet allocation. Results: 549 assessments were collected for two EPAs: 198 for GS Consultation and 351 for Trauma. 27 EM and 27 Surgery faculty provided assessments for 71 residents. EM faculty were significantly more likely than Surgery faculty to submit feedback coded as Communication, Demeanor, and Timeliness, (all chi-square test p-values < 0.01). No significant differences were found for Clinical Performance, Skill Level, or Areas for Improvement. Similarly, topic modeling indicated that assessments submitted by EM faculty focused on communication, timeliness, and interpersonal skills, while those submitted by Surgery faculty focused on the residents' abilities to effectively gather information and correctly diagnose the underlying pathology. Conclusions: Feedback from EM and Surgery faculty differed significantly based on NLP analyses. EPA assessments should stem from multiple sources to avoid assessment gaps and represent a more holistic picture of performance.

How Can Intranasal Oxytocin Research Be Trusted? A Systematic Review of the Interactive Effects of Intranasal Oxytocin on Psychosocial Outcomes.

Over the past two decades, research about the role of oxytocin (OT) in human behavior has grown exponentially. However, a unified theory of OT effects has yet to be developed. Relatedly, growing concerns about the robustness of conclusions drawn in the field have been raised. The current article contributes to this debate by reporting on and discussing key conclusions from a systematic review of published studies addressing the interactive effects of intranasal OT (IN-OT) administration on psychosocial outcomes in a healthy population. The review indicates that (a) tested interactive IN-OT effects were highly heterogeneous; (b) for most published interactions, no replication was attempted; (c) when attempted, replications were largely unsuccessful; (d) significance was unrelated to sample size; (e) statistical power was critically low and unrelated to the rate of significant results; and (f) research practices were characteristic of an exploratory approach. This concerning state of affairs makes it virtually impossible to tease apart true from false interactive IN-OT effects. We provide constructive directions on the basis of this observation and positive predictive value simulations for future research that should help extract true effects from noise and move the IN-OT field forward.

Growth performance, carcass characteristics, fresh belly quality, and commercial bacon slicing yields of growing-finishing pigs from sire lines intended for different industry applications.

The objective was to control intrinsic and extrinsic factors associated with the production and slaughter of pigs to determine effects of sire line (Pietrain vs. Duroc ancestry) on growth performance, carcass and belly characteristics, and commercial bacon yields of growing-finishing pigs. There were no differences in growth performance (P ≥ 0.08) or belly processing characteristics (P ≥ 0.09). Pietrain sired pigs had a greater lean yield (P ≤ 0.01). Duroc sired pigs had darker, more highly marbled loins (P ≤ 0.04) and thicker bellies (P < 0.001). Bacon from Pietrain sired pigs had a greater (P = 0.04) lean to fat ratio with 1.58% increase (P = 0.04) in average bacon slice lean. Barrows had more highly marbled loins (P ≤ 0.01) and thicker bellies (P < 0.001) than gilts. Bacon from barrows had a greater slice area (P < 0.001) while bacon from gilts had a greater lean to fat ratio (P = 0.04).

Twisted vortex Gaussian Schell-model beams.

We introduce a new class of partially coherent vortex beams in which the angular momentum of the beam is provided from two different sources: the underlying vortex of the random beam and the "twist" given to the ensemble of beams. The statistical and propagation properties of such beams are investigated, and their orbital angular momentum properties are analyzed. The combination of distinct orbital angular momentum sources allows unusual behaviors that were previously unobserved.

Partially coherent vortex beams of arbitrary order.

We derive analytic solutions for an infinite set of partially coherent vortex beams (PCVBs) of any azimuthal order and for any propagation distance. The correlation singularities of the beams and their orbital angular momentum are investigated. This detailed study of PCVBs opens the possibility of using such beams for remote sensing and free-space optical communications.

Relationships among early postmortem loin quality and aged loin and pork chop quality characteristics between barrows and gilts.

Rapid assessment of pork quality by packers necessitates using early postmortem (∼1 d) traits as an indication of aged pork quality (∼14 d). Efforts have been made to develop a grading system based on color and marbling of the ventral side of boneless loins. In order for this system to be successful, there must be a correlation between early postmortem quality traits observed by packers and the same traits observed by consumers after aging. However, the strength and direction of those correlations are unclear. It is also unknown if the correlations between early and aged postmortem quality differ between barrows (B) and gilts (G). Therefore, the objectives were to determine correlations between early postmortem loin quality characteristics and aged loin quality characteristics, and determine if those correlations differed between barrows and gilts. Early postmortem (∼1 d) quality traits included: instrumental and subjective color, marbling and firmness, and loin pH on the ventral surface of the loin. Loins were aged until 14 d postmortem in vacuum packages. Aged quality traits included traits evaluated early as well as shear force and cook loss. Correlations were compared between barrows and gilts using a Fisher's z test. Overall, early subjective firmness scores of barrows were greater (P < 0.001) than those of gilts. No other early quality traits differed between sexes. Early pH was correlated with aged pH (r = 0.80 B; 0.75 G), ventral lightness (r = -0.57 B; -0.54 G), ventral yellowness (r = -0.55 B; -0.55 G), subjective ventral color (r = 0.55, B; 0.41 G), and subjective chop color (r = 0.42 B; 0.44 G). Correlations of early pH and aged quality did not differ between sexes. Early lightness was correlated with aged ventral pH (r = -0.56) and subjective color (r = -0.39) in barrows but not gilts (P ≤ 0.04). Early lightness was correlated with aged lightness (r = 0.60 B; 0.51 G) and yellowness (r = 0.49 B; 0.55 G), but was not correlated with to any aged chop quality traits. Early marbling was correlated with ventral color (r = 0.42) in barrows and ventral marbling (r = 0.67 B; 0.66 G) and chop marbling (r = 0.57 B; 0.59 G) in barrows and gilts. In summary, early pH and lightness were correlated with aged quality characteristics and correlations rarely differed between barrows and gilts. Sex does not need to be accounted for when relating early and aged quality characteristics.

Glycaemic control and excess risk of ischaemic and haemorrhagic stroke in patients with type 1 diabetes: a cohort study of 33 453 patients.

OBJECTIVE: To estimate the excess risk of stroke in relation to glycaemic control in patients with type 1 diabetes. METHODS: In this prospective, matched cohort study, we identified patients with type 1 diabetes, aged ≥18 years, who were registered in the Swedish National Diabetes Register from 1998-2011 and five control subjects for each case from the general population, matched for age, sex and county of residence. The risks of all strokes, ischaemic stroke and haemorrhagic stroke were estimated using Cox hazard regression. RESULTS: Of 33 453 type 1 diabetes patients [mean age, 35.5 (SD 14.4) years; mean follow-up, 7.9 (SD 4.3) years; and mean diabetes duration, 20.2 years (SD 14.6)], 762 (2.3%) were diagnosed with stroke compared with 1122 (0.7%) of 159 924 control subjects [mean follow-up, 8.2 (SD 4.3) years]. The overall multiple-adjusted hazard ratios (HRs) for type 1 diabetes patients versus control subjects were 3.29 (95% CI: 2.96-3.66) and 2.49 (95% CI: 1.96-3.16) for ischaemic and haemorrhagic stroke, respectively. The risk of ischaemic and haemorrhagic stroke incrementally increased with increasing HbA1c; the risk of ischaemic stroke was significantly increased with HbA1c within target [≤6.9% (≤52 mmol mol-1 )] [multiple-adjusted HR 1.89 (95% CI: 1.44-2.47)]. For HbA1c ≥9.7% (≥83 mmol mol-1 ), there was a markedly increased risk of both ischaemic and haemorrhagic stroke, with multiple-adjusted HRs of 7.94 (95% CI: 6.29-10.03) and 8.17 (95% CI 5.00-13.35), respectively. CONCLUSIONS: Individuals with type 1 diabetes have an increased risk of ischaemic and haemorrhagic stroke, increasing markedly with poor glycaemic control.

Long-term excess risk of stroke in people with Type 2 diabetes in Sweden according to blood pressure level: a population-based case-control study.

AIMS: To estimate the risk of stroke in people with Type 2 diabetes with different blood pressure levels compared with the risk in the general population in Sweden. METHODS: This prospective case-control study included 408 076 people with Type 2 diabetes, aged ≥ 18 years, and free of prior stroke, registered in the Swedish National Diabetes Register 1998-2011. Age- and sex-matched control subjects (n = 1 913 507) without stroke from the general population were included. Stroke diagnoses were retrieved using International Classification of Disease codes from the Swedish patient and death registers. Cox hazard ratios and 95% confidence intervals (CIs) were estimated at six different blood pressure levels. RESULTS: During a median follow-up of 4 years, 19 548 (4.8%) people with Type 2 diabetes and 61 690 (3.2%) without diabetes were diagnosed with stroke, corresponding to an adjusted hazard ratio of 1.43 (95% CI 1.41-1.46) for people with Type 2 diabetes as a group. Compared with people without diabetes, the risk of stroke for people with Type 2 diabetes with different blood pressure levels was significantly higher, starting at blood pressure levels > 130/80 mmHg. Hazard ratios for stroke were 1.20 (95% CI 1.16-1.24), 1.47 (95% CI 1.43-1.50), and 1.97 (95% CI 1.90-2.03) for blood pressure categories of 130-139/80-89 mmHg, 140-159/90-99 mmHg and ≥ 160/≥ 100 mmHg, respectively, after adjustment for age, sex, diabetes duration, being born in Sweden, maximum education level and baseline comorbidities. CONCLUSIONS: People with Type 2 diabetes and blood pressure < 130/80 mmHg had a risk of stroke similar to that of the general population.

Walking the tightrope-perspectives on local politicians' role in implementing a national social care policy on evidence-based practice.

BACKGROUND: Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. METHODS: Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. RESULTS: Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers' perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. CONCLUSIONS: Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.

Determination of 'recruited volume' following a PEEP step is not a measure of lung recruitability.

BACKGROUND: It has been proposed that the analysis of positive end-expiratory pressure (PEEP)-induced volume changes can quantify alveolar recruitment. The potential of a lung to be recruited is expected to be high in acute respiratory distress syndrome (ARDS), where collapsed lung tissue is very common. The volume change that is beyond the delta volume because of the patient's compliance has been termed 'recruited volume' (RecV). However, data of patients with low and high RecV showed less severe lung disease in high 'recruiters', indicating that RecV may not equal the 'potentially recruitable lung tissue' seen in computed tomography scans. We hypothesized that RecV is higher in lung-healthy (LH) patients with little collapsed lung compared with ARDS patients. METHODS: RecV and inspiratory capacity (IC) were determined in 12 LH and in 25 ARDS patients during incremental PEEP (steps of 2 cmH2 O). RecV was determined as the time-dependent increase in end-expiratory volume following the first expiration to the new PEEP level (ΔTDV). Gas distribution in LH patients was analyzed by electric impedance tomography. RESULTS: Cumulative RecV(ΔTDV) and IC were higher (P < 0.01) in LH compared with ARDS patients, 1739 ml vs. 832 ml and 4432 ml vs. 2020 ml, respectively. In both groups, RecV correlated excellently with IC (R(2) = 0.86). In LH, RecV emanated mainly from nondependent lung regions at PEEP below 15 cmH2O. Maximum plateau pressure was reached with fewer PEEP steps in ARDS compared with LH patients (11 vs. 14, P < 0.01). CONCLUSION: Our findings suggest that RecV predominately measures a slow fraction of inflation of already aerated lung tissue and not recruitment of collapsed alveoli.

Complete representation of a correlation singularity in a partially coherent beam.

An understanding of phase singularities of correlation functions is important in optical coherence theory and imaging science, but to date such singularities have only been theoretically studied in a single transverse plane, at most. In this Letter we evaluate the complete structure of a correlation singularity of a partially coherent Laguerre-Gauss beam, describing it in both the transverse and the propagation directions. These results agree with previously found solutions, and introduce new aspects of correlation singularities.

Use of contrast-enhanced fluid-attenuated inversion recovery sequence to detect brain lesions in dogs and cats.

BACKGROUND: The diagnostic value of a contrast-enhanced T2-weighted FLAIR sequence (ceFLAIR) in brain imaging is unclear. HYPOTHESIS/OBJECTIVES: That the number of brain lesions detected with ceFLAIR would be no greater than the sum of lesions detected with nFLAIR and ceT1W sequence. ANIMALS: One hundred and twenty-nine animals (108 dogs and 21 cats) undergoing magnetic resonance imaging (MRI) of the head between July 2010 and October 2011 were included in the study. METHODS: A transverse ceFLAIR was added to a standard brain MRI protocol. Presence and number of lesions were determined based on all available MRI sequences by 3 examiners in consensus and lesion visibility was evaluated for nFLAIR, ceFLAIR, and ceT1W sequences. RESULTS: Eighty-three lesions (58 intra-axial and 25 extra-axial) were identified in 51 patients. Five lesions were detected with nFLAIR alone, 2 with ceT1W alone, and 1 with ceFLAIR alone. Significantly higher numbers of lesions were detected using ceFLAIR than nFLAIR (76 versus 67 lesions; P = 0.04), in particular for lesions also detected with ceT1W images (53 versus 40; P =.01). There was no significant difference between the number of lesions detected with combined nFLAIR and ceT1W sequences compared to those detected with ceFLAIR (82 versus 76; P =.25). CONCLUSION AND CLINICAL IMPORTANCE: Use of ceFLAIR as a complementary sequence to nFLAIR and ceT1W sequences did not improve the detection of brain lesions and cannot be recommended as part of a routine brain MRI protocol in dogs and cats with suspected brain lesions.

Incidence of Type 2 diabetes among occupational classes in Sweden: a 35-year follow-up cohort study in middle-aged men.

AIMS: To assess if low occupational class was an independent predictor of Type 2 diabetes in men in Sweden over a 35-year follow-up, after adjustment for both conventional risk factors and psychological stress. METHODS: A random population-based sample of 6874 men aged 47-56 years without a history of diabetes was divided into five occupational classes and the men were followed from 1970 to 2008. Diabetes cases were identified through the Swedish inpatient and death registers. Subdistribution hazard ratios (SHRs) and 95% CIs from competing risk regressions, cumulative incidence and conditional probabilities were calculated, after accounting for the risk of death attributed to other causes. RESULTS: A total of 907 (13%) men with diabetes were identified over 35 years with a median follow-up of 27.9 years. The cumulative incidence of diabetes, when taking into account death as a competing event, was 11% in high officials, 12% in intermediate non-manual employees, 14% in assistant non-manual employees, 14% in skilled workers, and 16% in unskilled and semi-skilled workers. Men with unskilled and semi-skilled manual occupations had a significantly higher risk of diabetes than high officials (reference) after adjustment for age, BMI, hypertension, smoking and physical activity (SHR 1.39, 95% CI 1.08-1.78). Additional adjustment for self-reported psychological stress did not attenuate the results. CONCLUSIONS: A low occupational class suggests a greater risk of Type 2 diabetes, independently of conventional risk factors and psychological stress.

Dose reduction in computed tomography of the chest: image quality of iterative reconstructions at a 50% radiation dose compared to filtered back projection at a 100% radiation dose.

PURPOSE: The aim of this study was to evaluate the potential of iterative reconstruction (IR) in chest computed tomography (CT) to reduce radiation exposure. The qualitative and quantitative image quality of standard reconstructions with filtered back projection (FBP) and half dose (HD) chest CT data reconstructed with FBP and IR was assessed. MATERIALS AND METHODS: 52 consecutive patients underwent contrast-enhanced chest CT on a dual-source CT system at 120 kV and automatic exposure control. The tube current was equally split on both tube detector systems. For the HD datasets, only data from one tube detector system was utilized. Thus, FD and HD data was available for each patient with a single scan. Three datasets were reconstructed from the raw data: standard full dose (FD) images applying FBP which served as a reference, HD images applying FBP and IR. Objective image quality analysis was performed by measuring the image noise in tissue and air. The subjective image quality was evaluated by 2 radiologists according to European guidelines. Additional assessment of artifacts, lesion conspicuity and edge sharpness was performed. RESULTS: Image noise did not differ significantly between HD-IR and FD-FBP (p = 0.254) but increased substantially in HD-FBP (p < 0.001). No statistically significant differences were found for the reproduction of anatomical and pathological structures between HD-IR and FD-FBP, subsegmental bronchi and bronchioli. The image quality of HD-FBP was rated inferior because of increased noise. CONCLUSION: A 50 % dose reduction in contrast-enhanced chest CT is feasible without a loss of diagnostic confidence if IR is used for image data reconstruction. Iterative reconstruction is another powerful tool to reduce radiation exposure and can be combined with other dose-saving techniques. KEY POINTS: • Iterative reconstructions allow for image noise and artifact reduction.• Comparable image data can thus be attained even at 50 % radiation dose.• Diagnostic confidence remains unaffected.

Gunshot fatalities: correlation between post-mortem multi-slice computed tomography and autopsy findings: a 30-months retrospective study.

In this study we compared retrospectively the autopsy and the CT-scan findings in 47 gunshot victims (96 wounds) in order to assess the accuracy of the two methods in injury and ballistic diagnoses. Firing distance was determined in 46 wounds (47.9%). Firing range was determined by autopsy alone in 37 cases (80.5%) and by CT-scan alone in three cases (6.5%). In the six remaining cases (13%), autopsy and CT-scan reports concluded both to the same firing range. Entrance wounds were detected concordantly by both CT-scan and autopsy in 63 of the 91 penetrating wounds (69.2%). Exit wounds were present in 69 shots. They were concordantly detected by autopsy and CT-scan in 36 cases (52.2%). It was possible at CT imaging to determine the track of the bullet in up to 62 wounds (72.1%). CT-scan was superior to autopsy in determining two items: face fractures and pneumencephalon. CT scan was of limited value in demonstrating skull base fractures and contusions of the brain. There was good correspondence in demonstrating subarachnoid hemorrhage. CT-scan was accurate to demonstrate presence of gas, either in the pleural cavity (pneumothorax) or in the vessels' lumen (air embolism). Both autopsy and CT-scan were concordant in demonstrating thoracic well injuries, heart lacerations and intra thoracic hemorrhage. CT-scan was far below autopsy in detecting solid organs injuries except for kidneys. The present survey shows that CT-scan is second to none in demonstrating features as pneumencephalon, facial fractures, midline shifts, air embolism, pneumothorax, and pelvic bones fractures. It may contribute to determine the firing range in cases of contact-range and of intermediate range though the firing range assessment remains beyond post-mortem imaging possibilities, at least at the current state of knowledge.